Migration and changes in loneliness over a 4-year period: the case of older former Soviet Union immigrants in Israel

Both older adult and immigrant populations are at a high risk of loneliness. The current research compares older veteran Israelis to older immigrants who arrived in Israel from the former Soviet Union (FSU) after 1989. Early studies have found high levels of loneliness among older FSU immigrants; however, little is known regarding changes in loneliness among this group over time. The present study examines change in loneliness among older FSU immigrants and older veteran Jewish Israelis and its potential predictors. A prospective association between immigrant’s status and loneliness over time was examined using the second (2009/2010) and third (2013) waves of SHARE-Israel. The sample consisted of 208 FSU immigrants and 1080 veteran Jewish Israelis. Bivariate analyses indicated that in 2009/2010, older FSU immigrants were significantly lonelier than older veteran Jews, and more disadvantaged on all social and health variables measured. Yet, no significant differences emerged between the two groups with regard to loneliness in 2013. In the adjusted model, older immigrants presented positive change in loneliness (less loneliness over time) compared with veteran Jewish Israelis. Depressive symptoms explained a large part of the variance in change in loneliness. Potential explanations suggest that the long-term psychological adjustment process and the characteristics of the FSU immigrants in Israel as a large and relatively strong immigrant group have served as protective factors with regard to changes in loneliness over time.     

Incidence of Heart Failure Among Immigrants to Ontario,Canada: A CANHEART Immigrant Study

BackgroundSeveral known traditional cardiovascular risk factors contribute to the development of heart failure (HF); however, whether ethnicity is also an important predictor is not well established. We determined the incidence of hospitalization for HF among ethnic groups in Ontario, Canada, and examined differences in risk factor prevalence that may contribute to disparities in HF hospitalization incidence between groups.Methods and ResultsWe conducted a retrospective observational study from 2008 to 2012 with the use of a linked cohort derived from population-based health administrative, clinical, and survey datasets. We followed 895,823 recent immigrants from 8 ethnic groups and 5.3 million long-term residents aged 40–105 years for incident HF hospitalization. Sex-stratified age-standardized HF incidence was lower among all immigrant groups than long-term residents. Among immigrants, Black men and West Asian women had the highest incidence of hospitalizations for HF (1.19 and 1.60 per 1000 person-years, respectively), and East Asians of both sexes had the lowest incidence. After adjusting for sociodemographic characteristics, comorbidities, and other risk factors, the association between ethnicity and HF hospitalization risk remained significant.ConclusionsHF hospitalization incidence varies widely among ethnic immigrant groups, highlighting the importance of ethnicity as a potential independent risk factor for HF development.     

Immigrant patients with chronic hepatitis C and advanced fibrosis have a higher risk of hepatocellular carcinoma

To explore the impact of the differences in baseline characteristics between immigrants with chronic hepatitis C (CHC) and native-born patients on the prognosis of advanced fibrosis. A retrospective cohort study was conducted in 318 patients (including 128 immigrants) with CHC and advanced fibrosis attending a tertiary referral clinic. Patients' medical records were reviewed to collect data describing immigrant status, baseline characteristics, and liver-related clinical outcomes. Kaplan-Meier (KM) analyses and Cox proportional-hazards regression analyses were performed to explore the differences between the two groups with respect to clinical outcomes. Relative to native-born patients, immigrant patients were older, more likely to be female, and more likely to be Asian. Immigrants were less likely to be heavy drinkers, heavy smokers, injection drug users, and more likely to have type 2 diabetes. KM analyses indicated that immigrant patients had a significantly higher risk of hepatocellular carcinoma (HCC) than Canadian-born patients (P = 0.005). Univariate Cox proportional-hazards analyses indicated that immigrant status (hazard ratio (HR) 2.22; P = 0.006), age (HR 1.07; P < 0.001), heavy drinking (HR 2.69; P = 0.001), heavy smoking (HR 2.03; P = 0.019), and type 2 diabetes (HR 2.06; P = 0.011) were significantly associated with the risk of HCC. Multivariable Cox proportional-hazards analyses showed that immigrant status was not an independent risk factor for HCC (HR 1.37; P = 0.318) after adjusting for age and type 2 diabetes. Older age and higher prevalence of type 2 diabetes accounted for the increased risk of HCC among immigrant patients with CHC and advanced fibrosis.     

