International Journal of Epidemiology
Volume 41, Issue 4, 2012, Pages 1153-1161

Longitudinal study of mortality among refugees in Sweden (Article) (Open Access)

Hollander A.-C.* , Bruce D. , Ekberg J. , Burström B. , Borrell C. , Ekblad S.
  • a Department of Public Health Sciences, Division of Social Medicine, Norrbacka, Karolinska Institutet, Stockholm, Sweden
  • b Department of Public Health Sciences, Division of Social Medicine, Norrbacka, Karolinska Institutet, Stockholm, Sweden
  • c Centre of Labour Market Policy Research, Department of Economics and Statistics, Linnaeus University, Växjö, Sweden
  • d Department of Public Health Sciences, Division of Social Medicine, Norrbacka, Karolinska Institutet, Stockholm, Sweden
  • e Agència de Salut Pública de Barcelona, Barcelona, Spain, Universitat Pompeu Fabra, Barcelona, Spain
  • f Department of Public Health Sciences, Division of Social Medicine, Norrbacka, Karolinska Institutet, Stockholm, Sweden, Unit of Cultural Medicine, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden

Abstract

Background: Refugee immigrants have poorer health than other immigrant groups but little is known about their mortality. A comparison of mortality among refugees and non-refugee immigrants is liable to exaggerate the former if the latter includes labour migrants, whose mortality risk may be lower than that of the general population. To avoid bias, labour migrants are not included in this study. The aim was to investigate mortality risks among refugees compared with non-labour non-refugee immigrants in Sweden. Methods: Population-based cohort design, starting 1 January 1998 and ending with death or censoring 31 December 2006. Persons included in the study were those aged 18-64 years, had received a residence permit in Sweden 1992-98 and were defined by the Swedish Board of Migration as either a refugee or a non-labour non-refugee immigrant. The outcomes were all-cause and cause-specific mortalities and the main exposure was being a refugee. Cox-regression models estimated hazard ratios (HRs) of mortality. Results: The study population totalled 86 395 persons, 49.3% women, 24.2 % refugees. Adjusted for age and origin, refugee men had an over-risk of cardiovascular mortality (HR = 1.58, 95% CI = 1.08-2.33). With socio-economic factors added to the model, refugee men still had an over-risk mortality in cardiovascular disease (HR = 1.53, 95% CI = 1.04-2.24) and external causes (HR = 1.59, 95% CI = 1.01-2.50). Conclusion: Refugee men in Sweden have a higher mortality risk in cardiovascular and external causes compared with male non-labour non-refugee immigrants. This study suggests that the refugee experience resembles other stressors in terms of the association with cardiovascular mortality. © The Author 2012; all rights reserved.

Author Keywords

Cardiovascular diseases immigrants Longitudinal studies Refugees Mortality

Index Keywords

immigrant longitudinal study refugee Registries Proportional Hazards Models health risk human Longitudinal Studies Refugees middle aged priority journal health status hazard ratio Sweden Humans cardiovascular disease Adolescent male female risk factor Risk Factors spatiotemporal analysis socioeconomics longitudinal gradient Article Retrospective Studies major clinical study adult Sex Factors cardiovascular mortality cause of death mortality public health immigrant population
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84865711604&doi=10.1093%2fije%2fdys072&partnerID=40&md5=2a5e5ef6f4aa1a285dc12046e66e8ff5
DOI: 10.1093/ije/dys072
ISSN: 03005771
Cited by: 38
Original Language: English