LESSONS FROM THE STUDY OF IMMIGRANT MORTALITY
LESSONS FROM THE STUDY OF IMMIGRANT MORTALITY
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DOI：
10.1016/s0140-6736(84)91943-3
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发表时间：
1984-01-01
期刊：
影响因子：
168.9
通讯作者：
BULUSU, L
中科院分区：
文献类型：
--
作者：
MARMOT, MG;ADELSTEIN, AM;BULUSU, L
这本身就是一篇重要的论文，但那些对这一主题最感兴趣的人可能会希望阅读完整的报告(Marmotet al.，《英格兰和威尔士的移民死亡率》，1970-78年)。医学和人口学科研究，第47号。人口普查和调查办公室。作者将死亡率研究作为移民群体与捐助国和受援国人口以及那里的生活方式相比较的健康指标，并将特定群体的健康演变与与原籍国相似的初始模式的理论模式进行比较--由于移民往往不是随机选择的--然后是向与东道国模式非常相似的过渡阶段。它们概述了死亡证明和人口普查数据的使用，包括OPC的纵向研究，并证明了结合印度次大陆几个国家和整个爱尔兰的数据的合理性；在大多数表格中，标准化死亡率(SMR)表示为英格兰和威尔士的期望值，但对于来自印度次大陆的移民，比例死亡率(PMR)用于分别针对男性和女性的“印度”和“英国”族裔群体(即每个种族群体中因特定原因死亡的比例)。数据的一些主要迹象是：除爱尔兰外，移民往往比其原籍国的非移民更健康。印度次大陆和爱尔兰男性的结核病发病率较高，加勒比海男性的缺血性心脏病发病率较低，但脑血管疾病的发病率较高，除爱尔兰人外，肺癌和肠癌的发病率较低。然而，从意大利(法国、西班牙、苏格兰、美国和南非，尽管这里没有列出这些国家)移民的原籍国和东道国之间的缺血性心脏病发病率来看，这表明了一些适应。结核病已经下降到几乎英格兰和威尔士的平均水平，目前主要是长期居住的波兰移民。除了移民前的社会经济环境，压力可能与爱尔兰移民事故以及肺癌和宫颈癌的高发病率有关。来自印度次大陆的“英国”移民的比例介于“印度人”和英格兰和威尔士之间；作者认为，这与环境因素而不是遗传因素有关(尽管“英国人”群体中可能存在一些基因混合因素(我要补充的是，也可能存在中间的饮食偏好--也许包括在作者提到的“文化影响的持久性？”中)。表3显示了移民人口作为一个整体的传统社会阶层分组的相似模式。对于爱尔兰移民，与英格兰和威尔士的总数字相比，这一比例往往很高。印度次大陆的移民比例显示出不那么明显的社会梯度，而加勒比和非洲移民的比例则表明正常的梯度发生了逆转，即在较高的社会阶层中风险更高。讨论部分包含了关于国际比较的几个论点，以及适应东道国环境趋势的迹象，这需要仔细审查表格，甚至是完整的报告。也许最明确的迹象之一是，印度和加勒比移民因妊娠和分娩并发症造成的高死亡率不能简单地用…来解释。
This is an important paper in itself but those most interested in the topic will probably want to go to the full report (Marmotet al.,Immigrant mortality in England and Wales 1970-78. Studies of medical and population subjects, no. 47. Office of Population Censuses and Surveys. London, HMSO, 1984).The authors make the case for mortality studies as an indicator of health of immigrant groups as compared with the populations of donor and recipient countries, and of life-styles therein; and also for comparison of the health evolution in particular groups with a theoretical one of initial patterns resembling those in the country of origin-subject to bias since migrants tendnotto be a random selection-followed by transition stages towards close resemblance to patterns in the host country. They outline the use of death-certificate and census data including the OPCS longitudinal study, and justify combining data for the several countries of the Indian subcontinent and for the whole of Ireland; standardized mortality ratios (SMRs) are expressed as a ratio to the expected value for England and Wales for most tabulations, but for immigrants from the Indian subcontinent proportional mortality ratios (PMRs) are used in relating to ethnic "Indian" and ethnic "British" groups, for men and women separately (i.e. the proportion of deaths in each ethnic group due to a specific cause).Results are presented in 3 tables, with brief analyses. Some main indications from the data are: migrants tend to be healthier than non-migrants in their country of origin except for Ireland. Patterns suggestive of the country of origin are: high rates of tuberculosis in men from the Indian subcontinent and from Ireland, low rates from ischaemic heart disease but high for cerebrovascular disease in Caribbean men, and low rates for cancer of lung and intestine except for the Irish. Some adaptation is however suggested by ischaemic heart disease rates intermediate between original and host country for immigrants from Italy (also France, Spain, Scotland, the USA and South Africa though these are not tabulated here). Tuberculosis has fallen to almost the England and Wales average for the now mainly long-resident Polish immigrants. Along with pre-migration socioeconomic circumstances, stress may be linked with the high rates in Irish immigrants for accidents and for lung and cervical cancers. The "British" immigrants from the Indian subcontinent show rates intermediate between those for "Indians" and for England and Wales; the authors suggest that this is linked with environmental rather than genetic determinants of risk (though some genetic admixture in the "British" group may be present [and, I would add, there may also be intermediate dietetic preferences-perhaps subsumed in the authors' reference to the "the persistence of cultural influences"?]). Table 3 shows a familar pattern for the conventional social class grouping for the immigrant populations as a whole. With the Irish immigrants the rates tend to be high compared with the total figures for England and Wales. The rates for the Indian subcontinent show a less clear social gradient, whereas for Caribbean and African immigrants there is some suggestion of a reversal of the normal gradient, i.e. with higher risks in higher social classes.The discussion section contains several arguments about international comparisons and indications of trends towards adaptation to the environment of the host country that call for close scrutiny of the tables and perhaps even the full report. Perhaps one of the clearest indications is that the high mortality from complications of pregnancy and childbirth in Indian and Caribbean immigrants cannot be explained simply by …