Do immigrants have an increased prevalence of unhealthy behaviours and risk factors for coronary heart disease?

BACKGROUND: Although previous research has demonstrated a high risk of coronary disease in immigrants, the prevalence of unhealthy behaviours and risk factors is less known. The aim of this study was to investigate whether unhealthy behaviours and risk factors for coronary disease are more common in immigrants than in Swedish-born individuals. METHODS: Between 1 January 1996 and 31 December 2002 a simple random sample of the population was drawn and interviewed face to face. Eight immigrant groups in Sweden and a Swedish-born reference group, aged between 27 and 60 years, were studied. A log-binomial model was used to analyse the cross-sectional association between country of birth and unhealthy behaviours as well as coronary disease risk factors. RESULTS: Many of the immigrant groups showed higher risks of smoking, of physical inactivity and of obesity than Swedish-born individuals in age-adjusted models. On also adjusting for the level of education, occupational status and social network, the differences in risk persisted in the majority of groups. However, the over-risks of physical inactivity in Finnish and south European immigrant men and of diabetes in Finnish and Turkish immigrant women disappeared. CONCLUSIONS: The high prevalence of unhealthy behaviours and risk factors for coronary disease in many immigrant groups might be a lifestyle remnant from their country of birth or might be brought about by a stressful migration and acculturation into a new social and cultural environment. Nevertheless, it is important in primary healthcare to be aware of a possible preventable increased risk of unhealthy behaviours and risk factors for coronary disease in some immigrants.     

Dementia in immigrant groups: A cohort study of all adults 45 years of age and older in Sweden

ObjectiveTo study the association between country of birth and incident dementia in several immigrant groups in Sweden.MethodsThe study population included all adults (n = 3,286,624) aged 45 years and older in Sweden. Dementia was defined as having at least one registered diagnosis of dementia in the National Patient Register. The incidence of dementia in different immigrant groups, using Swedish-born as referents, was assessed by Cox regression, expressed in hazard ratios (HRs) and 95% confidence intervals (CI). All models were stratified by sex and adjusted for age, geographical residence in Sweden, educational level, marital status, and neighbourhood socioeconomic status.ResultsA total of 136,713 individuals had a registered dementia event, i.e. 4.2%; 3.6% among men and 4.9% among women. After adjusting for confounders, in general, there was a lower incidence of dementia among both male immigrants (HR 0.85, 0.83–0.88) and female immigrants (HR 0.93, 0.91–0.95) compared to their Swedish-born counterparts. Among immigrant groups, a higher incidence (HR, 95%CI) of dementia was observed among men from Finland (1.14, 1.08–1.20), Bosnia (1.61, 1.18–2.20), Estonia (1.25, 1.10–1.43) and Russia (1.37, 1.12–1.69), and women from Finland (1.20 1.15–1.24) and Norway (1.14, 1.07–1.22).ConclusionsRisk of dementia was lower in immigrants in general compared to the Swedish-born population; however there were substantial differences among immigrant groups in risk of dementia. Developing dementia in a new country with a different language could cause problems for both patients and the health care staff.     

