Cancer is a leading cause of death among individuals with type 2 diabetes (T2D), and immigrants in Europe face a higher T2D risk than native populations. We investigated mortality disparities in overall and eight specific T2D-related cancers among immigrants and native Swedes diagnosed with T2D between 2006 and 2021. An open cohort of 478,607 individuals aged ≥ 35 years at the time of T2D diagnosis (28% first-generation [G1] and 6% second-generation [G2] immigrants) was followed until December 31, 2023. Flexible parametric survival models were used to estimate hazard ratios (HRs), stratified by age at arrival and duration of residence for G1 immigrants. G1 immigrants, except those from Nordic countries, generally had lower overall cancer mortality than natives. However, mortality risks for specific cancers converged toward those of natives with longer residence in Sweden, and notably liver and endometrial cancer mortality were higher among those who arrived early in life compared with natives. In G2 immigrants, kidney and endometrial cancer mortality rates were elevated, particularly for those with Western (HR = 1.63) and Nordic (HR = 1.82) parental origins, respectively. Mortality rates from colorectal and liver cancers also appeared to increase among those more recently diagnosed with T2D. These findings underscore the need for strengthening integrated diabetes and cancer care and tailored support services for high-risk immigrant populations.

Introduction During the global pandemic, the elderly, foreign-born and socioeconomically deprived experienced disproportionately higher rates of COVID-19 morbidity and mortality than general populations. However, these groups have typically been analysed in isolation, without considering how social factors jointly influenced COVID-19-related health. Thus, the aim of this study is to quantify intersectional inequalities in COVID-19 morbidity and mortality in Sweden.Methods In this retrospective cohort study, national registers were used to identify 35-to-100-year-old residents of Sweden in January 2020 (n=6 014 164), tracking COVID-19 hospitalisations and deaths (International Classification of Diseases-10 Codes U07.1/U07.2, plus B34.2 for deaths) until December 2022. Intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy was applied with logistic regression, nesting individuals within intersectional strata based on age, gender, migrant status and region of origin, and income. Measures of discriminatory accuracy (area under the receiver operating characteristic curve or AUC), predicted probabilities and random effects were calculated.Results During follow-up, 77 844 (1.29%) individuals were hospitalised and 18 126 (0.30%) died due to COVID-19. Intersectional models explained 2.22% of the variation in mortality (AUC=0.835) vs 0.60% in hospitalisations (AUC=0.728). Predicted probabilities were lowest in 35-44-year-old Swedish-born women with high income at 0.19% (95% CI 0.16% to 0.21%) for hospitalisations, and 0.01% (95% CI 0.01% to 0.02%) for mortality; and highest among 85-100-year-old foreign-born men from the Global South with low income at 14.85% (95% CI 12.84% to 17.10%) for hospitalisations, and 8.25% (95% CI 6.32% to 10.70%) for mortality. Random effects indicated wider income inequalities in both outcomes in the youngest and narrower in the oldest, native-born and foreign-born groups from the Global North.Conclusions Intersectional inequalities in COVID-19 outcomes consistently increased with age, decreased with income and were higher for men and foreign-born individuals. The results emphasise the need to consider universal public health strategies to reach vulnerable populations during a pandemic.

Background  Immigrants in Sweden, particularly those from low- and middle-income countries, had higher risks of COVID-19 mortality and morbidity compared to the Swedish-born. However, prior studies have not quantified the contribution of the differential distribution of health and social determinants to the increased risks.

Methods  We used total population registers from Sweden to investigate disparities in COVID-19 hospitalization between five groups of immigrants and Swedish-born, using a cohort 577911 working-age adults (18–65 years) living in Stockholm during the first two waves of the COVID-19 pandemic. Applying a decomposition analysis, we quantified the relative contribution of age, sex, income, education, occupation type, residential area, and pre-existing medical conditions to these disparities.

Results  Our study shows that immigrants have higher risks of hospitalization compared to Swedish-born, and that the investigated factors accounted for these disparities to varying degrees across immigrant groups. For the most affected immigrant groups (from Africa and Middle East), the examined factors together account for only a minor part of the disparities (21% and 18% for Wave 1; 16% and 11% for Wave 2), with occupation type and residential area contributing substantially.

Conclusions  Common observable social determinants of health account for a moderate share of the overall disparities in COVID-19 hospitalizations between Swedish-born individuals and immigrant from the most affected regions of origin.

