key international and u.s data sources on migration and health · 2019-07-19 · summer institute...
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National Center for Emerging and Zoonotic Infectious Diseases
Key international and U.S data sources on migration and health
Alfonso Rodriguez-Lainz, PhD, DVM, MPVMDivision of Global Migration and QuarantineCenters for Disease Control and Prevention
Summer Institute in Migration and Global HealthOakland, California, July 10, 2019
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Outline Migrant definitions Key data sources on international migrants
– Publicly available data or web tools– International ad US agencies and organizations
• Numbers and sociodemographic characteristics • Health status
– Strengths and limitations Conclusions
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Who are international migrants?
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International migrant:no universally accepted definition
Countries, agencies and researchers use different criteria, based on national legislation, policies or area of expertise– E.g., which legal status categories are included, duration of stay
Terms such as “migrant,” “immigrant,” “refugee”, “foreign-born”, “Latino,” “farmworker,” may have different meanings, are used inconsistently, inappropriately (e.g., as synonyms) or not defined
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International migrant United Nations (UN) Population Division
A person who is living in a country other than his/her country of birth
In most countries, this definition corresponds to the “foreign-born” population
https://www.un.org/en/development/desa/population/migration/publications/migrationreport/docs/MigrationReport2017_Highlights.pdf
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International migrants in the U.SI was
born in India
I was born in Iraq
I was born in China
I was born in Mexico
I was born in Nigeria
I was born in CubaSource: U.S Census Bureau
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According to the UN … Legal status categories included in international migrants**
– Naturalized citizens*– Legal permanent residents– Temporary worker* and international student visa*– Refugees and asylum-seekers* – Unauthorized immigrants*
Not international migrants: International travelers for tourism, business, religious pilgrimage
*Some countries exclude these categories from international migrants statistics** The US Census Bureau includes all those categories in its foreign-born definition
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Some clarifications on terminology
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International migrants’ population size:Two different components
International migrant “stock” – Number of migrants in a country at a given point in time
(e.g., mid-year 2017)• Note: they have different lengths of stay
International migrant “flows” – Number of migrants arriving (immigrant flows) or departing
(emigrant flows) a country during a given time period (e.g., 12 months of 2017)
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International migrants’ population size:Two different components
44 million foreign-born residents in 2017
(International migrant “stock”)
~8 million foreign-born arrived to live in the US in 2017
Inflow
~1 million foreign-born left the US in 2017
to live in another country(voluntary or deported)
Outflow
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“Immigrant”: different definitions in the U.S
Immigrant = foreign-born– Used by Migration Policy Institute, Pew Research Center
Immigrant = legal permanent resident – Used by Department of Homeland Security
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Racial/ethnic minority categories are not a good proxy for international migrant
Source: American Community Survey, 2016
Racial/ethnic minority categories by nativity
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Farmworkers
Individuals working in agriculture Different definitions used by agencies
– Annual average number (US): 1-2 million – Most (78%) are foreign-born
Note: the term “migrant” farmworker frequently refers to those traveling from state to state, following the crops– Only 6% of farmworkers are “migrants” (2016)
Credit: https://www.pinterest.com/pin/765260161653103310
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Data sources on international migrants
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International migrants (or foreign-born): a very diverse population
Includes people of many different:– Countries of birth– Racial/ethnic background– Languages– Religions– Occupations– Reason for migrating– Migration legal status– Health status
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Data sources on international migrantsWho? Where? When? Who?
– All migrants? Certain legal categories (e.g., naturalized citizens, refugees)? Specific country of birth?
– Certain demographics? e.g., females, elderly, construction workers– 2nd generation?
Where?– Living in which country, state, county?
