Native-born Swedes Research Articles

Cancer, cardiovascular disease, and all-cause mortality in Iraqi- and Swedish-born individuals in Sweden: the MEDIM cohort study

Immigrants from the Middle East to Sweden have a twice as high prevalence of type 2 diabetes (T2D) and obesity as native-born Swedes. Both obesity and T2D have been linked to increased incidence of cancer, cardiovascular disease (CVD) and all-cause mortality (ACM); however, data on differences between ethnicities are scarce. In a population-based cohort we aimed to study the impact of Middle Eastern and European ethnicity on ACM, cancer- and CVD related mortality, incidence of cancer and CVD in an eight-year follow-up study. Methods: People born in Iraq or Sweden, who were 30–75 years of age, were invited from 2010 to 2012 to participate in the population based MEDIM study including a health exam, fasting blood sampling, assessment of insulin secretion and action (through oral glucose tolerance test) and questionnaires assessing history of CVD, cancer and T2D. Register data were retrieved from baseline until the 31st of December 2018 from the Swedish National Patient Register and Cause of Death register regarding CVD diagnosis, cancer diagnosis and cause of death. Information regarding diabetes diagnosis was retrieved from the National Diabetes Register. Individuals with a history of cancer or CVD at baseline were excluded. Cox regression analysis was assessed to study the adjusted hazard ratios (HR) for the relationships between ethnicity and ACM, cancer events, CVD events, death from cancer, and death from CVD, with adjustments for age, sex, anthropometrical measures, T2D and lifestyle. A total of 1398 Iraqi- and 757 Swedish-born residents participated in the study. ACM was considerably lower in Iraqi- compared to Swedish-born individuals HR 0.32 (95% CI 0.13–0.79) (p < 0.05). Furthermore, cancer related morbidity and mortality HR 0.39 (0.22–0.69) (p < 0.01) as well as CVD related morbidity and mortality HR 0.56 (0.33–0.95) (p < 0.05) were lower in the Iraqi-born group compared to the Swedish-born group for. The differences in mortality and cancer rates across ethnicities are not fully explained by anthropometric, environmental or metabolic measures but lie elsewhere. Further studies are needed to increase the understanding of contributing mechanisms.

Comparison of Framingham 10-year cardiovascular risks in Sweden- and foreign-born primary health care patients in Sweden

BackgroundThe prevalence of cardiovascular disease around the world varies by ethnicity and region of birth. Immigrants living in Sweden may have a higher prevalence of cardiovascular diseases than native-born Swedes, but little is known about their actual cardiovascular risk. This study aimed to examine the relationship in Sweden between 10-year cardiovascular risk and birthplace.MethodThis cross-sectional study was based on cardiovascular risk factor data obtained from the 4D Diabetes Project, a Programme 4D subproject in Sweden. Participants were recruited from two primary healthcare centres in Stockholm without a history of diabetes or pre-diabetes. The outcome variable was 10-year cardiovascular risk based on the calculation of a Framingham Risk Score with six risk factors: age, sex, LDL, HDL, BP, diabetes and smoking for each participant. Multiple linear regression was performed to generate β-coefficients for the outcome.ResultsThere was an average of 8.86% cardiovascular risk over 10 years in Sweden-born participants and a 5.45% 10-year risk in foreign-born, (P < 0.0001). Foreign-born participants were about 10 years younger (mean age 46 years vs. 56 years, P < 0.001), with a significantly higher proportion of smokers (23.9% vs. 13.7%; P = 0.001). To be born in Sweden (with parents born in Sweden) was significantly associated with a 10-year cardiovascular risk in the crude model (β- coefficient = 3.40, 95% CI 2.59–4.22; P < 0.0001) and when adjusted for education and alcohol consumption (β- coefficient = 2.70 95% CI 1.86–3.54; P < 0.0001). Regardless of the birthplace, 10-year cardiovascular risk was lower for those with higher education compared to those with less than 10 years of education.ConclusionThis study found a relationship between 10-year calculated cardiovascular risk and place of birth. Sweden-born participants had a higher association with 10-year cardiovascular risk than foreign-born participants. These results contradict previous reports of higher rates of CVD in residents of Middle-Eastern countries and Middle-Eastern immigrants living in Sweden.

