Elderly Immigrants, Socio-economic Status and Health. An epidemiological study of cardiovascular risk factors, impaired mobility and self-reported health status

Abstract: Aims: To analyse the relationship between country of birth/ethnicity, socio-economic status (SES) and impaired mobility, impaired working capacity, cardiovascular disease (CVD) risk factors, health behaviours among those with CVD risk factors, self-reported health status, impaired instrumental activities of daily living (IADL) and all-cause mortality. Methods: Two main data sources were used: the Swedish Survey of Living Conditions (in Swedish ULF) 1986–1993, people aged 55–74 years, and the Third National Health and Nutrition Examination Survey (NHANES III) 1988–1994 in the USA, people aged 65–84. Logistic, linear and proportional hazard models were used in the statistical modelling. Results: There was a strong relationship between being a foreign-born labour immigrant from Finland or Southern Europe or being a refugee from All Others (Eastern Europe, Asia, Africa and South and Central America), and impaired mobility and impaired working capacity. People with a low educational status had the highest odds ratios (ORs) for impaired mobility and impaired working capacity. Elderly foreign-born people ran an increased risk of engaging in no physical activity (men only), being a current smoker and/or having an increased body mass index (BMI) than Swedish-born people. Immigrants from Southern and Eastern Europe and Finland had increased risks of poor self- reported health status. Southern Europeans, people from All Others and Finns exhibited an increased risk of impaired IADL compared to those born in Sweden. However, country of birth was not associated with premature all-cause mortality. Black and Mexican American women had significantly higher prevalences of type II diabetes mellitus than White women. Black women were more likely to have abdominal obesity and hypertension and to be physically inactive than White women. Black men had significantly higher prevalences of hypertension and physical inactivity than White men. Among individuals with CVD risk factors, especially Mexican American women whose primary language was Spanish, health behaviours were in need of improvement. Conclusion: Country of birth/ethnicity is a powerful predictor of poor health among elderly people even after adjustment for SES. Being non-acculturated (women only) seems to be associated with negative health behaviours. These findings, particularly a disadvantaged risk profile for CVD, argue for appropriate prevention programmes modified for the linguistic, cultural and medical needs of foreign-born people/ethnic minorities.