Native Swedes Research Articles

Immigrant enclaves and risk of diabetes: a prospective study.

BackgroundThe diversity of the Swedish population has increased substantially over the past three decades. The aim of this study was to assess whether living in an ethnic enclave is associated with risk of diabetes mellitus (DM) among first and second-generation immigrants and native Swedes.MethodsCumulative incidence of DM in three urban municipalities was assessed from 2006–2010 by linking records from the national census, multi-generational family register, and prescription drug register. Immigrant enclaves were identified using Moran’s Index. Multi-level logistic regression was used to assess the relationship between enclave residence and risk of DM for three groups: Iraqi immigrants, non-Iraqi immigrants, and native Swedes (N = 887,603).ResultsThe cumulative incidence of DM was greater in Iraqi enclaves compared to other neighborhoods (4.7% vs. 2.3%). Among Iraqi immigrants, enclave residence was not associated with odds of DM (Odds ratio (OR): 1.03, 95% Confidence Interval (CI): 0.86 – 1.24). Among other immigrants, enclave residence was not associated with DM after accounting for neighborhood deprivation. Among native Swedes, enclave residence was associated with elevated risk of DM even after accounting for neighborhood deprivation and individual-level characteristics (OR: 1.23, 95% CI: 1.11 – 1.36).ConclusionsResidential ethnic composition is associated with DM but this relationship differs across ethnic group. Enclave residence is not associated with increased odds of DM for immigrants, regardless of their nation of origin, but it is associated with increased likelihood of DM for native Swedes.

A family history of diabetes determines poorer glycaemic control and younger age of diabetes onset in immigrants from the Middle East compared with native Swedes

AimsImmigrant populations from the Middle East develop diabetes earlier than indigenous European populations; however, the underlying etiology is poorly understood. This study looked at the risk factors associated with early diabetes onset and, in non-diabetics, glycaemic control in immigrants from Iraq compared with native Swedes. MethodsThis cross-sectional population-based study comprised 1398 Iraqi immigrants and 757 Swedes (ages 30–75years) residing in the same area of Malmö, Sweden. Outcomes were age at diabetes onset and glycaemic control (HbA1c) as assessed by Cox proportional hazards and linear regression, respectively. ResultsIn Iraqis vs Swedes, clustering in the family history (in two or more relatives) was more prevalent (23.2% vs 3.6%, P<0.001) and diabetes onset occurred earlier (47.6years vs 53.4years, P=0.001). Having an Iraqi background independently raised the hazard ratio (HR) for diabetes onset. Diabetes risk due to family history was augmented by obesity, with the highest HRs observed in obese participants with clustering in the family history (HR: 5.1, 95% CI: 3.2–8.2) after adjusting for country of birth and gender. In participants without previously diagnosed diabetes (Iraqis: n=1270; Swedes: n=728), HbA1c levels were slightly higher in Iraqis than in Swedes (4.5% vs 4.4%, P=0.038). This difference was explained primarily by clustering in the family history rather than age, obesity, lifestyle or socioeconomic status. ConclusionThe study shows that the greater predisposition to diabetes in Middle Eastern immigrants may be explained by a more extensive family history of the disorder; clinical interventions tailored to Middle Eastern immigrants with such a family history are thus warranted.

Sickness absence at a young age and later sickness absence, disability pension, death, unemployment and income in native Swedes and immigrants

Sickness absence at a young age and later sickness absence, disability pension, death, unemployment and income in native Swedes and immigrants

Psychological Well-Being and Brokerage in Friendship Networks of Young Swedes

All ethnic groups have norms and values according to which one is expected to behave. Immigrants in particular have personal networks that simultaneously consist of co-ethnics and friends of a different ethnic background. As a consequence, they may be accustomed to the behavior, norms, and values of their own ethnic group, and also be expected to behave according to those of another ethnic group. This may either lead to ego-gratification and the strengthening and enrichment of their personality, or to feelings of stress and non-acceptance if they cannot behave fully in accordance with the expectations of their friends. This study addresses the association between interethnic open triads in networks (i.e., brokerage) and individual psychological well-being. That is, we examine whether having intra-ethnic and interethnic relationships with friends who are not also friends with each other, is either positively or negatively associated with psychological well-being. Using (network) data from a large sample (N = 2,942; age = 19) of native Swedes and first- and second-generation immigrants from former Yugoslavia and Iran (all born in 1990 and currently living in Sweden), we show that interethnic brokerage is negatively associated with psychological well-being, which implies that the different norms, values and corresponding behaviors that prevail in different ethnic groups to which the ethnic broker is connected may result in internal and external conflicts, to feelings that one is not fully accepted by any of these groups, and ultimately to a lower level of psychological well-being.

