Introduction: Empirical evidence on migrant morbidity suggests that migrant populations have a higher burden of disease compared to non-migrants in high-income destination countries. Yet, empirical evidence on migrant mortality typically shows a lower risk of death compared to non-migrants. Migrants might be living longer lives in worse health—a ‘migrant “morbidity-mortality” paradox’.

Sources of data: Peer-reviewed, English-language publications.

Areas of agreement: The paradox has been reported in different destinations, across different migrant groups, and across different health outcomes. It presents most consistently among migrants and women born in low and middle-income countries, and/or when morbidity is self-reported.

Areas of controversy: The majority of the evidence is based upon unlinked, aggregated, cross-sectional prevalence data that has well-known limitations. Nearly all the studies to date have been descriptive, and there is a lack of understanding concerning what might explain this paradox among migrants.

Growing points: That migrants are living longer subject to a higher burden of diseases is a social and public health concern that needs to be further explored and understood through more research.

Areas timely for developing research: We need more evidence of the paradox based upon linked individual-level, incidence-based data that compares the morbidity and mortality risks of the same migrant and non-migrant populations using objective data on morbidity from primary care (general practitioners) or secondary care (hospitalizations). We need to know how widespread the paradox is, which migrant populations are most affected by it, and the potential mechanisms responsible for it.

International migrants and their children represent increasing shares of the populations of major host countries and have growing potential to affect estimates of national mortality. Yet, while many studies have observed mortality differences between migrants, their children, and the majority population, few have progressed beyond this point to quantify the actual impact of these differences upon national life expectancy levels. Studies that have, reveal that migrants increasingly enhance national life expectancy, but do not progress beyond a single average generational effect. Here, using established demographic methods, we aim to quantify and unpack the impact of migrants and the children of migrants on national life expectancy in Sweden, with emphasis on potential differences by age, generations, and migration background. Going “against the grain” relative to other countries, we reveal an initial negative effect of first-generation migrants on national life expectancy levels in Sweden, followed by a gradual waning and disappearance of this effect over time. This change is attributable to the transformation in origin composition of Sweden's migrant population from migrants born in Nordic countries (that have higher mortality than the majority population) to migrants born in non-Western countries (that have lower mortality than the majority population), particularly at working ages. For children of migrants, nearly all ages and migrant backgrounds contribute to an increasingly negative effect on national life expectancy over time. The unique and disparate mortality risks of migrants, the children of migrants, and the majority population suggest a need to monitor their mortality separately so as to maximise potential future gains in national life expectancy in Sweden.

Introduction The native-born children of migrants represent one of the fastest-growing and most diverse young populations in the world today. A growing body of research highlights an elevated young adult mortality risk in this ‘second generation’ (G2) relative to the majority population at the same ages. Previous studies have tried to understand this increased risk by examining its association with inequality in the adult socioeconomic background (SEB) of the G2. Here, we instead analyse the association of second-generation status with childhood SEB.

Methods We use administrative register data from Sweden to fit multistate, competing-risk, flexible parametric survival models on a data set of 13404 deaths in 2.35million young adults. We examine mortality from all causes and specific causes of death at the generational level and by parental region of birth, both before and after having adjusted for childhood SEB.

Results The G2 have higher all-cause mortality hazard rates (HR=1.29 (95% CIs=1.23 to 1.34)) than the majority population before adjusting for childhood SEB. Following adjustment, the size of the hazard rate is smaller, but remains higher than the majority population (aHR=1.16 (95% CIs=1.11 to 1.21)). The G2 additionally experience persistent and higher hazard rates of mortality from suicide (aHR=1.29 (95% CIs=1.20 to 1.39)), substance misuse (aHR=1.41 (95% CIs=1.26 to 1.58)) and assault (aHR=2.54 (95% CIs=2.02 to 3.20)). By parental origins, similar patterns to those described are documented among G2 that have at least one parent born in Finland, the other Nordic countries, former Yugoslavia, the rest of Europe, sub-Saharan Africa, Northern Africa, and Iran and Iraq. However, higher all-cause (aHR=1.42 (95% CIs=1.33 to 1.51)) and external-cause hazard rates of mortality (aHR=1.59 (95% CIs=1.48 to 1.72)) only persist among G2 with parent(s) born in Finland.