This study aimed to compare differences in low birthweight (LBW, < 2500 g) between the offspring of Swedish-born women and migrant women from the Global North and Global South, while simultaneously considering the role of other social factors. We used total population registers to study resident women who gave birth in Sweden between 1997 and 2016, representing a total of 1,917,171 live births. Logistic regression analyses were performed using two analytical approaches: (1) a standard approach, applying regression models to assess the association between region of birth and LBW while adjusting for social factors; and (2) an intersectional approach, with an additive combination of region of birth, income, and parental support variables. Both approaches yielded odds ratios (OR) with 95% confidence intervals (CI) and were adjusted for year of birth, maternal age, and parity. Results from both approaches showed differences in the odds of LBW according to maternal background. Importantly, findings from the intersectional approach demonstrated that women from the Global South had consistently higher odds of LBW across income levels, but with risks amplified among those living alone. These findings show that maternal migration background is a strong determinant of LBW, and that its impact is differentially compounded by social factors.

Background Maternal age and cohabitation (women living with a partner in marriage or in a common-law relationship) are known to be associated with adverse birth outcomes. However, how these two factors jointly contribute to birth outcomes is not well understood, particularly among minor mothers. Methods All live births that occurred in Argentina 2001–2021 (N=13 807 028) were used to estimate the prevalence of births to minor mothers (<18 years). In analyses restricted to mothers aged ≤24 years (N=5 159 231), multinomial and binary logistic models were used to obtain crude and adjusted ORs (aOR) for the joint association between cohabitation status and maternal age groups (minors: ≤15 and 16–17 years, and young adults: 18–19 years and 20–24 years) with preterm birth (PTB), small-for-gestational age (SGA) groups and repeat birth. Results Minor mothers accounted for 6% of all births (n=791 731), lived in poor regions and were more likely to have incomplete primary education and no employment. Among mothers aged <24 years, adverse outcomes jointly varied according to cohabitation status and maternal age (p value for interaction <0.001 in all models). Adverse outcomes were more frequent among minors. Compared with non-cohabiting mothers aged 20–24 years, cohabiting mothers aged 20–24 years had lower odds of very PTB (0.82% vs 1.19%), moderately PTB (7.15% vs 6.33%), extreme SGA (1.98% vs 2.56%) and moderately SGA (3.63% vs 4.48%, respectively). However, compared with non-cohabiting mothers aged 20–24 years, cohabiting minor mothers, particularly those aged ≤15 years had higher odds of very PTB (24–31 gestation weeks) (AOR: 1.86 (95% CI 1.76, 1.97)), moderately PTB (32–36 weeks) (AOR: 1.53 (95% CI 1.49, 1.57)), extreme SGA (<3rd percentile) (AOR: 1.10 (95% CI 1.06, 1.14)) and moderately SGA (3rd to <10th percentile) (AOR: 1.05 (95% CI 1.01, 1.08)). Conclusions The cohabitation advantage among young adults was not observed among minor mothers, particularly those aged ≤15 years.

The intricate relationship between immigration and health, a complex and multidimensional phenomenon, presents challenges for both receiving and sending countries of immigrants. Given the complex mechanisms involved, understanding and assessing the factors associated with disparities in immigrants’ health is a theoretical, methodological, and empirical challenge. Acknowledging and systematically understanding this phenomenon is crucial for the social cohesion of increasingly diverse countries. This introductory chapter reflects on the multifaceted nature of immigrant health, a theme that subsequent chapters in the book delve into from a more empirical perspective. This chapter first identifies current challenges in studies on immigrant health, offering reflections on these challenges’ effects on contemporary societies. Secondly, it provides an overview of immigration to Spain in recent decades, shedding light on the associated challenges in health policy management. Following this, the conceptual frameworks that guide most of the studies included in this book are presented. Special attention is given to the perspective of the healthy immigrant, discussing their ability to describe and explain phenomena related to immigrant health, along with the recognition of its limitations. The chapter concludes by presenting the main objectives of the book.

