Abstract
Background: Young refugees are at increased risk of labor market marginalization (LMM). We sought to examine whether the association of multimorbidity patterns and LMM differs in refugee youth compared to Swedish-born youth and identify the diagnostic groups driving this association. Methodology: We analyzed 249,245 individuals between 20–25 years, on 31 December 2011, from a combined Swedish registry. Refugees were matched 1:5 to Swedish-born youth. A multimorbidity score was computed from a network of disease co-occurrences in 2009–2011. LMM was defined as disability pension (DP) or >180 days of unemployment during 2012–2016. Relative risks (RR) of LMM were calculated for 114 diagnostic groups (2009–2011). The odds of LMM as a function of multimorbidity score were estimated using logistic regression. Results: 2841 (1.1%) individuals received DP and 16,323 (6.5%) experienced >180 annual days of unemployment during follow-up. Refugee youth had a marginally higher risk of DP (OR (95% CI): 1.59 (1.52, 1.67)) depending on their multimorbidity score compared to Swedish-born youth (OR (95% CI): 1.51 (1.48, 1.54)); no differences were found for unemployment (OR (95% CI): 1.15 (1.12, 1.17), 1.12 (1.10, 1.14), respectively). Diabetes mellitus and influenza/pneumonia elevated RR of DP in refugees (RRs (95% CI) 2.4 (1.02, 5.6) and 1.75 (0.88, 3.45), respectively); most diagnostic groups were associated with a higher risk for unemployment in refugees. Conclusion: Multimorbidity related similarly to LMM in refugees and Swedish-born youth, but different diagnoses drove these associations. Targeted prevention, screening, and early intervention strategies towards specific diagnoses may effectively reduce LMM in young adult refugees.
Highlights
The population of refugees has grown substantially over the last 15 years; 70.8 million people were forcibly displaced worldwide by the end of 2018; half of these refugees were under 18 years of age and 138,600 were unaccompanied children [1]
The multimorbidity network showed that diabetes mellitus (E10–E14), influenza, and pneumonia (J09–J18) contributed higher risk of disability pension (DP) in refugee youths compared to the Swedish-born youths; external causes of morbidity (Y85–Y89), such as inflammatory bowel disease (K50–K52), showed higher risk of long-term unemployment in refugee youths, compared to the Swedish-born youths
We found a positive association between multimorbidity and labor market marginalization (LMM) expressed as long-term unemployment and disability pension in refugees and Swedish-born young adults, with similar importance in both groups
Summary
The population of refugees has grown substantially over the last 15 years; 70.8 million people were forcibly displaced worldwide by the end of 2018; half of these refugees were under 18 years of age and 138,600 were unaccompanied children [1]. Adverse past and current migration experiences, including traumatic events and social exclusion in the host country, put young refugees at a higher risk for severe adverse health outcomes. These medical conditions could potentially affect their capabilities to integrate into the host country and establish themselves at the labor market. Labor market marginalization (LMM) of the migrant population has become a major concern in European countries [2,3]. The number of young adults granted disability pensions has increased in recent decades in Sweden [6], and the gap in unemployment rates between migrants and their native-born counterparts has persisted [7]. We sought to examine whether the association of multimorbidity patterns and LMM differs in refugee youth compared to Swedish-born youth and identify the diagnostic groups driving this association
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