Morbiditymortality paradox in Italianborn migrants Fiona Stanaway fiona

Morbidity-mortality paradox in Italian-born migrants Fiona Stanaway fiona. stanaway@sydney. edu. au Sydney School of Public Health University of Sydney, Australia The University of Sydney Page 1

Background aims – Italian migrants are 2 nd largest group of older migrants in Australia – Limited research on the health and ageing of this population and how their morbidity and mortality compares to that of the Australian-born population – Aim: to compare mortality between older Italian-born men and Australian-born men and examine how this relates to differences in distribution of risk factors and morbidity in the two groups The University of Sydney Page 2

CHAMP – Concord Health and Ageing in Men Project – Cohort study of community dwelling men aged 70 years and over – Study area = several suburbs in inner western Sydney – Suburbs with large migrant populations – particularly Italian migrants The University of Sydney Page 3

Comparison of SES measures in CHAMP men by country of birth 120 100 80 60 Italian-born Australian-born 40 20 0 Left school Manual <12 years old occupation The University of Sydney Pension as Own house income Page 4

Cardiovascular risk factors in CHAMP men by country of birth 45 40 35 30 25 Italian-born 20 Australian-born 15 10 5 0 Diabetes The University of Sydney Smoker Obese Page 5

Baseline health characteristics in CHAMP men by country of birth 30 25 20 Italian-born 15 Australian-born 10 5 0 Past heart attack The University of Sydney Past stroke Past cancer Page 6

Morbidity comparison between Italian-born and Australian-born men in 70 -79 year age group 45 40 35 30 25 20 15 10 5 0 Italian-born m s ia pt o D ep re ss iv e D sy m em en t irm pa im M ild co gn iti ve D L IA AD L di ds i ab sa bi ilit y y Australian-born The University of Sydney Page 7

Comparison of mortality between Italian-born and Australian-born men in CHAMP Model Hazard ratio for country of birth 95% Confidence Interval P value Country of birth alone (COB) 0. 68 0. 53 -0. 88 0. 003 COB + age 0. 82 0. 64 -1. 05 0. 11 COB + age + income 0. 71 0. 55 -0. 92 0. 01 COB + all differences 0. 75 0. 57 -0. 98 0. 03 The University of Sydney Page 8

Conclusions, implications and challenges – Mortality in older Italian-born men is lower than expected given their low SES and high morbidity – Doesn’t appear to be explained by many traditional risk factors – Could be driven by low cardiovascular disease and cancer which are important drivers of mortality – ? driven by Mediterranean diet – Implications – High morbidity without high mortality can have important implications for healthy ageing The University of Sydney Page 9

Any questions? The University of Sydney Page 10