Consanguinity and genetic diseases in North Africa and immigrants to Europe.

Endemic diseases are caused by environmental and genetic factors. While in this special issue several chapters deal with environmental factors, including infections, the present focus is on genetic causes of disease clustering due to inbreeding and recessive disease mechanisms. Consanguinity is implying sharing of genetic heritage because of marriage between close relatives originating from a common ancestor. With limited natural selection, recessive genes may become more frequent in an inbred compared with an outbred population. Consanguinity is common in North Africa (NA), and the estimates range from 40 to 49% of all marriages in Tunisia and 29-33% in Morocco. As a consequence, recessive disorders are common in the NA region, and we give some examples. Thalassaemia and sickle cell disease/anaemia constitute the most common inherited recessive disorders globally and they are common in NA, but with immigration they have spread to Europe and to other parts of the world. Another example is familial Mediterranean fever, which is common in the Eastern Mediterranean area. With immigrantion from that area to Sweden, it has become the most common hereditary autoinflammatory disease in that country, and there is no evidence that any native Swede would have been diagnosed with this disease. The examples discussed in this chapter show that the historic movement of populations and current immigration are influencing the concept of 'endemic' disease.

Recent research on the mental health of immigrants to Sweden: a literature review.

The arrival of large numbers of economic migrants and refugees has seen the Swedish immigrant population increase rapidly. Research has shown that immigrants may be more susceptible to mental disorders because of traumatic events prior to immigration and adverse circumstances in their new country. The aim of this literature review is to summarize and interpret recent research on the mental health of immigrants to Sweden. A systematic search for relevant literature in PubMed was performed on 13 February 2014. Relevant literature was limited to original research articles published between 1 January 1994 and 13 February 2014. Content relating to mental disorders and suicide was reviewed and summarized. Nationwide studies showed increased risks of common mental disorders such as depression, as well as psychotic disorders, in immigrants to Sweden compared to native Swedes. However, the results are complex, with notable differences between different immigrant groups and between males and females. Risk of suicide was increased in some immigrant groups, but decreased in others. There has been little qualitative research on the mental health of immigrants and few intervention studies have targeted immigrants. Immigrants to Sweden are a mixed group with differing, but often increased, risks of mental disorders. Targeted qualitative and intervention studies may facilitate efforts to develop and implement preventive methods for immigrants at high risk of mental ill health, and to tailor treatment to the specific needs of different immigrant groups.

Physical inactivity is strongly associated with anxiety and depression in Iraqi immigrants to Sweden: a cross-sectional study

BackgroundIncreasing evidence on associations between mental health and chronic diseases like cardio-vascular disease and diabetes together with the fact that little is known about the prevalence of anxiety/depression and associated risk factors among Iraqi immigrants to Sweden, warrants a study in this group. The aim was to study the prevalence of anxiety and depression in immigrants from Iraq compared to native Swedes and compare socioeconomic and lifestyle-related factors associated with these conditions.MethodA population-based, cross-sectional study of residents of Malmö, Sweden, aged 30–75 years, born in Iraq or Sweden. The overall response rate was 49% for Iraqis and 32% for Swedes. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale. Associations were studied using multivariate logistic regression models. The outcome was odds of depression and/or anxiety.ResultsCompared to Swedes (n = 634), anxiety was three times as prevalent (52.6 vs. 16.3%, p < 0.001) and depression five times as prevalent (16.3 vs. 3.1%, p < 0.001) in Iraqi immigrants (n = 1255). Iraqis were three times more likely to be anxious and/or depressed compared to Swedes (odds ratio (OR) 3.02, 95% confidence interval (CI) 2.06-4.41). Among Iraqis, physical inactivity (<150 min/week) (OR 2.00, 95% CI 1.49-2.69), economic insecurity (OR 2.16, 95% CI 1.56-3.01), inability to trust people (OR 1.75, 95% CI 1.28-2.39) and smoking (OR 1.43, 95% CI 1.02-2.01), were strongly associated with anxiety/depression. Among Swedes, living alone (OR 2.10, 95% CI 1.36-3.25) and economic insecurity (OR 2.38, 95% CI 1.38-4.12) showed the strongest associations with anxiety/depression. Country of birth modified the effect of physical inactivity (P interaction =0.058) as well as of marital status (P interaction =0.001).ConclusionOur study indicates that economic insecurity has a major impact on poor mental health irrespective of ethnic background but that physical inactivity may be more strongly associated with anxiety/depression in immigrants from the Middle East compared to native Swedes. Preventive actions emphasizing increased physical activity may reduce the risk of poor mental health in immigrants from the Middle East, however intervention studies are warranted to test this hypothesis.

