Mortality in migrants with dementia living in the Lazio region, Italy

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Abstract Background Dementia is a major cause of disability and death among older people. Older migrants living in Italy are increasing and the prevalence of dementia is expected to rise in this population. Nevertheless, there is lack of real-world information concerning their health outcomes. The aim of this work was to analyse mortality in migrants with dementia living in Lazio, Italy (IMMIDEM project, GR-2021-12372081) Methods In a retrospective cohort study, people with dementia aged ≥50 living in Lazio on 31st December 2018 were selected using Health Information Systems (HIS) and followed-up for 5 years. The migrant status was defined according to the Country of birth as native Italians, people from High Migratory Pressure Countries (HMPC) or Highly Developed Countries (HDC). Age-standardized mortality rate (SMR) was estimated overall and by migrant status. Time to event analysis was performed using Kaplan-Meier curves, log-rank tests, and multivariate Cox regression. Results On 31st December 2018, 38,835 individuals with dementia were living in Lazio, 2.1% from HMPC and 0.9% from HDC. Natives and HDC were older than HPMC, while migrants showed a higher proportion of female. The SMR was lower in migrants from HPMC (42.2%; CI95% 37.0%-48.1%) and from HDC (33.2%; CI95% 25.4%-43.4%) than among natives (52.4%; CI95% 50.7%-54.1%). The age-adjusted mortality hazard ratio (HR) was lower in migrants (HDCs HR = 0.76, CI95%:0.66-0.89; HMPC HR = 0.88, CI95%:0.80-0.97) than natives. Conclusions The study showed a lower mortality rate among migrants with dementia compared to native Italians. Under-diagnosis, the “salmon bias”, and the “‘healthy migrant effect” could explain this apparent paradox, consistently with available literature. In addition, following-up migrants in the HIS may be difficult and underestimation may occur. Enhancing the comprehension of this phenomenon could allow the formulation of more effective, diversity-sensitive policies and practices for the management of dementia. Key messages • The mortality rate among migrants with dementia was found lower than that among native Italians. • Understanding the morbidity and mortality patterns in migrants with dementia is important to develop practice to adequately respond to their health needs and diversity-sensitive polices.

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