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Global patterns of mortality in international migrants: a systematic review and meta-analysis

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dc.contributor.author Aldridge, Robert W.
dc.contributor.author Nellums, Laura B.
dc.contributor.author Bartlett, Sean
dc.contributor.author Barr, Anna Louise
dc.contributor.author Patel, Parth
dc.contributor.author Burns, Rachel
dc.contributor.author Hargreaves, Sally
dc.contributor.author Miranda, J. Jaime
dc.contributor.author Tollman, Stephen
dc.contributor.author Friedland, Jon S.
dc.contributor.author Abubakar, Ibrahim
dc.date.accessioned 2019-03-05T15:23:28Z
dc.date.available 2019-03-05T15:23:28Z
dc.date.issued 2018
dc.identifier.uri https://hdl.handle.net/20.500.12866/5889
dc.description.abstract Background: 258 million people reside outside their country of birth; however, to date no global systematic reviews or meta-analyses of mortality data for these international migrants have been done. We aimed to review and synthesise available mortality data on international migrants. Methods: In this systematic review and meta-analysis, we searched MEDLINE, Embase, the Cochrane Library, and Google Scholar databases for observational studies, systematic reviews, and randomised controlled trials published between Jan 1, 2001, and March 31, 2017, without language restrictions. We included studies reporting mortality outcomes for international migrants of any age residing outside their country of birth. Studies that recruited participants exclusively from intensive care or high dependency hospital units, with an existing health condition or status, or a particular health exposure were excluded. We also excluded studies limited to maternal or perinatal outcomes. We screened studies using systematic review software and extracted data from published reports. The main outcomes were all-cause and International Classification of Diseases, tenth revision (ICD-10) cause-specific standardised mortality ratios (SMRs) and absolute mortality rates. We calculated summary estimates using random-effects models. This study is registered with PROSPERO, number CRD42017073608. Findings: Of the 12 480 articles identified by our search, 96 studies were eligible for inclusion. The studies were geographically diverse and included data from all global regions and for 92 countries. 5464 mortality estimates for more than 15·2 million migrants were included, of which 5327 (97%) were from high-income countries, 115 (2%) were from middle-income countries, and 22 (<1%) were from low-income countries. Few studies included mortality estimates for refugees (110 estimates), asylum seekers (144 estimates), or labour migrants (six estimates). The summary estimate of all-cause SMR for international migrants was lower than one when compared with the general population in destination countries (0·70 [95% CI 0·65–0·76]; I 2 =99·8%). All-cause SMR was lower in both male migrants (0·72 [0·63–0·81]; I 2 =99·8%) and female migrants (0·75 [0·67–0·84]; I 2 =99·8%) compared with the general population. A mortality advantage was evident for refugees (SMR 0·50 [0·46–0·54]; I 2 =89·8%), but not for asylum seekers (1·05 [0·89–1·24]; I 2 =54·4%), although limited data was available on these groups. SMRs for all causes of death were lower in migrants compared with the general populations in the destination country across all 13 ICD-10 categories analysed, with the exception of infectious diseases and external causes. Heterogeneity was high across the majority of analyses. Point estimates of all-cause age-standardised mortality in migrants ranged from 420 to 874 per 100 000 population. Interpretation: Our study showed that international migrants have a mortality advantage compared with general populations, and that this advantage persisted across the majority of ICD-10 disease categories. The mortality advantage identified will be representative of international migrants in high-income countries who are studying, working, or have joined family members in these countries. However, our results might not reflect the health outcomes of more marginalised groups in low-income and middle-income countries because little data were available for these groups, highlighting an important gap in existing research. Our results present an opportunity to reframe the public discourse on international migration and health in high-income countries. en_US
dc.language.iso eng
dc.publisher Elsevier
dc.relation.ispartofseries Lancet
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject all cause mortality en_US
dc.subject Article en_US
dc.subject asylum seeker en_US
dc.subject birthplace en_US
dc.subject disease classification en_US
dc.subject financial management en_US
dc.subject groups by age en_US
dc.subject health status en_US
dc.subject high income country en_US
dc.subject hospital subdivisions and components en_US
dc.subject hospital volume en_US
dc.subject human en_US
dc.subject ICD-10 en_US
dc.subject intensive care en_US
dc.subject low income country en_US
dc.subject middle income country en_US
dc.subject migrant en_US
dc.subject migrant worker en_US
dc.subject mortality rate en_US
dc.subject outcome assessment en_US
dc.subject perinatal period en_US
dc.subject population research en_US
dc.subject pregnancy outcome en_US
dc.subject priority journal en_US
dc.subject randomized controlled trial (topic) en_US
dc.subject residential home en_US
dc.subject standardized mortality ratio en_US
dc.subject systematic review en_US
dc.title Global patterns of mortality in international migrants: a systematic review and meta-analysis en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1016/S0140-6736(18)32781-8
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.00
dc.relation.issn 1474-547X


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