ObjectivesStudies have found a ‘healthy-migrant effect’ (HME) among arriving migrants, that is, a better health status compared with others in the home country, but also in comparison with the population in the host country. The aims were to investigate whether the HME hypothesis is applicable to the Swedish context, that is, if health outcomes differed between a group of mainly labour migrants (Western migrants) and a group of mainly refugee/family reunion migrants (non-Western migrants) compared with the native Swedish population, and if there were any correlations between labour market attachment (LMA) and these health outcomes.DesignRegister-based, longitudinal cohort study.ParticipantsThe cohort was defined on 31 December 1990 and consisted of all migrants aged 18–47 years who arrived in Sweden in 1985–1990 (n=74 954) and a reference population of native Swedes (n=1 405 047) in the same age span. They were followed for three consecutive 6-year periods (1991–1996, 1997–2002 and 2003–2008) and were assessed for five measures of health: hospitalisation for cardiovascular and psychiatric disorders, mortality, disability pension, and sick leave.ResultsWestern migrants had, compared with native Swedes, lower or equal HRs for all health measures during all time periods, while non-Western migrants displayed higher or equal HRs for all health measures, except for mortality, during all time periods. Age, educational level, occupation and LMA explained part of the difference between migrants and native Swedes. High LMA was associated with higher HRs for cardiovascular disorders among Western migrants, higher HRs of psychiatric disorders among non-Western migrants and higher HRs of mortality among both migrant groups compared with native Swedes.ConclusionsThere were indications of a HME among Western migrants, while less proof of a HME among non-Western migrants. Stratification for LMA and different migrant categories showed some interesting differences, and measurements of the HME may be inconclusive if not stratified by migrant category or other relevant variables.

BackgroundThe aim was to investigate the associations between mental disorders and three different measures of labour-market marginalisation, and differences between native Swedes and immigrants.MethodsThe study comprised 1,753,544 individuals, aged 20–35 years, and resident in Sweden 2004. They were followed 2005–2011 with regard to disability pension, sickness absence (≥90 days) and unemployment (≥180 days). Immigrants were born in Western countries (Nordic countries, EU, Europe outside EU or North-America/Oceania), or in non-Western countries (Africa, Asia or South-America). Mental disorders were grouped into seven subgroups based on a record of in- or specialised outpatient health care 2001–2004. Hazard ratios (HRs) with 95% confidence intervals (CIs) were computed by Cox regression models with both fixed and time-dependent covariates and competing risks. We also performed stratified analyses with regard to labour-market attachment.ResultsIndividuals with mental disorders had a seven times higher risk of disability pension, a two times higher risk of sickness absence, and a 20% higher risk of unemployment than individuals without mental disorders. Individuals with personality disorders and schizophrenia/non-affective psychoses had highest risk estimates for having disability pension and long-term sickness absence, while the risk estimates of long-term unemployment were similar among all subgroups of mental disorders. Among persons with mental disorders, native Swedes had higher risk estimates for disability pension (HR:6.6; 95%CI:6.4–6.8) than Western immigrants (4.8; 4.4–5.2) and non-Western immigrants (4.8; 4.4–5.1), slightly higher risk estimates for sickness absence (2.1;2.1–2.2) than Western (1.9;1.8–2.1), and non-Western (1.9;1.7–2.0) immigrants but lower risk estimates for unemployment (1.4;1.3–1.4) than Western (1.8;1.7–1.9) and non-Western immigrants (2.0;1.9–2.1). There were similar risk estimates among sub-regions within both Western and non-Western countries. Stratification by labour-market attachment showed that the risk estimates for immigrants were lower the more distant individuals were from gainful employment.ConclusionsMental disorders were associated with all three measures of labour-market marginalisation, strongest with subsequent disability pension. Native Swedes had higher risk estimates for both disability pension and sickness absence, but lower risk estimates for unemployment than immigrants. Previous labour-market attachment explained a great part of the association between immigrant status and subsequent labour-market marginalisation.

