Global patterns of mortality in international migrants: a systematic review and meta-analysis

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Study Justification:
This study aimed to fill a gap in existing research by conducting a systematic review and meta-analysis of mortality data for international migrants. With 258 million people residing outside their country of birth, it is important to understand the mortality patterns and outcomes for this population. Previous studies had not conducted a global analysis of mortality in international migrants, making this study necessary to provide a comprehensive understanding of the topic.
Highlights:
– The study included 96 eligible studies from all global regions and 92 countries, providing a geographically diverse dataset.
– Data from over 15.2 million migrants were included in the analysis.
– The study found that international migrants have a mortality advantage compared to the general population in destination countries.
– This mortality advantage was consistent across various disease categories, except for infectious diseases and external causes.
– Limited data was available for marginalized groups in low-income and middle-income countries, highlighting an important research gap.
Recommendations:
– The study recommends reframing the public discourse on international migration and health in high-income countries based on the mortality advantage identified in international migrants.
– Further research is needed to understand the health outcomes of marginalized groups in low-income and middle-income countries, as data for these groups were limited.
Key Role Players:
– Researchers and scientists specializing in migration and health
– Policy makers and government officials responsible for immigration and health policies
– Non-governmental organizations (NGOs) working with migrant populations
– International organizations such as the World Health Organization (WHO) and International Organization for Migration (IOM)
Cost Items for Planning Recommendations:
– Research funding for further studies on health outcomes of marginalized migrant groups in low-income and middle-income countries
– Budget allocation for public health programs targeting international migrants in high-income countries
– Funding for NGOs working with migrant populations to provide healthcare services and support
– Resources for training healthcare professionals to address the specific health needs of international migrants

The strength of evidence for this abstract is 8 out of 10.
The evidence in the abstract is strong, but there are some areas for improvement. The study conducted a systematic review and meta-analysis, which are considered high-quality research methods. The authors searched multiple databases and used specific inclusion and exclusion criteria. They included a large number of studies and participants, providing a comprehensive overview of mortality in international migrants. The study also reported summary estimates and conducted subgroup analyses to explore heterogeneity. However, the abstract does not provide information on the quality assessment of included papers, which is an important aspect of systematic reviews. Additionally, the abstract could benefit from providing more details on the methodology, such as the specific search terms used and the data extraction process. To improve the evidence, the authors should consider including information on the risk of bias assessment and providing more transparency in the methodology section.

