Functional limitations and overweight among migrants in the Histoire de Vie study (Insee, 2003).
BACKGROUND
In France, epidemiological data on immigrant population are limited since characterization of immigrants is viewed as a sensitive issue. The Histoire de Vie survey has enabled the description of the association of immigration characteristics and two health indicators.


METHODS
Health-related functional limitations and overweight status (BMI> or =25 kg/m(2)) were studied among 18 to 64 years old using indirect age standardization. Immigration status was characterized in four different ways: via the migratory pathways of interviewees and their parents (French born to two French-born parents, second-generation, immigrated at the age of 15 or younger, immigrated at the age of 16 or older), citizenship (French by birth, French by naturalisation, non French), geographical origin (France, Europe, outside Europe) and language(s) spoken at home (French mother tongue, French for persons who do not have French as mother tongue, French and another language, another language). The analyses were conducted separately in men and in women and stratified by occupational status (upper and lower). For functional limitations, the analysis was repeated excluding participants whose limitations occurred before the age of 19, which was the average age of immigration, to assess a possible healthy migrant effect.


RESULTS
Compared to French men born to two French parents, an increased rate of functional limitations was observed among men born in Europe and/or who had at least one parent born in Europe (SMR: 1.4; 95% CI: 1.06-1.81) and a reduced rate among participants born outside Europe or who had at least one parent born outside Europe (SMR: 0.63; 95% CI: 0.46-0.86); these differences remained when social status was taken into account. Among women, a tendency towards a lower rate of functional limitations was found in lower social status groups among those who immigrated as adults, among non French citizens and among non Europeans. Restricting the analysis to individuals free of limitations at the age of 19 did not suggest a healthier migrant effect. Among men, the risk of being overweight did not differ according to immigration characteristics. Women who immigrated in their adult life (SMR: 1.42; 95% CI: 1.18-1.74), who had foreign citizenship (SMR: 1.44; 95% CI: 1.18-1.74) and who still spoke their mother tongue at home (SMR: 1.53; 95%CI: 1.23-1.88) were more likely to be overweight than non migrant women. These results were observed in lower social groups but not in upper social groups.


CONCLUSIONS
These results demonstrate a heterogeneous relationship between immigration status and health, according to age at immigration, gender and origin while the migrant second-generation appears quite close to the population born French to two French-born parents. Further studies are needed to provide data on a wider range of health indicators. In the future, health surveys should document detailed information to allow for a full characterisation of the migrant population.
Inserm U687, Hôpital National de Saint-Maurice, Saint-Maurice, France. France.lert@st-maurice.inserm.fr
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D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015992:Body Mass Index; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D016021:Epidemiologic Studies; D005060:Europe / Q000208:ethnology; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007802:Language; D008297:Male; D008875:Middle Aged; D009790:Occupations / Q000706:statistics & numerical data; D050177:Overweight / Q000453:epidemiology*; D012737:Sex Factors; D012923:Social Class