Lung cancer incidence differences in migrant men in Belgium, 2004-2013: histology-specific analyses.

BACKGROUND: Immigrants make up an important share of European populations which has led to a growing interest in research on migrants' health. Many studies have assessed migrants' cancer mortality patterns, yet few have studied incidence differences. This paper will probe into histology-specific lung cancer incidence by migrant origin aiming to enhance the knowledge on lung cancer aetiology and different risk patterns among population groups. METHODS: We used data on all lung cancer diagnoses during 2004-2013 delivered by the Belgian Cancer Registry individually linked with the 2001 Belgian Census and the Crossroads Bank for Social Security. Absolute and relative inequalities in overall and histology-specific lung cancer incidence have been calculated for first-generation Italian, Turkish and Moroccan migrant men aged 50-74 years compared to native Belgian men. RESULTS: Moroccan men seemed to be the most advantaged group. Both in absolute and relative terms they consistently had lower overall and histology-specific lung cancer incidence rates compared with native Belgian men, albeit less clear for adenocarcinoma. Turkish men only showed lower overall lung cancer incidence when adjusting for education. On the contrary, Italian men had higher incidence for overall lung cancer and squamous cell carcinoma, which was explained by adjusting for education. CONCLUSIONS: Smoking habits are likely to explain the results for Moroccan men who had lower incidence for smoking-related histologies. The full aetiology for adenocarcinoma is still unknown, yet the higher incidence among Italian men could point to differences in occupational exposures, e.g. to carcinogenic radon while working in the mines.

Are we really all in this together? The social patterning of mortality during the first wave of the COVID-19 pandemic in Belgium.

BACKGROUND: Belgium was one of the countries that was struck hard by COVID-19. Initially, the belief was that we were 'all in it together'. Emerging evidence showed however that deprived socioeconomic groups suffered disproportionally. Yet, few studies are available for Belgium. The main question addressed in this paper is whether excess mortality during the first COVID-19 wave followed a social gradient and whether the classic mortality gradient was reproduced. METHODS: We used nationwide individually linked data from the Belgian National Register and the Census 2011. Age-standardized all-cause mortality rates were calculated during the first COVID-19 wave in weeks 11-20 in 2020 and compared with the rates during weeks 11-20 in 2015-2019 to calculate absolute and relative excess mortality by socioeconomic and -demographic characteristics. For both periods, relative inequalities in total mortality between socioeconomic and -demographic groups were calculated using Poisson regression. Analyses were stratified by age, gender and care home residence. RESULTS: Excess mortality during the first COVID-19 wave was high in collective households, with care homes hit extremely hard by the pandemic. The social patterning of excess mortality was rather inconsistent and deviated from the usual gradient, mainly through higher mortality excesses among higher socioeconomic groups classes in specific age-sex groups. Overall, the first COVID-19 wave did not change the social patterning of mortality, however. Differences in relative inequalities between both periods were generally small and insignificant, except by household living arrangement. CONCLUSION: The social patterning during the first COVID-19 wave was exceptional as excess mortality did not follow the classic lines of higher mortality in lower classes and patterns were not always consistent. Relative mortality inequalities did not change substantially during the first COVID-19 wave compared to the reference period.

Migrant mortality differences in the 2000s in Belgium: interaction with gender and the role of socioeconomic position.

