European Journal of Public Health
Volume 25, Issue 1, 2015, Pages 84-89

Remigration of migrants with severe disease: Myth or reality? - A register-based cohort study (Article) (Open Access)

Norredam M.* , Hansen O.H. , Petersen J.H. , Kunst A.E. , Kristiansen M. , Krasnik A. , Agyemang C.
  • a Department of Public Health, Danish Research Centre for Migration, Ethnicity and Health, University of Copenhagen, Øster Farimagsgade 5, Copenhagen K, 1014, Denmark, Department of Immigrant Medicine, Section of Infectious Diseases, Hvidovre Hospital, Copenhagen, Denmark
  • b Section for Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
  • c Section for Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
  • d Department of Public Health, Amsterdam Medical Centre, Amsterdam University, Amsterdam, Netherlands
  • e Department of Public Health, Danish Research Centre for Migration, Ethnicity and Health, University of Copenhagen, Øster Farimagsgade 5, Copenhagen K, 1014, Denmark
  • f Department of Public Health, Danish Research Centre for Migration, Ethnicity and Health, University of Copenhagen, Øster Farimagsgade 5, Copenhagen K, 1014, Denmark
  • g Department of Public Health, Amsterdam Medical Centre, Amsterdam University, Amsterdam, Netherlands

Abstract

Background: 'Remigration bias' is often referred to when explaining low mortality outcomes among migrants compared with local-born. The hypothesis suggests that severely ill migrants tend to return to their country of origin, but it has hitherto not been tested in a large-scale epidemiological study. Consequently, we studied whether migrants with severe disease were more likely to emigrate compared with migrants without severe disease. Methods: A historic prospective cohort study was conducted based on all adult refugees and family reunification immigrants (n = 114,331) who obtained residence permission in Denmark between 1 January 1993 and 31 December 2010. Migrants with severe disease were identified through the Danish National Patient Register. Emigrations during follow-up (1 January 1993 to 31 December 2011) were identified using the Danish Civil Registration System. Hazard ratios were calculated for emigration among migrants with different levels of disease severity, adjusting for sex, age and income. Results:. Results showed progressively fewer emigrations with increasing disease severity. Migrants with low (HR = 0.92; 95% CI: 0.80-1.06), moderate (HR = 0.84; 95% CI: 0.67-1.06) and high (HR = 0.70; 95% CI: 0.55-0.90) disease severity had fewer emigrations to 'country of origin' compared with migrants without disease. For emigration to 'any country', results likewise showed fewer emigrations among migrants with low (HR = 0.86; 95% CI: 0.78-0.95), moderate (HR = 0.73; 95% CI: 0.62-0.87) and high (HR = 0.64; 95% CI: 0.53-0.76) disease severity. This tendency was also observed by nationality and migrant status. On the disease-specific level, no uniform tendencies in emigration patterns were identified. Conclusion: The results do not generally support the hypothesis of 'remigration bias' but rather suggest the opposite. Accordingly, remigration bias does not appear to explain lower mortality of migrants. © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Author Keywords

[No Keywords available]

Index Keywords

Denmark male Emigrants and Immigrants statistics and numerical data female prospective study cohort analysis Humans Registries chronic disease register Prospective Studies human adult migrant middle aged Cohort Studies Severity of Illness Index
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84922469340&doi=10.1093%2feurpub%2fcku138&partnerID=40&md5=45f841c74072930c7e7dc05c864789fb
DOI: 10.1093/eurpub/cku138
ISSN: 11011262
Cited by: 38
Original Language: English