Does Migration Widen Mortality Inequalities Between Rural and Urban Areas? Long-Term Mortality Risk Among Rural Stayers, Rural Migrants, Urban Migrants, and Returners in Norway

Abstract

In many countries, the main internal migration trend has been from rural to urban areas. However, there is little knowledge of whether internal migration from rural to urban areas contributes to widening geographical inequalities in health and survival. In the present study, we investigated differences in long-term mortality risk among stayers (individuals who did not move from their rural municipality), rural migrants (individuals who moved to other rural municipalities), urban migrants (individuals who moved to urban municipalities), and returners (individuals who first moved to urban municipalities and then returned to rural municipalities). Data from a population-based survey carried out among adults in Finnmark aged 30–62 years in 1987/88 was linked to the National Population Register and the Norwegian Cause of Death Registry to identify migration and deaths from recruitment to the health survey up to December 2017. Flexible parametric survival models were used to examine the age-varying associations between different migration careers and mortality. For both men and women, the estimated mortality risk was lower for all internal migrant groups when compared to stayers. However, for men, the findings only applied to ages under 85 years for rural migrants, 81 years for urban migrants, and 71 years for returners, while for women, the findings applied to ages under 75 years for rural migrants, 78 years for urban migrants, and the age range 46–86 years for returners. The lower mortality risk observed among migrants contributes to widening health inequalities between rural depopulation areas and areas with increasing populations. Migrants to rural areas may limit this effect.