BACKGROUND: Belgium has a long history of migration. As the migrant population is ageing, it is crucial thoroughly to document their health. Many studies that have assessed this, observed a migrant mortality advantage. This study will extend the knowledge by probing into the interaction between migrant mortality and gender, and to assess the role of socioeconomic position indicators in this paradox. METHODS: Individually linked data of the 2001 Belgian Census, the National Register and death certificates for 2001-2011 were used. Migrant origin was based on both own and parents' origin roots. We included native Belgians and migrants from the largest migrant groups aged 25 to 65 years. Absolute and relative mortality differences by migrant origin were calculated for the most common causes of death. Moreover, the Poisson models were adjusted for educational attainment, home ownership and employment status. RESULTS: We observed a migrant mortality advantage for most causes of death and migrant groups, which was strongest among men. Adjusting for socioeconomic position generally increased the migrant mortality advantage, however with large differences by gender, migrant origin, socioeconomic position indicator and causes of death. CONCLUSIONS: Adjusting for socioeconomic position even accentuated the migrant mortality advantage although the impact varied by causes of death, migrant origin and gender. This highlights the importance of including multiple socioeconomic position indicators when studying mortality inequalities. Future studies should unravel morbidity patterns too since lower mortality not necessarily implies better health. The observed migrant mortality advantage suggests there is room for improvement. However, it is essential to organize preventative and curative healthcare that is equally accessible across social and cultural strata.

Trends in Belgian cause-specific mortality by migrant origin between the 1990s and the 2000s.

BACKGROUND: Belgium has a large migrant community that is increasingly ageing. As migrants may have faced environmental and social exposures before, during and after migration, they may have experienced an accelerated epidemiological transition. Studying mortality differentials between the migrant and native population may therefore allow for a better understanding of the aetiology of diseases. While many studies have assessed migrant mortality, few have looked into the role of gender or the trend over time. Therefore, this study aims to probe into mortality differences between the native and migrant population for all major causes of death (COD) during the 1990s and 2000s. We will discriminate between all major migrant groups and men and women as they have different migration histories. METHODS: Individually linked data of the Belgian Census, the National Register and death certificates for the periods 1991-1997 and 2001-2008 were used. Migrant origin was based on both own and parents' origin, hereby maximizing the population with migrant roots. We included native Belgians and migrants from the largest migrant groups aged 25 to 65 years. Both absolute and relative mortality differences by migrant origin were calculated for the most common COD. RESULTS: We generally observed a migrant advantage for overall, cause-specific and cancer-specific mortality, with infection-related cancer mortality being the only exception. The effect was particularly strong for lifestyle-related COD, non-western migrants, and men. Over time, mortality declined among native Belgian men and women, yet remained stable for several migrant groups. This converging trend was largely due to smoking and reduced reproductive behaviour among migrants. CONCLUSIONS: The migrant mortality advantage stresses that there is room for improvement in the area of health in Belgium. Since the largest differences between native Belgians and migrants were observed for lifestyle-related diseases, and there is a tendency towards convergence of mortality over time, primary prevention tackling the most vulnerable groups remains crucial. Moreover, efforts should be made to ensure equal access to health care among the social and cultural strata.

Socioeconomic position, population density and site-specific cancer mortality: A multilevel analysis of Belgian adults, 2001-2011.

Our study explores the association between individual and neighborhood socioeconomic position (SEP) and all-cancer and site-specific cancer mortality. Data on all Belgian residents are retrieved from a population-based dataset constructed from the 2001 census linked to register data on emigration and mortality for 2001-2011. The study population contains all men and women aged 40 years or older during follow-up. Individual SEP is measured using education, employment status and housing conditions. Neighborhood SEP is measured by a deprivation index (in quintiles). Directly age-standardized mortality rates and multilevel Poisson models are used to estimate the association between individual SEP and neighborhood deprivation and mortality from all-cancer and cancer of the lung, colon and rectum, pancreas, prostate and female breast. The potential confounding role of population density is assessed using multilevel models as well. Our findings show an increase in mortality from all-cancer and site-specific cancer by decreasing level of individual SEP for both men and women. In addition, individuals living in highly deprived neighborhoods experience significantly higher mortality from all-cancer, lung cancer, pancreatic cancer and female colorectal cancer after controlling for individual SEP. Male colorectal and prostate cancer and female breast cancer are not associated with neighborhood deprivation. Population density acts as a confounder for female lung cancer only. Our study indicates that deprivation at both the individual and neighborhood level is associated with all-cancer mortality and mortality from several cancer sites. More research into the role of life-style related and clinical factors is necessary to gain more insight into causal pathway.

Evolution of socioeconomic inequalities in site-specific cancer mortality among Belgian women between 1991 and 2008 using a fundamental cause approach.

