title: Mortality in adult immigrants in the 2000s in Belgium: a test of the 'healthy-migrant' and the 'migration-as-rapid-health-transition' hypotheses.
abstract: OBJECTIVE
  Firstly, to map out and compare all-cause and cause-specific mortality patterns by migrant background in Belgium; and secondly, to probe into explanations for the observed patterns, more specifically into the healthy-migrant, acculturation and the migration-as-rapid-health-transition theories.
  
  
  METHODS
  Data comprise individually linked Belgian census-mortality follow-up data for the period 2001-2011. All official inhabitants aged 25-54 at time of the census were included. To delve into the different explanations, differences in all-cause and chronic- and infectious-disease mortality were estimated using Poisson regression models, adjusted for age, socioeconomic position and urbanicity.
  
  
  RESULTS
  First-generation immigrants have lower all-cause and chronic-disease mortality than the host population. This mortality advantage wears off with length of stay and is more marked among non-Western than Western first-generation immigrants. For example, Western and non-Western male immigrants residing 10 years or more in Belgium have a mortality rate ratio for cardiovascular disease of 0.72 (95% CI 0.66-0.78) and 0.59 (95% CI 0.53-0.66), respectively (vs host population). The pattern of infectious-disease mortality in migrants is slightly different, with rather high mortality rates in first-generation sub-Saharan Africans and rather low rates in all other immigrant groups. As for second-generation immigrants, the picture is gloomier, with a mortality disadvantage that disappears after control for socioeconomic position.
  
  
  CONCLUSIONS
  Findings are largely consistent with the healthy-migrant, acculturation and the migration-as-rapid-health-transition theories. The convergence of the mortality profile of second-generation immigrants towards that of the host population with similar socioeconomic position indicates the need for policies simultaneously addressing different areas of deprivation.
authors.affiliation: Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: Hadewijch
authors.initials: H
authors.lastname: Vandenheede
authors.affiliation: Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: Didier
authors.initials: D
authors.lastname: Willaert
authors.affiliation: Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: Hannelore
authors.initials: H
authors.lastname: De Grande
authors.affiliation: Community Health Centre De Sleep, Ghent, Belgium.
authors.forename: Steven
authors.initials: S
authors.lastname: Simoens
authors.affiliation: Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium.|Employment Conditions Knowledge Network, Universitat Pompeu Fabra, Barcelona, Spain.
authors.forename: Christophe
authors.initials: C
authors.lastname: Vanroelen
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara / Q000208:ethnology; D001530:Belgium / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000208:ethnology / Q000401:mortality*; D002423:Cause of Death; D054242:Emigrants and Immigrants; D004641:Emigration and Immigration; D005006:Ethnicity; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007239:Infections / Q000208:ethnology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D014171:Transients and Migrants
keywords: Belgium; chronic disease; infection; migrants; mortality