Longitudinal study of mortality among refugees in Sweden

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.