title: Can selective migration explain why health is worse in regions with population decline?: A study on migration and self-rated health in the Netherlands.
abstract: BACKGROUND
  Health disparities between population declining and non-declining areas have received little attention, even though population decline is an established phenomenon in Europe. Selective migration, in which healthier people move out of deprived areas, can possibly explain worse health in declining regions. We assessed whether selective migration can explain the observed worse average health in declining regions as compared with non-declining regions in the Netherlands.
  
  
  METHODS
  Combining data from the Dutch Housing and Living Survey held in 2002 and 2006 with Dutch registry data, we studied the relation between health status and migration in a 5-year period at the individual level by applying logistic regression. In our sample of 130,600 participants, we compared health status, demographic and socioeconomic factors of movers and stayers from declining and non-declining regions.
  
  
  RESULTS
  People in the Netherlands who migrated are healthier than those staying behind [odds ratio (OR): 1.80]. This effect is larger for persons moving out of declining regions (OR: 1.76) than those moving into declining regions (OR: 1.47). When controlled for demographic and socioeconomic characteristics, these effects are not significant. Moreover, only a small part of the population migrates out of (0.29%) or into (0.25%) declining regions in the course of 5 years.
  
  
  CONCLUSIONS
  Despite the relation between health and migration, the effect of selective migration on health differences between declining and non-declining regions in the Netherlands is small. Both health and migration are complexly linked with socioeconomic and demographic factors.
authors.affiliation: Unit of PharmacoEpidemiology and PharmacoEconomics, Pharmacy Department, University of Groningen, Groningen, The Netherlands Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands a.dijkstra@rug.nl.
authors.forename: Aletta
authors.initials: A
authors.lastname: Dijkstra
authors.affiliation: Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands Healthy Ageing Population and Society (HAPS), University of Groningen, Groningen, The Netherlands.
authors.forename: Eva U B
authors.initials: EU
authors.lastname: Kibele
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
authors.forename: Antonia
authors.initials: A
authors.lastname: Verweij
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
authors.forename: Fons
authors.initials: F
authors.lastname: van der Lucht
authors.affiliation: Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands The Netherlands Interdisciplinary Demographic Institute (NIDI/KNAW/RUG), The Hague, The Netherlands.
authors.forename: Fanny
authors.initials: F
authors.lastname: Janssen
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D003430:Cross-Sectional Studies; D004641:Emigration and Immigration / Q000706:statistics & numerical data*; D005260:Female; D006304:Health Status; D054624:Health Status Disparities; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011157:Population Dynamics / Q000706:statistics & numerical data; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D057566:Self Report; D012737:Sex Factors; D012959:Socioeconomic Factors; D014171:Transients and Migrants / Q000706:statistics & numerical data*; D055815:Young Adult