Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden.
Department of Neuroscience, Uppsala University, Uppsala, Sweden.
BMJ Open. 2022 May 11;12(5):e054351. doi: 10.1136/bmjopen-2021-054351.
The aims were to investigate the associations between specific mental and somatic disorders and subsequent all-cause and cause-specific mortality (suicide, external and other causes) in young refugees and non-refugee migrants compared with Swedish-born individuals of similar age.
In this register-based prospective cohort study, all 1 003 760 individuals (40 305 refugees, 31 687 non-refugee migrants as the exposure groups and the rest as the Swedish-born comparison group), 16-25 years old, residing in Sweden on 31 December 2004 were included. These individuals were followed regarding the outcome of all-cause and cause-specific mortality (suicide and external causes) between 2005 and 2016. The study population was also stratified according to any use of specialised healthcare for mental or somatic diagnoses before baseline (2000-2004). Cox regression models yielding crude and multivariate Hazard Ratios (HR and aHR, respectively) with 95% Confidence Intervals (CI) were used to investigate the afore-mentioned associations.
A lower proportion of both refugees (12%) and non-refugee migrants (10%) had college/university education compared with the Swedish-born individuals (17%). The proportion of unemployed (>180 days) among refugees (2.3%) and non-refugees (2.9%) was higher than the Swedish born (1.4%). Refugees and non-refugee migrants had about a 20% lower risk of all-cause mortality and external causes of mortality compared with Swedish-born individuals. An even greater reduction in suicide risk (aHR 0.51, 95% CI 0.37 to 0.70, and 0.63, 95% CI 0.49 to 0.82 for non-refugees and refugees, respectively) was found. When restricted to those with a mental or somatic disorder, a lower risk of both general and specific mortality was also found among both refugees and non-refugee migrants compared with Swedish-born individuals. Refugees had, however, equal point estimates of all-cause mortality associated with substance misuse disorder and neoplasms as their Swedish-born peers with these disorders.
With few exceptions, young migrants with specific mental and somatic disorders have a mortality advantage compared with their Swedish-born peers with the same disorders. Further research on protective factors is warranted.
本研究旨在调查特定精神和躯体障碍与全因死亡率和特定原因死亡率（自杀、外部原因和其他原因）之间的关联，比较对象为年轻难民和非难民移民与瑞典出生的相似年龄个体。
这是一项基于登记的前瞻性队列研究，共纳入了 1003760 名年龄在 16-25 岁、2004 年 12 月 31 日居住在瑞典的个体（40305 名难民、31687 名非难民移民作为暴露组，其余作为瑞典出生的对照组）。这些个体在 2005 年至 2016 年期间被跟踪随访全因死亡率和特定原因死亡率（自杀和外部原因）的结局。根据基线（2000-2004 年）前是否专门因精神或躯体疾病就诊，研究人群还进行了分层。使用 Cox 回归模型得出粗风险比（Crude Hazard Ratio，HR）和多变量风险比（Multivariate Hazard Ratio，aHR，分别）及其 95%置信区间（Confidence Interval，CI）来研究上述关联。
与瑞典出生的个体相比，难民（12%）和非难民移民（10%）中接受过大学/大专教育的比例较低。难民（2.3%）和非难民（2.9%）中失业（>180 天）的比例高于瑞典出生的个体（1.4%）。与瑞典出生的个体相比，难民和非难民移民的全因死亡率和外部原因死亡率降低了约 20%。自杀风险的降低更为显著（非难民和难民的风险比分别为 0.51（95%CI 0.37 至 0.70）和 0.63（95%CI 0.49 至 0.82））。当仅限于患有精神或躯体障碍的个体时，难民和非难民移民的全因和特定原因死亡率也低于瑞典出生的个体。然而，难民因物质使用障碍和恶性肿瘤导致的全因死亡率与瑞典出生的同障碍个体的点估计值相当。
除了少数例外，患有特定精神和躯体障碍的年轻移民与患有相同障碍的瑞典出生的同龄人相比，死亡率较低。需要进一步研究保护因素。