Conclusions G2 with various parental origins have higher mortality rates than the majority population do, and this difference is partly explained by their childhood SEB.

Background: Explanations for the disproportional COVID-19 burden among immigrants relative to host-country natives include differential exposure to the virus and susceptibility due to poor health conditions. Prior to the pandemic, immigrants displayed deteriorating health with duration of residence that may be associated with increased susceptibility over time. The aim of this study was to compare immigrant–native COVID-19 mortality by immigrants’ duration of residence to examine the role of differential susceptibility. Methods: A population-based cohort study was conducted with individuals between 18 and 100 years old registered in Sweden between 1 January 2015 and 15 June 2022. Cox regression models were run to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results: Inequalities in COVID-19 mortality between immigrants and the Swedish-born population in the working-age group were concentrated among those of non-Western origins and from Finland with more than 15 years in Sweden, while for those of retirement age, these groups showed higher COVID-19 mortality HRs regardless of duration of residence. Both age groups of immigrants from Africa and the Middle East showed consistently higher COVID-19 mortality HRs. For the working-age population: Africa: HR<15: 2.46, 95%CI: 1.78, 3.38; HR≥15: 1.49, 95%CI: 1.01, 2.19; and from the Middle East: HR<15: 1.20, 95%CI: 0.90, 1.60; HR≥15: 1.65, 95%CI: 1.32, 2.05. For the retirement-age population: Africa: HR<15: 3.94, 95%CI: 2.85, 5.44; HR≥15: 1.66, 95%CI: 1.32, 2.09; Middle East: HR<15: 3.27, 95%CI: 2.70, 3.97; HR≥15: 2.12, 95%CI: 1.91, 2.34. Conclusions: Differential exposure, as opposed to differential susceptibility, likely accounted for the higher COVID-19 mortality observed among those origins who were disproportionately affected by the pandemic in Sweden.

Background: The number of confirmed COVID-19 deaths differed across countries and across waves of the pandemic. Patterns also differed between groups within a country.

Objective: We combine data on excess mortality with data on cause-of-death-specific mortality in the case of Sweden to identify which groups had excess mortality beyond what can be captured by analyses of COVID-19-specific deaths. We also explore the possibility that some groups may have benefited in terms of reduced all-cause mortality, potentially due to home-centered living conditions during the pandemic.

Methods: We produced and compared three sets of group-specific incidence rates: deaths from (1) any cause in 2020, (2) any cause in 2019, (3) any cause excluding COVID-19 in 2020. We compared rates across different socioeconomic profiles based on combinations of sex, age, marital status, education, and country of birth.

Contribution: We show that many of those who died during 2020 would not have done so in the absence of the pandemic. We find some evidence of COVID-19 mortality underestimation, mainly among individuals with a migration background. We also found groups for which mortality decreased during the pandemic, even when including COVID-19 mortality. Progression across the first and second waves of the pandemic shows that more groups appeared to become protected over time and that there was less underestimation of COVID-19 mortality in the second part of 2020.

Background: Children of immigrants often have excess mortality rates, in contrast to the low mortality typically exhibited by their parents’ generation. However, prior research has studied children of immigrants who were selected for migration, thereby rendering it difficult to isolate the intergenerational impact of migration on adult mortality.

Methods: We use semiparametric survival analysis to carry out a total population cohort study estimating all-cause and cause-specific mortality among all adult men and women from age of 17 years among all men and women born in 1953–1972 and resident in Finland in 1970–2020. We compare children of forced migrants from ceded Karelia, an area of Finland that was ceded to Russia during the Second World War, with the children of parents born in present-day Finland.

