The ambiguous socioeconomic gradient in immigrants’ health

The empirical evidence on pervasive and persistent socioeconomic inequalities in health is exhaustive. Existing studies, mostly from outside Sweden, have shown rather unexpected weak associations between health outcomes and education, social class or income-based measures among immigrants. Yet the extent to which these flattened social gradients in health are related to the frequently observed “healthy migrant paradox”, whereby immigrants show health advantages upon arrival in settlement, remains unclear. Although this health advantage has been shown to diminish with increasing duration of residence, there is a paucity of research about the adjacent development of immigrants’ health inequalities, and the extent to which socioeconomically determined health inequalities may alter by migration background characteristics (i.e., country of origin, duration of residence, age at arrival).

This project aims to address these gaps by exploring how the health gradient in immigrant health is shaped by the presence or absence of a health advantage. Researchers will investigate how income-related inequalities in health and mortality develop over the course of immigrants’ settlement in Sweden.

The use of high-quality Swedish register data allows the research team to account for heterogeneity of migration background characteristics, in terms of origin, reason for migration, age at arrival, and duration of residence, and thus help to understand the mechanisms that mitigate or fuel health inequalities in this growing Swedish population group.

Project members

• Alexander Miething, Principal Investigator
• Andrea Dunlavy

1. Miething, A., Dunlavy, A., & Juárez, S. P. (2025). Income inequalities and mortality by generation among individuals with a foreign background in Sweden: A population-based study. The Lancet Regional Health- Europe, 55, 101344.
2. Syriopoulou, E., Osterman, E., Miething, A., Nordenvall, C., & Andersson, T. M. L. (2024). Income disparities in loss in life expectancy after colon and rectal cancers: a Swedish register-based study. Journal of Epidemiology and Community Health, 78(6), 402-408.
3. Miething, A., & Juárez, S. P. (2023). Income mortality paradox by immigrants’ duration of residence in Sweden: A population register-based study. Journal of Epidemiology and Community Health, 78(1), 11-17.
4. Östergren, O., Rehnberg, J., Lundberg, O., & Miething, A. (2023). Disruption and selection: The income gradient in mortality among natives and migrants in Sweden. European Journal of Public Health, 33(3), 372-377.
5. Almquist, Y.B., Miething, A. (2022). The impact of an unemployment insurance reform on incidence rates of hospitalisation due to alcohol-related disorders: a quasi-experimental study of heterogeneous effects across ethnic background, educational level, employment status, and sex in Sweden. BMC Public Health, 22, 1847.