Vigorous physical activity may be important for the insulin sensitivity in immigrants from the Middle East and native Swedes.

To compare physical activity measures and their associations with insulin sensitivity, β-cell function and body mass index (BMI) between Iraqi immigrants and native Swedes. A cross-sectional study of 493 Iraqis (58% men) and 469 Swedes (54% men) aged 30 to 75 years living in the city of Malmö, Sweden. Accelerometry was used for physical activity measures (sedentary time, breaks in sedentary time, moderate and vigorous physical activity, total counts). Insulin sensitivity index and oral disposal index were determined from an oral glucose tolerance test and BMI by body weight and height. Iraqi men were less physically active than Swedish men, while the physical activity was more similar in the women. BMI was a strong predictor of insulin sensitivity and β-cell function and frequently associated with the physical activity measures. BMI modified the associations of insulin sensitivity and β-cell function with the physical activity measures to such extent that only VPA and total counts show direct associations with insulin sensitivity in addition to the indirect associations via BMI. Iraqi women demonstrated weaker associations compared with Swedish women. Physical activity and performed at vigorous intensity may be important mainly for the insulin sensitivity in Iraqi immigrants and native Swedes.

Ethnic differences in the contribution of insulin action and secretion to type 2 diabetes in immigrants from the Middle East compared to native Swedes

AimsWe investigated insulin action (insulin sensitivity index, ISI) and insulin secretion (oral disposition indices, DIo) and studied metabolic, demographic and lifestyle-related risk factors for type 2 diabetes and insulin action, in the largest non-European immigrant group to Sweden, immigrants from Iraq and native Swedes. MethodsPopulation-based, cross-sectional study conducted 2010–2012 including residents 30–75 years of age born in Iraq or Sweden, in whom oral glucose tolerance tests were performed and sociodemography and lifestyle behaviors were characterized. ResultsIn Iraqis compared to Swedes, ISI was more impaired (76.9 vs. 102.3, p<.001) whereas corrected insulin response CIR was higher (226.6 vs. 188.6, p=.016). However, insulin secretion was inadequate given the substantial insulin resistance, as indicated by lower DIo indices in Iraqis than in Swedes (DIo 12,712.9 vs. 14,659.2, p<.001). The crude ethnic difference in ISI was not offset by traditional risk factors like waist circumference, body mass index or family history of diabetes.In Iraqis, ISI conveyed somewhat higher odds of type 2 diabetes than in Swedes (odds ratio OR 0.98, 95% CI 0.97–0.99) vs. OR 0.95, 0.92–0.99), as indicated by an interaction between country of birth and ISI (Pinteraction=.044). ConclusionThis study reports ethnic differences in the contribution of insulin action to type 2 diabetes. Our data suggests that the impaired insulin action observed in immigrants from the Middle East to Sweden is not fully explained by established risk factors.

Linking Integration and Housing Career: A Longitudinal Analysis of Immigrant Groups in Sweden

This study investigates the extent to which immigrant groups are integrated in the Stockholm region through an analysis of their housing careers. Housing conditions are linked to many important life course events, as well as to the resources and preferences of each individual family. Housing conditions influence integration, but factors related to integration can also be a cause of housing conditions. In the study, we take a truly longitudinal approach to housing careers by exploring differences in the timing of career-related events between several immigrant groups and native Swedes. The objective of the study is to explore whether the housing careers of immigrant groups follow family and work careers in a similar way as the native population. The data are derived from a longitudinal individual-level register-based data-set maintained by Statistics Sweden. The analysis is carried out by way of survival analysis. Our results confirm that there are substantial ethnic differences in housing careers that cannot be attributed to family composition or career. Our results also highlight three important factors that reduce the differences between native Swedes and immigrants groups in the tendency to enter homeownership: university degree, type of municipality and duration of stay in Sweden.

Ethnicity is an independent risk indicator when estimating diabetes risk with FINDRISC scores: A cross sectional study comparing immigrants from the Middle East and native Swedes

