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

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

Who are international migrants?

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

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

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

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

Some clarifications on terminology

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)

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

“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

Racial/ethnic minority categories are not a good proxy for international migrant

Source: American Community Survey, 2016

Racial/ethnic minority categories by nativity

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

Data sources on international migrants

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

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

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

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

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

Migrants’ sociodemographics:International data sources

International Organization for Migration (IOM) Migration Data Portal

70 indicators 20 data sources Trend data Guidance documents Interviews with experts

https://migrationdataportal.org/

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

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

Migrants’ sociodemographics:US data sources

US Census Bureau: Foreign-born data

http://www.census.gov/topics/population/foreign-born.html

American Community Survey (ACS)Current Population Survey (CPS)

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/#

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/#

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

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/

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/

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

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

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

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

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

Migrant healthInternational data sources

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

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

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

Migrant health US Data sources

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

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

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

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)

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

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

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

https://www.healthypeople.gov/2020/data-search/Search-the-Data#hdisp=1;

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/

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

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

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

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

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.

Extra slides

National Center for Emerging and Zoonotic Infectious Diseases

CALIFORNIA HEALTH INTERVIEW SURVEY

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/

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)

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

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

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

Accessing CHIS data

http://healthpolicy.ucla.edu/chis/data/Pages/GetCHISData.aspx

CHIS interactive web-based data access tools

http://healthpolicy.ucla.edu/Pages/AskCHIS.aspx

AskCHIS free training modules

AskCHIS On-Demand Learning Center (~18 minutes)– http://healthpolicy.ucla.ed

u/chis/Pages/CHISTraining.aspx