PURPOSE: According to the "fundamental cause theory", emerging knowledge on health-enhancing behaviours and technologies results in persisting and even widening health disparities, favouring the higher socioeconomic groups. This study aims to assess (trends in) socioeconomic inequalities in site-specific cancer mortality in Belgian women. METHODS: Data were derived from record linkage between the Belgian census and register data on mortality for 1991-1997 and 2001-2008 for all Belgian female inhabitants aged 50-79 years. Both absolute and relative inequalities by education and housing conditions were calculated. RESULTS: The results revealed persisting socioeconomic inequalities in total and site-specific cancer mortality. As expected, these inequalities were larger for the more preventable cancer sites. Generally, socioeconomic inequalities remained quite stable between the 1990s and the 2000s, although for some preventable cancer sites (e.g., uterus and oesophagus) a significant increase in inequality was observed. CONCLUSIONS: These persisting socioeconomic inequalities are likely due to differences in exposure to risk factors and unhealthy behaviours, and access and utilization of healthcare across the social strata. Since equality in health should be a priority for a fair public health policy, efforts to reduce inequalities in risk behaviours and access and use of health care should remain high on the agenda.

Evolution of educational inequalities in site-specific cancer mortality among Belgian men between the 1990s and 2000s using a "fundamental cause" perspective.

BACKGROUND: According to the "fundamental cause" theory, emerging knowledge on health-enhancing behaviours and technologies results in health disparities. This study aims to assess (trends in) educational inequalities in site-specific cancer mortality in Belgian men in the 1990s and the 2000s using this framework. METHODS: Data were derived from record linkage between the Belgian censuses of 1991 and 2001 and register data on mortality. The study population comprised all Belgian men aged 50-79 years during follow-up. Both absolute and relative inequality measures have been calculated. RESULTS: Despite an overall downward trend in cancer mortality, educational differences are observed for the majority of cancer sites in the 2000s. Generally, inequalities are largest for mortality from preventable cancers. Trends over time in inequalities are rather stable compared with the 1990s. CONCLUSIONS: Educational differences in site-specific cancer mortality persist in the 2000s in Belgium, mainly for cancers related to behavioural change and medical interventions. Policy efforts focussing on behavioural change and healthcare utilization remain crucial in order to tackle these increasing inequalities.

Trends in site- and sex-specific cancer mortality between 1979 and 2010 in Belgium compared with Europe using WHO data.

BACKGROUND: Cancer mortality constitutes a major health burden in Europe. Trends are different for men and women, and across Europe. This study aims to map out Belgian cancer mortality trends for the most common cancer types in both sexes between 1979 and 2010, and to link these with trends in cancer mortality and smoking prevalence across Europe. METHODS: Mortality and population data were obtained from the World Health Organization Mortality Database. Age-standardized mortality rates were calculated by direct standardization using the European Standard Population. RESULTS: Belgian mortality decreased for the most common cancer sites between 1979 and 2010, except for female lung cancer. Yet, Belgian male lung and female breast cancer rates remain high compared with the remainder of Western Europe. For some cancer sites, mortality trends are similar among the European Regions (e.g. stomach cancer), yet for others trends are divergent (e.g. colorectal cancer). CONCLUSIONS: Generally, cancer mortality shows a favorable trend in Belgium and Europe. Yet, female lung cancer mortality rates are increasing in Belgium. Furthermore, Belgium still has higher male lung and female breast cancer mortality rates compared with the European regional averages. Considering this and the current smoking prevalence, enduring tobacco control efforts should be made.

Socioeconomic disparities in lung cancer mortality in Belgian men and women (2001-2011): does it matter who you live with?

