Mortality among second-generation immigrants in France

France has a large population of second-generation immigrants, i.e., the native-born children of immigrants. While socio-economic disparities by country of origin are well documented, health inequalities – especially in terms of mortality – remain unknown. Michel Guillot et Myriam Khlat, senior researchers at Ined, and Matthew Wallace, post-doctoral researcher at Stockholm University, have analyzed levels of mortality between 1999 and 2010 among adults born in France from two immigrant parents. This study, carried-out for the first time in France, reveals a large amount of excess mortality among North African-origin males.

Among EU countries with populations greater than 1 million, France is the country with the largest second-generation population in both absolute and relative terms. In 2014, the population of individuals born in France with at least one foreign-born parent represented 9.5 million, or 14.3% of the total population. Due to France’s specific immigration history, the second-generation population is, today, large and diverse: the regions of origin most represented are southern Europe (Portugal, Italy, or Spain) and North Africa (Algeria, Morocco, or Tunisia), which each region totaling about one-third. The last third comprises a very diverse set of parental countries of origin, including countries in sub-Saharan Africa, Europe, and Asia.

A unique study in the French context

While disadvantages in terms of educational attainment, employment and income among second-generation immigrants of non-EU origin, especially North African, are well documented, no study so far had examined disadvantages in the area of mortality.
The authors of this article, Michel Guillot, Myriam Khlat and Matthew Wallace, decided to study this topic for the first time. They used the Echantillon Longitudinal de Mortalité (ELM; Longitudinal Mortality Sample), a nationally representative sample of 380,000 individuals aged 18 and above in 1999 taken from the 1999 Etude de l’Histoire Familiale (EHF; Family History Survey) with mortality follow-up via linked death records until 2010. They compared mortality levels for second-generation immigrants aged 18 to 64 of southern European and North African origin with their first-generation counterparts and with the reference population (individuals born in France with two parents born in France).

Large amount of excess mortality among males of North African origin

While the estimated probability of dying between 18 and 65 was 162 per 1000 for males of the reference population, it was 1.7 times higher for males born in France with two immigrant parents from North Africa (276 per 1000). It was however lower for second-generation immigrants from Southern Europe (106 per 1000) as well as for first-generation immigrant males whatever their country of origin. The excess mortality among North African-origin second-generation males remained large and significant after adjusting for educational attainment.
Results for women were not statistically significant relative to the reference population except for first-generation immigrants from southern Europe who experience a mortality advantage similar to their male counterparts.

Second-generation status of North African origin as an important source of health disparity

The low mortality levels observed among first-generation immigrants can be explained in part by migration selection effects (the “healthy migrant effect”), a well-known phenomenon in this area of study.
Reasons for the excess mortality among second-generation North African-origin males are more difficult to identify due to a lack of data including on health behaviors and causes of death. As for factors such as socioeconomic status, results suggest that this excess mortality is not simply explained by differences in educational attainment, but by a broad set of disadvantages in areas including labor market outcomes and income levels. Moreover, studies have shown that the perception of labor market discrimination is indeed more prevalent among second-generation than first-generation immigrants of the same origin, which may translate into worse health outcomes.

These first mortality results show that the various adverse outcomes experienced by second-generation North African-origin males in France also have an important, previously unknown public health dimension. They are particularly significant given the size of the North African–origin population in France and current concerns about the specific conditions they face, including socioeconomic disadvantage and discrimination.