Journal of Immigrant and Minority Health

, Volume 13, Issue 2, pp 361–370 | Cite as

Patterns of Death in the First and Second Generation Immigrants from Selected Middle Eastern Countries in California

Original Paper


Migrant studies in the United States (US) have rarely covered the Middle Eastern population (ME), and have never distinguished the first and second generations born in the US. This study aims to describe the mortality patterns of ME immigrants by origin, acculturation, and generation. Death certificates issued from 1997 through 2004 were used to calculate, for Middle Eastern immigrants, the proportional odds ratios (POR) for major causes of death, with comparison to non-Hispanic Whites born in the US to US-born parents. First generation immigrants had higher odds for colorectal cancers, diabetes, and diseases of the heart, while their odds for chronic obstructive pulmonary disease (COPD) and suicide were lower. Men had higher odds for all cancers combined, cancers of the lymphatics, and pancreas. Women had lower odds for lung cancer, and dementia, and higher odds for breast cancer. The second generation men had higher odds for all cancers combined, and diseases of the heart, whereas women had lower odds for lung cancer and cerebrovascular accidents. Higher odds for colorectal cancers and lower odds for COPD were noted in both sexes. Some of the observed differences may be based on ethnic characteristics, including genetic makeup, early exposures, and culturally determined values. Time since immigration is associated with convergence of most odds to that of the native population.


Migrant studies Middle East Ethnic groups Mortality Proportional odds ratio 



Authors would like to express their appreciation to Dr. Frank Silvio, and Terri Chew from the County of Los Angeles Department of Health Services, and Dr. Cutris J. Codon, and Elizabeth Gonzales from the Orange County Department of Public Health for graciously providing the AVSS data for this analysis. The ideas and opinions expressed herein are those of the author(s) and endorsement by the State of California, Department of Public Health, County of Los Angeles Department of Health Services, and Orange County Department of Public Health, and Public Health Institute is not intended nor should be inferred. This work was supported in part by the grant CA103457 from the National Cancer Institute to Kiumarss Nasseri.


