Spousal Order of Migration and Hospitalization among Immigrants to Denmark

Sven Drefahl, Stockholm University
Anna Oksuzyan, Max Planck Institute for Demographic Research
Angela Carollo, Max Planck Institute for Demographic Research
Eleonora Mussino, Demography Unit, Department of Sociology, Stockholm University
Linda Ahrenfeldt, Epidemiology, Biostatistics and Biodemography, Max-Planck Odense Center
Rune Lindahl-Jacobsen, MaxO, University of Southern Denmark
Jennifer Caputo, Max Planck Institute for Demographic Research

Research indicates that migrants to Nordic countries experience a mortality advantage relative to native populations, although they may also have more chronic diseases and mental health problems. Studies show that both selection effects and the stress of acculturation play roles in explaining health and mortality differences between migrant and native populations. However, the contextual determinants of migrant population health that may help explain these patterns and paradoxes are understudied, including whether the health of migrants is dependent on whether they arrived before, after, or with family members. Using register data in Denmark, which is an exceptionally rich high-quality data source for socio-demographic characteristics at the individual level, the present study investigates the relationship between spousal order of migration and long term health and how this relationship differs between the two genders and across different migrant groups. The study population consists of all people aged 50 and older who were living in Denmark between January 1, 1980 to December 31, 2014. New individuals residing in Denmark enter the study from the month they turn 50 during 1980–2014 or through immigration into the country after age 50. In this study we use event history models for repeated events to examine the influence of various predictors on hospitalizations after age 50. All individuals are followed until hospitalization, which is the failure event in our analysis, censoring due to emigration, death, or December 31, 2014, whichever comes first. For each spouse in a couple we identify the time of first migration to Denmark and distinguish across couples, in which both spouses migrated to Denmark within 12 months, and in which the second spouse arrived 12 or more months after the first-arriving spouse. All models control for changes in civil status, income, education, and time since arrival to Denmark.

Background

A substantial body of research has indicated that migrants enjoy better health and lower mortality compared to those born in the destination countries, the so called healthy migrant effect. Mortality differences in immigrants versus host population, however, differ by cause of death, country of birth, and the duration of stay in the host country. Acculturation and suboptimal use of psychiatric healthcare services, screening tests, and perinatal healthcare services have been suggested to partially explain no apparent health advantage for migrants across some causes of death and countries of birth. Recent research evidence suggest that a reason to migrate is an important factor explaining the variation of health advantage across migrant groups.

Another aspect of migratory patterns that is likely to be important when studying differences in health and survival across migrant groups and between the two genders is the order of migration. The sequencing of arrival to a destination country has been suggested to have important implications for economic, social, and cultural integration and adaptation in the host country. However, large-scale quantitative studies investigating the role of sequencing of arrival to a destination country and immigrant health outcomes are noticeably lacking. Using register data in Denmark, which is an exceptionally rich high-quality data source on socio-demographic characteristics at the individual level, the present study investigates the relationship between the order of migration and survival and how this relationship differs between the two genders and across different migrant groups.

We, first, examine differences in mortality among foreign-born migrant spouses according to the order of their arrival to Denmark by country of birth but regardless of gender vs. native-born Danes. Next, we focus on mortality differentials among foreign-born migrant spouses by the order of migration distinguishing between woman-first and man-first sequencing of arrival. Finally, we examine gender differences in mortality across these migrant groups and the Danish population.

Since arriving first has been shown to be advantageous in terms of education, employment, and wages, it is reasonable to expect that within each gender the primary arriving migrants will have greater survival advantage than their second arriving counterparts. These effects are likely to differ across the countries of origin being more apparent in non-Western migrant groups than among migrants from Nordic and other European countries due to predominantly male migration for economic reasons from non-Western countries to Denmark. It can also be, however, that first arriving spouse experienced more stressful settlement and adaptation processes in a destination country, such as finding a proper housing for the family, childcare or school facilities for children, educational or labor opportunities for a second arriving spouse in addition to carrying out his/her job responsibilities and learning the language. The first arriving spouse can be exposed to greater stress also over a longer period is s/he remains a sole breadwinner. Considering that health advantage for migrants diminishes over time, we can expect that the second arriving spouse may have greater survival advantage compared to his/her second arriving partner.

Data and Methods

Denmark maintains systematically organized databases, called registers that contain the information on a wide variety of the population characteristics, with nationwide coverage and a very low percentage of missing data. In this study we utilize the data from the Danish Civil Registration System (CRS), the Register of Causes of Death, the Income Statistics Register and the Population Education Register (PER).

The study population consists of all people aged 16 and older who were living in Denmark between January 1, 1980 to December 31, 2015. Our focus is foreign-born migrant spouses. For each spouse in a couple we identify the time of first migration to Denmark and distinguish across couples, in which both spouses migrated to Denmark within 12 months, and the couples, in which the second spouse arrived 12 months or more after the first-arriving spouse.

We use hazard regression to examine the influence of various predictors on the individual mortality. All individuals are followed until death, which is the failure event in our analysis, censoring due to emigration, or December 31, 2015, whichever comes first.

Presented in Session 1122: International Migration and Migrant Populations