Cardiovascular diseases and risk factors among Chinese immigrants

The aim of this study is to identify the prevalence of cardiovascular disease (CVD) and major CVD risk factors, including diabetes, hypertension, dyslipidemia, obesity and smoking among Chinese immigrants by a systematic review of studies from various countries. PubMed and the China National Knowledge Infrastructure databases were searched for studies of the prevalence of major CVDs and risk factors, and of CVD mortality among Chinese immigrants. The search identified 386 papers, 16 of which met the inclusion criteria for this review. In mainland China, there is a pattern of high stroke prevalence but low coronary heart disease (CHD) prevalence. Among Chinese immigrants, there is a much lower prevalence and mortality of stroke, but a higher prevalence and mortality of CHD, even though these are lower than the rates in immigrants of other ethnicities in the host country. The prevalence of CVD risk factors is also markedly different in immigrants. Compared with mainland Chinese, Chinese immigrants have a higher prevalence of diabetes and hypertension, higher serum cholesterol, poorer dietary patterns, and higher prevalence of obesity and smoking. Thus, the epidemiological pattern of CVD among Chinese immigrants changes compared with resident mainland Chinese. The less healthy environmental factor after immigration may be a major trigger in the adverse CVD status of Chinese immigrants. It is important for policy-makers to pay more attention to specific minority immigrant groups, and to implement more effective preventive measures to improve the health of immigrant populations.     

Avoidable hospitalisation for diabetes mellitus among immigrants and natives: Results from the Italian Network for Longitudinal Metropolitan Studies

Background and aimsItaly has experienced a relevant increase in migration inflow over the last 20 years. Although the Italian Health Service is widely accessible, immigrants can face many barriers that limit their use of health services. Diabetes mellitus (DM) has a different prevalence across ethnic groups, but studies focusing on DM care among immigrants in Europe are scarce. This study aimed to compare the rates of avoidable hospitalisation (AH) between native and immigrant adults in Italy.Methods and resultsA multi-centre open cohort study including all 18- to 64-year-old residents in Turin, Venice, Reggio-Emilia, Modena, Bologna and Rome between 01/01/2001 and 31/12/2013–14 was conducted. Italian citizens were compared with immigrants from high migratory pressure countries who were further divided by their area of origin. We calculated age-, sex- and calendar year-adjusted rate ratios (RRs) and 95% confidence intervals (95% CIs) of AH for DM by citizenship using negative binomial regression models. The RRs were summarized using a random effects meta-analysis. The results showed higher AH rates among immigrant males (RR: 1.63, 95% CI: 1.16–2.23), whereas no significant difference was found for females (RR: 1.14, 95% CI: 0.65–1.99). Immigrants from Asia and Africa showed a higher risk than Italians, whereas those from Central-Eastern Europe and Central-Southern America did not show any increased risk.ConclusionAdult male immigrants were at higher risk of experiencing AH for DM than Italians, with differences by area of origin, suggesting that they may experience lower access to and lower quality of primary care for DM. These services should be improved to reduce disparities.     

Risk of venous thromboembolism in first- and second-generation immigrants in Sweden

Background

There are ethnic differences in the incidence of venous thromboembolism. This is the first nationwide study to examine whether there is an association between country of birth in first-generation immigrants and first hospitalisation for venous thrombosis (VT) and pulmonary embolism (PE), and to study whether a similar association exists in second-generation immigrants.

Methods

The study is a nationwide follow-up study. The study subjects were first- and second-generation immigrants residing in Sweden between January 1, 1964 and December 31, 2007. The reference population comprised first- and second-generation Swedish-born individuals. Standardised incidence ratios (SIRs) for VT and PE, standardised with regard to age, geographic region of residence, time period, and socioeconomic status, were estimated by sex in first- and second-generation immigrants.

Results

First-generation male and/or female immigrants from Greece, Italy, Spain, Finland, Baltic countries, Central Europe, Eastern Europe, Russia, Latin America, Turkey, Iran, and Iraq had a lower risk of VT and/or PE than Swedish-born individuals. The lower risk of VT and/or PE in some first-generation immigrant groups was not replicated in the second generation. However, in certain second-generation immigrant groups, the risk of VT/PE was similar to that in the corresponding parental groups.