  1. 1.
    Parkin DM, Khlat M. Studies of cancer in migrants: rationale and methodology. Eur J Cancer. 1996;32A:761–71.PubMedCrossRefGoogle Scholar
  2. 2.
    Stirbu I, Kunst AE, Vlems FA, Visser O, Deville W, Nijhuis HGJ, et al. Cancer mortality rates among first and second generation migrants in the Netherlands: convergence towards the rates of the native Dutch population. Int J Cancer. 2006;119:2665–72.PubMedCrossRefGoogle Scholar
  3. 3.
    Kliewer EV, Smith KR. Breast cancer mortality among immigrants in Australia and Canada. J NCI. 1995;87:1154–61.Google Scholar
  4. 4.
    Swerdlow AJ, Marmot MG, Grulich AE, Head J. Cancer mortality and British ethnic immigrants from Indian subcontinent to England and Wales. Br J Cancer. 1995;72:1312–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Gadd M, Johansson SE, Sundquist J, Wändell P. Are there differences in all-cause and coronary heart disease mortality between immigrants in Sweden and in their country of birth? A follow-up study of total populations. BMC Public Health. 2006;6:102. Apr 21.PubMedCrossRefGoogle Scholar
  6. 6.
    Razum O, Zeeb H, Gerhardus A. Cardiovascular mortality of Turkish nationals residing in west Germany. Ann Epidemiol. 1998;8:334–41.PubMedCrossRefGoogle Scholar
  7. 7.
    Malenfant EC. Suicide in Canada’s immigrant population. Health Rep. 2004;15:10–7.Google Scholar
  8. 8.
    Razum O, Jahn A, Blettner M, Reitmaier P. Trends in maternal mortality ratio among women of German and non-German nationality in west Germany, 1980–1996. Int J Epidemol. 1999;28:919–24.CrossRefGoogle Scholar
  9. 9.
    Iwasaki M, Mameri CP, Hamada GS, Tsugane S. Cancer mortality among Japanese immigrants and their descendants in the state of Sao Paulo, Brazil, 1999–2001. Jpn J Clin Oncol. 2004;34:673–80.PubMedCrossRefGoogle Scholar
  10. 10.
    Baaten GG, Sonder GJ, Dukers NH, Coutinho RA, Van den Hoek JA. Population-based study on the seroprevalence of hepatitis A, B, and C virus infection in Amsterdam, 2004. J Med Virol. 2007;79:1802–10.PubMedCrossRefGoogle Scholar
  11. 11.
    Sundquist K, Li X. Coronary heart disease risks in first- and second-generation immigrants in Sweden: a follow-up study. J Intern Med. 2006;259:418–27.PubMedCrossRefGoogle Scholar
  12. 12.
    Acevedo-Garcia D, Pan J, Jun HJ, Osypuk TL, Emmons KM. The effect of immigrant generation on smoking. Soc Sci Med. 2005;61:1223–42. Epub 2005 Apr 18.PubMedCrossRefGoogle Scholar
  13. 13.
    Eschbach K, Stimpson JP, Kuo YF, Goodwin JS. Mortality of foreign-born and US-born Hispanic adults at younger ages: a reexamination of recent patterns. Am J Public Health. 2007;97:1297–304. Epub 2007 May 30.PubMedCrossRefGoogle Scholar
  14. 14.
    Bos V, Kunst AE, Garssen J, Mackenbach JP. Duration of residence was not consistently related to immigrant mortality. J Clin Epidemiol. 2007;60:585–92.PubMedCrossRefGoogle Scholar
  15. 15.
    Rothwell CJ. Reengineering vital registration and statistics systems for the United States. Prev Chronic Dis (serial online) 2004; 1(4)
  16. 16.
    Nasser K. Reengineering vital registration and statistics system (letter to the editor). Prev. Chronic Dis (serial online) 2005; 2(1)
  17. 17.
    Singh GK, Siahpush M. All-cause and cause-specific mortality of immigrants and native born in the United States. Am J Public Health. 2001;91:392–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Seeff LC, McKenna MT. Cervical cancer mortality among foreign-born women living in the United States, 1985–1996. Cancer Detect Prev. 2003;27:203–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Kurata J, Nogawa A, Watanabe Y, Kawai K. Peptic ulcer disease mortality. Comparison of native Japanese, Japanese Americans, and Caucasian Americans. J Clin Gastroenterol. 1994;18:145–54.PubMedCrossRefGoogle Scholar
  20. 20.
    Stellman SD. Proportional mortality ratios among Korean immigrants to New York city, 1986–1990. Yonsei Med J. 1996;37:31–7.PubMedGoogle Scholar
  21. 21.
    Nasseri K. Mortality in the first generation white immigrants in California, 1989–1999. J Immigr Minor Health. 2007;10:197–205. doi: 10.1007/s10903-007-9070-x.CrossRefGoogle Scholar
  22. 22.
    Yang RC, Mills PK, Nasseri K. Patterns of mortality in California Hmong, 1988–2002. J Immigr Minor Health 2009. doi  10.1007/s10903-009-9230-2.
  23. 23.
    Williams RL, Marinko JA, Chen PN. AVSS: Automated Vital Statistics System. Health Data Systems, Santa Barbara, CA. Available at: Accessed May 2008.
  24. 24.
    Electronic Dearth Reporting System. California Assembly Bill AB 2550, 2002. Available at: Accessed May 2008.
  25. 25.
    Office of Management and Budget, Interagency committee for the review of standards for data on race and ethnicity, tabulation working group. Provisional guidance on the implementation on the 1997 standards for federal data on race and ethnicity. Washington, DC: Office of Management and Budget; December 15, 2000 (cited 2007 Aug 25). (about 102 p) Available from Accessed May 2008.
  26. 26.
    Camarota SA. Immigrants from the middle east: a profile of the foreign-born population from Pakistan to Morocco. Center for Immigration Studies, August 2002. Available at
  27. 27.
    Hakimzadeh S, Dxon D. Spotlight on the Iranian foreign born. Migration Policy Institute, 2006. Available at: Accessed May 2008.
  28. 28.
    de la Cruz GP, Brittingham A. The Arab population 2000. Census 2000 brief. December 2003. Available at Accessed May 2008.
  29. 29.
    State of California, Department of Finance, E-5 population and housing estimates for cities, counties and the state, 2001–2008, with 2000 Benchmark. Sacramento, California, May 2008. Available at: Accessed 8 Aug 2008.
  30. 30.
    Lopez A. Middle eastern populations in California: estimates from the census 2000 supplementary survey. Center for Comparative Studies in Race and Ethnicity, Stanford University. Report no. 10. Available from
  31. 31.
    SEER Cause of Death Recode 1969+ (9/17/2004). Available at: Accessed May 2008.
  32. 32.
    Block G, Matanoski GM, Seltser RS. A method for estimating year of birth using social security number. Am J Epidemiol. 1983;118:377–95.PubMedGoogle Scholar
  33. 33.
    Shimizu H, Ross RK, Bernstein L, Yatani R, Henderson BE, Mack TM. Cancers of the prostate and breast among Japanese and white immigrants in Los Angeles county. Br J Cancer. 1991;63:963–6.PubMedCrossRefGoogle Scholar
  34. 34.
    Nasseri K. SSN Year of Issue Documentation, 2007. Available at
  35. 35.
    SAS Institute Inc. SAS 9.1 Cary. NC: SAS Institute Inc; 2004.Google Scholar
  36. 36.
    Nasseri K. Mortality in first generation white immigrants in California, 1989–1999. J Immigr Minor Health. 2008;10:197–205.PubMedCrossRefGoogle Scholar
  37. 37.
    Franzini L, Ribble JC, Kaddie AM. Understanding the Hispanic paradox. Ethn Dis. 2001;11:496–518.PubMedGoogle Scholar
  38. 38.
    Khlat M, Darmon N. Is there a Mediterranean migrants mortality paradox in Europe? Int J Epidemiol. 2003;32:1115–8.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Public Health Institute, California Cancer RegistrySanta BarbaraCalifornia
  2. 2.Bloomberg School of Public Health, The Johns Hopkins UniversityBaltimoreMaryland

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