APH 2002, 60, 23-25:
Commentary about: immigrant mortality in Belgium: the person and the place.
Consistent with studies on
other populations (6), Anson J. find that foreign-nationals and
foreign-born residents of Belgium enjoy lower mortality risks than
Belgian nationals and native-born Belgians. Having established that a
mortality advantage exists, the authors attempt to explain it. This
stage of their analysis begins by estimating separate Cox proportional
hazards models for each of 588 Belgian communes. Goodness of fit statistics
and hazard coefficients from each of these 588 models become the
dependent variables in the final stage of analysis. In the final stage,
the authors examine the ability of regional and commune-level
characteristics to explain between-commune variation in the importance
of nativity and nationality on mortality risk. For example, how much
variation, across communes, in mortality risk by nationality is
explained by the level of immigrant concentration in those communes?
This ambitious and complex
analysis raises a number of questions that merit further investigation.
Why, in the final models, do the community characteristics do a much
better job of explaining variation in mortality risk by nationality than
by nativity? What is the meaning of nationality in the context of
Belgium where, as the authors report, approximately one-third of foreign
nationals are Belgian-born? Why do females appear to be more sensitive
to community conditions than males? Finally, is the commune the most
appropriate level of aggregation for examining “community” effects?
With continued growth in
international migration projected (7), research on immigrant health will
only increase in the future. This trend is welcome because these studies
have great potential to reveal how community and other contextual
influences interact with individual behaviors to shape health outcomes.
Hopefully, as theories of migration and health are refined and tested,
better data become available, and techniques of analysis are improved,
our understanding of the association between immigrant status and health
will also grow.