BACKGROUND: Ample studies have observed an adverse association between individual socioeconomic position (SEP) and lung cancer mortality. Moreover, the presence of a partner has shown to be a crucial determinant of health. Yet, few studies have assessed whether partner's SEP affects health in addition to individual SEP. This paper will study whether own SEP (education), partner's SEP (partner's education) and own and partner's SEP combined (housing conditions), are associated with lung cancer mortality in Belgium. METHODS: Data consist of the Belgian 2001 census linked to register data on cause-specific mortality for 2001-2011. The study population includes all married or cohabiting Belgian inhabitants aged 40-84 years. Age-standardized lung cancer mortality rates (direct standardization) and mortality rate ratios (Poisson regression) were computed for the different SEP groups. RESULTS: In men, we observed a clear inverse association between all SEP indicators (own and partner's education, and housing conditions) and lung cancer mortality. Men benefit from having a higher educated partner in terms of lower lung cancer mortality rates. These observations hold for both middle-aged and older men. For women, the picture is less uniform. In middle-aged and older women, housing conditions is inversely associated with lung cancer mortality. As for partner's education, for middle-aged women, the association is rather weak whereas for older women, there is no such association. Whereas the educational level of middle-aged women is inversely associated with lung cancer mortality, in older women this association disappears in the fully adjusted model. CONCLUSIONS: Both men and women benefit from being in a relationship with a high-educated partner. It seems that for men, the educational level of their partner is of great importance while for women the housing conditions is more substantial. Both research and policy interventions should allow for the family level as well.

Falls among older general practice patients: a 2-year nationwide surveillance study.

BACKGROUND: Falling among older persons is a multifactorial health condition needing multifactorial care. Several targeted preventive interventions and their coordination are considered to be general practitioner (GP)-specific tasks. OBJECTIVES: To estimate the incidence of falls among older non-institutionalized general practice patients in Belgium (2009-10) and to describe the main characteristics of falls, fallers and fall risks; factors associated with multiple fall risks and the co-occurrence of fall risks; patient status 3 months later and care delivery. METHODS: A 2-year nationwide cross-sectional study based on data collected by the Belgian network of Sentinel General Practices on all non-institutionalized persons aged ≥65 years consulting their GP for new fall-related injuries. RESULTS: Baseline data were collected on 1503 persons and valid follow-up data were available on 715 persons (79%). The yearly incidence of older persons with fall-related injuries was estimated at 2.5% of the older general practice population; 39% of patients had also received hospital care, physician-specialist or nursing home care. A multifactorial risk profile was observed in 59% and associated with increasing age, recurrent falling, falling at home and during lower level activity. The clustering of frailty-specific fall risks was higher than expected by chance. At follow-up, 46% of at-risk patients had received physical therapy, 47% were using assistive devices, and medication had been reviewed in 28% of patients taking psychopharmacy and 17% of patients with polypharmacy. CONCLUSIONS: Our study shows a high burden of care for fall-related injuries in older general practice patients and provides baseline data for its future monitoring.

Availability of informal caregivers in surviving stroke patients in Belgium.

OBJECTIVE: To quantify the availability of informal caregivers in surviving stroke patients residing at home in Belgium. METHODS: National estimates on the availability of informal caregivers were made using data from a nationwide observational registration of family physicians working in sentinel practices and a nationwide administrative database for reimbursement of hospitals in Belgium. RESULTS: A total of 189 Belgian family physicians (FPs) from 141 practices participated in the study and recorded 326 patients (144 men and 182 women) with stroke. These FPs reach 1.5% of the Belgian population. After 1 month, 71% of the male and 75% of the female stroke survivors received support from family caregivers (p = 0.547). After 6 months, the percentage of male patients who received support from family caregivers decreased to 60% compared with 75% in female (p = 0.038). Of all patients with stroke admitted to Belgian hospitals during the reference year 2009 (n = 16.437), 8.997 returned home. Based on the findings from the sentinel practices, it is estimated that a mean of 73% (n = 6.568) and 67.5% (n = 6.073) of surviving patients with stroke can rely on informal caregivers in their home setting after one and 6 months, respectively. CONCLUSIONS: A vast majority of surviving stroke patients in Belgium can rely on informal caregivers in their home setting, but their availability rapidly decreases 6 months after the event. These findings underline the importance of proactive health policy making in stroke care taking into account the potentially decreasing number of available informal caregivers in the decades to come.

