title: Migrant mortality from diabetes mellitus across Europe: the importance of socio-economic change.
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.
authors.affiliation: Interface Demography, Department of Social Research, Vrije Universiteit Brussel, 5 Pleinlaan, 1050 Brussels, Belgium. hadewijch.vandenheede@vub.ac.be
authors.forename: Hadewijch
authors.initials: H
authors.lastname: Vandenheede
authors.forename: Patrick
authors.initials: P
authors.lastname: Deboosere
authors.forename: Irina
authors.initials: I
authors.lastname: Stirbu
authors.forename: Charles O
authors.initials: CO
authors.lastname: Agyemang
authors.forename: Seeromanie
authors.initials: S
authors.lastname: Harding
authors.forename: Knud
authors.initials: K
authors.lastname: Juel
authors.forename: Snorri Björn
authors.initials: SB
authors.lastname: Rafnsson
authors.forename: Enrique
authors.initials: E
authors.lastname: Regidor
authors.forename: Grégoire
authors.initials: G
authors.lastname: Rey
authors.forename: Michael
authors.initials: M
authors.lastname: Rosato
authors.forename: Johan P
authors.initials: JP
authors.lastname: Mackenbach
authors.forename: Anton E
authors.initials: AE
authors.lastname: Kunst
mesh_terms: D000328:Adult; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology* / Q000401:mortality*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012923:Social Class; D014171:Transients and Migrants; D055815:Young Adult