When?– Major differences in migrant cohorts
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Gaps in international migrants’ data
“The data on international migration that countries now collect and publish are so limited that … we are setting migration policies in the dark, … based on anecdotes and emotion”
In general, the quality and availability of data has improved in recent years
Source: Commission on International Migration Data, 2009
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Major gaps in international migrants’ data
Not collecting/reporting migrant identifiers (e.g., country of birth) Some migrant populations excluded from general population
data sources because “harder-to-reach” or access barriers– e.g., unauthorized migrants, recent arrivals, non-English speakers,
refugees, smaller migrant populations Small sample size for some migrant populations Sensitivity of migration-related data
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Migrant data sources are scattered across many organizations and locations
Immigration Data Matters report (2018)– >220 publicly available and most accurate
data resources• 50% US • 50% international
– Extensive but not comprehensive– By Topic, Agency and Region– Data description and access instructions
https://www.migrationpolicy.org/research/immigration-data-matters
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Migrants’ sociodemographics:International data sources
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International Organization for Migration (IOM) Migration Data Portal
70 indicators 20 data sources Trend data Guidance documents Interviews with experts
https://migrationdataportal.org/
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United Nations (UN) Population Divisionhttps://www.un.org/en/development/desa/population/migration/index.asp
Estimates of international migrant stocks (all countries) – National level (including refugees)– By age and sex– By origin and destination
International migrant flows estimates to and from selected countries – Caveat: many limitations
Publications, graphs, data (Excel & databases) Caveat: Definitions, data sources, currency and quality
vary by country and year http://www.un.org/en/development/desa/population/migration/data/index.shtml
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UN High Commissioner for Refugees (UNHCR)http://www.unhcr.org/en-us/resources-and-publications.html
Statistics on refugees and asylum-seekers Publications Database with demographic information
http://popstats.unhcr.org/en/overview
Map Portal http://maps.unhcr.org/en/home
Caveat: UNHCR tracks only the populations it helps and not all humanitarian or climate refugees – For e.g., 4.6 million Palestinian refugees assisted
by other UN agency are not included
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Migrants’ sociodemographics:US data sources
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US Census Bureau: Foreign-born data
http://www.census.gov/topics/population/foreign-born.html
American Community Survey (ACS)Current Population Survey (CPS)
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U.S Census Bureau American Community Survey (ACS)
Purpose: describe sociodemographic and economic characteristics of U.S population
Replaced the Decennial Census Long Form in 2010 Annual representative sample of the U.S resident population
(households and group quarters)– Annual sample size: ~3.5 million households– By mail/online => phone => in-person interview
http://www.census.gov/acs/www/#
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ACS: Strengths
Data collected continuously and available annually Information collected by professional interviewers High response rate: ~98% Data on multiple migration-related variables
– Country of birth, citizenship, year of arrival, language Many sociodemographic variables Health data: health insurance, disability Large sample size provides data on small geographic areas
and populations, including the foreign-born http://www.census.gov/acs/www/#
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ACS: Limitations For small geographies or populations the precision might be
inadequate or data may not be released because of confidentiality rules– 3- and 5-years combined data are average period estimates
Under-coverage for the foreign-born:– Particularly: non-citizens, recent arrivals, temporary residents,
limited-English speakers– Causes: distrust of government, language barriers, being out of
country at time of survey, or because of living in nontraditional households or unofficial dwellings
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Unofficial dwellings and multifamily housing
http://saudigazette.com.sa/article/160017/Stranded-in-the-Gulf-duped-Indian-workers-call-for-helpSource: GAO
http://www.cirsinc.org/
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Accessing U.S Census Bureau data Public Use Microdata Samples (PUMS)
– Subsample of individual people or housing units data (no identifiers)– Only larger geographic areas (state, >500,000 or >100,000 people,
depending on the data set) – US Census Bureau: http://www.census.gov/programs-
surveys/acs/data/pums.html– IPUMS USA: http://usa.ipums.org/usa/
Data Ferrett: http://dataferrett.census.gov/ American FactFinder: http://factfinder2.census.gov/
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American Factfinderhttp://factfinder2.census.gov/
Interactive tool to access to a large number of pre-defined tables with frequently used ACS data variables– Tables can be downloaded to Excel
Does not allow user-defined analysis (e.g., individual-level analysis or cross-tabulations)
Includes a basic mapping tool
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U.S Department of Homeland Securityhttp://www.dhs.gov/files/statistics/immigration.shtm
Statistics on foreigners admitted to the United States in a given year (i.e., inflows) by immigration legal status, age, sex, country of origin, and US state of destination– Legal permanent residents– Refugees and asylees– Temporary residents (e.g., work or study visas)