Correction: Evaluating the health and health economic impact of the COVID-19 pandemic on delayed cancer care in Belgium: A Markov model study protocol.

[This corrects the article DOI: 10.1371/journal.pone.0288777.].

Evaluating the health and health economic impact of the COVID-19 pandemic on delayed cancer care in Belgium: A Markov model study protocol.

INTRODUCTION: Cancer causes a substantial burden to our society, both from a health and an economic perspective. To improve cancer patient outcomes and lower society expenses, early diagnosis and timely treatment are essential. The recent COVID-19 crisis has disrupted the care trajectory of cancer patients, which may affect their prognosis in a potentially negative way. The purpose of this paper is to present a flexible decision-analytic Markov model methodology allowing the evaluation of the impact of delayed cancer care caused by the COVID-19 pandemic in Belgium which can be used by researchers to respond to diverse research questions in a variety of disruptive events, contexts and settings. METHODS: A decision-analytic Markov model was developed for 4 selected cancer types (i.e. breast, colorectal, lung, and head and neck), comparing the estimated costs and quality-adjusted life year losses between the pre-COVID-19 situation and the COVID-19 pandemic in Belgium. Input parameters were derived from published studies (transition probabilities, utilities and indirect costs) and administrative databases (epidemiological data and direct medical costs). One-way and probabilistic sensitivity analyses are proposed to consider uncertainty in the input parameters and to assess the robustness of the model's results. Scenario analyses are suggested to evaluate methodological and structural assumptions. DISCUSSION: The results that such decision-analytic Markov model can provide are of interest to decision makers because they help them to effectively allocate resources to improve the health outcomes of cancer patients and to reduce the costs of care for both patients and healthcare systems. Our study provides insights into methodological aspects of conducting a health economic evaluation of cancer care and COVID-19 including insights on cancer type selection, the elaboration of a Markov model, data inputs and analysis.

Correction: Evaluating the health and health economic impact of the COVID-19 pandemic on delayed cancer care in Belgium: A Markov model study protocol.

[This corrects the article DOI: 10.1371/journal.pone.0288777.].

Social inequalities and long-term health impact of COVID-19 in Belgium: protocol of the HELICON population data linkage.

INTRODUCTION: Data linkage systems have proven to be a powerful tool in support of combating and managing the COVID-19 pandemic. However, the interoperability and the reuse of different data sources may pose a number of technical, administrative and data security challenges. METHODS AND ANALYSIS: This protocol aims to provide a case study for linking highly sensitive individual-level information. We describe the data linkages between health surveillance records and administrative data sources necessary to investigate social health inequalities and the long-term health impact of COVID-19 in Belgium. Data at the national institute for public health, Statistics Belgium and InterMutualistic Agency are used to develop a representative case-cohort study of 1.2 million randomly selected Belgians and 4.5 million Belgians with a confirmed COVID-19 diagnosis (PCR or antigen test), of which 108 211 are COVID-19 hospitalised patients (PCR or antigen test). Yearly updates are scheduled over a period of 4 years. The data set covers inpandemic and postpandemic health information between July 2020 and January 2026, as well as sociodemographic characteristics, socioeconomic indicators, healthcare use and related costs. Two main research questions will be addressed. First, can we identify socioeconomic and sociodemographic risk factors in COVID-19 testing, infection, hospitalisations and mortality? Second, what is the medium-term and long-term health impact of COVID-19 infections and hospitalisations? More specific objectives are (2a) To compare healthcare expenditure during and after a COVID-19 infection or hospitalisation; (2b) To investigate long-term health complications or premature mortality after a COVID-19 infection or hospitalisation; and (2c) To validate the administrative COVID-19 reimbursement nomenclature. The analysis plan includes the calculation of absolute and relative risks using survival analysis methods. ETHICS AND DISSEMINATION: This study involves human participants and was approved by Ghent University hospital ethics committee: reference B.U.N. 1432020000371 and the Belgian Information Security Committee: reference Beraadslaging nr. 22/014 van 11 January 2022, available via https://www.ehealth.fgov.be/ehealthplatform/file/view/AX54CWc4Fbc33iE1rY5a?filename=22-014-n034-HELICON-project.pdf. Dissemination activities include peer-reviewed publications, a webinar series and a project website.The pseudonymised data are derived from administrative and health sources. Acquiring informed consent would require extra information on the subjects. The research team is prohibited from gaining additional knowledge on the study subjects by the Belgian Information Security Committee's interpretation of the Belgian privacy framework.