Triangulation of evidence on immigration and rates of alcohol use disorder in Sweden: Evidence of acculturation effects.

This study aimed to determine the robustness of the impact of immigration on risk for alcohol use disorder (AUD) using different measures, designs, and immigrant regional cohorts. The analytic sample included all individuals born between 1950 and 1990 and registered in Sweden from 1973 to 2017. Using Cox regression models, we examined the risk for AUD from Swedish nationwide registries in immigrants to Sweden from seven geographical regions: Africa, Asia and Oceania, Eastern Europe, Finland, Latin America and the Caribbean, Middle East/North Africa, and Western countries. We assessed greater exposure to Swedish culture, which we interpreted as increasing acculturation, by (i) comparing first-generation immigrants and their children with no and one native Swedish parent and (ii) examining age at immigration. The baseline comparison group was the native Swedish population. We also examined AUD risk in first-generation sibling pairs discordant for their age at immigration. In nearly all immigrant cohorts in Sweden, increasing degrees of acculturation, as assessed by both our variables, were associated with rates of AUD that approached those of the Swedish population. These findings occurred in both men and women and both regional cohorts whose first-generation immigrants had lower and higher levels of AUD than native-born Swedes. For most cohorts, the rates of change with acculturation were greater in women than in men. In sibling pairs from most regions, the sibling who was younger at immigration had a higher rate of AUD. An examination of both sexes and two different proxies for acculturation provides consistent support for socio-cultural influences on AUD risk. Our co-sibling analyses suggest that a meaningful proportion of this effect is likely to be causal in nature.

Diversity and health strategies for newly resettled refugees

PurposeIn general, newly resettled refugees have poorer physical and mental health than native-born Swedes. This indicates that the society must make special efforts to enable refugees to attain health that is on a par with the rest of the population. The challenges rest primarily with employees in the public sector. But what resources do professionals need to meet the refugees’ health needs? This paper is about the need to develop strategies for professionals working with diversity and health, with a focus on the establishment of newly resettled refugees in Sweden. Thus, the purpose of this paper is to identify the needs and obstacles in working with diversity and health for the newly resettled.Design/methodology/approachThe paper is based on focus group interviews with 40 professionals working in three large municipalities and one County Administrative Board, all of whom work with challenges related to migration and health on a daily basis.FindingsThe needs expressed by the interviewees are primarily about developing and improving communications. Three important areas of communication were expressed: how information can be transferred from sender to receiver, institutionalization and interactions at different levels.Originality/valueThis paper identifies important needs and obstacles when working with diversity and health in Sweden, with a focus on the establishment of newly resettled refugees. It is an important contribution because refugees in general have poorer physical and mental health than native-born Swedes and strategies to improve their health, therefore, need to be further developed.

Refugee Employment Integration Heterogeneity in Sweden: Evidence From a Cohort Analysis.

Sweden, like many other European countries, has lower employment levels for the foreign-born compared to native-born Swedes. To some extent, this could be due to the country's relatively large intake of refugees. However, few studies have focused entirely on the employment integration of these refugees. In order to fill this gap, we use detailed longitudinal Swedish register data of three arrival cohorts (1998–2000). These data cover the employment of refugees from different countries of origin in Sweden in the first 12 years since their arrival. In line with related work and theoretical considerations and with respect to group characteristics, outmigration, and employment integration over time, we find differences between dissimilar groups of refugees. The findings concerning employment integration decrease to a small degree after rich regression adjustments. Moreover, maybe more surprisingly, we find a very similar result within the main groups of refugees from countries such as Bosnia, Ethiopia, and Eritrea. Women from these groups, in particular, have similar or higher employment probabilities than Swedish-born women after between 5 and 8 years in the country. Overall, each group managed to catch up to a non-negligible, yet varying, degree compared to related empirical evidence from other countries. The role of contextual factors in the refugee sending and receiving countries is highlighted.