Estimates of unauthorized immigrants Enforcement actions (apprehensions, deportations) Reports and Excel tables
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Migration Policy Institute http://www.migrationinformation.org/
US and global statistics Migration Data Hub
– https://www.migrationpolicy.org/programs/migration-data-hub– State Immigration Data Profiles (sociodemographics of immigrants
at the state level)– Unauthorized Immigrant Population Profiles (state-level)
Many reports– E.g., profiles of individual immigrant populations in the US
http://www.migrationinformation.org/spotlight-library.cfm
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Migration Policy Institute:Mapping tools for the foreign-born population
By state and county By metropolitan area
http://www.migrationpolicy.org/programs/data-hub/charts/us-immigrant-population-state-and-countyhttp://www.migrationpolicy.org/programs/data-hub/charts/us-immigrant-
population-metropolitan-area?width=1000&height=850&iframe=true
Source: ACS 5-year data
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Pew Research Centerhttp://www.pewresearch.org/topics/immigration/
Many reports – Immigration trends: US and global– Unauthorized immigrants
• http://www.pewresearch.org/topics/unauthorized-immigration
Statistical Portrait of the Foreign-born Population in the United States (Excel)
– http://www.pewhispanic.org/2017/05/03/facts-on-u-s-immigrants-current-data/
Mapping: Origins and Destinations of the World’s Migrants– http://www.pewglobal.org/2018/02/28/global-migrant-stocks/?country=US&date=2017
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Migrant healthInternational data sources
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Migrant health data in Europe
WHO Europe Migrant Health– http://www.euro.who.int/en/healt
h-topics/health-determinants/migration-and-health
European Union ECDC – https://ecdc.europa.eu/en/migrant
-health
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UN High Commissioner for Refugees (UNHCR)http://www.unhcr.org/pages/49c3646cd4.html
Statistical reports on health of refugeesserved by UNHCR– Public Heath and HIV Annual Report– HIV Behavioral Surveillance studies– Malaria Health Information System Bulletin– Nutrition and Food Security
Source: UNHCR
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IOM Missing Migrants Projecthttps://missingmigrants.iom.int/downloads
Tracks incidents involving migrants, including refugees and asylum-seekers, who have died or gone missing in the process of migration towards an international destination
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Migrant health US Data sources
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National population surveys
Survey Migrant-related data NotesNational Health Interview Survey (NHIS)
Country of birthYears living in the USCitizenshipLanguage of the interview
Household surveyTotal n=100,000Foreign-born (n=17% of total)
National Health and Nutrition Examination Survey (NHANES)
Country of birthYears living in the USCitizenshipLanguage of the interview
Household survey + laboratoryTotal n=10,000Foreign-born (n=19% of total)Mexico-born (n=1,843) with 1994-2004 pool data
Behavioral Risk Factor Surveillance System
Language of the interview Phone surveyTotal n=400,000
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National Vital Statistics System http://www.cdc.gov/nchs/nvss/index.htm
Data source Migrant-related data Notes
Natality Data(NCHS)
Parents’ country of birth >99% completeStandard birth certificates
Mortality Data(NCHS)
Country of birth >99% completeStandard death certificates
May be based on observation by recorder
NCHS: National Center for Heath Statistics
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Access to national surveys and vital statistics data
Public Data– Caveat: likely not to include migrant-related indicators– E.g., for NCHS surveys and vital statistics:
https://www.cdc.gov/rdc/b1datatype/dt111.htm
Non-Public or Restricted Data– E.g., for NCHS surveys and vital statistics:
https://www.cdc.gov/rdc/b1datatype/dt122.htm
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Restricted data in national data sources National health surveys restrict access to some data because:
– Sensitive by nature• e.g., country of birth, citizenship, detailed race/ethnicity, geography
– Could compromise the confidentiality of the survey or precision of estimates
• Small sample size or geographic areas, or combination of variables
A special research proposal and process is required to access these data (http://www.cdc.gov/rdc/index.htm)
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CDC National Notifiable Diseases Surveillance System (~100 infectious diseases)
In 2014: Country of birth added for collection for all notifiable diseases! Currently being launched. But … different priority for programs
Prior to 2014: country of birth collected for a few diseases – E.g., HIV, TB, hepatitis, Hansen’s Disease
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Other data sources
Data source Migrant-related data
Notes
Occupational Health Surveillance Systems Underreporting of migrant workersNational Census of Fatal Occupational Injuries Country of birth
Workplace Injuries and Illnesses NonePesticides surveillance (SENSOR) None
Cancer registries Country of birth High % of missingdata. Varies by patient characteristics
Hospital and community clinic data systems Language
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Linked data sources
Link information on same individual from two different data sources
Allow use of richer use of migration-related and other variables from each data source
Example:– National Longitudinal Mortality Study, links CPS with mortality and
cancer registry data – https://www.cdc.gov/nchs/data-linkage/index.htm
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https://www.healthypeople.gov/2020/data-search/Search-the-Data#hdisp=1;
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CDC WONDER
WONDER online databases utilize a rich ad-hoc query system for the analysis of public health data.