Background: 258 million people reside outside their country of birth; however, to date no global systematic reviews or meta-analyses of mortality data for these international migrants have been done. We aimed to review and synthesise available mortality data on international migrants. Methods: In this systematic review and meta-analysis, we searched MEDLINE, Embase, the Cochrane Library, and Google Scholar databases for observational studies, systematic reviews, and randomised controlled trials published between Jan 1, 2001, and March 31, 2017, without language restrictions. We included studies reporting mortality outcomes for international migrants of any age residing outside their country of birth. Studies that recruited participants exclusively from intensive care or high dependency hospital units, with an existing health condition or status, or a particular health exposure were excluded. We also excluded studies limited to maternal or perinatal outcomes. We screened studies using systematic review software and extracted data from published reports. The main outcomes were all-cause and International Classification of Diseases, tenth revision (ICD-10) cause-specific standardised mortality ratios (SMRs) and absolute mortality rates. We calculated summary estimates using random-effects models. This study is registered with PROSPERO, number CRD42017073608. Findings: Of the 12 480 articles identified by our search, 96 studies were eligible for inclusion. The studies were geographically diverse and included data from all global regions and for 92 countries. 5464 mortality estimates for more than 15·2 million migrants were included, of which 5327 (97%) were from high-income countries, 115 (2%) were from middle-income countries, and 22 (<1%) were from low-income countries. Few studies included mortality estimates for refugees (110 estimates), asylum seekers (144 estimates), or labour migrants (six estimates). The summary estimate of all-cause SMR for international migrants was lower than one when compared with the general population in destination countries (0·70 [95% CI 0·65–0·76]; I2=99·8%). All-cause SMR was lower in both male migrants (0·72 [0·63–0·81]; I2=99·8%) and female migrants (0·75 [0·67–0·84]; I2=99·8%) compared with the general population. A mortality advantage was evident for refugees (SMR 0·50 [0·46–0·54]; I2=89·8%), but not for asylum seekers (1·05 [0·89–1·24]; I2=54·4%), although limited data was available on these groups. SMRs for all causes of death were lower in migrants compared with the general populations in the destination country across all 13 ICD-10 categories analysed, with the exception of infectious diseases and external causes. Heterogeneity was high across the majority of analyses. Point estimates of all-cause age-standardised mortality in migrants ranged from 420 to 874 per 100 000 population. Interpretation: Our study showed that international migrants have a mortality advantage compared with general populations, and that this advantage persisted across the majority of ICD-10 disease categories. The mortality advantage identified will be representative of international migrants in high-income countries who are studying, working, or have joined family members in these countries. However, our results might not reflect the health outcomes of more marginalised groups in low-income and middle-income countries because little data were available for these groups, highlighting an important gap in existing research. Our results present an opportunity to reframe the public discourse on international migration and health in high-income countries. Funding: Wellcome Trust, National Institute for Health Research, Medical Research Council, Alliance for Health Policy and Systems Research, Department for International Development, Fogarty International Center, Grand Challenges Canada, International Development Research Centre Canada, Inter-American Institute for Global Change Research, National Cancer Institute, National Heart, Lung and Blood Institute, National Institute of Mental Health, Swiss National Science Foundation, World Diabetes Foundation, UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, and European Society for Clinical Microbiology and Infectious Diseases (ESCMID) Study Group Research Funding for the ESCMID Study Group for Infections in Travellers and Migrants.

For this systematic review and meta-analysis, we searched MEDLINE, Embase, the Cochrane Library, and Google Scholar databases for studies published between Jan 1, 2001, and March 31, 2017, reporting mortality in international migrants, without language restrictions. Full search terms are provided in the appendix. We chose to search for studies published after Jan 1, 2001, because a previous systematic review of mortality in migrants had been published by this date, but it did not contain a meta-analysis and did not assess outcomes across all ICD-10 categories.3 On Sept 3, 2018, we updated our search using the same databases, search terms, and inclusion criteria. We included observational (cohort and cross-sectional), systematic reviews, and randomised controlled trials reporting quantitative data on mortality in international migrants of any age residing outside their country of birth. We excluded studies that recruited participants exclusively from intensive care or high dependency hospital units, with an existing health condition or status (eg, myocardial infarction, HIV, tuberculosis, pregnancy), or a particular health exposure (eg, smoking, high blood pressure). We also excluded studies limited to maternal or perinatal outcomes. The study with the largest or most representative sample was included, and when these were equal, the most recent study was included. Discrepancies in the inclusion or exclusion of papers during screening were discussed until consensus was achieved, and RWA resolved any final discrepancies. This study was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA)14 guidelines. The study protocol is available online. Deviations from the protocol are reported in the appendix. Five reviewers (RWA, SB, ALB, LBN, and PP) screened titles, abstracts, and full texts using Covidence systematic review software. Two reviewers independently examined citations at each stage. We adapted a previously used data extraction form,15 to record study design, year or years of study, country, country of origin, number of participants, standardised mortality ratios (SMRs), absolute mortality rates, and summary descriptions of the study population. Extracted data were reviewed and checked by a second author before cleaning and analysis. Duplicate data were removed for studies reporting information from the same migrant group (by country of destination) for the same mortality outcome and time period. Outcomes of interest were all-cause and ICD-10 cause-specific SMRs and absolute mortality rates. The number of datapoints that presented cause-specific mortality according to ICD-10 groups was also calculated. We report data by ICD-10 disease category, and converted outcomes from studies reporting data using older ICD versions as necessary. Four reviewers (SB, ALB, RB, and PP) assessed the risk of bias of included papers using a piloted quality assessment form adapted from the Newcastle Ottawa Scale.16 A randomly selected sample (10%) of these assessments was corroborated by LBN. We used the metafor package (version 2.0) in the statistical software R (version 3.5.1) and random-effects models to calculate pooled estimates of mortality and corresponding 95% CIs. Heterogeneity was assessed using the I2 statistic, and assessed further in subgroup analyses wherever possible. Mortality point estimates were included in each model with corresponding SEs extracted directly or calculated using CIs for each point estimate. Subgroup analyses were done when appropriate to assess mortality by sex, migrant type (eg, refugee or asylum seeker), World Bank geographical region of origin, World Bank income level of countries of origin, and evidence quality. The study is registered with PROSPERO, number CRD42017073608. The funders of the study had no role in study design, data collection, data analysis, data interpretation, writing of the report, or the decision to submit the paper for publication. All authors had full access to all data in the study and had final responsibility for the decision to submit for publication.

