Background: The health effects of emigration on relatives staying behind has received little attention in the recent literature. Our aim was to assess the association of spouse and offspring emigration with acute coronary syndrome (ACS) in Albania, a country which is undergoing a particularly rapid socio-economic transition accompanied by intensive emigration. Methods: A population-based case-control study, conducted in Tirana, Albania, in 2003-06, included 467 non-fatal consecutive ACS patients (370 men, 97 women; 88% response) and 737 population-representative controls (469 men, 268 women; 69% response) aged 35-74 years. Information on emigration of family members and financial support, socio-demographic characteristics and conventional coronary risk factors was obtained by a structured questionnaire and examination. Associations of emigrational variables with ACS were assessed by logistic regression. Results: Forty five percent of female and 25% of male patients, and 17 and 15% of controls, respectively, reported emigration of a close family member. These were younger and of lower education, income and social status than controls without emigrants. Forty nine percent of patient emigrants vs 76% of control emigrants remitted funds. Excess risk of ACS was confined to individuals whose emigrant relatives did not remit monies home [multivariable-adjusted odds ratio (OR) = 10.8, 95% confidence interval (CI) = 2.6-44.8 in women, and OR = 2.0, 95% CI = 0.9-4.3 in men; P for sex-interaction = 0.03] and was attributable largely to spouse emigration. Conclusions: Our findings, which require confirmation, suggest that emigration of close family, but especially of spouses, coupled with non-remittance of financial support is associated with marked health effects in the spouse or parent left behind, and that women are more vulnerable than men. © The Author 2007; all rights reserved.

Social support coronary heart disease Emigration Transitional country Financial support Sex differences acute coronary syndrome

educational status Eurasia immigrant sex-related difference Albania logistic regression analysis Spouses Europe population based case control study risk human coronary risk middle aged controlled study priority journal Aged socioeconomic status social support family health income foreign worker social status Humans health impact cardiovascular disease male gender bias female Socioeconomic Factors spouse Multivariate Analysis socioeconomics emigration Article Southern Europe major clinical study acute coronary syndrome adult migration Sex Distribution age distribution ischemic heart disease Emigration and Immigration Case-Control Studies structured questionnaire parent