Self-reported health status among migrant men and women in Spain Self-reported health status among migrant men and women in Spain. PELFI Study. L. Ferrer1,2, F. Gaillardin1, A. Cayuela3, F. Collazos4,  J. Casabona1,2 E. Ronda2,3 1CEEISCAT, ASPCAT; 2CIBERESP; 3Grupo de Investigación en Salud Pública. Universidad de Alicante; 4 Instituto de Investigación Vall d’Hebrón, Hospital Vall d’Hebrón

This study has been funded by Instituto de Salud Carlos III through the projects “ PI14/ 00146; P114/02005; PI13/01962” (Co-funded by European Regional Development Fund/European Social Fund) "Investing in your future"). Non conflict of interest

The singular situation of Spain

From the boom to the crisis Wage variation (%) (2009 - 2011)

The actual situation Total foreign born South America, Central America and Caribbean European Union without Spain Rest of Europe Asia Africa Total foreign born

Platform of Longitudinal Studies on Immigrant Families The PELFI study Platform of Longitudinal Studies on Immigrant Families Multicentric prospective cohort: Alicante, Badalona and Barcelona 364 Families from Ecuador, Colombia, Bolivia, Morocco, China, Pakistan and 77 Spanish-born (675 adults/353 children) Residing in Spain and with the idea of not moving to another country Non-probabilistic sample

The PELFI study Immigrant families were defined when both parents (and father/mother for mono- parental) were born in Ecuador, Colombia, Bolivia, China, Morocco and Pakistan. Recruitment occurred in neighborhoods with the highest percentage of foreign residents. The sample of Spanish-born workers were selected from the same neighborhoods. Within each family, every adult (≥18 years) and adolescent (12-17 years) were interviewed in their home by professional interviewers specifically trained and when possible of the same origin as the family.

Objective Compare self-reported health between migrants and natives and identify health determinants in migrants stratified by gender in the participants in a suc-cohort of the PELFI study.

Methods Period of data collection: 2015 (baseline) Sub-cohort : Badalona Data collection: face-to-face questionnaire (translated into mother tongues Urdu, Mandarin, Arabic) Llengues del qúestionari: Descriptive analysis (frequencies and means) Sobre la medida de salud perceibida: Self-perceived health by visual analogue scale (EQ-VAS) where the endpoints are labelled ‘Best imaginable health state’ ‘Worst imaginable health state’ (0-100) included in Health-related quality of life questionnaire developed by the EuroQol Group

Methods Variables: Socio-demographics and psychosocial characteristics Self-perceived health by visual analogue scale (EQ-VAS) included in Health-related quality of life questionnaire developed by the EuroQol Group: Ratings below the median EQ-VAS in migrant participants were recorded as “worse SPH” (EQ-VAS<77) Statistical analysis Bivariate analysis (Chi square test and Fisher exact test) Multivariate (logistic regressions) Llengues del qúestionari: Urdu, mandarin and arabic and spanish Descriptive analysis (frequencies and means) Sobre la medida de salud perceibida: Self-perceived health by visual analogue scale (EQ-VAS) where the endpoints are labelled ‘Best imaginable health state’ ‘Worst imaginable health state’ (0-100) included in Health-related quality of life questionnaire developed by the EuroQol Group

Characteristics of participants FAMILY CHARACTERISTICS   Migrants (n=167) % Natives (n=38) P-value SOCIODEMOGRAPHICS Mean age (standard deviation) 42 (9.5) 43 (7.2) 0.438 Sex (% men) 74 (44.3) 18 (47.4) 0.732 Education level (Seondary or less) 144 (86.8) 30 (78.9) 0.221 Occupation (employed) 38 (41.7) 28 (75.7) <0,001 FAMILY CHARACTERISTICS Biparental family (to have a partner and live together) 149 (91.4) 38 (100) 0.077 Mean number of children/woman 2,8 1,8 LIVING CONDITIONS Overcrowded (>2 person/room) 139 (85.3) 21 (55.3) Monthly salary (<600€) 43 (36.4) 2 (5.6) SOCIAL SUPPORT Low social support 107 (66.0) 4 (10.8)

Migration process by sex   Men (n=74) Women (n=93) p-value Migration status (Spanish citizienship or permanent residence) 90.3  85.9  0.456 Lenght of residence (mean, SD) 15 (4.4) 10 (5.8) <0,001 Reasons to emigrate Podriamos subsituir el gràfico de “reasons to emigrate” por los del dominio del castellano y discriminación por sexo. *p<0.05

Migration process by sex (2) Spanish language skills* *p<0,05 *p<0,05

Self-related health by migration status* and by sexº (EQ-VAS median) Valores de la escala EQ-VAS (median)*: Migrants 77 Natives 80 Migrants Men 79 MigrantsWomen 71 Valores de la escala EQ-VAS (mean)*: Migrants 72 Natives 78Migrants Men 76 MigrantsWomen 69 Valores de la escala EQ-VAS (percentil 25)*: Migrants 62 Natives XXX Migrants Men 72 MigrantsWomen 55 *p<0.05; º p<0.05

Health problems by migration status (EQ-5D descriptive system)

Impact of socioeconomic variables and social support on health inequities between migrant and natives in Spain Destacar: migrants present worse health than natives (OR=2,2) but after adjusting for sex, socioeconomic variables and social suport the probability disapppear

Determinants of worse self-reported health among men and women migrants (OR and 95%CI) MEN WOMEN * Adjusted by length of residence

Limitations Sample size Convenience sample Different interpretation of self-perceived health status by cultural backgrounds

Conclusions Health inequalities between migrants and natives disappears after considering social determinants of health Migrant women have worse self rated health than men and explicative factors differ by gender. A better understanding of how gender interacts with other determinants is needed to diminish health inequalities and to improve social cohesion. Further research is needed on cultural and social factors in tand in the host country that define and strenght gender patterns. Further research is needed to better understand how gender interacts with other determinants to explain how why and when migrants heatlh deteriores and, finally, to inform health policies and interventions aiming to diminish inequalities in health between migrant men and women.

More information about the PELFI Project http://www.ciberesp.es/programas-de- investigacion/subprogramas-estrategicos/subprograma- inmigracion-y-salud-ciberesp-sis-ciberesp lfserret@iconcologia.net