European Journal of Epidemiology
Volume 31, Issue 7, 2016, Pages 667-677

Cardiovascular disease incidence and survival: Are migrants always worse off? (Article)

Byberg S.* , Agyemang C. , Zwisler A.D. , Krasnik A. , Norredam M.
  • a Section for Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Øster Farimagsgade 5, Building 10, Copenhagen K, 1014, Denmark
  • b Department of Social Medicine, Amsterdam Medical Centre, Amsterdam University, Amsterdam, Netherlands
  • c The Danish Heart Registry, National Institute of Public Health, University of Southern Denmark, Odense, Denmark, Department of Cardiology, Holbæk Hospital, Holbæk, Denmark
  • d Section for Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Øster Farimagsgade 5, Building 10, Copenhagen K, 1014, Denmark
  • e Section for Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Øster Farimagsgade 5, Building 10, Copenhagen K, 1014, Denmark, Section of Immigrant Medicine, Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark

Abstract

Studies on cardiovascular disease (CVD) incidence and survival show varying results between different ethnic groups. Our aim was to add a new dimension by exploring the role of migrant status in combination with ethnic background on incidence of—and survival from—CVD and more specifically acute myocardial infarction (AMI) and stroke. We conducted a historically prospective cohort study comprising all newly-arrived migrants to Denmark between 1.1.1993 and 31.12.2010 (n = 114,331), matched 1:6 to Danish-born by age and sex. CVD incidence was retrieved from the National Patient Registry and differences in incidence were assessed by Poisson regression and stratified by sex. Survival differences were assessed by Cox regression using all-cause and cause-specific mortality as outcome. Male refugees had significantly lower incidence of CVD (RR = 0.89; 95 % CI 0.85–0.93) and stroke (IRR = 0.62; 95 % CI 0.56–0.69) compared to Danish-born, but significantly higher incidence of AMI (IRR = 1.12; 95 % CI 1.02–1.24). Female refugees had similar rates of CVD and AMI, but significantly lower incidence of stroke (RR = 0.76; 95 % CI 0.67–0.85). Both male and female family-reunified immigrants had significantly lower incidence of CVD, AMI and stroke. All-cause and cause-specific survival after CVD, AMI and stroke was similar or significantly better for migrants compared to Danish-born, regardless of type of migrant (refugee vs. family-reunified) or country of origin. Refugees are disadvantaged in terms of some types of cardiovascular disease compared to Danish-born. Family-reunified migrants on the other hand had lower rates of CVD. All migrants had better survival than Danish-born indicating that migrants may not always be disadvantaged in health. © 2015, Springer Science+Business Media Dordrecht.

Author Keywords

Stroke Migrants Acute myocardial infarction Survival Incidence cardiovascular disease

Index Keywords

prospective study immigrant refugee Myocardial Infarction Registries Stroke cerebrovascular accident survival survival analysis health disparity Health Status Disparities Cardiovascular Diseases register human cause specific survival Refugees middle aged Prospective Studies Cohort Studies Denmark Ethnic Groups statistics and numerical data ethnic group controlled study overall survival Aged ethnology prognosis Young Adult Humans migrant cardiovascular disease Danish citizen male Emigrants and Immigrants female Socioeconomic Factors socioeconomics Incidence Article major clinical study adult migration age cardiovascular mortality outcome assessment cohort analysis acute heart infarction ethnicity Transients and Migrants sex
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84929429365&doi=10.1007%2fs10654-015-0024-7&partnerID=40&md5=d7e548d01da499cf87727006eab33f6c
DOI: 10.1007/s10654-015-0024-7
ISSN: 03932990
Cited by: 11
Original Language: English