Background: Youth unemployment is an increasing problem for societies around the world. Research has revealed negative health effects of unemployment, and this longitudinal register-based cohort study examined the relationship between unemployment and later sickness absence, disability pension and death among youth in Sweden. Method: The study group of 199 623 individuals comprised all immigrants born between 1968 and 1972 who immigrated before 1990 (25 607) and a random sample of native Swedes in the same age-range (174 016). The baseline year was 1992, and the follow-up period was from 1993 to 2007. Subjects with unemployment benefit in 1990–91, disability pension in 1990–92, severe disorders leading to hospitalization in 1990–92 and subjects who emigrated during follow-up were excluded. Results: Those who were unemployed in 1992 had elevated risk of ≥60 days of sickness absence (OR 1.02–1.49), disability pension (HR 1.08–1.62) and all except native Swedish women had elevated risk of death (HR 1.01–1.65) during follow-up compared with non-unemployed individuals. The risk of future sickness absence increased with the length of unemployment in 1992 (OR 1.06–1.54), and the risk of sickness absence increased over time. A larger part of the immigrant cohort was unemployed at baseline than native Swedes. Selection to unemployment by less healthy subjects may explain part of the association between unemployment and the studied outcomes. Conclusion: Unemployment at an early age may influence the future health of the individual. To a society it may lead to increased burdens on the welfare system and productivity loss for many years.

BackgroundLabour-market marginalisation (LMM) and common mental disorders (CMDs) are serious societal problems. The aims were to describe trajectories of LMM (both work disability and unemployment) among young adults with and without CMDs, and to elucidate the characteristics associated with these trajectories.MethodsThe study was based on Swedish registers and consisted of all individuals 19–30 years with an incident diagnosis of a CMD in year 2007 (n = 7245), and a matched comparison group of individuals without mental disorders during the years 2004–07 (n = 7245). Group-based trajectory models were used to describe patterns of LMM both before, and after the incident diagnosis of a CMD. Multinomial logistic regressions investigated the associations between sociodemographic and medical covariates and the identified trajectories.ResultsTwenty-six percent (n = 1859) of young adults with CMDs followed trajectories of increasing or constant high levels of work disability, and 32 % (n = 2302) followed trajectories of increasing or constant high unemployment. In the comparison group, just 9 % (n = 665) followed increasing or constant high levels of work disability and 21 % (n = 1528) followed trajectories of increasing or constant high levels of unemployment. A lower share of young adults with CMDs followed trajectories of constant low levels of work disability (n = 4546, 63%) or unemployment (n = 2745, 38%), compared to the level of constant low work disability (n = 6158, 85%) and unemployment (n = 3385, 50%) in the comparison group. Remaining trajectories were fluctuating or decreasing. Around 50% of young adults with CMDs had persistent levels of LMM at the end of follow-up. The multinomial logistic regression revealed that educational level and comorbid mental disorders discriminated trajectories of work disability, while educational level, living area and age determined differences in trajectories of unemployment (R2difference = 0.02–0.05, p < 0.001).ConclusionsA large share, nearly 50%, of young adults with CMDs, substantially higher than in the comparison group of individuals without mental disorders, display increasing or high persistent levels of either work disability or unemployment throughout the follow-up period. Low educational level, comorbidity with other mental disorders and living in rural areas were factors that increased the probability for LMM.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-6141-y) contains supplementary material, which is available to authorized users.

BackgroundThe aim was to elucidate if the risk of labour market marginalisation (LMM), measured as long-term unemployment, long-term sickness absence, disability pension and a combined measure of these three measures, differed between refugees and non-refugee migrants with different regions of birth compared with native Swedes.MethodsAll non-pensioned individuals aged 19–60 years who were resident in Sweden on 31 December 2009 were included (n=4 441 813, whereof 216 930 refugees). HRs with 95% CIs were computed by Cox regression models with competing risks and time-dependent covariates with a follow-up period of 2010–2013.ResultsRefugees had in general a doubled risk (HR: 2.0, 95% CI 1.9 to 2.0) and non-refugee migrants had 70% increased risk (HR: 1.7, 95% CI 1.7 to 1.7) of the combined measure of LMM compared with native Swedes. Refugees from Somalia (HR: 2.7, 95% CI 2.6 to 2.8) and Syria (HR: 2.5, 95% CI 2.5 to 2.6) had especially high risk estimates of LMM, mostly due to high risk estimates of long-term unemployment (HR: 3.4, 95% CI 3.3 to 3.5 and HR: 3.2, 95% CI 3.1 to 3.2). African (HR: 0.7, 95% CI 0.6 to 0.7) and Asian (HR: 1.0, 95% CI 1.0 to 1.1) refugees had relatively low risk estimates of long-term sickness absence compared with other refugee groups. Refugees from Europe had the highest risk estimates of disability pension (HR: 1.9, 95% CI 1.8 to 2.0) compared with native Swedes.ConclusionRefugees had in general a higher risk of all measures of LMM compared with native Swedes. There were, however, large differences in risk estimates of LMM between subgroups of refugees and with regard to type of LMM. Actions addressing differences between subgroups of refugees is therefore crucial in order to ensure that refugees can obtain as well as retain a position on the labour market.