AimsThis study sought to compare type 2 diabetes (T2D) risk indicators in Iraqi immigrants with those in ethnic Swedes living in southern Sweden. MethodsPopulation-based, cross-sectional cohort study of men and women, aged 30–75 years, born in Iraq or Sweden conducted in 2010–2012 in Malmö, Sweden. A 75g oral glucose tolerance test was performed and sociodemographic and lifestyle data were collected. T2D risk was assessed by the Finnish Diabetes Risk Score (FINDRISC). ResultsIn Iraqi versus Swedish participants, T2D was twice as prevalent (11.6 vs. 5.8%, p<0.001). A large proportion of the excess T2D risk was attributable to larger waist circumference and first-degree family history of diabetes. However, Iraqi ethnicity was a risk factor for T2D independently of other FINDRISC factors (odds ratio (OR) 2.5, 95% CI 1.6–3.9).The FINDRISC algorithm predicted that more Iraqis than Swedes (16.2 vs. 12.3%, p<0.001) will develop T2D within the next decade. The total annual costs for excess T2D risk in Iraqis are estimated to exceed 2.3 million euros in 2005, not accounting for worse quality of life. ConclusionsOur study suggests that Middle Eastern ethnicity should be considered an independent risk indicator for diabetes. Accordingly, the implementation of culturally tailored prevention programs may be warranted.

Unemployment at a Young Age and Later Unemployment in Native Swedish and Immigrant Young Adults

The youth unemployment rate is increasing in many countries and unemployment affects future work participation. Immigrants have more difficulties than natives in succeeding on the labour market. This study examined the long-term effect of unemployment on future unemployment in Sweden. All immigrants born during 1968-1972 and a random sample of native Swedes of the same age are included. The follow-up period was 15 years, 1993-2007. Unemployed individuals had an elevated risk of unemployment during follow-up. The risk of unemployment increased with the length of unemployment in 1992. Immigrants had a higher risk of unemployment both at baseline and follow-up compared with native Swedes, but followed the same pattern as native Swedes when exposed to unemployment. For individuals with ≥100 days of unemployment in 1992, participation in an Active Labour Market Program (ALMP) increased the risk of future unemployment, whereas both higher educational level at baseline and attainment of a higher educational level between 1993 and 1997 decreased the risk. In addition to the human suffering caused, this can result in increased welfare payments and loss of productivity and tax income to a society. Immigrants seem not to be more vulnerable to unemployment than native Swedes.

Where Do Immigrants Fare Worse? Modeling Workplace Wage Gap Variation with Longitudinal Employer-Employee Data

We propose a strategy for observing and explaining workplace variance in categorically linked inequalities. Using economy wide Swedish linked employer-employee panel data, we examine variation in workplace wage inequalities between native Swedes and non-Western immigrants. Consistent with relational inequality theory (RIT) we find that immigrant-native wage gaps vary dramatically across workplaces, even net of strong human capital controls. We also find that, net of observed and fixed effect controls for individual traits, workplace immigrant-native wage gaps decline with increased workplace immigrant employment and managerial representation and increase when job segregation rises. These results are stronger in high inequality workplaces and for white collar employees: contexts in which we expect status-based claims on organizational resources, the central causal mechanism identified by relational inequality theory, to be stronger. While Sweden displays substantial workplace rank segregation between non-western immigrants and native Swedes and patterns of statistical discrimination against non-western immigrants, both decline with increased labor force experience. Overall, workplace variation in the non-western immigrant-native wage gaps are contingent on organizational variation in the relative power of groups and the institutional context in which that power is exercised.

Cross-cultural validation of a simple self-report instrument of physical activity in immigrants from the Middle East and native Swedes

To investigate cross-cultural validity of a simple self-report instrument of physical activity intended to be used in Swedish health care. A validation study performed in 599 Iraqis (58% men) and 553 Swedes (53% men) aged 30-75 years living in the city of Malmö, Sweden. The self-report instrument by the Swedish National Board of Health and Welfare was compared to corresponding measures assessed from accelerometry as reference. The agreement between the methods in assessing the participants as sufficiently/insufficiently physically active (cut-point 150 min/week) was 65% in the Iraqis and 52% in the Swedes (p<0.001). The proportion disagreement where the self-reported physical activity was sufficient but insufficient according to the accelerometry was 26% and 45% in Iraqis and Swedes, respectively. Physical activity time (min/week) was overestimated by self-report compared to accelerometry by 71% in the Iraqis and 115% in the Swedes (p<0.001). The smallest and largest overestimation was seen in Iraqi (57%) and Swedish (139%) women, respectively. The deviation of the self-report instrument compared to accelerometry was related to the physical activity level, as the overestimation mainly occurred at lower physical activity. The self-report instrument proposed by the Swedish National Board of Health and Welfare may overestimate the proportion sufficiently physically active, but to an extent depending on cultural background and gender.

