As global deaths from COVID-19 continue to rise, the world's governments, institutions, and agencies are still working toward an understanding of who is most at risk of death. In this study, data on all recorded COVID-19 deaths in Sweden up to May 7, 2020 are linked to high-quality and accurate individual-level background data from administrative registers of the total population. By means of individual-level survival analysis we demonstrate that being male, having less individual income, lower education, not being married all independently predict a higher risk of death from COVID-19 and from all other causes of death. Being an immigrant from a low- or middle-income country predicts higher risk of death from COVID-19 but not for all other causes of death. The main message of this work is that the interaction of the virus causing COVID-19 and its social environment exerts an unequal burden on the most disadvantaged members of society. Better understanding of who is at highest risk of death from COVID-19 is important for public health planning. Here, the authors demonstrate an unequal mortality burden associated with socially disadvantaged groups in Sweden.

BACKGROUND France has a large population of second-generation immigrants (i.e., native-born children of immigrants) who are known to experience important socioeconomic disparities by country of origin. The extent to which they also experience disparities in mortality, however, has not been previously examined. METHODS We used a nationally representative sample of individuals 18 to 64 years old in 1999 with mortality follow-up via linked death records until 2010. We compared mortality levels for second-generation immigrants with their first-generation counterparts and with the reference (neither first- nor second-generation) population using mortality hazard ratios as well as probabilities of dying between age 18 and 65. We also adjusted hazard ratios using educational attainment reported at baseline. RESULTS We found a large amount of excess mortality among second-generation males of North African origin compared to the reference population with no migrant background. This excess mortality was not present among second-generation males of southern European origin, for whom we instead found a mortality advantage, nor among North African- origin males of the first-generation. This excess mortality remained large and significant after adjusting for educational attainment. CONTRIBUTION In these first estimates of mortality among second-generation immigrants in France, males of North African origin stood out as a subgroup experiencing a large amount of excess mortality. This finding adds a public health dimension to the various disadvantages already documented for this subgroup. Overall, our results highlight the importance of second-generation status as a significant and previously unknown source of health disparity in France.

Improvements in life expectancy at birth in the UK had stalled prior to 2020 and have fallen during the COVID-19 pandemic. The stagnation took place at a time of relatively high net migration, yet we know that migrants to Australia, the USA and some Nordic countries have positively impacted national life expectancy trends, outperforming native-born populations in terms of life expectancy. It is important to ascertain whether migrants have contributed positively to life expectancy in the UK, concealing worsening trends in the UK-born population, or whether relying on national life expectancy calculations alone may have masked excess mortality in migrant populations. We need a better understanding of the role and contribution of migrant populations to national life expectancy trends in the UK.

BACKGROUND

The Healthy Immigrant Effect (HIE) refers to the fact that recent migrants are in better health than the nonmigrant population in the host country. Central to explaining the HIE is the idea that migrants are positively selected in terms of their socioeconomic and health characteristics when compared to nonmigrants in their country of origin. However, due to a lack of reliable and comparable data, most existing studies rely on socioeconomic and health measures as collected in the host country after migration and do not actually measure selection.

OBJECTIVE

We directly test selection as an explanation of the HIE among migrants living in France.

METHODS

Using the French Trajectories and Origins (TeO) survey and Barro-Lee dataset, we construct a direct measure of migrants' educational selectivity. We then test its effect on health differences between migrants and nonmigrants using measures self-rated health, health limitations, and chronic illnesses, by fitting logistic regression and Karlson-Holm-Breen (KHB) decompositions.

RESULTS

After demonstrating that migrants in France experience an HIE, especially males, we also show that educational level as measured in the host country cannot account for the HIE. By contrast, we provide important evidence that educational selectivity constitutes a significant factor in explaining health disparities between migrant and nonmigrant populations.

CONTRIBUTION

Capitalizing on a novel measure of migrants' educational selectivity, we give credit to the oft-cited but rarely tested theory that the HIE is a consequence of migrants' positive selection.

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.

De tidigare årens utveckling med ökad medellivslängd i Sverige bröts under förra året. Det visar den här rapporten från IFFS, Institutet för framtidsstudier, som tagits fram på Folkhälsomyndighetens uppdrag.

