The Health of Older Immigrants to Western Countries

1
The Health of Older Immigrants to Western
Countries

• Kyriakos S. Markides, PhD
• University of Texas Medical Branch
• Galveston, Texas, USA
• Adelaide, Australia, July 2, 2011

2
Purpose

• To provide an overview of the health status and
  health care needs of older immigrants to the
  United States, Canada, and Australia, the three
  largest traditional immigrant receiving nations.

3
Introduction

• Most Advanced Western societies are receiving
  increasing numbers of immigrants originating in
  non-Western or developing countries.
• While immigrants tend to be relatively young,
  their large numbers will ensure rising numbers of
  older immigrants of foreign-born older people who
  may have special concerns.

4
Research in in the United States, Canada and
Australia

• The United States, Canada, and Australia have
  been the three major immigrant nations where
  there have been considerable research interest in
  the health of immigrants.
• The volume and nature of immigration has
  changed in recent decades with most immigrants
  coming from non-European origins.

5
All Cause MortalityNative born vs. Foreign born
rate ratio
Canada 1 All immigrants vs. Canadian-born United States2 All immigrants vs. U.S. Born Australia3 U.K. Ireland/Other Europe/Asia vs. Australian-born
Males 0.81 Females 0.89 0.77 0.84 0.89 0.83 0.72 0.94 0.82 0.80
Sources 1Trovato, 2003 2Singh Hiatt, 2006 3Australian Institute of Health and Welfare, 2002 Data 11991 21999-2001 31997-1999
6
Overview of Findings in the United States

• Immigrants are younger, less educated, have lower
  incomes, and live in large families.
• Hispanic immigrants were least likely to have
  health insurance.
• Non-Hispanic black and Hispanic immigrants were
  less likely to be obese than their U.S.-born
  counterparts.
• Hispanic immigrants were more likely to be obese
  the longer they lived in the U.S.

7
Overview of Findings in the United States
(continued)

• Non-Hispanic black and Hispanic immigrants
  experienced fewer symptoms of psychological
  distress than their U.S.-born counterparts.
• Foreign-born persons in all major ethic groups
  (Blacks, Hispanics, persons of Asian origin) have
  consistently lower mortality rates than
  native-born persons.
• Foreign-born Blacks and persons of Asian-origin
  have the lowest odds of mortality with the
  native-born Blacks having the highest odds. The
  mortality advantage appears to be greatest in old
  age, especially among Hispanics.

8
Overview of Findings in the United States
(continued)

• U.S. national data show that the immigrant health
  advantage tends to diminish with time and to
  disappear in the next generation.
• A central mechanism of convergence is obesity.
  BMI levels of immigrants converge with native
  levels within 10 years among women, and 15 years
  among men.

9

A Hispanic Epidemiologic Paradox in the United
States

• Risk factor profiles

• Hispanics (except
• Cuban Americans)
• are socioeconomically
• disadvantaged, but have favorable overall
  mortality.

• High rates of DIABETES
• High rates of OBESITY
• Similar rates of hypertension/cholesterol
• Rising SMOKING rates among men, lower among women
  (fewer cigarettes). Cuban American males smoke
  the most.
• High ALCOHOL (binge) drinking rates among men,
  low among women.
• Alcohol consumption in women increases with
  acculturation.
• Low rates of physical ACTIVITY
• Strong families
• Migration selection

• Markides and Coreil (1986)