Conclusions

Country of birth affects the risk of VT and PE in several immigrant groups. Our study indicates that ethnicity-related inherited and acquired venous thromboembolism risk factors play a role in the aetiology of venous thromboembolism. Ethnic differences in thromboembolism risk even exist in Caucasian European populations, and may thus be important to consider in genetic studies.     

A network-level explanation for the differences in HIV prevalence in South Africa's racial groups

Analyses of individual-level risk factors have not been able to adequately explain why HIV has spread so extensively in southern Africa and why this has occurred especially within certain racial or ethnic groups. Using data from a longitudinal study of a representative sample of adolescents aged 14-22 living in Cape Town, South Africa, this article presents evidence of how differences in individual-level risk factors as well as sexual network structures between different racial or ethnic groups may help explain the differential spread of HIV in South Africa. Particular emphasis is placed on how levels of partner concurrency, respondent concurrency, mutual concurrency, serial concurrency and numbers of sexual partners and an average early age of sexual debut combine in different ways in the different racial or ethnic groups to create networks of sexual partnerships that differ in the density of their interconnections and hence potential for HIV spread. These network-level differences offer a potential explanation for the observed generalised HIV epidemic seen among the population of black South Africans.     

Cardiovascular Health in Africans Living in the United States

Cardiovascular disease (CVD) is the leading cause of death globally as well as in the United States. African-born immigrants comprise one of the fastest growing immigrant groups in the United States. Despite differences in culture, lifestyle, psychosocial issues, diet, and birth environment, African-born immigrants are often categorized with African Americans and other foreign-born blacks in studies attempting to define CVD risk in blacks. This review examines the very few studies that have attempted to separately characterize the cardiovascular health of this unique group, particularly as it relates to the African continent. Concurrently, cardiovascular disease and risk factors are compared between African-born immigrants and African Americans—the larger umbrella term that covers most persons of African descent in the United States, regardless of place of birth.     

Ethnic inequalities in acute myocardial infarction hospitalization rates among young and middle-aged adults in Northern Italy: high risk for South Asians

The knowledge of ethnic-specific health needs is now essential to design effective health services and population-based prevention strategies. However, data on migrant populations living in Southern Europe are limited. The study is designed to investigate ethnic inequalities in hospitalization for acute myocardial infarction (AMI) in the Veneto region (Italy). Hospital admissions for AMI in Veneto for the whole resident population aged 20–59 years during 2008–2013 were studied. Age and gender-specific AMI hospitalization rates for immigrant groups (classified by country of origin according to the United Nations geoscheme) and Italians were calculated. The indirect standardization method was used to estimate standardized hospitalization ratios (SHR) for each immigrant group, with rates of Italian residents as a reference. Overall, 8200 AMI events were retrieved, 648 among immigrants. The highest risk of AMI is seen in South Asians males (SHR 4.2, 95% CI 3.6–4.9) and females (SHR 2.5, 95% CI 1.4–4.5). AMI rates in South Asian males sharply increase in the 30–39 years age class. Other immigrant subgroups (Eastern Europe, North Africa, Sub-Saharan Africa, other Asian countries, Central-South America, high-income countries) displayed age- and gender-adjusted hospitalization rates similar to the native population. Present findings stress the urgent need for implementation of ethnic-specific health policies in Italy. The awareness about the high cardiovascular risk in subjects from South Asia must be increased among general practitioners and immigrant communities.     

