Gender patterns in immigrants' health profiles in France: Tobacco, alcohol, obesity and self-reported health (2020)

Background: to date, little attention has been given to gender differences in the health of migrants relative to native-born. In this study, we examine the health profile of the largest immigrant groups in metropolitan France, considering several health indicators and with a special interest in the gendered patterns.
Methods: The data originate from the 2017 Health Barometer survey representative of metropolitan France. A subsample of 19,857 individuals aged 18-70 years was analysed using modified Poisson regression, and risk ratio estimates (RR) were provided for the different migrant groups regarding alcohol use, current smoking, obesity and less-than-good self-reported health, adjusting for age and educational level.
Results: None of the groups of male migrants differs from the native-born in terms of self-reported health, and they have healthier behaviours for alcohol (men from sub-Saharan Africa: 0.42 (0.29-0.61)) and from the Maghreb: 0.30 (0.1-0.54)) and smoking (men from sub-Saharan Africa: 0.64 (0.4-0.84)), with less frequent obesity (men from the Maghreb: 0.61 (0.3-0.95)). The latter, however, more frequently report current smoking (1.21 (1.0-1.46)). For women, less-than-good health is more frequently reported by the groups from sub-Saharan Africa (1.42 (1.1-1.75)) and from the Maghreb (1.55 (1.3-1.84)). Healthier behaviours were found for alcohol (women from overseas départements: 0.38 (0.1-0.85)) and from the Maghreb: (0.18 (0.0-0.57)) and current smoking (women from southern Europe: 0.68 (0.4-0.97), from sub-Saharan Africa: 0.23 (0.1-0.38) and from the Maghreb: 0.42 (0.2-0.61)). Conversely, some were more frequently obese (women from overseas départements: 1.79 (1.2-2.56) and from sub-Saharan Africa: 1.67 (1.2-2.23)). In the latter two groups from Africa, there is a larger relative male excess for tobacco than in the native-born (male-to-female ratios of respectively 2.87 (1.6-5.09) and 3.1 (2.0-4.65) vs 1.13 (1.0-1.20)) and there is a female excess for obesity (0.51 (0.2-0.89) and 0.41 (0.2-0.67)) in contrast with the native-born (1.07 (0.9-1.16)). The female disadvantage in terms of less-than-good self-reported health is more pronounced among migrants from the Maghreb than among the natives (0.56(0.4-0.46) vs. 0.86 (0.8-0.91)).
Conclusion: Considering a set of four health indicators, we provide evidence for distinctive gender patterns among immigrants in France. Male immigrants have a healthy behavioural profile in comparison with the natives and no health disadvantage. Female immigrants have a more mixed profile, with a health disadvantage for the non-Western groups from Africa. The contribution to this discordance of socioeconomic factors and gender relations needs to be investigated.