Health determinants among refugees in Austria and Germany: A propensity-matched comparative study for Syrian, Afghan, and Iraqi refugees

Abstract

In recent years, Germany and Austria have been among the leading European receiving countries for asylum seekers and refugees (AS&R). The two countries have cultural and economic similarities, but differ, for example, in their health care systems, with AS&R having unrestricted access to health services upon arrival in Austria, but not in Germany. This study investigates the determinants of health among refugees in Austria and Germany, and how these determinants differ between the two countries. We analyze comparable and harmonized survey data from both countries for Syrian, Afghan, and Iraqi nationals aged 18 to 59 years who had immigrated between 2013 and 2016 (Germany: n = 2,854; Austria: n = 374). The study adopts a cross-sectional design, and uses propensity score matching to examine comparable AS&R in the two receiving countries. The results reveal that the AS&R in Germany (72%) were significantly less likely to report being in (very) good health than their peers in Austria (89%). Age and education had large impacts on health, whereas the effects of length of stay and length of asylum process were smaller. Compositional differences in terms of age, sex, nationality, education, and partnership situation explained the country differences only in part. After applying propensity score matching to adjust for structural differences and to assess non-confounded country effects, the probability of reporting (very) good health was still 12 percentage points lower in Germany than in Austria. We conclude that many of the determinants of health among AS&R correspond to those in the non-migrant population, and thus call for the implementation of similar health policies. The health disadvantage found among the AS&R in Germany suggests that removing their initially restricted access to health care may improve their health.

Complex post-traumatic stress disorder and post-migration living difficulties in traumatised refugees and asylum seekers: the role of language acquisition and barriers

“…As the third most common country of origin, the UN Refugee Agency (UNHCR) recorded around 2.7 million Afghan refugees recognized under international law, and 0.3 million asylum seekers currently awaiting legal recognition, in 2019 (UNHCR, 2020 ). Compared to refugee populations from other countries of origin in Austria, Afghans report particularly low health (Georges, Buber-Ennser, Rengs, Kohlenberger, & Doblhammer, 2021 ). Prolonged, repeated, and/or interpersonal traumatic experiences in the country of origin or during flight are highly prevalent among refugees (Bogic, Njoku, & Priebe, 2015 ), with between 40 and 90% reporting at least one traumatic experience, depending on the sample and location (Scoglio & Salhi, 2020 ).…”

Self-rated health and quality of life among Syrian Refugees in Ireland – data from a cross-sectional study

“…According to the present study, 67.4% of Syrian refugees in Ireland described their health to be either 'very good' or 'good' at the time of the study. The results from the other research, investigating self-reported health among newly arrived refugees, suggest variability in this regard, ranging from 58% in Norway to more than 70% in Germany and Austria [24,41]. However, the comparison with the overall health of the Irish population, where 83% of adults reported good overall health [42], indicates a health disparity between the refugee population and Irish nationals, even though the refugees had a younger age profile.…”

Self-rated health and quality of life among Syrian refugees in Ireland – data from a cross-sectional study

“…According to the present study, 67.4% of Syrian refugees in Ireland described their health to be either ‘very good’ or ‘good’ at the time of the study. The results from the other research, investigating self-reported health among newly arrived refugees, suggest variability in this regard, ranging from 58% in Norway to more than 70% in Germany and Austria [ 24 , 41 ]. However, the comparison with the overall health of the Irish population, where 83% of adults reported good overall health [ 42 ], indicates a health disparity between the refugee population and Irish nationals, even though the refugees had a younger age profile.…”