Epidemiological and clinical features in immigrant children with coeliac disease: an Italian multicentre study

BACKGROUND: There are no available data concerning the incidence and the clinical pattern of coeliac disease in immigrant children coming to Italy from developing countries. AIMS: To evaluate the epidemiological and clinical features of coeliac immigrant children coming to Italy. PATIENTS AND METHODS: Hospital records of 1917 children diagnosed in 22 Italian Centres from 1999 to 2001 as having coeliac disease were retrospectively reviewed, comparing immigrant patients versus Italian ones. RESULTS: 36/1917 (1.9%) coeliac children were immigrant. This prevalence was similar to that of the immigrant children among the whole paediatric population living in Italy. Prevalence was influenced by geographical factors, being higher in Northern Italy (1.7%) and in Central Italy (2.5%) than in Southern-Insular Italy (1.5%), as consequence of a higher proportion of immigrants in these regions. The native areas of the immigrant children were East Europe (15/36), Northern Africa (14/36), Southern Asia (4/36), West Africa (1/36), East Africa (1/36) and the Middle East (1/36). The clinical spectrum and dietary habits in immigrant patients were similar to those of the Italian children. CONCLUSIONS: Coeliac disease among the immigrant children coming from developing countries is an emerging problem, and physicians need to be fully aware of it. An important risk factor for coeliac disease in immigrant children appears to be sharing of the same dietary habits with the Italian population. The finding of coeliac disease in children coming from many countries worldwide suggests that coeliac disease is a global public health problem.     

English language skills,ethnic concentration,and household composition: older Mexican immigrants

OBJECTIVES: The authors examine the living arrangements of older Mexican immigrants to demonstrate how the formation of complex households is related to English language proficiency. Specifically, they examine whether the ability to use the English language is a determinant of an older Mexican immigrant persons' capacity to maintain residential independence. They also examine how living in communities with a relatively high proportion of Hispanic persons impacts household structure. METHODS: Data from the 1990 U.S. Census of Population are used to evaluate multilevel multinomial logistic regression models of living arrangements among older Mexican immigrants. RESULTS: The authors found that strong English language skills increase the likelihood of living independently and increase the likelihood of being the head of a household. They also found that living in an area with a relatively high proportion of Hispanic persons increases the likelihood that older Mexican immigrants will live independently as compared with living with others without headship. Finally, interaction models were examined, demonstrating that living in a community with a relatively high proportion of Hispanics reduces the strength of the relationship between English language proficiency and living arrangement outcomes for older Mexican immigrants. DISCUSSION: The authors discuss the implications of their findings and point out possible avenues for further research.     

Prevalence of HIV Risk Behaviors among Undocumented Central American Immigrant Women in Houston, Texas

Undocumented Central American immigrants in the United States are disproportionately affected by HIV infection. However, epidemiological data on sexual behaviors among undocumented women are sparse and the extent to which behaviors vary by duration of residence in the U.S.is largely unknown. In 2010, we used respondent driven sampling to conduct an HIV behavioral survey among Central American immigrant women residing in Houston, Texas without a valid U.S. visa or residency papers. Here we describe the prevalence of sexual risk behaviors and compare recent (5 years or less in the U.S.) and established immigrants (over 5 years in the U.S.) to elucidate changes in sexual risk behaviors over time. Our data suggest that recent immigrants have less stable sexual partnerships than established immigrants, as they are more likely to have multiple and concurrent sexual partnerships, as well as partnerships of shorter duration.     

