title: Health inequality between immigrants and natives in Spain: the loss of the healthy immigrant effect in times of economic crisis.
abstract: BACKGROUND
  The immigrant population living in Spain grew exponentially in the early 2000s but has been particularly affected by the economic crisis. This study aims to analyse health inequalities between immigrants born in middle- or low-income countries and natives in Spain, in 2006 and 2012, taking into account gender, year of arrival and socioeconomic exposures.
  
  
  METHODS
  Study of trends using two cross-sections, the 2006 and 2012 editions of the Spanish National Health Survey, including residents in Spain aged 15-64 years (20 810 natives and 2950 immigrants in 2006, 14 291 natives and 2448 immigrants in 2012). Fair/poor self-rated health, poor mental health (GHQ-12 > 2), chronic activity limitation and use of psychotropic drugs were compared between natives and immigrants who arrived in Spain before 2006, adjusting robust Poisson regression models for age and socioeconomic variables to obtain prevalence ratios (PR) and 95% confidence interval (CI).
  
  
  RESULTS
  Inequalities in poor self-rated health between immigrants and natives tend to increase among women (age-adjusted PR2006 = 1.39; 95% CI: 1.24-1.56, PR2012 = 1.56; 95% CI: 1.33-1.82). Among men, there is a new onset of inequalities in poor mental health (PR2006 = 1.10; 95% CI: 0.86-1.40, PR2012 = 1.34; 95% CI: 1.06-1.69) and an equalization of the previously lower use of psychotropic drugs (PR2006 = 0.22; 95% CI: 0.11-0.43, PR2012 = 1.20; 95% CI: 0.73-2.01).
  
  
  CONCLUSIONS
  Between 2006 and 2012, immigrants who arrived in Spain before 2006 appeared to worsen their health status when compared with natives. The loss of the healthy immigrant effect in the context of a worse impact of the economic crisis on immigrants appears as potential explanation. Employment, social protection and re-universalization of healthcare would prevent further deterioration of immigrants' health status.
authors.affiliation: 1 CIBER Epidemiología y Salud Pública, Spain 2 Agència de Salut Pública de Barcelona, Health Information Systems Unit, Barcelona, Spain 3 Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain.
authors.forename: Mercè
authors.initials: M
authors.lastname: Gotsens
authors.affiliation: 1 CIBER Epidemiología y Salud Pública, Spain 2 Agència de Salut Pública de Barcelona, Health Information Systems Unit, Barcelona, Spain 3 Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain dmalmusi@aspb.cat.
authors.forename: Davide
authors.initials: D
authors.lastname: Malmusi
authors.affiliation: 1 CIBER Epidemiología y Salud Pública, Spain.
authors.forename: Nazmy
authors.initials: N
authors.lastname: Villarroel
authors.affiliation: 1 CIBER Epidemiología y Salud Pública, Spain 4 Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, Alicante, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Vives-Cases
authors.affiliation: 5 Health Policy and Health Services Research Group, Health Policy Research Unit, Consorci de Salut i Social de Catalunya, Barcelona, Spain.
authors.forename: Irene
authors.initials: I
authors.lastname: Garcia-Subirats
authors.affiliation: 1 CIBER Epidemiología y Salud Pública, Spain 6 Centre d'Estudis Epidemiologics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Badalona, Spain 7 Universitat Autònoma de Barcelona, Bellaterra, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Hernando
authors.affiliation: 1 CIBER Epidemiología y Salud Pública, Spain 2 Agència de Salut Pública de Barcelona, Health Information Systems Unit, Barcelona, Spain 3 Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain 8 Universitat Pompeu Fabra, Barcelona, Spain.
authors.forename: Carme
authors.initials: C
authors.lastname: Borrell
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D003430:Cross-Sectional Studies; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D006304:Health Status; D054624:Health Status Disparities; D006306:Health Surveys; D006801:Humans; D008297:Male; D008603:Mental Health / Q000208:ethnology*; D008875:Middle Aged; D057566:Self Report; D012737:Sex Factors; D012959:Socioeconomic Factors; D013030:Spain / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000208:ethnology*; D013997:Time Factors; D055815:Young Adult