title: Differences in uptake of immunisations and health examinations among refugee children compared to Danish-born children: a cohort study.
abstract: Refugee children and their families constitute a vulnerable group regarding health and access to care. In a register-based cohort design, we examined differences in uptake of immunisations and child health examinations between refugee children and Danish-born children, including predictors of uptake among refugee children. Refugee children (n = 16,701) who, between January 1993 and December 2010, obtained residency permits in Denmark were included and matched in a 1:6 ratio on age and sex with Danish-born children (n = 100,206). Personal identification numbers were cross-linked to the National Danish Health Service Register, identifying all contacts for immunisation and child health examinations. We estimated hazard ratios (HR) of uptake. Refugee children had a lower uptake of all immunisations compared to Danish-born children. The lowest uptake was found for immunisation against diphtheria, tetanus, pertussis and polio (HR = 0.50; 95 % confidence interval (CI) 0.48-0.51). Participation in child health examinations was also lower among refugee children with the lowest at the last child health examination at age 5 (HR = 0.48; 95 % CI 0.47-0.50). Adjusting the analysis for parental income increased the HRs by 10-20 %.
  
  
  CONCLUSIONS
  This Danish register-based study using nationwide data revealed a lower uptake of routine immunisations and child health examinations among refugee children compared to Danish-born children.
  
  
  BACKGROUND
  •Uptake of immunisation and child health examination is associated with low household income, unemployment and low educational status among the parents. •Uptake may be even lower among refugee families as they constitute a vulnerable group regarding access to healthcare. What is New: •Refugee children had lower uptake of immunisations and child health examinations compared to Danish-born children. •Several predictors of uptake were identified including region of origin and duration of residence.
authors.affiliation: Danish Research Centre for Migration, Department of Public Health, Ethnicity and Health (MESU), Section for Health Services Research, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark. sanm@sund.ku.dk.
authors.forename: Sanne Pagh
authors.initials: SP
authors.lastname: Moller
authors.affiliation: Centre for Health Equity Studies (CHESS), Karolinska Institutet/Stockholm University, SE-106 91, Stockholm, Sweden.|Clinical Epidemiology, Department of Medicine, Karolinska Institutet/Stockholm University, SE-171 76, Stockholm, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Hjern
authors.affiliation: Section for Social Medicine, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark.
authors.forename: Anne-Marie Nybo
authors.initials: AM
authors.lastname: Andersen
authors.affiliation: Danish Research Centre for Migration, Department of Public Health, Ethnicity and Health (MESU), Section for Health Services Research, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark.|Section of Immigrant Medicine, Department of Infectious Diseases, Copenhagen University Hospital, Kettegård Allé 30, 2650, Hvidovre, Denmark.
authors.forename: Marie
authors.initials: M
authors.lastname: Norredam
mesh_terms: D002648:Child; D000067576:Child Health / Q000706:statistics & numerical data*; D002662:Child Health Services / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003718:Denmark; D005260:Female; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D008297:Male; D010808:Physical Examination / Q000706:statistics & numerical data*; D012036:Refugees / Q000706:statistics & numerical data*; D012042:Registries
keywords: Access; Child healthcare; Children; Immunisations; Migration; Refugee; Register-based