There is a scarcity of studies examining the impact of the COVID-19 pandemic on the descendants of immigrants, a group representing a growing segment of the population in many countries. This study utilized a national cohort event history analysis in Sweden, consisting of all residents aged over 20 years at the end of 2019 (n = 7 871 444), with a follow-up period from 31 December 2019 to 1 June 2021. Poisson regression was used to estimate incidence rate ratios for severe COVID-19 morbidity [hospitalization, intensive care unit (ICU) admission] and COVID-19-related mortality based on generation status [first generation (G): foreign-born, arrived as adults; the 1.5 generation: foreign-born, arrived as a child; second generation: native-born to two foreign-born parent; and 2.5 generation: native-born to one foreign-born parents] stratified by their region of origin (Nordics, Global South, and Global North) using the majority population (two native-born parents) as reference. All immigrant generations experienced higher rates for severe COVID-19 morbidity compared to the majority population. While this pattern is observed across all regions of origin, the largest differences appear among individuals with a Global South background. Adjusting for social and health factors moderately attenuates the estimates for the descendants of immigrants. Mixed results are found regarding COVID-19 mortality by region of origin and generational status. All immigrant generations experience a COVID-19 morbidity burden comparable to first-generation immigrants and should thus be considered when planning preventive measures to prepare for future pandemics and health crises.

This study examines COVID-19 mortality across long-term care settings comparing migrants and Swedish-born during the first 2 years of the pandemic. Previous research shows that migrants faced higher risks of severe COVID-19 outcomes, contrasting with the observed Migrant Mortality Advantage. Using Swedish total population data (2019–22), we stratified participants aged 70+ by care setting and migration status. We analysed the first pandemic year (March 2020–February 2021) and the second year (March 2021–February 2022), alongside pre-pandemic mortality data for context. Outcome measures included all deaths from COVID-19 and other causes. Cox proportional hazards models were employed adjusting for sociodemographic and health variables. Our findings highlight the significant impact of care settings on COVID-19 mortality in the first pandemic year, exceeding that for other causes of death. Migrants born in low- or middle-income countries in institutional care had higher mortality rates (HR = 42.88, 95% CI = 36.69–50.13) than Swedish-born individuals in institutional care (HR = 25.83, 95% CI = 24.12–27.65) relative to Swedish-born with no care. This contrasts with mortality patterns for non-COVID causes before and during the pandemic, indicating a specific migrant disadvantage during the first year. In the second year, the excess COVID-19 mortality in care settings decreased yet continued to be higher for migrants than for Swedish-born, likely influenced by the equalizing effect of vaccinations. Despite mitigation efforts, a clear migrant mortality disadvantage persisted among those receiving home care or living in care homes.

Birthweight has been extensively used to construct perinatal indicators for identifying and monitoring newborns at risk. These indicators include measures such as low birthweight (<2500 grams irrespective of gestational age) and being small for gestational age (e.g., birthweight below the tenth percentile for a given gestational age). Determinants of adverse health at birth encompass biological and behavioral factors, often exhibiting a social pattern, with the highest prevalence observed in families of low socioeconomic status. Given the strong link between health and social outcomes throughout the life course, perinatal health is considered a vital dimension for examining how inequalities are (re)produced in society. Although immigrants are categorized as a socially vulnerable group experiencing multiple disadvantages, such as racism and discrimination, international evidence indicates that the offspring of foreign-born (immigrant) mothers often experience similar or even better perinatal health outcomes than their counterparts in the receiving country, which supports the healthy immigrant paradox. In this chapter, we conduct a narrative synthesis of the literature based on a systematic search using two electronic databases (PubMed and Web of Sciences) to identify quantitative studies published in peer-reviewed journals before March 2023. These studies were written in English or Spanish and include the birthweight outcomes of the offspring of immigrant women residing in Spain, with comparison groups consisting of the offspring of Spanish-born women. Using the vote-counting method, we assessed 28 studies that met our inclusion criteria. The findings of our review generally confirm the perinatal health advantage of small children among the offspring of most immigrant-origin mothers in Spain, except for those of African and Asian descent, compared with children of Spanish-born women. However, mothers from most immigrant origins exhibited higher risks than Spanish-born ones of delivering children with macrosomia (high birthweight), which challenges the interpretation of immigrants’ health advantage.

Literature reviews constitute a core competence for public health professionals. Many public health graduate students thus choose to conduct a literature review for their thesis, but may face challenges delivering a high-quality systematic review due to time and resource constraints. Informed by the principle of constructive alignment, this article thus provides guidelines for conducting a systematized literature review on quantitative studies within the scope of a master’s thesis in public health, incorporating key elements of a systematic review (i.e., transparency, reproducibility) in a pedagogical context. Based on the authors’ research and supervision experience with the methodology at Stockholm University, this description of best practice presents 12 steps for successfully completing a quantitative systematized literature review, including formulating research questions, conducting searches, extracting and synthesizing findings, and thesis writing, while outlining the tasks of students, supervisors, and examiners in alignment with different learning outcomes. This guide can be used by postgraduate educators to effectively enhance the skills of future public health professionals.