I rapporten presenteras statistik över dödligheten på nationell och regional nivå, och jämförs även med tidigare år. Syftet med rapporten är att genom sammanställd data kunna bedöma pandemins påverkan på överdödligheten i Sverige. Resultatet visar att den förväntade medellivslängden minskade med 0,69 år för män och 0,40 år för kvinnor under år 2020 jämfört med 2019. Det innebär att tidigare ökningar av medellivslängd bröts under 2020 och istället låg på samma nivåer som år 2017 för män och år 2018 för kvinnor.

Som underlag för rapporten om dödlighet och överdödlighet i olika åldersgrupper har IFFS använt SCB:s statistik över samtliga dödsfall och Folkhälsomyndighetens statistik över dödsfall i covid-19.

Rapporten har skrivits av forskare verksamma vid IFFS och Stockholms universitet som självständigt undersökt hur dödsmönstren utmärkt sig under 2020.

Preliminary evidence points to higher morbidity and mortality from coronavirus disease 2019 (COVID-19) in certain racial and ethnic groups, but population-based studies using microlevel data are lacking so far. We used register-based cohort data including all adults living in Stockholm, Sweden, between January 31, 2020 (the date of the first confirmed case of COVID-19) and May 4, 2020 (n = 1,778,670) to conduct Poisson regression analyses with region/country of birth as the exposure and underlying cause of COVID-19 death as the outcome, estimating relative risks and 95% confidence intervals. Migrants from Middle Eastern countries (relative risk (RR) = 3.2, 95% confidence interval (CI): 2.6, 3.8), Africa (RR = 3.0, 95% CI: 2.2, 4.3), and non-Sweden Nordic countries (RR = 1.5, 95% CI: 1.2, 1.8) had higher mortality from COVID-19 than persons born in Sweden. Especially high mortality risks from COVID-19 were found among persons born in Somalia, Lebanon, Syria, Turkey, Iran, and Iraq. Socioeconomic status, number of working-age household members, and neighborhood population density attenuated up to half of the increased COVID-19 mortality risks among the foreign-born. Disadvantaged socioeconomic and living conditions may increase infection rates in migrants and contribute to their higher risk of COVID-19 mortality.

A small but growing body of studies have documented the alarming mortality situation of adult descendants of migrants in a number of European countries. Nearly all of them have focused on all-cause mortality to reveal these important health inequalities. This paper takes advantage of the Swedish population registers to study all-cause and cause-specific mortality among men and women aged 15–44 in Sweden from 1997 to 2016 to a level of granularity unparalleled elsewhere. It adopts a multi-generation, multi-origin and multi-cause-of-death approach. Using extended, competing-risks survival models, it aims to show (1) how the all-cause mortality of immigrants arriving as adults (the G1), immigrants arriving as children (the G1.5) and children of immigrants born in Sweden to at least one immigrant parent (the G2) differs versus ancestral Swedes and (2) what causes-of-deaths drive these differentials. For all-cause mortality, most G1 (not Finns or Sub-Saharan Africans) have a mortality advantage. This contrasts with a near systematic reversal in the mortality of the G1.5 and G2 (notably among men), which is driven by excess accident and injury, suicide, substance use and other external cause mortality. Given that external causes-of-death are preventable and avoidable, the findings raise questions about integration processes, the levels of inequality immigrant populations are exposed to in Sweden and ultimately, whether the legacy of immigration has been positive. Strengths of the study include the use of quality data and advanced methods, the granularity of the estimates, and the provision of evidence that highlights the precarious mortality situation of the seldom-studied G1.5. 

