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Title: Migration and health: exploring the role of migrant status through register-based studies.
Author: Nørredam M.
Journal: Dan Med J; 2015 Apr; 62(4):B5068. PubMed ID: 25872539.
Abstract:
This thesis aims to explore migrant status as a determinant in register-based studies on migrant health. It is based on eight studies that investigate the following three main issues: 1) What is the importance of migrant status for morbidity patterns among migrants compared with Native Danes? 2) Do migrant status and ethnicity affect clinical indicators of access among migrants compared with native Danes? 3) What is the importance of migrant status for mortality patterns among migrants compared with Native Danes? The thesis builds on a register-based historical prospective cohort design. Through Statistics Denmark, all refugees (n = 29,174) and family reunification immigrants (n = 33,287) who received residence permits in Denmark from 1 January 1993 to 31 December 1999 were included and matched 4:1 on age and sex with Native Danes. Register linkage was obtained twice during follow-ups in 2004 and 2008 respectively. Personal identification numbers were cross-linked to the Danish Psychiatric Central Register, the National Patient Registry, the Registry of Coercive Measures in Psychiatric Treatment, the Register of Causes of Death, and the Danish Cancer Registry. Migrant status defined by legal grounds for obtaining a residence permit was dichotomised into refugees and family reunification immigrants and used as the determinant in most studies. Analyses involved both Poisson and Cox regression analysis. Most analyses were stratified by ethnicity and adjusted for age and sex. Some were also stratified for individual income. Three sub-themes were investigated: morbidity, clinical indicators of access, and mortality. The first sub-theme (Papers I-III) showed that refugees had a consistently higher morbidity from several mental health disorders in contrast to family reunification immigrants, whose morbidity from mental disorders was lower than or similar to native Danes. The cancer incidence study did not find an effect of migrant status but found, rather, that migrants from the Middle East and North Africa had a lower cancer risk and that Eastern European migrants had a similar cancer risk compared with native Danes. The second sub-theme (Papers IV-VI) focused on different proxy measures of clinical indicators of access. Use of coercion was generally higher among migrants – especially refugee men and immigrant women – compared with native Danes. For cancer stage at diagnosis, migrants in general showed an unfavourable tendency towards more non-local versus local stages and more unknown versus known stages. No consistent patterns were found according to migrant status.The third sub-theme on mortality (Papers VI-VIII) found that refugees – especially family reunification immigrants – had lower all-cause mortality and lower mortality from cancer, cardiovascular disease, and injuries. In contrast, refugees in particular and migrants in general had a higher mortality from infectious disease. The thesis demonstrates the unique opportunities for performing register-based research in Denmark, particularly in relation to migrants. It also demonstrates the role of migrant status as a useful variable in migrant studies in addition to ethnicity. Across all three sub-themes, inequalities in morbidity patterns were sometimes in favour of migrants and sometimes in favour of native Danes. Finally, inequalities in health were more pronounced for the refugee group, which was consistently more at risk compared with native Danes or which apparently benefited less from the protective factors of being a migrant compared with family reunification immigrants.

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