Center of Public Health Sciences, University of Iceland, Reykjavik, Iceland.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
PLoS Med. 2020 Dec 1;17(12):e1003392. doi: 10.1371/journal.pmed.1003392. eCollection 2020 Dec.
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.
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.
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.
近几十年来，数以百万计的难民和移民逃离战争，前往欧洲寻求庇护。本研究的目的是量化 1991-2001 年巴尔干战争期间逃离到瑞典的移民与同期逃离到瑞典的其他欧洲移民相比，在死亡率和主要疾病方面的风险。
我们对 1991-2001 年期间逃离到瑞典的前南斯拉夫的 104770 名巴尔干战争移民和 147430 名逃离到瑞典的其他 24 个欧洲国家的移民进行了基于登记的队列研究。心血管疾病（CVD）、癌症和精神疾病的住院和专科门诊诊断从瑞典国家患者登记处和瑞典癌症登记处获得，死亡率数据从瑞典死因登记处获得。我们使用 Cox 回归调整了个体水平的社会人口特征和移民国家吸烟流行率的数据，以对比巴尔干战争移民和其他欧洲移民的健康结果风险。在平均 12.26 年的随访期间，与其他欧洲移民相比，作为巴尔干战争移民，患 CVD 的风险增加（HR 1.39，95%CI 1.34-1.43，p<0.001）和死于 CVD（HR 1.45，95%CI 1.29-1.62，p<0.001）、患癌症（HR 1.16，95%CI 1.08-1.24，p<0.001）和死于癌症（HR 1.27，95%CI 1.15-1.41，p<0.001）的风险更高。与其他欧洲移民相比，作为巴尔干战争移民，患精神疾病的总体风险也更高（HR 1.19，95%CI 1.14-1.23，p<0.001），尤其是创伤后应激障碍（HR 9.33，95%CI 7.96-10.94，p<0.001），而自杀风险（HR 0.68，95%CI 0.48-0.96，p=0.030）和自杀未遂风险（HR 0.57，95%CI 0.51-0.65，p<0.001）则降低。移民的时间较晚，以及在移民时在瑞典没有任何一级亲属，与 CVD 和精神疾病风险的增加有关。研究的局限性包括缺乏移民时个人健康状况和行为的信息。
我们的研究结果表明，与其他欧洲移民相比，巴尔干战争移民在抵达瑞典的头十年中面临更高的主要疾病和死亡率风险。在瑞典没有家庭成员或移民时间较近的战争移民可能特别容易受到不良健康结果的影响。研究结果表明，战争造成的流离失所者是一个弱势群体，需要对精神疾病和躯体疾病进行长期健康监测。
