Integration policies and immigrants’ mortality: an explorative European study, by Umar Ikram, Davide Malmusi, Knud Juel, Gregoire Rey and Anton Kunst, from the Department of Public Health, Academic Medical Center, Amsterdam; Agència de Salut Pública de Barcelona; National Institute of Public Health, University of Southern Denmark, Copenhagen; 4INSERM, CépiDc, Le Kremlin-Bicêtre, France. Presented at the 7th European Public Health Conference: "Mind the gap: Reducing inequalities in health and health care" hold in Glasgow, Scotland, UK, from 20th to 22nd November 2014.

1. Integration policies and immigrants’ mortality:
an explorative European study
Umar Ikram1, Davide Malmusi2, Knud Juel3, Gregoire Rey4, Anton Kunst1
1Department of Public Health, Academic Medical Center, Amsterdam; 2Agència de Salut Pública de Barcelona; 3National Institute
of Public Health, University of Southern Denmark, Copenhagen; 4INSERM, CépiDc, Le Kremlin-Bicêtre, France
This work was supported by European Commission DG SANCO (grant number 2005122)
and 7th Framework Programme (SOPHIE project, grant number 278173)
Correspondence: Umar Ikram, u.ikram@amc.nl
Methods
• Mortality and population data from the Migrant Ethnic Health
Observatory project (Netherlands 1996-2006 open
cohort; France 2005-07 unlinked mortality register
and census data; Denmark 1992-2001 open cohort)
• Immigrants from Turkey and Morocco, and local-born populations
aged 20-69 years
• Age-standardised mortality rates by sex, country of residence and
country of birth
• Mortality rate ratios calculated using Poisson regression
Objective
To assess mortality differences among Turkish- and
Moroccan-born immigrants living in three European countries
with distinct types of integration policies
• Netherlands à multiculturalist
• France à assimilationist
• Denmark à exclusionist
Background
• European countries have followed
different models of integration policy
• Integration policies may influence
migrants’ health through social
determinants
• Recently an association has been
shown between country integration
policy model and immigrants’ self-
rated health (Malmusi 2014)
Within-country inequalities in mortality
Age-adjusted Mortality Rate Ratios. Ref: Local-born population
Conclusion
• This study suggests that different macro-level policy contexts may influence immigrants' health.
• Comparable mortality registrations in Europe with detailed socio-demographic information on immigrants might help
disentangle this association
Men Women
Age-standardised mortality rate
by sex, country of birth and country of residence
Migrant Integration Policy Index 2007 LCA (Meuleman & Reeskens 2008).
Blue=Multiculturalist, Orange=Assimilationist, Red= Exclusionist
0,5
1,0
2,0
Netherlands
France
Denmark
Netherlands
France
Denmark
Turkish born Moroccan-born
MRR
Men
0,5
1,0
2,0
Netherlands
France
Denmark
Netherlands
France
Denmark
Turkish born Moroccan-born
MRR
WomenResults
• Compared with their peers in the Netherlands, Turkish-born had
higher mortality in Denmark (MRR men 1.92; 95% CI 1.74-2.13
and women 2.11; 1.80-2.47) but lower in France (men 0.64;
0.59-0.69 and women 0.58; 0.51-0.67).
• The mortality differences between immigrants and local-born
population were largest in Denmark and lowest in France.
• These patterns were consistent across all age groups, and more
marked for cardiovascular diseases.
0
100
200
300
400
500
600
700
800
900
1000
Age-standardisedmortaltiyrate(per100,000PY)
Netherlands
France
Denmark