Immigrant enclaves and risk of drug involvement among asylum-seeking immigrants in Sweden: A quasi-experimental study

BackgroundSweden is a major host nation for asylum-seeking immigrants, and residential placement of these immigrants is an important policy concern. This quasi-experimental study estimated of the impact of being placed into an “immigrant enclave” on risk of officially-recognized drug involvement (ORDI) among asylum-seeking immigrants over a 15-year period. MethodsAll data come from Swedish registries. The sample consisted of (a) asylum-seeking immigrants aged 5–35 years old at arrival (N = 51,017) that were subject to a nationwide policy (enforced 1987–1991) that dispersed asylum-seeking immigrants across municipalities, and (b) native-born Swedes aged 15 and older during this same period (N = 1,040,311). Neighborhood immigrant composition was quantified using the Reardon Index; residents of “immigrant enclave” neighborhoods (n = 960) were compared to residents of all other neighborhoods (n = 2,471). Cox proportional hazards models assessed the relationship between living in an enclave and risk of ORDI, identified by national registries, through 2015. ResultsOverall, 29.7% of immigrants were assigned to, and 25.5% of Swedes lived in, an enclave. Cumulative incidence of ORDI in enclaves was 6.34% as compared to 6.89% in other neighborhoods. Immigrants living in an enclave had lower risk of ORDI (Hazard ratio (HR): 0.86, 95% Confidence Interval (CI): 0.77 – 0.96). This protective association was marginally stronger in lower poverty areas. Native-born Swedes living in an enclave had higher risk of ORDI (HR: 1.05, 95% CI: 1.03–1.08), a relationship that was exacerbated by neighborhood poverty. ConclusionsNeighborhood immigrant composition is associated with risk of ORDI, with differential associations for immigrants and native-born populations.

Welfare states and immigrant poverty

This article examines immigrant poverty across three institutionally distinct European states: Germany, Sweden, and the United Kingdom. Focusing on 33 immigrant groups and controlling for sending country in addition to human capital and family characteristics, the analysis explores host country variation in (1) immigrant/native-born poverty gaps and (2) the underlying poverty levels at which these gaps occur. Findings reveal the largest poverty gaps in Sweden and demonstrate that this is due to immigrants’ comparatively severe labor market disadvantages. However, underlying poverty levels are also lowest in Sweden because of a two-pronged policy strategy of enabling work (particularly among women, immigrant and native-born alike) and reducing poverty through income support. Thus, immigrants in Sweden live at lower levels of poverty than their immigrant counterparts elsewhere, despite facing higher levels of inequality vis-à-vis native-born Swedes. The conclusion considers implications of poverty gaps and poverty levels, especially for the children of immigrants.

Labor-market status, migrant status and first childbearing in Sweden

Background Labor market uncertainties and employment insecurity have emerged as increasingly important factors in research on family formation and fertility.Objective In the present study, we provide evidence from Sweden on how non-employment, unemployment, and temporary employment relate to young people's first birth risks.Methods We use a combination of Labor Force Survey data on employment characteristics and register data on demographic outcomes to investigate how the labor market status and stability of employment are associated with the first birth behavior of women and men, and of Swedish-and foreign-born people in Sweden.Results Consistent with previous research, we find that people who are not in the labor force are less likely than those who are employed to enter parenthood. In most cases, we also find that young people who are in temporary employment are less likely than those who are permanently employed to start a family.Conclusions Our study demonstrates that foreign-born people living in Sweden tend to adapt to the behavior of native-born Swedes, and that patterns for women and men are largely similar. We relate these findings to the equalizing impact of the country's universal welfare regime.

