Epidemiological research in industrial medicine: the healthy / unhealthy worker effect and problems of causality

The author investigates issues related to the professional ability of a person, analyzes the current state of terminology, including the terms "healthy worker effect", "healthy migrant effect", concludes that it is necessary to unify the scientific and medical terminology used in scientific research into the "healthy worker effect.

Cognitive Disability Among Arab Americans by Nativity Status: Lack of Evidence for the Healthy Migrant Effect

Limited research exists on cognitive disabilities among foreign-born adults, particularly non-Hispanic Arab Americans. We analyzed 10 years (2008-2017) of data from the American Community Survey (ACS) Public Use Microdata Samples (PUMS) (n=5,011,469; ages >45 years). In US-born adults, the age- and sex-adjusted prevalence of cognitive disability among non-Hispanic Arab Americans was 5.3%, which was lower than non-Hispanic whites (6.5%), blacks (10.8%), and Hispanics (10.0%). Among foreign-born adults, the prevalence of cognitive disability was highest, 7.3%, for non-Hispanic Arab Americans compared to all other racial and ethnic groups. Among foreign-born adults, non-Hispanic Arab Americans had 1.24 times greater odds (95% CI=1.12, 1.37) of having a cognitive disability compared to foreign-born non-Hispanic whites. This is the first study to examine cognitive disabilities among US- and foreign-born Arab Americans. More research is needed to better understand factors that may contribute to the increased prevalence of cognitive disabilities for foreign-born adults.

Birth Tourism Is Associated with Fewer Neonatal Intensive Care Unit Admissions: A Healthy Migrant Effect?

Objective This work aimed to study perinatal, maternal, and neonatal characteristics of birth tourism (BT) mother–baby dyads and the rate of neonatal intensive care unit (NICU) admissions of BT infants. Study Design Retrospective study at a regional perinatal center comparing BT mother–baby dyads to all dyads. BT infants admitted to the NICU were compared with a randomly selected group of infants admitted to the NICU during the same time period. Results A total of 1,755 BT dyads were identified over 4 years. BT mothers were older (32 vs. 28 years, p < 0.0001), more likely to carry multiples (5.5 vs. 1.4%, p < 0.0001), deliver via cesarean section (40 vs. 34%, p < 0.0001), and require postpartum intensive care (0.6 vs. 0.1%, p < 0.0001). BT infants had significantly fewer NICU admissions 96 (5.5%) versus 3,213 (11.3%; p < 0.0001). There were no statistically significant differences in NICU course and outcome between BT and non-BT control infants. Conclusion Birth tourism is associated with unique determinants of health. In our study, there were fewer NICU admissions, potentially explained by the healthy migrant effect. Key Points

Cardiovascular health care and health literacy among immigrants in Europe: a review of challenges and opportunities during the COVID-19 pandemic

Objectives Europe is a destination for many migrants, a group whose proportion of the overall population will increase over the next decades. The cardiovascular (CV) risk distribution and outcomes, as well as health literacy, are likely to differ from the host population. Challenges related to migrant health status, cardiovascular risk distribution and health literacy are compounded by the ongoing coronavirus disease 2019 (COVID-2019) crisis. Methods We performed a narrative review of available evidence on migrant CV and health literacy in Europe. Results Health literacy is lower in migrants but can be improved through targeted interventions. In some subgroups of migrants, rates of cardiovascular disease (CVD) risk factors, most importantly hypertension and diabetes, are higher. On the other hand, there is strong evidence for a so-called healthy migrant effect, describing lower rates of CV risk distribution and mortality in a different subset of migrants. During the COVID-19 pandemic, CV risk factors, as well as health literacy, are key elements in optimally managing public health responses in the ongoing pandemic. Conclusions Migrants are both an opportunity and a challenge for public health in Europe. Research aimed at better understanding the healthy migrant effect is necessary. Implementing the beneficial behaviors of migrants could improve outcomes in the whole population. Specific interventions to screen for risk factors, manage chronic disease and increase health literacy could improve health care for migrants. This pandemic is a challenge for the whole population, but active inclusion of immigrants in established health care systems could help improve the long-term health outcomes of migrants in Europe.

Migrant Health: Healthy Migrant Effect and the Need to Prioritize Migrant Health

Globally, the number of international migrants is about 258 million with over 60% of these living in Asia and Europe and the rest of the 40% living in Northern America, Africa, Latin America and the Caribbean and Oceania. We aimed to describe the healthy migrant effect, the public health challenges faced by migrants and approaches that host countries can adopt to improve migrant health. We used literature searched from key databases such as Google Scholar, PubMed, among others, to collect relevant and recent information about migrant health. Several studies have shown recent migrants to be healthier than native-born populations. Several studies have concluded that with a longer stay in a host country, the health of migrants tends to deteriorate which could be as a result of low living and working conditions and adoption of risky health behaviour. Communicable diseases, non-communicable diseases (NCDs), mental and social problems, contribute significantly to the morbidity burden of new migrants in host countries. Migrants in host countries are less likely to access or fully benefit from the healthcare system as they face various challenges such as language barrier, denial of access basing on the lack of documentation, and negative healthcare provider attitudes. This mini-review identifies that in order to ensure the health of migrants, host countries have to effectively coordinate and collaborate with other countries and sectors. Furthermore, it highlights a need to promote migrant-sensitive health policies aimed at improving the health of migrants, promoting equitable access to health protection and care for migrants and advocating migrants’ health rights.

Association of Maternal Ethnicity and Urbanicity on Severe Pediatric Disease: A Nationwide Cohort Study

Background: A healthy migrant effect on birth outcomes has been reported, however, whether this protective effect persists throughout childhood is unknown. The effect of urbanicity on child health among an immigrant population is unclear. The objective of this study was to compare the incidence rate and cumulative incidence of severe diseases among urban children of Taiwan-born mothers, rural children of Taiwan-born mothers, urban children of foreign-born mothers, and rural children of foreign-born mothers. Methods: A nationwide cohort study was conducted for children born in Taiwan during 2004-2011 and follow-up till age 4 to 11 years old by linkage the Taiwan Birth Registry 2004-2011, Taiwan Death Registry 2004-2015, and National Health Insurance Research Database 2004-2015. Cox proportional hazards model (multivariable) was used to examine differences among the four study groups. Results: There were 682,982 urban children of Taiwan-born mothers, 662,818 rural children of Taiwan-born mothers, 61,570 urban children of foreign-born mothers, 87,473 rural children of foreign-born mothers. Children of foreign-born mothers had a lower incidence of vasculitis, mainly Kawasaki disease. The incidences of congenital disorders did not differ between children of foreign-born mothers and children of Taiwan-born mothers. The incidence of psychotic disorders was higher in urban children. However, children in rural areas had a higher incidence of major trauma/burn and a higher mortality rate. Conclusions: A healthy migrant effect was only seen for Kawasaki disease. The mental health of urban children born to immigrant mothers warrants concern.