Naturalization fosters the long-term political integration of immigrants

Does naturalization cause better political integration of immigrants into the host society? Despite heated debates about citizenship policy, there exists almost no evidence that isolates the independent effect of naturalization from the nonrandom selection into naturalization. We provide new evidence from a natural experiment in Switzerland, where some municipalities used referendums as the mechanism to decide naturalization requests. Balance checks suggest that for close naturalization referendums, which are decided by just a few votes, the naturalization decision is as good as random, so that narrowly rejected and narrowly approved immigrant applicants are similar on all confounding characteristics. This allows us to remove selection effects and obtain unbiased estimates of the long-term impacts of citizenship. Our study shows that for the immigrants who faced close referendums, naturalization considerably improved their political integration, including increases in formal political participation, political knowledge, and political efficacy.One of the key debates over immigration policy involves the political integration of immigrants and their access to citizenship. Some argue that immigrants should be given easy access to citizenship and encouraged to naturalize because naturalization provides immigrants with the necessary resources and incentives to rapidly integrate and invest in a future in the host country. In this view, the acquisition of citizenship is an important catalyst that has an independent effect on accelerating and deepening the process of political integration. In contrast, others argue that access to citizenship should be highly restricted because naturalization itself does little to foster integration. In fact, naturalization is likely to dampen the incentives to integrate because once immigrants are given the passport of the host society, they can no longer be motivated to integrate by the promise of obtaining the benefits that come with citizenship (e.g., access to welfare benefits or the right to stay in the country indefinitely). From this perspective, citizenship is not an instrument to improve integration but merely a reward that is promised to immigrants in exchange for successfully completing the integration process. However, others argue that pressuring immigrants to naturalize might backfire and simply reinforce immigrant identities.^*Does naturalization promote political integration? Despite the importance of this question for the design of immigration and citizenship policy and much theorizing among social scientists and pundits, there exists little rigorous causal evidence on the impacts of naturalization on the political integration of immigrants. Most studies only examine the impact of naturalization on economic integration (see, for example, ref. 5), and the few existing studies that consider effects on political integration by comparing the political participation of naturalized and nonnaturalized immigrants are based on limited research designs and data that prevent them from isolating the independent effect of naturalization from a plethora of confounding factors (see, for example, ref. 6 and references therein).When trying to isolate the effect of naturalization, the key problem for causal inference is that naturalization is far from randomly assigned. Instead, the process through which immigrants obtain citizenship involves a complex double selection process. In the first stage, immigrants selectively apply for naturalization, and this decision often depends on characteristics that are not observed by the researcher. For example, immigrants who are more motivated, have more resources, or are better informed are more likely to apply (see, for example, refs. 7 and 8). In the second stage, decision makers carefully select who among the applicants is approved or rejected for citizenship. This screening is also based on characteristics that are typically unobserved by the researcher. For example, applicants who make a bad impression in the application interview, have a low perceived integration potential, or lack sufficient language skills might be more likely to be rejected.This double selection process severely confounds the existing comparisons of naturalized and nonnaturalized immigrants. For example, if we find that naturalized immigrants are politically more informed or earn higher wages than nonnaturalized immigrants, we cannot conclude that these differences are caused by naturalization because the double selection ensures that the two groups differ on the many important confounding characteristics. Eliminating the bias from this double selection process is a rather hopeless endeavor with typical observational data because researchers cannot possibly measure and statistically control for the myriad reasons that determine why immigrants apply and why decision makers approve or reject applications.We provide new evidence that takes advantage of a natural experiment to identify the long-term effects of naturalization on the political integration of immigrants in Switzerland. Before 2003, some Swiss municipalities used secret ballot referendums as the mechanism to decide on naturalization applications. Voters received voting leaflets that informed them about the applicants and then cast a secret ballot to approve or reject each applicant. Immigrants who gained a majority of “yes” votes received the Swiss passport. This setting allows us to remove the bias from the double selection process.In contrast to previous studies that do not measure whether immigrants applied for citizenship or not, we can remove the first-stage bias from selection into applying because we can restrict the comparison with only those immigrants who applied for naturalization and faced referendums, thereby removing from the control group those immigrants who were not motivated or lacked the resources to apply. We can also remove the second-stage bias from selection into approval using two different identification strategies. First, because we measure the same applicant characteristics that were reported to voters when they voted on the applicants, we can control for the characteristics that determined the approval of applicants and identify the effect of naturalization under a selection on observables assumption. In other words, once we control for their reported characteristics, the applicants are observably equivalent to voters, and therefore, they can no longer screen applicants based on unobservable attributes, such as their integration potential. Second, we can apply a regression discontinuity (RD) design that compares the outcomes of immigrants whose naturalization requests were barely approved or barely rejected by voters. Balance checks suggest that in close referendums that are decided within a narrow vote margin, who gets the Swiss passport and who does not is essentially as good as randomly assigned. Therefore, lucky applicants who are narrowly approved and unlucky applicants who are narrowly rejected are similar on all confounding characteristics, and any differences in their integration outcomes can be attributed to the independent effect of naturalization.What we find is that naturalization has a strong independent effect on improving the long-term political integration among the competitive immigrant applicants in our sample, including increases in formal political participation, political knowledge, and political efficacy. These effects are robust across the different identification strategies and also large in substantive terms. For example, when looking at our summary index of political integration that combines all outcomes, we find that naturalization causes more than a full standard deviation (SD) unit increase in the political integration index.Our study makes four main contributions. First, we provide new evidence of the effects of citizenship on the integration of immigrants that takes advantage of a natural experiment where naturalization is as good as randomly assigned. The results suggest that naturalization can act as a catalyst that helps to turn immigrants into “citizens” in the Tocquevillian sense. Second, because the average naturalized immigrant in our sample obtained the Swiss passport 13 y ago, we examine whether naturalization has any long-term effects on incorporating immigrants into the democratic process. Existing work typically only considers short-term outcomes. Third, whereas most studies have looked at the economic integration of immigrants, we provide evidence on the effect of naturalization on the political integration of immigrants. The political integration of immigrants is a major challenge for many countries that face rising immigrant populations and anti-immigrant backlash among natives. Successfully incorporating immigrants into the political process matters not only for the immigrants but also for the quality of the democracy in the host country because such integration enables immigrants to voice their grievances through legitimate electoral and nonelectoral means rather than sporadic violence and terror. Finally, our study fills a gap by examining the effect of naturalization on political integration in Switzerland specifically, a country where immigrant integration is a particularly controversial issue, given the exceptionally large immigrant population (24%) and rather divisive immigration debates in recent decades.     