County Differences in Mortality among Foreign-Born Compared to Native Swedes 1970–1999

Background. Regional variations in mortality and morbidity have been shown in Europe and USA. Longitudinal studies have found increased mortality, dissimilarities in mortality pattern, and differences in utilization of healthcare between foreign- and native-born Swedes. No study has been found comparing mortality among foreign-born and native-born Swedes in relation to catchment areas/counties. Methods. The aim was to describe and compare mortality among foreign-born persons and native Swedes during 1970–1999 in 24 counties in Sweden. Data from the Statistics Sweden and the National Board of Health and Welfare was used, and the database consisted of 723,948 persons, 361,974 foreign-born living in Sweden in 1970 and aged 16 years and above and 361,974 matched Swedish controls. Results. Latest county of residence independently explained higher mortality among foreign-born persons in all but four counties; OR varied from 1.01 to 1.29. Counties with a more rural structure showed the highest differences between foreign-born persons and native controls. Foreign-born persons had a lower mean age (1.0–4.3 years) at time of death. Conclusion. County of residence influences mortality; higher mortality is indicated among migrants than native Swedes in counties with a more rural structure. Further studies are needed to explore possible explanations.

Utilization of In-Hospital Care among Foreign-Born Compared to Native Swedes 1987–1999

In previous longitudinal studies of mortality and morbidity among foreign-born and native-born Swedes, increased mortality and dissimilarities in mortality pattern were found. The aim of this study is to describe, compare, and analyse the utilization of in-hospital care among deceased foreign- and Swedish-born persons during the years 1987–1999 with focus on four diagnostic categories. The study population consisted of 361,974 foreign-born persons aged 16 years and upward who were registered as living in Sweden in 1970, together with 361,974 matched Swedish controls for each person. Data from Statistics Sweden (SCB) and the National Board of Health and Welfare Centre for Epidemiology, covering the period 1970–1999, was used. Persons were selected if they were admitted to hospital during 1987–1999 and the cause of death was in one of four ICD groups. The results indicate a tendency towards less health care utilization among migrants, especially men, as regards Symptoms, signs, and ill-defined conditions and Injury and poisoning. Further studies are needed to explore the possible explanations and the pattern of other diseases to see whether migrants, and especially migrant men, are a risk group with less utilization of health care.

Ethnic differences in blood pressure in young men living in similar environment: a study of international adoptees in Sweden

To analyze differences in blood pressure in young men with different ethnic backgrounds but living in similar environment. We utilized information on virtually the total Swedish male population born between 1951 and 1987 including 5388 international adoptees, 8834 Swedish adoptees and 1 469 196 Swedish nonadoptees. Systolic blood pressure (SBP), height and weight were measured during conscription examination at the average age of 18.2 years. SBP was lower in international adoptees than in native-born Swedes regardless of the geographic area of origin of the adoptees. BMI and height partly explained this difference, but additional adjustment for childhood social position only slightly modified the results. The largest difference was observed in adoptees from the Indian subcontinent when compared with native-born Swedes (-5.21 95% confidence intervals -6.16 to -4.27 when adjusted for height, BMI and childhood social position). Slightly lower SBP was also observed in Swedish adoptees when compared with Swedish nonadoptees. The association between BMI and SBP did not differ between international adoptees and native-born Swedes. Our results suggest that international adoptees are not at higher risk for elevated blood pressure in young adulthood than native-born Swedes. Non-white genetic heritage or environmental exposures during pregnancy or in early life specific for adopted children may be associated with lower risk of hypertension.

Cross-Cultural Equivalence of HSCL-25 and WHO (ten) Wellbeing Index: Findings From a Population-Based Survey of Immigrants and Non-Immigrants in Sweden

The aim of this study was to investigate whether the Hopkins Symptom Checklist (HSCL-25) and the WHO (ten) Wellbeing Index are cross-culturally equivalent by comparing Scandinavians with Middle Eastern immigrants in Sweden. The study population consisted of a stratified random sample of native-born Swedes and immigrants from Finland, Iraq and Iran. Both instruments loaded on a single factor in the respective populations. A few of the items did however not discriminate or predict equally well in the groups, nonetheless it was found to have marginally influenced the instruments' total scores in both groups. The analyses also revealed that the groups had similar intercept and slope when the exogenous factor traumatic episodes was used to predict the measurement scores, supporting scalar equivalency. In conclusion, the results support the use of these instruments in population-based surveys within multicultural Western societies.