I’m sorry, but I couldn’t find any specific information in the provided text about innovations to improve access to maternal health. The text seems to be focused on a systematic review and meta-analysis of mortality data for international migrants. If you have any specific questions or need assistance with another topic, please let me know and I’ll be happy to help.
AI Innovations Description
The provided text is a description of a systematic review and meta-analysis that examined mortality rates among international migrants. It does not directly address access to maternal health or provide a recommendation for improving access to maternal health. However, based on the information provided, here is a general recommendation that could be used to develop an innovation to improve access to maternal health:

1. Strengthen healthcare systems: Enhance the capacity and resources of healthcare systems in both high-income and low-income countries to provide comprehensive and accessible maternal health services. This could include improving infrastructure, increasing the number of skilled healthcare providers, and ensuring the availability of essential medical supplies and equipment.

It is important to note that this recommendation is based on the general understanding that strengthening healthcare systems is crucial for improving access to maternal health. However, specific strategies and interventions would need to be tailored to the unique context and challenges of each country or region.
AI Innovations Methodology
Based on the provided information, it seems that you are looking for innovations to improve access to maternal health. Unfortunately, the text you provided is a description of a systematic review and meta-analysis on mortality in international migrants, and it does not directly address innovations for improving access to maternal health. However, I can provide you with a general methodology to simulate the impact of recommendations on improving access to maternal health.

Methodology to Simulate the Impact of Recommendations on Improving Access to Maternal Health:

1. Define the recommendations: Identify specific recommendations that can potentially improve access to maternal health. These recommendations can be based on evidence-based practices, expert opinions, or existing guidelines.

2. Identify key indicators: Determine the key indicators that will be used to measure the impact of the recommendations on improving access to maternal health. These indicators can include metrics such as the number of women receiving prenatal care, the number of skilled birth attendants available, or the maternal mortality rate.

3. Collect baseline data: Gather baseline data on the current status of maternal health access in the target population or region. This data will serve as a reference point for comparison after implementing the recommendations.

4. Develop a simulation model: Create a simulation model that incorporates the baseline data, the identified recommendations, and the key indicators. The model should simulate the impact of implementing the recommendations on the selected indicators.

5. Input data and parameters: Input the baseline data into the simulation model, along with the parameters related to the recommendations. These parameters can include the expected increase in the number of healthcare providers, the estimated increase in the number of women accessing prenatal care, or the anticipated reduction in maternal mortality.

6. Run the simulation: Execute the simulation model to generate projected outcomes based on the implemented recommendations. The simulation should provide estimates of the potential impact on the selected indicators, such as the increase in the number of women receiving prenatal care or the reduction in maternal mortality.

7. Analyze the results: Analyze the results of the simulation to assess the potential impact of the recommendations on improving access to maternal health. Compare the projected outcomes with the baseline data to determine the effectiveness of the recommendations.

8. Refine and iterate: Based on the analysis of the simulation results, refine the recommendations if necessary and repeat the simulation process. This iterative approach allows for continuous improvement and optimization of the recommendations to achieve the desired impact on improving access to maternal health.

It is important to note that the methodology described above is a general framework and can be adapted to specific contexts and data availability. Additionally, the accuracy and reliability of the simulation results depend on the quality of the input data and the assumptions made in the simulation model.

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