Time travel with Oliver Twist--towards an explanation foa a paradoxically low mortality among recent immigrants

First-generation immigrant populations in industrialized countries frequently have a lower mortality than the host population, a finding that is unexpected and often dismissed as the result of bias. We propose an alternative explanation for a real, albeit temporal, mortality advantage. We base our argument on two premises: First, that there are differences in the progression of the health transition between the immigrants' countries of origin and industrialized host countries; and, second, that there are differences in the speed at which changes in mortality from various causes occur after migration. Mortality from treatable communicable and maternal conditions, still high in many countries of origin, quickly declines to levels close to those of the host country. Mortality from ischaemic heart disease, the most common cause of death in the host countries, takes years or decades to rise to comparable heights. This is because of the time lag between increases in risk factor levels and an increased risk of coronary death. Hence, first-generation immigrants may initially experience a lower mortality than the host population, a point that has so far been under-appreciated in discussions of immigrant mortality. After adopting a western lifestyle immigrants face an increasing risk of ischaemic heart disease. The increase occurs on top of a persisting risk from conditions associated with childhood deprivation, e.g. stomach cancer and stroke--the unfinished agenda of the health transition that immigrants experience.     

Disparities in 30-day readmission rates among Medicare enrollees with dementia

Background

Readmissions contribute to excessive care costs and burden for people living with dementia. Assessments of racial disparities in readmissions among dementia populations are lacking, and the role of social and geographic risk factors such as individual-level exposure to greater neighborhood disadvantage is poorly understood. We examined the association between race and 30-day readmissions in a nationally representative sample of Black and non-Hispanic White individuals with dementia diagnoses.

Methods

This retrospective cohort study used 100% Medicare fee-for-service claims from all 2014 hospitalizations nationwide among Medicare enrollees with dementia diagnosis linked to patient, stay, and hospital factors. The sample consisted of 1,523,142 hospital stays among 945,481 beneficiaries. The relationship between all cause 30-day readmissions and the explanatory variable of self-reported race (Black, non-Hispanic White) was examined via generalized estimating equations approach adjusting for patient, stay, and hospital-level characteristics to model 30-day readmission odds.

