Adult mortality among second-generation immigrants in France: Results from a nationally representative record linkage study

Abstract

BACKGROUNDFrance has a large population of second-generation immigrants (i.e., native-born children of immigrants) who are known to experience important socioeconomic disparities by country of origin. The extent to which they also experience disparities in mortality, however, has not been previously examined. METHODSWe used a nationally representative sample of individuals 18 to 64 years old in 1999 with mortality follow-up via linked death records until 2010. We compared mortality levels for second-generation immigrants with their first-generation counterparts and with the reference (neither first-nor second-generation) population using mortality hazard ratios as well as probabilities of dying between age 18 and 65. We also adjusted hazard ratios using educational attainment reported at baseline. RESULTSWe found a large amount of excess mortality among second-generation males of North African origin compared to the reference population with no migrant background. This excess mortality was not present among second-generation males of southern European origin, for whom we instead found a mortality advantage, nor among North Africanorigin males of the first-generation. This excess mortality remained large and significant after adjusting for educational attainment. CONTRIBUTIONIn these first estimates of mortality among second-generation immigrants in France, males of North African origin stood out as a subgroup experiencing a large amount of excess mortality. This finding adds a public health dimension to the various primarily immigrants from European countries (Italy, Spain, Portugal, Belgium, and Poland), followed after 1945 by large waves of 'colonial' migrants (mostly from North Africa). Despite a decrease in labor migration after 1973, immigration to France continued, mostly via family reunification, and the diversity of immigrants continued to increase, with larger proportions of immigrants from sub-Saharan Africa and Asia. This immigration history has generated a second-generation population that, today, is both large and diverse. The regions of origin most represented among second-generation immigrants are southern Europe (Portugal, Italy, or Spain) and North Africa (Algeria, Morocco, or Tunisia), which each region totaling about one-third. The last third comprises a very diverse set of parental countries of origin, including countries in sub-Saharan Africa, Europe, and Asia.Previous studies have shown that in France, second-generation immigrants of non-EU origin, particularly those of North African origin, experience systematic disadvantages in important areas such as educational attainment, employment, and income (Silberman and Fournier 1999;Canaméro, Canceill, and Cloarec 2000;Meurs, Pailhé, and Simon 2006;INSEE 2012;Brinbaum, Primon, and Meurs 2016). The extent to which they also experience disadvantages in the area of mortality, however, has not been previously examined. This is a significant gap given the size of the secondgeneration population in France and the importance of documenting health dispar...

Divergent mortality patterns for second generation men of North-African and South-European origin in France: Role of labour force participation

“…After adjusting for level of educational attainment, the estimate for the G2s of North-African origin decreased somewhat but remained high and significant. This suggests that the mortality disadvantage which the G2s of North-African origin experience (Guillot et al, 2019) is not only a reflection of their disadvantaged educational profiles. Controlling for level of educational attainment had little impact on the mortality advantage of the G2s of South-European origin, although a strengthening of the advantage would have been expected as they tend to be less educated than the reference population.…”

“…Individuals who reached age 65 during the follow-up period were right-censored at that age, even if they later died during the study period (say, at age 70). We focused exclusively on males because divergent mortality trajectories over generations were not observed among females (Guillot et al, 2019). Foreign-born individuals, as well as individuals born in the French overseas territories and their descendants were also excluded.…”

“…The few existing studies for European countries reveal a pattern of mortality disadvantage for the second generation, in direct contrast with the “healthy migrant effect” characteristic of the first-generation. To date, this has been documented for specific second generations groups from Switzerland (Tarnutzer, Bopp, & group, 2012), Sweden (Manhica, Toivanen, Hjern, & Rostila, 2015), Belgium (De Grande, Vandenheede, Gadeyne, & Deboosere, 2014; Vandenheede, Willaert, De Grande, Simoens, & Vanroelen, 2015), England and Wales (Wallace, 2016), and France (Guillot, Khlat, & Wallace, 2019).…”

“…However, these confounders deserve scrutiny, as socioeconomic factors have been shown in certain contexts to have distinctive effects on the mortality of individuals with a foreign background. In the French study, mentioned above as one of only a handful to have studied second generation mortality in Europe (Guillot et al, 2019), the authors drew attention to the sharp contrast between the disadvantaged mortality situation of second generation men of North African origin in comparison to natives and the advantaged mortality situation of second generation men of South-European origin. This was all the more striking as the first-generation of North African and South European men both experienced a ‘migrant mortality advantage’ of a similar magnitude relative to natives.…”

Infant mortality among native-born children of immigrants in France, 2008–17: results from a socio-demographic panel survey

“…With this in mind, our work represents a valuable addition to the small evidence base on the recent mortality situation of the native-born children of immigrants in France. 28 , 29 Our work can help to reignite debate about the lack of progress made in the reduction of this inequality and inform new evidence-based policy. The findings also raise questions about a national citizenship model that advises against the identification of different population sub-groups in France to ensure equal treatment for all.…”