Coping Strategies in the Presence of One's Own Impending Death from Cancer

An incurable cancer is a threat to life itself. This study focused on how native-born Swedes, who define themselves as nonreligious, actually reflect and act when they try to create helpful strategies in the presence of their own impending deaths and how the strategies serve their purposes. Twenty patients were interviewed in depth. The patients were enrolled in an advanced hospital-based home care team. The interviews were taped, transcribed and analyzed with a qualitative, hermeneutic interpretative method. The informants' efforts to develop useful strategies to restrain death could be symbolized as a cognitive and emotional pendulum, swinging between the extremes of life and death. During the swings of the pendulum, the informants used every means available: their own resources, other people, animals, nature, a transcendent power, hope, imagination and magical thinking. They strove to find factors that fitted their conceptual system and supported their inner balance and structure, all to keep death at a discreet distance and preserve their links to life. These links were togetherness, involvement, hope and continuance, and they served as a shield against hurtful feelings connected to their impending death. The new knowledge about how strategies in the presence of one's own impending death can develop and be used is perhaps the most novel and clinically relevant contribution of this study.

Higher Mortality and Different Pattern of Causes of Death Among Foreign-Born Compared to Native Swedes 1970–1999

In a previous Swedish longitudinal study of mortality among 723,948 foreign born and native-born Swedes, 1970-1999, increased mortality was found among foreign-born persons. This study describes and analyses the differences in mortality between 361,974 foreign-born persons and 361,974 native Swedes during the period 1970-1999, based on data from Statistics Sweden and the National Board of Health and Welfare. The mortality pattern showed dissimilarities; with a significantly higher number of deaths among foreign-born persons in six diagnose groups and a significantly lower mean age at time of death. A high number of deaths were found for migrants from Denmark in Neoplasm, for migrants from Finland and Poland in Diseases of the circulatory system and for migrants from Yugoslavia in Symptoms, signs and ill-defined conditions. There is a tendency to a more similar pattern between foreign- and Swedish-born persons over time. Migration may be a risk factor for health, and therefore seems to be an important factor to consider when studying morbidity and health and when planning preventive work.

Mortality among 723 948 foreign- and native-born Swedes 1970–1999

Mortality in a population is regarded as an accurate and valid measure of the population's health. There are a few international studies, predominantly cross-sectional, of mortality among all foreign-born compared with an indigenous population, and the results have varied. No Swedish longitudinal study describing and analysing mortality data was found in a literature review. This study describes and analyses the differences in mortality between foreign-born persons and native Swedes during the period 1970-1999, based on data from Statistics Sweden and the National Board of Health and Welfare. The database consisted of 723,948 persons, 361 974 foreign-born living in Sweden in 1970, aged > or = 16 years, and 361 974 Swedish controls matched for age, sex, occupation and type of employment, living in the same county in 1970. The results showed increased mortality for foreign-born persons compared with the Swedish controls [odds ratio (OR) 1.08; 95% confidence interval (CI) 1.07-1.08]. Persons who had migrated 'late' (1941-1970) to Sweden were 2.5 years younger at time of death than controls. In relation to country of birth, the highest risk odds were for men born in Finland (OR 1.21), Denmark (OR 1.11) and Norway/Iceland (OR 1.074). Age cohorts of foreign-born persons born between 1901 and 1920 had higher mortality at age 55-69 years than cohorts born between 1921 and 1944. Migrants had higher mortality than the native population, and migration may be a risk factor for health; therefore, this seems to be an important factor to consider when studying mortality and health.

Do Country-Specific Skills Lead to Improved Labor Market Positions?

The gap in labor market rewards between immigrants and the native born is sometimes explained with reference to immigrants' lack of country-specific skills. This study investigates whether speaking and understanding Swedish well, having an education obtained in Sweden, and living with a Swedish partner improve immigrants' position in the labor market. The findings show that these characteristics do not substantially reduce the risk of unemployment, and the risk remains clearly above the level of native-born Swedes. However, employed immigrants with a Swedish education and very good language skills are as likely as Swedes to be educationally overqualified for their job. In sum, country-specific skills are helpful in the process of reward attainment but do not go all the way in accounting for the labor market disadvantage of immigrants. The residual may be due to discrimination.