Results

Black Medicare beneficiaries had 37% higher readmission odds compared to White beneficiaries (unadjusted OR 1.37, CI 1.35–1.39). This heightened readmission risk persisted after adjusting for geographic factors (OR 1.33, CI 1.31–1.34), social factors (OR 1.25, CI 1.23–1.27), hospital characteristics (OR 1.24, CI 1.23–1.26), stay-level factors (OR 1.22, CI 1.21–1.24), demographics (OR 1.21, CI 1.19–1.23), and comorbidities (OR 1.16, CI 1.14–1.17), suggesting racially-patterned disparities in care account for a portion of observed differences. Associations varied by individual-level exposure to neighborhood disadvantage such that the protective effect of living in a less disadvantaged neighborhood was associated with reduced readmissions for White but not Black beneficiaries. Conversely, among White beneficiaries, exposure to the most disadvantaged neighborhoods associated with greater readmission rates compared to White beneficiaries residing in less disadvantaged contexts.

Conclusions

There are significant racial and geographic disparities in 30-day readmission rates among Medicare beneficiaries with dementia diagnoses. Findings suggest distinct mechanisms underlying observed disparities differentially influence various subpopulations.     

Tuberculosis among immigrants from developing countries in the province of Milan, 1993-1996.

SETTING: The Province of Milan, which has high rates of immigration from developing countries, and the Villa Marelli Institute (VMI), Reference Centre for Tuberculosis Control of Lombardy. OBJECTIVE: To describe epidemiology and clinical patterns of tuberculosis among immigrants from developing countries (IDCs) in the Province from 1993 to 1996. DESIGN: Retrospective analysis of the registries of the Regional Bureau for Public Health and of the VMI concerning immigrant patients with active TB living in the Province. Restriction fragment length polymorphism (RFLP) analysis of the available strains to detect recent transmission among immigrants. RESULTS: IDCs represented 22.8% of all TB cases. The standardised incidence rate was eight times higher in IDCs compared to Italians. Of 596 cases notified in IDCs, 524 (87.9%) had been referred at least once to the VMI. Of these, 77.2% were diagnosed within 5 years of arrival, and 86.6% were brought to medical attention because of symptoms. RFLP fingerprinting demonstrated that the mean period of stay in Italy was significantly higher in clustered than in non clustered patients (61.5 versus 37.3 months). Spread to the native population was episodic. CONCLUSIONS: The incidence of TB is higher among more recent immigrants (i.e., Peruvians). TB cases are largely due to reactivation of infection occurring in the country of origin. Preventive measures for early diagnosis of disease or chemoprophylaxis of dormant infection are not regularly performed, but should be implemented for those immigrants at high risk.     

深圳市宝安区1997～2004年AIDS流行病学分析

目的通过对深圳市宝安区1997~2004年艾滋病疫情分析,发现艾滋病流行的特点及影响因素,并提出相应的防治对策。方法宝安区自1993年开始对艾滋病高危人群和特殊人群进行监测,对艾滋病高危人群、特殊人群、外来工、中学学生以及社区居民等进行艾滋病防治知识宣传教育;同时对艾滋病高危人群和艾滋病病毒/艾滋病(HIV/AIDS)患者进行行为干预。结果宝安区自1997年发现首例输入HIV感染者以来,检出的HIV/AIDS患者数量持续上升,2002年检出HIV/AIDS患者86例,是前5年(1997~2001年)HIV/AIDS患者总数(23例)的3.7倍,艾滋病流行呈快速增长趋势。HIV感染者以流动和暂住人口为主,男性远多于女性,年龄主要分布在20~40岁,主要以静脉吸毒传播为主,性传播和母婴传播有所增加。结论宝安区艾滋病传播已进入快速增长期,正由高危人群向一般人群播散,应采取积极有效的综合干预措施。