”The healthy migrant effect in the Swedish context”

Research Group Magnus Helgesson Bo Johansson Tobias Nordqvist Eva Vingård Magnus Svartengren Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Sweden

Background Today, around 18 % of the population in Sweden are born abroad Some studies have observed a “healthy migrant effect” (HME) Many studies from Europe have, however, not found a HME The HME might differ between subgroups of migrants

Aim To investigate if the “healthy migrant” hypothesis is applicable in a Swedish context, and if there were differences between migrants from Western and non-Western countries. We also examined if there was any correlation between work attachment and the HME. 

Study Design Cohort study based on Swedish registers Immigrants from six regions 1985 -1990 (18-47 years) A control group of native Swedes (in same age) Follow-up period of 18 years (three six-year intervals)

Study Design Study population at baseline 1990. All persons that immigrated to Sweden 1985-1990 from six regions* and were 18-47 years in 1990 Native Swedes Western migrants Non-Western migrants 1 405 047 14 199 60 755 *Western migrants: Western Europe except Nordic countries, North America and Oceania Non-Western migrants: Middle East, Latin America and north/northeast Africa

Outcome measures Five separate measures of the HME Inpatient health care for: Cardiovascular and Psychiatric disorders Mortality Societal health measures: Sick leave and Disability pension

Results Risk of five measures of morbidity/mortality in comparison to the Swedish reference population* Year 1-6 Cardivascular Psychiatric Mortality Sick leave Disab.pension Western Equal Lower Non-Western Higher Year 7-12 Cardivascular Psychiatric Mortality Sick leave Disab.pension Western Lower Equal Non-Western Higher Year 13-18 Cardivascular Psychiatric Mortality Sick leave Disab.pension Western Equal Lower Non-Western Higher *Adjusted for sex, age, educational level, occupation and work attachment

Results Risk of morbidity/mortality with regard to work attachment (in year 1–6) in comparison to the Swedish reference population Year 7-12 LMA Cardivascular Psychiatric Mortality Low year 1-6 Western Lower   Non-Western Higher Equal High year 1-6 Year 13-18 LMA Cardivascular Psychiatric Mortality Low year 1-6 Western Equal Lower   Non-Western Higher High year 1-6 *Adjusted for sex, age, educational level and occupation

Conclusion The HME seem to hold partly for Western migrants, i.e. mostly labour migrants to Sweden The HME do not hold among non-Western migrants, mostly refugees and family reunion migrants When stratifying for work attachment, the HME still hold for Western migrants with low work attachment

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