Reports and other query systems are also available
https://wonder.cdc.gov/
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CDC Wonder: Migrant-related dataData system Migrant-related variables
Births Mother’s detailed country of birthAIDS Public Use Data (1981-2002) Country of birth (US vs. Foreign-born)Tuberculosis (1993-2017) Origin of birth (US vs. Foreign-born)
Years in the USRevised Occupation (Migratory Agricultural)
Mortality DataInfant DeathsFetal DeathsCancer StatisticsSexually Transmitted Disease MorbidityNNDSS Data Tables
None
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Data on farmworkersNational Agricultural Workers Surveyhttp://www.doleta.gov/agworker/naws.cfm
Employment-based, random-sample annual survey of U.S. crop workers (since 1989)– Face-to-face interviews (English/Spanish)– N=1,500/year
Data collected:– Demographics, employment, migration– Health and occupational safety
Data publicly available
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Conclusions
Many different sources of data on international migrants Availability of information varies by data system
– Some key data systems have no or limited migrant data Quality and representativeness of data vary by system
– Undercoverage of most vulnerable migrants In general, the availability and quality of data has improved
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Conclusions (Cont.)
There is an urgent need for data on health risks and outcomes associated with migration and effective interventions– Especially for specific migrant populations defined by country
of birth, legal status, and other factors Importance of data protection and avoiding community
stigmatization Highlight positive indicators for migrants Guard against the temptation to avoid, limit, or delay data
collection on migrants because of its sensitivity
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For more information, contact CDC1-800-CDC-INFO (232-4636)TTY: 1-888-232-6348 www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
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Extra slides
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National Center for Emerging and Zoonotic Infectious Diseases
CALIFORNIA HEALTH INTERVIEW SURVEY
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California Health Interview Survey (CHIS)
Statewide telephone survey Coordinated by UCLA Center for Health Policy Research Started in 2001 Annual data release
http://chis.ucla.edu/
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CHIS and migrant health:Sample sizes
Total sample size: ~110,000 individuals (~50,000 households) Data for state and county-level (and below), major
race/ethnicity groups and countries or regions of birth– Oversample some Asian groups (e.g., Vietnamese and Korean)
~25% of adult sample is foreign-born (~10,000 participants)
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CHIS and migrant health:Linguistic and cultural validity
Validated questionnaires in 7 languages: – English, Spanish, Chinese (Mandarin and Cantonese
dialects), Vietnamese, Korean, and Tagalog
Multilingual interviewers
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CHIS and migrant health:Migration-related variables
Country of birth Citizenship (U.S-born citizen, naturalized citizen, non-citizen) Years lived in United States Language spoken at home English-speaking ability Parents’ country of birth* Parents’ citizenship* Parents’ years lived in United States*
*Only for children & adolescents
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CHIS and migrant health:Limitations
Household response rate: 29.5% (2005)– However, phone survey data has been validated with
household survey, confirming the quality and representativeness of the data
Landline phone-based: Many migrants don’t have one– Recently added cell-phone component
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Accessing CHIS data
http://healthpolicy.ucla.edu/chis/data/Pages/GetCHISData.aspx
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CHIS interactive web-based data access tools
http://healthpolicy.ucla.edu/Pages/AskCHIS.aspx
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AskCHIS free training modules
AskCHIS On-Demand Learning Center (~18 minutes)– http://healthpolicy.ucla.ed
u/chis/Pages/CHISTraining.aspx