Nationwide longitudinal population-based study on mortality in Italy by immigrant status

A systematic analysis of the mortality of immigrant residents throughout Italy has never been carried out. The present study aimed to evaluate differences in mortality by immigrant status. A longitudinal study of the Italian resident population (native and immigrants) recorded in the 2011 National Institute of Statistics Census was conducted. This cohort was followed up from 2012 to 2018 until death, emigration, or end of the study period. The exposure variable was the immigrant status, measured through citizenship, dichotomized into Italian and immigrant. The main outcome was overall and cause-specific mortality. Age-standardized mortality ratios (SMRs) were calculated. The SMRs among immigrants were half that of Italians, both for men (SMR 0.52) and women (SMR 0.51), with the lowest SMRs observed for subjects from North Africa and Oceania. For some causes of death, mortality was higher among immigrants: tuberculosis in both men (SMR 4.58) and women (SMR 4.72), and cervical cancer (SMR 1.58), complications of pregnancy, childbirth, and puerperium (SMR 1.36), and homicide (SMR 2.13) for women. A multivariable quasi-Poisson regression analysis, adjusted for age and macro area of residence in Italy, confirmed a lower all-cause mortality for immigrants compared to Italians, both for men (RR 0.46) and women (RR 0.44). Although immigration to Italy is no longer a recent phenomenon, and the presence of immigrants is acquiring structural characteristics, our study confirms their health advantage, with a lower mortality than that of Italians for almost all causes of death and for all areas of origin.