Cardiovascular disease in relation to diabetes status in immigrants from the Middle East compared to native Swedes: a cross-sectional study

BackgroundType 2 diabetes is highly prevalent in immigrants to Sweden from Iraq, but the prevalence of cardiovascular disease (CVD) and its risk factors are not known. In this survey we aimed to compare the prevalence of CVD and CVD-associated risk factors between a population born in Iraq and individuals born in Sweden.MethodsThis population-based, cross-sectional study comprised 1,365 Iraqi immigrants and 739 Swedes (age 30-75 years) residing in the same socioeconomic area in Malmö, Sweden. Blood tests were performed and socio-demography and lifestyles were characterized. To investigate potential differences in CVD, odds ratios (ORs) with 95% confidence intervals (CIs) were estimated by multivariate logistic regression analysis with adjustment for metabolic, lifestyle and psychosocial risk factors for CVD. Outcome measures were odds of CVD.ResultsThere were no differences in self-reported prevalence of CVD between Iraqi- and Swedish-born individuals (4.0 vs. 5.5%, OR 0.9, 95% CI 0.4-1.8). However, the prevalence of type 2 diabetes was higher in Iraqi compared to Swedish participants (8.4 vs. 3.3%, OR = 4.2, 95% CI 2.6-6.7). Moreover, among individuals with type 2 diabetes, Iraqis had a higher prevalence of CVD (22.8 vs. 8.0%, OR = 4.2, 95% CI 0.9-20.0), after adjustment for age and sex. By contrast, among those without diabetes, immigrants from Iraq had a lower prevalence of CVD than Swedes (2.2 vs. 5.5%, OR = 0.6, 95% CI 0.3-0.9).Type 2 diabetes was an independent risk factor for CVD in Iraqis only (OR = 6.8, 95% CI 2.8-16.2). This was confirmed by an interaction between country of birth and diabetes (p = 0.010). In addition, in Iraqis, type 2 diabetes contributed to CVD risk to a higher extent than history of hypertension (standardized OR 1.5 vs. 1.4).ConclusionsThis survey indicates that the odds of CVD in immigrants from Iraq are highly dependent on the presence or absence of type 2 diabetes and that type 2 diabetes contributes with higher odds of CVD in Iraqi immigrants compared to native Swedes. Our study suggests that CVD prevention in immigrants from the Middle East would benefit from prevention of type 2 diabetes.

Sequential probit modelling of family and community effects on educational progress among children to Polish and Turkish immigrants in Sweden

We explore effects of individual, family, and neighborhood effects on educational progress. The statistical model used is a multilevel sequential probit model. Such formulation allows the covariate-effects to vary across different educational levels. Results based on about 2,100 children whose parents are either native Swedes or migrants from Poland or Turkey provide new insights with regard to differentials in educational progress across background varaiables. Among others, we find that parental education is a strong predictor of educational progress at all levels. On the other hand, while family structure, family economy, and ethinic background are strongly correlated to educational progress at lower levels, their effect diminishes at higher levels of education. Possible exaplanations and implications of the results are presented.

The association between cytokines and insulin sensitivity in Iraqi immigrants and native Swedes

ObjectivesTo investigate the associations between cytokines and insulin sensitivity in Swedish residents born in Iraq and Swedish residents born in Sweden.DesignCross-sectional study.SettingsIraqi and Swedish origin residents of Rosengård area of...

The trends and the risk of type 1 diabetes over the past 40 years: an analysis by birth cohorts and by parental migration background in Sweden

ObjectiveTo investigate the trends and the risk of developing type 1 diabetes in the offspring of Swedes and immigrants by specific parental migration background, age, sex and birth cohort.DesignRegistry-based cohort...

322 Unemployment at a young age and later unemployment in native Swedish and immigrant young adults

ObjectivesThe youth unemployment rate is increasing around the world due to recent recessions in the worldwide economy. Unemployment has been seen to affect future work participation. This register-based study examined...

Social assistance among immigrants and natives in Sweden

PurposeThe purpose of this paper is to provide an overview of the issue of social assistance receipt among immigrants to Sweden and compare to receipt by natives.Design/methodology/approachThe paper describes the institutional background, reports statistical information and surveys the literature on the immigrant‐native disparity in social assistance receipt.FindingsMost out‐payment for social assistance in Sweden refers to foreign‐born persons, a category comprising 14 percent of the population. Immigrants tend to assimilate out of social assistance receipt. However, receipt continues to be higher many years after immigration among immigrants from non‐rich countries than for natives with several identical characteristics. The elevated probabilities of social assistance receipt among immigrants from non‐rich countries are interpreted to be mainly due to failed integration into the labor market at the destination.Practical implicationsPolicies for integrating immigrants into the labor market are also policies for reducing social assistance receipt among immigrants and reducing immigrant‐native social assistance disparity. However, other factors such as the structure of Swedish welfare policy play a role as well.Originality/valueThis is the first survey of the literature on disparities in social assistance receipt between immigrants and natives in Sweden.