Incidence, patient characteristics and treatment initiated for GP-diagnosed depression in general practice: results of a 1-year nationwide surveillance study.

BACKGROUND: Despite its public health significance, data about depression in general practice are often unavailable. OBJECTIVE: To study (i) the incidence of GP-diagnosed depression during 2008, (ii) associations between patient characteristics, appraised severity and initiated treatment, (iii) GPs' usual care compared to diagnostic criteria from Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition guidelines and the newly developed practice guideline of the Society of Flemish GPs (2008) and (iv) GPs' initiated treatments compared to the Flemish Guideline. METHODS: General practice-based data were collected on all patients of ≥18 years who were diagnosed by their GP with a new episode of depression in Belgian sentinel general practices (SGP) during 2008. RESULTS: Data on 1739 persons were recorded by 172 sentinel general practices. Incidence rates for GP-diagnosed depression were estimated at 719/100 000 men and 1440/100 000 women. Thirty-one per cent of patients had mild, 50% had moderate and 19% had severe GP-diagnosed depression. Although only 43% of the patients at risk for suicide were considered to have severe depression, having thoughts of death or suicide was the main factor associated with increased severity of depression. Seventy-five per cent of patients received a prescription for an antidepressive agent; 29% received a prescription for another psychoactive agent; in 36%, non-pharmaceutical support was initiated by the GP and 25% received a referral. In contrast with the Flemish GP guideline criteria: (i) 69% of patients with a new episode of mild or a first episode of moderate depression were prescribed an antidepressive agent and (ii) only 39% of the patients with severe depression were both prescribed an antidepressive agent and referred to a mental health service. CONCLUSIONS: This study has yielded original data on the incidence and management of depression in Belgian general practice. Our findings show that efforts are needed to improve depression management in Belgian general practice.

Short-term follow-up of patients diagnosed by their GP with mild depression or first-time moderate depression. Results of a 1-year nationwide surveillance study.

BACKGROUND: Despite its public health significance, data about depression in general practice are often unavailable or incomplete. OBJECTIVE: To study half-year follow-up data on patients diagnosed by their GP with a new episode of mild or a first episode of moderate depression, specifically: (i) treatment continuation, (ii) remission and, in ongoing episodes, suicidal behaviour and inability to work and (iii) the match between treatments initiated and delivered as well as the determinants of actual delivery of non-pharmacological support initiated by the GP for patients with ongoing depression. METHODS: General practice-based data were collected on all patients aged ≥18 years who were diagnosed by their GP with a new episode of depression in Belgian sentinel general practices during 2008. RESULTS: Follow-up data were available for 900 of 1048 patients. Complete treatment dropout was found in 9%, treatment discontinuation in 40% and a GP visit ≤8 weeks preceding the follow-up in 51%. Of the latter 457 patients, 60% were still depressed. Among these, one suicide attempt was reported and 24% were unable to work for ≥1 month. While 91% of the patients who received psychoactive agents at diagnosis had actually taken them, and 62% of the referred patients actually received treatment from another caregiver, non-pharmacological support by the GP was delivered in only 43% of patients for whom it was initiated. CONCLUSIONS: Half a year after diagnosis, half of patients continue to visit their GP and 60% of those patients remain depressed. The delivery of non-pharmacological GP support takes place for less than half of the patients for whom that intervention is initiated. Our follow-up findings reinforce the policy recommendations made by stakeholders, i.e. the introduction and reimbursement of a mental health consultation in family practice and integration of primary care psychologists. Quality improvement interventions may be a strategy to overcome premature discontinuation of non-pharmacological support by GPs.