The 'healthy immigrant effect' and 'migrant mortality advantage' describe the better health and lower mortality of international immigrants as compared with the native-born populations of high-income countries. However, a growing body of evidence suggests that it is much more common to observe low mortality among immigrants than it is good health, pointing to the existence of a potential paradox that mirrors the well-known gender paradox in health and mortality. To investigate this, we used the Office for National Statistics Longitudinal Study, a large-scale representative 1% sample of the England and Wales resident population comprising linked individual-level health, mortality, and socio-demographic data. We compared health and mortality within and across major immigrant groups over 20 years using logistic regression for health and discrete-time survival analysis for mortality, both before and after adjusting for socio-demographic factors. Of the eight origin subgroups studied, we found persistent evidence of a health-mortality paradox within three: men and women from India, Pakistan and Bangladesh, and the Caribbean. We discuss potential explanations and implications of this paradox and suggest that decision makers need to react to help these subgroups preserve their health in order to delay the onset of limiting illnesses and emergence of this paradox.

Background: Within Europe, France stands out as a major country that lacks recent and reliable evidence on how infant mortality levels vary among the native-born children of immigrants compared with the native-born children of two parents born in France. Methods: We used a nationally representative socio-demographic panel consisting of 296 400 births and 980 infant deaths for the period 2008-17. Children of immigrants were defined as being born to at least one parent born abroad and their infant mortality was compared with that of children born to two parents born in France. We first calculated infant mortality rates per 1000 live births. Then, using multi-level logit models, we calculated odds ratios of infant mortality in a series of models adjusting progressively for parental origins (M1), core demographic factors (M2), father's socio-professional category (M3) and area-level urbanicity and deprivation score (M4). Results: We documented a substantial amount of excess infant mortality among those children born to at least one parent from Eastern Europe, Northern Africa, Western Africa, Other Sub-Saharan Africa and the Americas, with variation among specific origin countries belonging to these groups. In most of these cases, the excess infant mortality levels persisted after adjusting for all individual-level and area-level factors. Conclusions: Our findings, which can directly inform national public health policy, reaffirm the persistence of longstanding inequality in infant mortality according to parental origins in France and add to a growing body of evidence documenting excess infant mortality among the children of immigrants in Europe.

Background: The migrant mortality advantage is generally interpreted as reflecting the selection of atypically healthy individuals from the country of origin followed by the wearing off of selection effects over time, a process theorised to be accelerated by progressive and negative acculturation in the host country. However, studies examining how migrant mortality evolves over duration of stay, which could provide insight into these two processes, are relatively scarce. Additionally, they have paid little attention to gender-specific patterns and the confounding effect of age. In this study, we analyze all-cause mortality according to duration of stay among male and female migrants in France, with a particular focus on the role of age in explaining duration of stay effects.

Methods: We use the Echantillon Demographique Permanent (Permanent Demographic Sample; EDP), France's largest socio-demographic panel and a representative 1% sample of its population. Mortality was followed-up from 2004 to 2014, and parametric survival models were fitted for males and females to study variation in all-cause mortality among migrants over duration of stay. Estimates were adjusted for age, duration of stay, year, education level and marital status. Duration of stay patterns were examined for both open-ended and fixed age groups.

Results: We observe a migrant mortality advantage, which is most pronounced among recent arrivals and converges towards the mortality level of natives with duration of stay. We show this pattern to be robust to the confounding effect of age and find the pattern to be consistent among males and females.

Conclusions: Our novel findings show an intrinsic pattern of convergence of migrant mortality towards native-born mortality over time spent in France, independent from the ages at which mortality is measured. The consistent pattern in both genders suggests that males and females experience the same processes associated with generating the migrant mortality advantage. These patterns adhere to the selection-acculturation hypothesis and raise serious concerns about the erosion of migrant health capital with increasing exposure to conditions in France.

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.

It is well known that children of immigrants experience inequality. Less is known about how inequalities compare across multiple life domains and multiple generations. We conduct a case study of England and Wales, focussing on children of Caribbean immigrants (the ‘Windrush generation’). We use large-scale census data to compare inequalities across five domains of life—education, employment, occupation, housing, and health—separately for women and men across three distinct generations: the one-point-five generation, second-generation, and two-point-five generation. The children of the Windrush generation experience social inequality in all life domains, relative to comparable groups of the White British population, although there is considerable variation according to sex and generation. Men of all generations are uniformly disadvantaged; children of the Windrush are more disadvantaged if they belong to the two-point-five generation. Inequality is pervasive, persistent, and strongly indicative of segmented adaptation.