Department of Public Health Sciences, Division of Social Medicine, Norrbacka, Karolinska Institutet, Stockholm, Sweden.
Int J Epidemiol. 2012 Aug;41(4):1153-61. doi: 10.1093/ije/dys072. Epub 2012 May 2.
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.
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.
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).
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.
难民移民的健康状况不如其他移民群体，但对于他们的死亡率知之甚少。如果将劳动力移民包括在内，那么将难民与非难民移民的死亡率进行比较可能会夸大前者的死亡率，因为后者的死亡率可能低于总人口的死亡率。为了避免偏见，本研究不包括劳动力移民。本研究旨在调查瑞典难民与非劳动力非难民移民的死亡率风险。
本研究采用基于人群的队列设计，从 1998 年 1 月 1 日开始，至 2006 年 12 月 31 日死亡或截止。研究对象为年龄在 18-64 岁之间、1992-98 年在瑞典获得居留许可的人，并由瑞典移民局定义为难民或非劳动力非难民移民。结局是全因死亡率和死因特异性死亡率，主要暴露因素是难民身份。Cox 回归模型估计死亡率的风险比（HRs）。
研究人群总计 86395 人，其中 49.3%为女性，24.2%为难民。调整年龄和原籍国后，难民男性患心血管疾病的风险较高（HR=1.58，95%CI=1.08-2.33）。在模型中加入社会经济因素后，难民男性患心血管疾病（HR=1.53，95%CI=1.04-2.24）和外部原因（HR=1.59，95%CI=1.01-2.50）的死亡率仍较高。
瑞典的难民男性在心血管疾病和外部原因方面的死亡率风险高于非劳动力非难民移民男性。本研究表明，从与心血管死亡率的关联来看，难民经历与其他应激源相似。
