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|Changing disease patterns amongst migrants: a focus on the Australian national health priority areas.
|School of Population Health
|The broad aim of this thesis was to explore trends in migrant mortality and morbidity rates in Australia between 1981 and 2007. The focus was on conditions that are part of the National Health Priority Areas. Approximately one in four Australians was born overseas and although they generally enjoy better health than the Australian-born population, there are a number of conditions in which some migrant groups are over represented, including diabetes and stomach cancer. This study consisted of three parts: the first dealt with mortality trends, the second with the impact of duration of residence on mortality rates and the third with hospitalisation trends. Mortality data were obtained from the Australian Bureau of Statistics, while hospitalisation data were acquired from the Australian Institute of Health and Welfare. Directly age- and sex-standardised mortality and hospitalisation rates were computed for each of the migrant groups and conditions of interest. These rates were compared to those for the Australian-born population and time trends were examined. While for many conditions mortality and hospitalisation rates reduced over the study period, the reverse was true for musculoskeletal conditions, melanoma, diabetes and mental health disorders, which may reflect greater exposure to risk factors or a lack of culturally appropriate support services. Furthermore, an increase in prostate cancer hospitalisations was observed, which may in part be explained by greater participation in screening. Migrants displayed lower mortality and hospitalisation rates compared to the Australian-born population and tended to retain their health advantage with increasing time spent in Australia. Migrants born in Southern Europe and Asia had the greatest health advantage, with low rates of colorectal cancer and cardiovascular disease. However, there were a number of notable exceptions such as diabetes, where individuals born in Southern Europe and Southern Asia displayed high morbidity and mortality rates, in part explained by their genetic predisposition to glucose intolerance, higher BMI and abdominal obesity. Stomach cancer was more prevalent among Southern and Eastern European and Chinese migrants. Liver and bladder cancer were also more common among migrants from Southern and Eastern Europe, Chinese Asia and South East Asia. The main strengths of this study included the focus on the entire Australian population, which enabled the analysis of mortality and hospitalisation trends among smaller migrant groups, such as those originating from Sub-Saharan Africa. Furthermore, the study provided an important update of knowledge in this field, where few studies focusing on a range of conditions have been conducted in recent years. The findings have implications for public health policy and practice as well as medical services, both for migrants and the Australian-born population. Migrants at risk of specific health problems should be targeted by health promotion programs that incorporate education about risk factors, screening, fitness programs and culturally appropriate treatment. For well-established migrant groups delivering programs and information is facilitated by the availability of existing ethnic community networks. However, newly established migrant groups, migrants in rural areas, refugees and humanitarian entrants are more difficult to target, due to their relative isolation. Ethnic radio, television programs, printed media, internet resources and migrant resource centres may be useful in reaching these groups. The benefits of the traditional diets and cultural norms of some migrant groups have potential policy and practice implications for the wider Australian population. For instance, modifying dietary guidelines to have a greater emphasis on aspects of the traditional Mediterranean diet may bring about positive changes in colorectal cancer and cardiovascular disease outcomes.
Hiller, Janet Esther
|Thesis (Ph.D.) University of Adelaide, School of Population Health, 2011.
|migrants; Australia; mortality trends; hospitalisation trends
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