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Migrant mortality from diabetes mellitus across Europe: the importance of socio-economic change

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Abstract

The first objective of this study was to determine and quantify variations in diabetes mortality by migrant status in different European countries. The second objective was to investigate the hypothesis that diabetes mortality is higher in migrant groups for whom the country of residence (COR) is more affluent than the country of birth (COB). We obtained mortality data from 7 European countries. To assess migrant diabetes mortality, we used direct standardization and Poisson regression. First, migrant mortality was estimated for each country separately. Then, we merged the data from all mortality registers. Subsequently, to examine the second hypothesis, we introduced gross domestic product (GDP) per capita of COB in the models, as an indicator of socio-economic circumstances. The overall pattern shows higher diabetes mortality in migrant populations compared to local-born populations. Mortality rate ratios (MRRs) were highest in migrants originating from either the Caribbean or South Asia. MRRs for the migrant population as a whole were 1.9 (95% CI 1.8–2.0) and 2.2 (95% CI 2.1–2.3) for men and women respectively. We furthermore found a consistently inverse association between GDP of COB and diabetes mortality. Most migrant groups have higher diabetes mortality rates than the local-born populations. Mortality rates are particularly high in migrants from North Africa, the Caribbean, South Asia or low-GDP countries. The inverse association between GDP of COB and diabetes mortality suggests that socio-economic change may be one of the key aetiological factors.

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Abbreviations

ASMR:

Age-standardized mortality rates

COB:

Country of birth

COR:

County of residence

GDP:

Gross domestic product

ICD:

International classification of diseases

MRR:

Mortality rate ratio

PY:

Person-years at risk

Q (1Q–4Q):

Quartile (first–fourth quartile)

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Acknowledgments

This paper is a product of the EU-funded project Migrant and Ethnic Minority Health Observatory (MEHO) (http://www.meho.eu.com). This research was funded by a PhD grant of the Research Foundation Flanders and by the VUB research council (Geconcerteerde OnderzoeksActie (GOA) 2008 ‘The migration factor. The impact of international migration on migrant communities and on demographic processes and structures in the receiving country’). We are also grateful for the helpful comments of Professor Raj Bhopal and Professor Karien Stronks.

Conflict of interest

The authors declare that there is no conflict of interest associated with this manuscript.

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Authors and Affiliations

  1. Interface Demography, Department of Social Research, Vrije Universiteit Brussel, 5 Pleinlaan, 1050, Brussels, Belgium

    Hadewijch Vandenheede & Patrick Deboosere

  2. NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands

    Irina Stirbu

  3. Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands

    Charles O. Agyemang & Anton E. Kunst

  4. Social and Public Health Sciences Unit, Medical Research Council, Glasgow, UK

    Seeromanie Harding

  5. National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark

    Knud Juel

  6. Division of Community Health Sciences, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK

    Snorri Björn Rafnsson

  7. Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Madrid, Spain

    Enrique Regidor

  8. INSERM, CépiDc, Le Vésinet, France

    Grégoire Rey

  9. Centre for Public Health, Queen’s University, Belfast, Northern Ireland, UK

    Michael Rosato

  10. Department of Public Health, Erasmus Medical Centre, University of Rotterdam, Rotterdam, The Netherlands

    Johan P. Mackenbach

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  1. Hadewijch Vandenheede
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  2. Patrick Deboosere
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  11. Johan P. Mackenbach
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  12. Anton E. Kunst
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Correspondence to Hadewijch Vandenheede.

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Vandenheede, H., Deboosere, P., Stirbu, I. et al. Migrant mortality from diabetes mellitus across Europe: the importance of socio-economic change. Eur J Epidemiol 27, 109–117 (2012). https://doi.org/10.1007/s10654-011-9638-6

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  • DOI: https://doi.org/10.1007/s10654-011-9638-6

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