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Variations in hospitalization rates across first generation immigrants and their descendants are investigated in the context of Canada. The authors examine immigrant generations of United Kingdom, Chinese and other Asian origins with respect to all-cause and circulatory disease related hospitalization rates. Compared with third-generation and beyond descendants (that is, native-born Canadians), age-adjusted odds of all-cause hospitalization among first-generation recent immigrants in Canada for less than 10 years were significantly lower than for longer-term immigrants in Canada for more than ten years, and for second-generation descendants. Controls for group variations in socioeconomic status attenuated these differentials but the lower circulatory disease hospitalization risk among first- and second-generation immigrants of Chinese origin persisted, while among those of South Asian descent, only the first generation showed a lowered risk but not the second generation.

Cancer mortality differences between immigrants and the Australian population are investigated in the context of how diet, lifestyle factors and acculturation affect the risk of death. In general, immigrants have lower cancer mortality rates. Greeks and Italians in particular, enjoy a significant mortality advantage in relation to other Australians. It also found that there are a number of specific cancers where mortality rates are higher for some migrant groups. Upon arrival, East and South East Asian immigrants have an approximately thirty-fold higher age-adjusted risk of dying from nasopharyngeal cancer compared to their Australian-born counterparts, but this differential reduces to nine-fold after 30 years of living in Australia. Migrants from the United Kingdom, the former Yugoslavia, Greece and Italy have higher age-adjusted mortality rates from cancer of the stomach and pancreas, which decreases with increasing duration of residence in Australia. It is thought that these differentials reflect group variability in dietary and lifestyle habits and degree of retention of Old World traditions.

The historical evolution of migrant studies in France is outlined. Over the past three decades there has been a shift in research orientation from an early period in the 1980s, when the focus was mostly on cancer epidemiology concerning the foreign born, to a more recent period since 2000 focused largely on the social determinants of health and mortality inequalities. The French literature agrees in many respects with the literatures of other immigrant-receiving countries in the western world that younger migrants in the pre-labor force ages tend to show higher death rates whereas those in the prime labor force ages enjoy a notably low mortality risk. An interesting differential observed is the higher mortality of female migrants from the sub-Saharan Africa region. It is suggested that in this case the underlying factor for this is the unusually high rates of maternal mortality in African women, particularly those from Morocco. This raises the interesting juxtaposition that within the immigrant population – usually found to be in better health than the native born – there exists some vulnerable subgroups with unusually poor health and survival prospects. As reported by the authors, in France the ‘healthy migrant effect’ universally reported in the international literature is visible in only a subset of studies.

The immigrant mortality advantage is examined from the perspectives of the health selection and acculturation hypotheses. Differential mortality between immigrant and native born populations is studied across 19 causes of death encompassing chronic and external types of mortality. With few exceptions, the immigrant population showed lower death rates on virtually all causes of death. Acculturation (years in Canada since immigration) was found to have an eroding effect on the immigrant mortality advantage for most causes of death. The protective effect of health selection on survival probabilities is shown to last for 25 years or more for some causes of death, particularly ischemic heart disease among males. For diseases such as diabetes and breast cancer the health selection effect seems to be relatively short lived, lasting only between five and ten years, respectively. In females the selectivity effect on mortality risk is virtually lost by 35 years’ duration. In males, at this stage of the migration experience there is a persisting small protective effect of health selection. Taken together the findings suggest that immigrants experience health erosion the longer the period of residence in Canada, but the degree of erosion varies depending on the type of disease examined.