787 Mortality among migrant children and young people (CYP): results from a systematic review
Bibliographic record
Abstract
Objectives Migration status is a key determinant of health, but health outcomes among migrant children and young people (CYP) are poorly understood. A ‘healthy migrant’ effect has been demonstrated among adults,1 but evidence for the same effect in CYP is lacking. Our objectives are to summarise evidence on mortality among migrant CYP (aged < 18 and living elsewhere than their country of birth), including cause-specific mortality. These results are part of a systematic review addressing a range of health outcomes among migrant CYP.2 Methods PubMed/Medline, Embase and Cochrane databases were searched between 01/01/2000 and 01/06/2021 for English-language studies presenting mortality data for migrant CYP, with or without a control group.2 PROSPERO number CRD42020166305. Results The search strategy yielded 903 studies: 23 were included and 2 further studies were identified via reference searching. Meta-analysis was not possible due to inconsistent methodologies and outcomes measures. Table 1. shows the characteristics of included studies. Four studies address all-cause mortality, of which two show a mortality advantage among migrant children, specifically refugee children (US3 and Canada4). Conversely, a German study showed similar mortality rates among migrant CYP and the general population,5 and a case-control study in Sweden showed increased mortality among migrant CYP.6 Intercountry adoptees in Sweden increased ‘avoidable mortality’ (preventable or treatable deaths) compared with the host population.7 Nine studies presented data on cause-specific mortality and two on mortality in intensive care. Of these, a large study on children with leukaemia in Canada showed superior adjusted event-free survival among migrant CYP. The remaining studies all showed higher crude death rates in migrant CYP compared with the host population, including tuberculosis, burns, road-traffic accidents, suicide, heat-related causes and work-injuries. A study without control group described 3 deaths among ‘illegal immigrant’ CYP in the US. Eight studies presented under-5 mortality rates for refugee camps ranging from 0.21 to 10.3/10,000 person-days, but none provided control groups. In three studies this exceeded the United Nations Human Rights Commissioner for Refugees emergency threshold (2/10,000 person days). Conclusion Results are inconclusive but show some evidence of the ‘healthy migrant’ effect in CYP, including refugees, living in high income countries. However, crude mortality from some preventable causes is higher among migrant CYP, consistent with findings in the adult population.1 These results demonstrate a paucity of studies on migrant CYP, particularly in low and middle-income countries and studies with control groups, limiting the conclusions that can be drawn. References Aldridge RW, Nellums LB, Bartlett S, Barr AL, Patel P, et al. Global patterns of mortality in international migrants: a systematic review and meta-analysis. The Lancet 2018. Armitage AJ, Heys M, Lut I, Hardelid P. Health outcomes in international migrant children: protocol for a systematic review. BMJ Open 2021;11(5):e041173. Linton NM, DeBolt C, Newman LP, et al. Mortality rate and causes of death among refugees resettled in Washington State, 2006–2016. Journal of Immigrant and Minority Health 2020 DesMeules M, Gold J, McDermott S, Cao Z, Payne J, Lafrance B, et al. Disparities in mortality patterns among Canadian immigrants and refugees, 1980–1998: results of a national cohort study. Journal of Immigrant and Minority Health 2005. Makarova N, Brand T, Brünings-Kuppe C, Pohlabeln H, Luttmann S. Comparative analysis of premature mortality among urban immigrants in Bremen, Germany: a retrospective register-based linkage study. BMJ Open 2016. Albin B, Hjelm K, Ekberg J, Elmståhl S. Mortality among 723 948 foreign-and native-born Swedes 1970–1999. The European Journal of Public Health 2005. Hjern A, Vinnerljung B, Lindblad F. Avoidable mortality among child welfare recipients and intercountry adoptees: a national cohort study. Journal of Epidemiology & Community Health 2004.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.047 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.013 |
| Bibliometrics | 0.011 | 0.014 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".