Colorectal cancer incidence and survival inequalities among labour immigrants in Belgium during 2004-2013.

Colorectal cancer (CRC) is one of the leading causes of cancer-related morbidity and mortality. We aim to map out differences in CRC incidence and survival between first-generation traditional labour immigrants of Italian, Turkish and Moroccan descent and native Belgians; and assess the contribution of socioeconomic position (SEP) to these differences. Individually-linked data of the 2001 Belgian Census, the Crossroads Bank for Social Security and the Belgian Cancer Registry are used. Age-standardized incidence rates and incidence rate ratios are calculated by country of origin, with and without adjusting for SEP. For CRC patients, 5-year relative survival rates and the relative excess risk for dying within five years after diagnosis are calculated by migrant origin. Lower CRC incidence was observed among immigrants compared to native Belgians, in particular among non-Western immigrants, which could not be explained by SEP. Survival inequalities were less clear, yet, after adjusting for age and stage at diagnosis and educational attainment, we observed a survival advantage among Turkish and Italian immigrant men. Health gains can be made for the native population by adapting lifestyle. The later stage at diagnosis for immigrants is of concern. Barriers regarding screening as perceived by the vulnerable groups should be identified.

Factors Associated with Return Migration of First-Generation Immigrants in Belgium (2001-2011).

Belgium is a country with a long and diverse history of migration. Given the diverse context of immigration to Belgium, reasons for return migration will most likely vary as well. With this study, we want to quantify the return migration of Belgium's immigrants and assess whether socio-economic, sociodemographic and health factors are related to return migration. Individually linked census and register data comprising the total Belgian first-generation immigrant population aged 25+ were used. Age-standardized emigration rates (ASER) by migrant origin and gender were calculated for the period 2001-2011. Additionally, relative return migration differences were calculated by country of origin and gender, adjusted for age group, length of stay, household composition, socio-economic indicators (education, home ownership and employment status) and self-rated health in 2001. Return migration was most common among immigrants from Spanish descent and from the neighbouring countries and higher among men than among women. Return migration was highly selective in terms of older age, lower length of stay in Belgium, not living with a partner or children, being high-educated, unemployed and in good health. Key issues for future research include examining the reasons for return migration, identifying the country of destination and accounting for household characteristics.

A population-based study on mortality among Belgian immigrants during the first COVID-19 wave in Belgium. Can demographic and socioeconomic indicators explain differential mortality?

INTRODUCTION: Belgium has noted a significant excess mortality during the first COVID-19 wave. Research in other countries has shown that people with migrant origin are disproportionally affected. Belgium has an ethnically diverse and increasingly ageing population and is therefore particularly apt to study differential mortality by migrant group during this first wave of COVID-19. DATA AND METHODS: We used nationwide individually-linked data from the Belgian National Register providing sociodemographic indicators and mortality; and the administrative census of 2011 providing indicators of socioeconomic position. Age-standardized all-cause mortality rates (ASMRs) were calculated during the first COVID-19 wave (weeks 11-20 in 2020) and compared with ASMRs during weeks 11-20 in 2019 to calculate excess mortality by migrant origin, age and gender. For both years, relative inequalities were calculated by migrant group using Poisson regression, with and without adjustment for sociodemographic and socioeconomic indicators. RESULTS: Among the middle-aged, ASMRs revealed increased mortality in all origin groups, with significant excess mortality for Belgians and Sub-Saharan African men. At old age, excess mortality up to 60% was observed for all groups. In relative terms, most male elderly migrant groups showed higher mortality than natives, as opposed to 2019 and to women. Adding the control variables decreased this excess mortality. DISCUSSION: This study underlined important inequalities in overall and excess mortality in specific migrant communities, especially in men. Tailor-made policy measures and communication strategies should be set-up taking into account the particular risks to which groups are exposed.