Mortality and major disease risk among migrants of the 1991–2001 Balkan wars to Sweden: A register-based cohort study

Abstract

Background In recent decades, millions of refugees and migrants have fled wars and sought asylum in Europe. The aim of this study was to quantify the risk of mortality and major diseases among migrants during the 1991–2001 Balkan wars to Sweden in comparison to other European migrants to Sweden during the same period. Methods and findings We conducted a register-based cohort study of 104,770 migrants to Sweden from the former Yugoslavia during the Balkan wars and 147,430 migrants to Sweden from 24 other European countries during the same period (1991–2001). Inpatient and specialized outpatient diagnoses of cardiovascular disease (CVD), cancer, and psychiatric disorders were obtained from the Swedish National Patient Register and the Swedish Cancer Register, and mortality data from the Swedish Cause of Death Register. Adjusting for individual-level data on sociodemographic characteristics and emigration country smoking prevalence, we used Cox regressions to contrast risks of health outcomes for migrants of the Balkan wars and other European migrants. During an average of 12.26 years of follow-up, being a migrant of the Balkan wars was associated with an elevated risk of being diagnosed with CVD (HR 1.39, 95% CI 1.34–1.43, p < 0.001) and dying from CVD (HR 1.45, 95% CI 1.29–1.62, p < 0.001), as well as being diagnosed with cancer (HR 1.16, 95% CI 1.08–1.24, p < 0.001) and dying from cancer (HR 1.27, 95% CI 1.15–1.41, p < 0.001), compared to other European migrants. Being a migrant of the Balkan wars was also associated with a greater overall risk of being diagnosed with a psychiatric disorder (HR 1.19, 95% CI 1.14–1.23, p < 0.001), particularly post-traumatic stress disorder (HR 9.33, 95% CI 7.96–10.94, p < 0.001), while being associated with a reduced risk of suicide (HR 0.68, 95% CI 0.48–0.96, p = 0.030) and suicide attempt (HR 0.57, 95% CI 0.51–0.65, p < 0.001). Later time period of migration and not having any first-degree relatives in Sweden at the time of immigration were associated with greater increases in risk of CVD and psychiatric disorders. Limitations of the study included lack of individual-level information on health status and behaviors of migrants at the time of immigration. Conclusions Our findings indicate that migrants of the Balkan wars faced considerably elevated risks of major diseases and mortality in their first decade in Sweden compared to other European migrants. War migrants without family members in Sweden or with more recent immigration may be particularly vulnerable to adverse health outcomes. Results underscore that persons displaced by war are a vulnerable group in need of long-term health surveillance for psychiatric disorders and somatic disease.

Nordic Health Registry-Based Research: A Review of Health Care Systems and Key Registries

“…41,42 Migrants may originate from countries without vaccination programs, with poor quality of primary prevention, diet options, and employment conditions as well as high level of trauma exposure and mental distress with the implications of disease development. 41,42 Further, language and cultural barriers or different health beliefs or attitudes may lead to miscommunication between patients and health care providers with the result of poor health care service and patient dissatisfaction as well as non-compliance. This potential problem is despite the fact that interpreter services are heavily applied.…”

Mental and somatic disorders and the subsequent risk of all-cause and cause-specific mortality in refugees, non-refugee migrants and the Swedish-born youth: a population-based cohort study in Sweden

“… 25 26 Refugees have a higher risk of having experienced traumatic events, which might put them at a higher risk of developing different disorders and subsequently premature mortality compared with other migrants. 27 On the other hand, refugees and non-refugee migrants from the same countries of birth might share common culturally determined features, including the perception of healthcare, acceptance of treatment and health behaviour. To be able to create tailor-made interventions, there is, therefore, a need to study different subgroups of migrants separately.…”

The Relationship Between Inflammation and Post-traumatic Stress Disorder

“…It is hoped to predict the development of PTSD in patients with acute trauma so that early intervention can be initiated (5). They are estimated to be associated with subsequent major disease risk (6)(7)(8). Therefore, it is important to understand the mechanism of human physiological function changes or possible related indicators that may be caused by traumatic stress to improve treatment options for traumatic stress.…”