Danish Research Centre for Migration, Ethnicity and Health, Department of Public Health, University of Copenhagen, Denmark, Øster Farimagsgade 5, Building 10, DK-1014, Copenhagen K, Denmark.
BMC Public Health. 2012 Sep 10;12:757. doi: 10.1186/1471-2458-12-757.
Comparisons of mortality patterns between different migrant groups, and between migrants and natives, are relevant to understanding, and ultimately reducing, inequalities in health. To date, European studies on migrants' mortality patterns are scarce and are based solely on country of birth, rather than migrant status. However, mortality patterns may be affected by implications in relation to migrant status, such as health hazards related to life circumstances before and during migration, and factors related to ethnic origin. Consequently, we investigated differences in both all-cause and cause-specific mortality from cancer and cardiovascular disease among refugees and immigrants, compared with the mortality among native Danes.
A register-based, historical prospective cohort design. All refugees (n = 29,139) and family-reunited immigrants (n = 27,134) who, between 1 January 1993 and 31 December 1999, were granted right of residence in Denmark were included and matched 1:4 on age and sex with native Danes. To identify deaths, civil registration numbers were cross-linked to the Register of Causes of Death (01.01.1994-31.12.2007) and the Danish Civil Registration System (01.01.1994-31.12.2008). Mortality rate ratios were estimated separately for men and women by migrant status and region of birth, adjusting for age and income and using a Cox regression model, after a median follow-up of 10-13 years after arrival.
Compared with native Danes, all-cause mortality was significantly lower among female (RR = 0.78; 95%CI: 0.71;0.85) and male (RR = 0.64; 95%CI: 0.59-0.69;) refugees. The rates were also significantly lower for immigrants: women (RR = 0.44; 95%CI: 0.38;0.51) and men (RR = 0.43; 95%CI: 0.37;0.51). Both migrant groups also had lower cause-specific mortality from cancer and cardiovascular diseases. For both all-cause and cause-specific mortality, immigrants generally had lower mortality than refugees, and differences were observed according to ethnic origin.
Mortality patterns were overall advantageous for refugees and immigrants compared with native Danes. Research should concentrate on disentangling the reasons behind migrants' health advantages, in order to enlighten future preventive public-health efforts, for the benefit of the entire population.
比较不同移民群体之间以及移民与本地人之间的死亡率模式，对于理解并最终减少健康方面的不平等现象至关重要。迄今为止，欧洲关于移民死亡率模式的研究很少，而且仅基于出生国，而不是移民身份。然而，死亡率模式可能会受到与移民身份相关的影响，例如在移民前后与生活环境相关的健康危害，以及与族裔有关的因素。因此，我们研究了难民和家庭团聚移民与丹麦本地人相比，癌症和心血管疾病的全因和特定原因死亡率的差异。
这是一项基于登记的、历史前瞻性队列设计。在 1993 年 1 月 1 日至 1999 年 12 月 31 日期间，我们纳入了所有在丹麦获得居住权的难民（n=29139）和家庭团聚移民（n=27134），并按年龄和性别与丹麦本地人 1:4 匹配。为了确定死亡人数，将公民登记号码与死因登记册（1994 年 1 月 1 日至 2007 年 12 月 31 日）和丹麦民事登记系统（1994 年 1 月 1 日至 2008 年 12 月 31 日）进行交叉链接。根据移民身份和出生地，使用 Cox 回归模型，在到达后中位数随访 10-13 年后，分别估计男性和女性的死亡率比值，同时调整年龄和收入。
与丹麦本地人相比，女性难民（RR=0.78；95%CI：0.71；0.85）和男性难民（RR=0.64；95%CI：0.59；0.69）的全因死亡率显著降低。移民的死亡率也显著降低：女性（RR=0.44；95%CI：0.38；0.51）和男性（RR=0.43；95%CI：0.37；0.51）。两组移民的癌症和心血管疾病的特定原因死亡率也较低。与全因死亡率和特定原因死亡率相比，移民的死亡率通常低于难民，而且根据族裔差异也观察到了差异。
与丹麦本地人相比，难民和移民的死亡率模式总体上更为有利。研究应集中于阐明移民健康优势的背后原因，以便为未来的预防性公共卫生工作提供信息，使整个人口受益。
