title: Questioning the discriminatory accuracy of broad migrant categories in public health: self-rated health in Sweden.
abstract: BACKGROUND
  Differences between natives and migrants in average risk for poor self-rated health (SRH) are well documented, which has lent support to proposals for interventions targeting disadvantaged minority groups. However, such proposals are based on measures of association that neglect individual heterogeneity around group averages and thereby the discriminatory accuracy (DA) of the categories used (i.e. their ability to discriminate the individuals with poor and good SRH, respectively). Therefore, applying DA measures rather than only measures of association our study revisits the value of broad native and migrant categorizations for predicting SRH.
  
  
  METHODS
  We analyzed 27,723 individuals aged 18-80 who responded to a 2008 Swedish public health survey. We performed logistic regressions to estimate odds ratios (ORs), predicted risks and the area under the receiver operating characteristic curve (AU-ROC) as a measure of epidemiological DA.
  
  
  RESULTS
  Being born abroad was associated with higher odds of poor SRH (OR = 1.75), but the AU-ROC of this variable only added 0.02 units to the AU-ROC for age alone (from 0.53 to 0.55). The AU-ROC increased, but remained unsatisfactorily low (0.62), when available social and demographic variables were included.
  
  
  CONCLUSIONS
  Our results question the use of broad native/migrant categorizations as instruments for forecasting individual SRH. Such simple categorizations have a very low DA and should be abandoned in public health practice. Measures of association and DA should be reported together whenever an intervention is being considered, especially in the area of ethnicity, migration and health.
authors.affiliation: 1 Department of Sociology, Faculty of Social Sciences, Lund University, Lund, Sweden 2 Department of Clinical Sciences, Unit of Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden shai.mulinari@soc.lu.se.
authors.forename: Shai
authors.initials: S
authors.lastname: Mulinari
authors.affiliation: 3 Department of Social Welfare Studies (ISV), REMESO Institute for Research on Migration, Ethnicity and Society, Linköping University, Norrköping, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Bredström
authors.affiliation: 2 Department of Clinical Sciences, Unit of Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden.
authors.forename: Juan
authors.initials: J
authors.lastname: Merlo
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D000068598:Data Accuracy; D005260:Female; D006304:Health Status; D006306:Health Surveys / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011634:Public Health / Q000706:statistics & numerical data*; D012372:ROC Curve; D057566:Self Report / Q000592:standards*; D012737:Sex Factors; D012959:Socioeconomic Factors; D013548:Sweden / Q000453:epidemiology; D014171:Transients and Migrants / Q000706:statistics & numerical data*; D055815:Young Adult