Results: Children with two parents who were forced migrants have higher mortality than children with two parents born in Northern, Southern, and Western Finland, but similar or lower mortality than the subpopulation of children whose parents were born in the more comparable areas of Eastern Finland. For women and men, a mortality advantage is largest for external causes and persists after controlling for socioeconomic factors.Conclusion: Our findings suggest that forced migration can have a beneficial impact on the mortality of later generations, at least in the case where forced migrants are able to move to contextually similar locations that offer opportunities for rapid integration and social mobility. The findings also highlight the importance of making appropriate comparisons when evaluating the impact of forced migration

Introduction: The ‘second-generation’ (i.e. the children of migrants) represent one of the fastest growing subpopulations of the child and young adult populations in Europe today. The research so far appears to indicate that their mortality risk is elevated relative to people with non-migrant backgrounds.

Sources of data: Peer-reviewed publications.

Areas of agreement: Second-generation status is a clear marker of elevated mortality risk in Europe in early life (including stillbirth, perinatal, neonatal and infant mortality) and adulthood, particularly if the parent(s) were born outside of Europe. Socioeconomic inequality plays an important, albeit rarely defining, role in these elevated risks.

Areas of controversy: It remains unclear what causes-of-death are driving these elevated mortality risks. The exact influence of (non-socioeconomic) explanatory factors (e.g. health care, racism & discrimination, and factors related to integration) on the elevated mortality risks of the second-generation also remains unclear.

Growing points: The second-generation will continue to grow and diversify in Europe; we must intervene to address these inequalities now.

Areas timely for developing research: Place more emphasis on the complexity of migration background, specific causes-of-death, and understanding the roles of explanatory factors beyond socioeconomic background.

While a sizeable body of research has focused upon the ‘migrant mortality advantage’ (lower mortality among migrants compared to native-born populations), it has lacked a dedicated age perspective that investigates how mortality varies among migrants across age. This is especially true for older ages. In this chapter, evidence on the mortality of older migrants is summarised utilising the prevailing theoretical framework. The chapter first explores how mortality varies among migrants over age, positioning the mortality patterns of older migrants in the context of younger migrants. Next, it focuses in older migrants to explore heterogeneity in their mortality by sex, age at arrival, and length of stay. Studies that explore the quality of the years lived by older migrants are then summarised, followed by those that evaluate the reliability of mortality estimates among older migrants. The chapter concludes with a synopsis of the condition of the literature on older migrant mortality, followed by suggestions to build on and improve existing evidence.

The migrant mortality advantage has been observed extensively, but its authenticity is debated. In particular, concerns persist that the advantage is an artefact of the data, generated by the problems of recording mobility among foreign-born populations. Here, we build on the intersection of two recent developments: the first showing substantial age variation in the advantage-a deep U-shaped advantage at peak migration ages-and the second showing high levels of population over-coverage, the principal source of data artefact, at the same ages. We use event history analysis of Sweden's population registers (2010-15) to test whether this over-coverage can explain age variation in the migrant mortality advantage. We document its U-shape in Sweden and, crucially, demonstrate that large mortality differentials persist after adjusting for estimated over-coverage. Our findings contribute to ongoing debate by demonstrating that the migrant mortality advantage is real and by ruling out one of its primary mechanisms.

In this study, we provide an account of mortality levels in Sweden in 2020, focusing on both excess mortality and mortality due to COVID-19 deaths.We present various measures of life expectancy for women and men based on age-specific death rates in 2020. Our measures of excess mortality are based on comparisons with benchmarks derived from a previous mortality forecast for 2020 by Statistics Sweden and observed average mortality rates during 2017–2019. We present data on regional and seasonal variation in excess mortality, as well as estimates of Years of Potential Life Lost due to COVID-19. We decompose excess mortality in 2020 into excess mortality due to COVID-19 and excess mortality attributable to other causes. We also provide some estimates on the impact of excess mortality in 2020 on the remaining life expectancy for different cohorts of women and men in Sweden. We demonstrate that the impact of COVID-19 mortality was concentrated at higher ages, and among men in particular. Conversely, some younger age groups experienced negative excess mortality. The mortality changes during 2020 caused life expectancy levels to revert back to those observed in 2018 for women and in 2017 for men.