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Migration and coronary heart disease: A study of Finnish twins living in Sweden and their co-twins residing in Finland

Department of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Sweden, Centre for Research in Migration and Ethnic Relations, Stockholm University, Sweden, ebba.hedlund{at}ki.se

Jaakko Kaprio

Department of Public Health, University of Helsinki, Finland, Department of Mental Health & Alcohol Research, National Public Health Institute, Finland

Anders Lange

Centre for Research in Migration and Ethnic Relations, Stockholm University, Sweden

Markku Koskenvuo

Department of Public Health, University of Turku, Finland

Laura Jartti

Department of Medicine, University of Turku, Finland

Tapani Rönnemaa

Department of Medicine, University of Turku, Finland

Niklas Hammar

Department of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Sweden

Background: Finland and Sweden are neighbouring countries with a substantially higher incidence and mortality from coronary heart disease (CHD) in Finland. Migration from Finland to Sweden has resulted in a population of about 187,000 Finnish immigrants, with a higher risk of CHD than Swedes. The aim of the present study was to analyse the prevalence of CHD in migrants to Sweden compared with co-twins remaining in Finland. Methods: The study population consisted of twin pairs of the Finnish Twin Cohort Study where at least one twin had lived one year or more in Sweden, including 1,534 subjects and 251 complete twin pairs discordant regarding residency in Sweden. Emigrant twins were compared with non-migrant co-twins regarding prevalence of CHD in 1998. CHD prevalence was assessed by self-reported questionnaires validated using information from a clinical examination. Results: Self-reported CHD showed a good correspondence with clinical diagnosis. Differences in social and behavioural risk factors for CHD among men were small but emigrants were more physically active than non-migrants. Female emigrants had less overweight and better education, but were more often working class than non-migrants. Intra-pair comparisons restricted to migration discordant pairs showed a tendency towards a reduced prevalence of CHD in the migrant co-twins (0.6; 0.3—1.4). In analyses of all subjects disregarding pair status, emigrants showed a reduced prevalence of CHD compared with subjects always living in Finland (0.6; 0.4—0.9). Conclusion: Emigration from Finland to Sweden may be associated with a reduced prevalence of CHD. The causes are most likely multifactorial and may involve changes in dietary habits, physical activity, psychosocial factors, and inflammation.

Key Words: CHD • country of birth • Finland • migration • Sweden • twin studies

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