Healthy migrant effect on cardiovascular disease and risks factors: Analysis from the social determinants of health approach
Authors:   ,   Universidad del Desarrollo, Rada Ramírez Isabel Cristina 
Published: December 2023

The international migration has steadily increased in Chile during the recent decades reaching an estimation of 1.452.104 international migrants. It has been described an intra-regional pattern called south-south migration. The health of this population is recognized as a global public health priority, mainly chronic diseases given the epidemiological transition that also has impacted migrant population. Currently, there is controversial evidence a possible healthy migrant effect on cardiovascular diseases and its risk factors, which suggest to lower prevalence of this conditions in comparison to local population. It has been postulated that the effect might be modulated by social determinants of health. The prevalence of cardiovascular conditions among migrant population residing in Chile is unknown, as well as the existence of the healthy migrant effect on cardiovascular health has not been investigated yet. In order to analyze the existence of this effect in migrant population compared to locals four sub-studies were conducted. The first substudy aimed to describe the scientific evidence of the last five years on healthy migrant effect on cardiovascular risk factors and cardiovascular diseases in the international migrant population vs. locals. A narrative review was conducted following a systematic search. The second substudy analyze the existence of EMS in self-reported chronic morbidity in the international migrant population vs. local, and its related social determinants (demographic, socioeconomic, health insurance, migratory process). From wich a secondary analysis of CASEN 2017 survey was performed with complex samples analyses. The third substudy aimed to analyze the existence of the healthy migrant effect on cardiovascular diseases and risk factors in the international migrant population vs. locations, and their related social determinants (demographic, socioeconomic, health system, psychosocial, and migration). The primary data collection included n=6.626 participants (n=3.324 Chileans and n=3.302 migrants) residing in La Pintana, La Granja and San Ramón who responded a survey of cardiovascular health and social determinants of heath. The second and third substudy analyzed the crude prevalence of health outcomes as proportions, the Pearson’s chi-square test was used to compared health outcomes between migrants and locals. Multivariate logistic regression was used to test the association of social determinants of health and health outcomes. The healthy migrant effect was tested by multivariate logistic regression sequentially adjusted by social determinants of health (reference=Chilean). The fourth substudy aimed to offer a regional perspective of the growing challenges faced by international migrants in Latin America in accessing hypertension preventive care from human rights, equity and universal primary health care approaches. The results of the first substudy revealed scarce reports of intraregional in Latin America, heterogeneous evidence which difficults consensus for healthy migrant effect on cardiovascular health. The second substudy showed a lower crude prevalence of chronic diseases that remained significant after adjusting by social determinants of health. Meanwhile the third substudy revealed an unadjusted lower prevalence of cardiovascular diseases, metabolic risk factors, tobacco and alcohol consumption. The advantage on acute myocardial infarcation disappeared after adjusting by demographic determinants of health, while the effect on cerebrovascular accident disappeared after adjusting by access to health care determinants of health. The healthy migrant effect on metabolic risk factors, alcohol and tobacco consumption remained significant after adjusting by all social determinants of health. The present study contributes to the knowledge of health and migration, make visible challengues on cardiovascular health from social determinants of health perspective and provide evidence for local and regional public health.