10
UNITED STATES LIFE TABLES BY HISPANIC ORIGIN
(2006)E. Arias, NCHS, 2010
Life Expectancy at Birth Total Male Female
Hispanic 80.6 77.9 83.1
Non-Hispanic White 78.1 75.6 80.4
Non-Hispanic Black 72.9 69.2 76.2
Adjusted for misclassification of race and
Hispanic origin on death certificates. 80 rates
for Hispanics based on Non-Hispanic White rates.
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Trends in the health of older Mexican Americans aged 75 Trends in the health of older Mexican Americans aged 75 Trends in the health of older Mexican Americans aged 75 Trends in the health of older Mexican Americans aged 75 Trends in the health of older Mexican Americans aged 75
Men Men Women Women
Health Conditions 1993-4 2004-5 1993-4 2004-5
Depressive symptoms (CESD 16) 75 (18.6) 121 (16.1) 181 (30.3) 291 (24.1)
ADL Disability ( 1) 93 (20.2) 237 (29.7) 176 (26.8) 524 (41.2)
Diabetes mellitus 100 (21.3) 248 (31.3) 142 (21.5) 442 (34.8)
Hypertension 233 (49.8) 435 (61.7) 399 (60.5) 780 (69.6)
Stroke 45 (9.6) 118 (14.9) 66 (10.0) 164 (12.9)
Obesity (BMI 30) 72 (18.0) 148 (22.8) 153 (26.7) 313 (31.5)
Cognitive impairment (MMSE lt 21) 96 (23.2) 310 (41.3) 157 (26.0) 477 (40.3)
Total N 469 797 662 1272
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DATA ON OLDER MEXICAN AMERICANS Interpretation

• Data clearly show an increase in ADL disability
  from 1993-1994 to 2004-2005 in Mexican Americans
  aged 75 and over, especially women.
• Part of the increase can be attributed to
  increases in the prevalence of obesity and
  diabetes.
• Data support the notion that the Mexican American
  population is at a stage of the epidemiologic
  transition when the general U.S. population was
  in the 1970sa period of rising life expectancy
  accompanied by increases in the prevalence of
  chronic diseases and disabilities.

13
Overview of Findings in Canada

• Data from the 1994-95 National Population Health
  Survey (NPHS) showed
• Immigrants, especially recent immigrants, are
  less likely than the native-born to have chronic
  conditions and disabilities. This is especially
  so among those from non-European countries
• (Mostly Asian-born)
• Chen, Ng, and Wilkins, 1996

14
Overview of Findings in Canada(continued)

• Immigrants were considerably less likely to have
  ever been smokers.
• Non-European immigrants were less physically
  active.
• European-origin immigrants were more physically
  active than the Canadian-born.
• Health Levels of immigrants tend to converge to
  Canadianborn levels in about 10 years.

15
Overview of Findings in Canada (continued)

• More recent analysis of multiple cross-sections
  of NPHS data found
• There is strong evidence that the healthy
  immigrant effect is present in both men and women
  for the incidence of chronic conditions.
• Convergence over time to native levels reflects
  actual convergence in physical health rather than
  convergence in screening and diagnosis of
  existing health problems.
• McDonald and Kennedy, 2004

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Overview of Findings in Australia

• Regardless of country of origin, almost all
  immigrants have good or better health compared to
  Australian-born counterparts (1).
• Health advantage becomes smaller with more time
  in Australia.
• Migrants from Asia have lowest standardized
  mortality ratio for all cause mortality,
  especially from colorectal and prostate cancers,
  respiratory causes and suicide2
• Those born in Asia less likely to be obese and
  overweight, to drink alcohol at risky levels.
  But, tend to have high rates of physical
  inactivity.
• 1Australian Institute of Health and Welfare, 2002
  
• 2Young, 1992

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Overview of Findings in Australia (continued)

• Data on immigrants to Australia aged 20-64 show
• Immigrants have better health than the
• Australian-born.
• Immigrants from non-English speaking Europe and
  from non-European countries have better health
  upon arrival than those from English speaking
  countries.
• Within 10-20 years the health of immigrants
  approximates the health of native-born
  Australians.
• Biddle, Kennedy, and McDonald, 2007

18
Common Patterns

• Immigrants have lower mortality rates compared to
  native born
• -but it does not appear that rising life
  expectancies will be accompanied by good health
  and good quality of life of many immigrants in
  old age.
• Convergence between the health statuses of the
  two with time in the host country.
• -This reflects adoption of a Western
  life-style that includes higher levels of smoking
  and alcohol consumption, and especially higher
  rates of obesity.

19
Implications

• Populations of Immigrants are aging rapidly
  and in some cases they are becoming more
  disabled, thus increasing the burden on families,
  communities and the health care system
• These issues are especially relevant in a time
  of shrinking financial resources.