title: Cardiovascular disease incidence and survival: Are migrants always worse off?
abstract: Studies on cardiovascular disease (CVD) incidence and survival show varying results between different ethnic groups. Our aim was to add a new dimension by exploring the role of migrant status in combination with ethnic background on incidence of-and survival from-CVD and more specifically acute myocardial infarction (AMI) and stroke. We conducted a historically prospective cohort study comprising all newly-arrived migrants to Denmark between 1.1.1993 and 31.12.2010 (n = 114,331), matched 1:6 to Danish-born by age and sex. CVD incidence was retrieved from the National Patient Registry and differences in incidence were assessed by Poisson regression and stratified by sex. Survival differences were assessed by Cox regression using all-cause and cause-specific mortality as outcome. Male refugees had significantly lower incidence of CVD (RR = 0.89; 95 % CI 0.85-0.93) and stroke (IRR = 0.62; 95 % CI 0.56-0.69) compared to Danish-born, but significantly higher incidence of AMI (IRR = 1.12; 95 % CI 1.02-1.24). Female refugees had similar rates of CVD and AMI, but significantly lower incidence of stroke (RR = 0.76; 95 % CI 0.67-0.85). Both male and female family-reunified immigrants had significantly lower incidence of CVD, AMI and stroke. All-cause and cause-specific survival after CVD, AMI and stroke was similar or significantly better for migrants compared to Danish-born, regardless of type of migrant (refugee vs. family-reunified) or country of origin. Refugees are disadvantaged in terms of some types of cardiovascular disease compared to Danish-born. Family-reunified migrants on the other hand had lower rates of CVD. All migrants had better survival than Danish-born indicating that migrants may not always be disadvantaged in health.
authors.affiliation: Section for Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Øster Farimagsgade 5, Building 10, 1014, Copenhagen K, Denmark. stinebyberg@gmail.com.
authors.forename: Stine
authors.initials: S
authors.lastname: Byberg
authors.affiliation: Department of Social Medicine, Amsterdam Medical Centre, Amsterdam University, Amsterdam, The Netherlands.
authors.forename: Charles
authors.initials: C
authors.lastname: Agyemang
authors.affiliation: The Danish Heart Registry, National Institute of Public Health, University of Southern Denmark, Odense, Denmark.|Department of Cardiology, Holbæk Hospital, Holbæk, Denmark.
authors.forename: Ann Dorthe
authors.initials: AD
authors.lastname: Zwisler
authors.affiliation: Section for Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Øster Farimagsgade 5, Building 10, 1014, Copenhagen K, Denmark.
authors.forename: Allan
authors.initials: A
authors.lastname: Krasnik
authors.affiliation: Section for Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity, and Health, University of Copenhagen, Øster Farimagsgade 5, Building 10, 1014, Copenhagen K, Denmark.|Section of Immigrant Medicine, Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark.
authors.forename: Marie
authors.initials: M
authors.lastname: Norredam
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000208:ethnology*; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D011446:Prospective Studies; D012036:Refugees / Q000706:statistics & numerical data*; D012042:Registries; D012959:Socioeconomic Factors; D020521:Stroke / Q000453:epidemiology; D014171:Transients and Migrants / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Acute myocardial infarction; Cardiovascular disease; Incidence; Migrants; Stroke; Survival