Alcohol Use Disorders and Immigration up to the Third Generation in France: Findings from a 39,617‐Subject Survey in the General Population

• Published in: Alcoholism, clinical and experimental research Vol. 41; no. 6; pp. 1137 - 1143
• Main Authors: Rolland, Benjamin, Geoffroy, Pierre‐Alexis, Pignon, Baptiste, Benradia, Imane, Font, Hélène, Roelandt, Jean‐Luc, Amad, Ali
• Format: Journal Article
• Language: English
• Published: England Wiley 01.06.2017
• Series: Alcoholism, Clinical and Experimental Research
• Subjects: Adult; Alcoholism; Alcoholism - diagnosis; Alcoholism - ethnology; Alcoholism - psychology; Alcohol‐Related Disorders; Cognitive science; Cohort Effect; Cross-Sectional Studies; Cultural Characteristics; Emigrants and Immigrants; Emigrants and Immigrants - psychology; Female; France; France - ethnology; Humans; Male; Middle Aged; Population Surveillance; Risk Factor; Risk Factors; Surveys and Questionnaires; United States - ethnology; France; Risk Factor; Emigrants and Immigrants; Alcohol-Related Disorders; Alcoholism
• ISSN: 0145-6008; 1530-0277; 1530-0277
• DOI: 10.1111/acer.13387

Background In the United States, first‐generation immigrants (FGIs) show lower prevalence rates of alcohol use disorders (AUDs) than the native population, although they experience more psychosocial risk factors. This epidemiological phenomenon is called an “immigrant paradox.” No previous study has investigated whether immigrants also exhibit a reduced risk of AUDs in Europe. In a study of the general population in France, we have assessed the adjusted risk of AUDs between nonimmigrants and FGIs, second‐generation immigrants (SGIs), and third‐generation immigrants (TGIs). Methods A cross‐sectional survey based on face‐to‐face interviews was conducted among 39,617 French subjects recruited using a quota‐sampling strategy. The sociodemographic data collected helped determine the subjects’ immigration status. The AUD assessment was performed using the Mini International Neuropsychiatric Interview (version 5.0.0). A multivariable logistic regression model was used to define the independent risk factors for AUDs with backward selection. Results The overall prevalence of AUDs in the sample was 4.34%. AUDs were diagnosed in 3.82% of the native population versus 5.84% of the immigrant population: 4.67% of FGIs, 5.71% of SGIs, and 6.63% of TGIs (p < 0.0001). The multivariable model showed that FGIs did not have a significantly different risk of AUDs compared to the native population (p = 0.5936), whereas SGIs (odds ratio [OR] = 1.18; 95% confidence interval [CI] [1.01 to 1.39]; p = 0.0496) and, to a greater extent, TGIs (OR = 1.38; 95% CI [1.17 to 1.63]; p = 0.0002) had a significantly greater risk of AUDs. The area under the curve of the model was 0.753. Conclusions Relative to French natives, a generational risk gradient for AUDs was found in the immigrant subjects, with a similar risk of FGIs, and an increased risk of SGIs and TGIs. In terms of the risk of AUDs, no “immigrant paradox” existed in French population. These results are in line with other recent findings, suggesting that the “immigrant paradox” is rarely found in Europe regarding many health‐related issues. In the USA, compared to natives, AUDs are less frequent in first‐generation immigrants (FGIs), whereas the rates of AUDs in subsequent generations tend to progressively align with the general population. This is what is called an ‘immigrant paradox’. In contrast, in our French data, both raw (see figure) and multivariate comparisons show that FGIs and natives exhibit no difference in the prevalence rate of AUDs, while second‐ and even more third‐generation immigrants exhibit an increased prevalence of AUDs.