Differences in mortality between different groups of older migrants and non-migrants in Belgium, 2001 to 2009

Background: European societies are rapidly ageing and becoming multicultural, and Belgium is part of the countries ahead in this transition. Differences in mortality between migrants and non-migrants in Europe have been shown to depend on age, sex, socio-economic status, migrant background and country of residence. However, little is known on mortality differences between migrants and non-migrants at older ages. Objective: The aim of this study is to determine which overall and cause-specific mortality differences exist between older migrants and non-migrants in Belgium. Methods: A mortality follow-up of the population aged 50 and over living in Flanders and the Brussels-Capital region at the time of the 2001 census was performed until 2009, by linking the census with the Belgian population and death certificates registers. Migrants were classified into western and non-western. Overall mortality differences were analysed via directly age-standardised mortality rates (ASMR) to the total population. Cause-specific mortality differences were analysed using Poisson regression models. All analyses were performed separately for men and women. Results: Older migrants, especially non-western migrants, experienced lower mortality than Belgians. The ASMR (per 1,000) were 32.0 (Belgians), 30.9 (western migrants) and 25.0 (non-western migrants) for males, and 28.2 (Belgians), 27.8 (western migrants) and 23.7 (non-western migrants) for women. Although migrant experienced lower mortality for most causes of death, infectious diseases and diabetes mellitus mortality was higher among older non-western migrants, and lung cancer mortality among female western migrants. The overall mortality advantage of migrants was mainly driven by their mortality advantage in the most important causes of death (i.e. cancers and cardiovascular diseases). Conclusion: Older migrants experienced lower mortality than Belgians. However, policies aiming at reducing ethnic mortality inequalities at older ages should consider improving the access and quality of the health care, and set measures to prevent obesity (related to diabetes mortality) and the increasing proportion of smoking migrant women