BackgroundThere are many immigrants in the Swedish workforce, but knowledge of their general and work-related health is limited. The aim of this register-based study was to explore whether documented migrant residents in Sweden have a different health status regarding receipt of a disability pension, mortality and hospitalization for lung, heart, psychiatric, and musculoskeletal disorders compared with the native population, and if there were variations in relation to sex, geographical origin, position on the labor market, and time since first immigration.MethodsThis study included migrants to Sweden since 1960 who were 28–47 years old in 1990, and included 243 860 individuals. The comparison group comprised a random sample of 859 653 native Swedes. These cohorts were followed from 1991 to 2008 in national registers. The immigrants were divided into four groups based on geographic origin. Hazard ratios for men and women from different geographic origins and with different employment status were analyzed separately for the six outcomes, with adjustment for age, education level, and income. The influence of length of residence in Sweden was analyzed separately.ResultsNordic immigrants had increased risks for all investigated outcomes while most other groups had equal or lower risks for those outcomes than the Swedes. The lowest HRs were found in the EU 15+ group (from western Europe, North America, Australia and New Zealand). All groups, except Nordic immigrants, had lower risk of mortality, but all had higher risk of disability pension receipt compared with native Swedes. Unemployed non-Nordic men displayed equal or lower HRs for most outcomes, except disability pension receipt, compared with unemployed Swedish men. A longer time since first immigration improved the health status of men, while women showed opposite results.ConclusionsEmployment status and length of residence are important factors for health. The contradictory results of low mortality and high disability pension risks need more attention. There is great potential to increase the knowledge in this field in Sweden, because of the high quality registers.

Background: Sickness absence with cash benefits from the sickness insurance gives an opportunity to be relieved from work without losing financial security. There are, however, downsides to taking sickness absence. Periods of sickness absence, even short ones, can increase the risk for future spells of sickness absence and unemployment. The sickness period may in itself have a detrimental effect on health. The aim of the study was to investigate if there is an association between exposure to sickness absence at a young age and later sickness absence, disability pension, death, unemployment and income from work. Methods: Our cohort consisted of all immigrants aged 21–25 years in Sweden in 1993 (N = 38 207) and a control group of native Swedes in the same age group (N = 225 977). We measured exposure to sickness absence in 1993 with a follow-up period of 15 years. We conducted separate analyses for men and women, and for immigrants and native Swedes. Results: Exposure to ≥60 days of sickness absence in 1993 increased the risk of sickness absence [hazard ratio (HR) 1.6–11.4], unemployment (HR 1.1–1.2), disability pension (HR 1.2–5.3) and death (HR 1.2–3.5). The income from work, during the follow-up period, among individuals with spells of sick leave for ≥60 days in 1993 was around two-thirds of that of the working population who did not take sick leave. Conclusions: Individuals on sickness absence had an increased risk for work absence, death and lower future income.

Background Despite a reported high rate of mental disorders in refugees, scientific knowledge on their risk of suicide attempt and suicide is scarce. We aimed to investigate (1) the risk of suicide attempt and suicide in refugees in Sweden, according to their country of birth, compared with Swedish-born individuals and (2) to what extent time period effects, socio-demographics, labour market marginalisation (LMM) and morbidity explain these associations. Methods Three cohorts comprising the entire population of Sweden, 16–64 years at 31 December 1999, 2004 and 2009 (around 5 million each, of which 3.3–5.0% refugees), were followed for 4 years each through register linkage. Additionally, the 2004 cohort was followed for 9 years, to allow analyses by refugees' country of birth. Crude and multivariate hazard ratios (HRs) with 95% confidence intervals (CIs) were computed. The multivariate models were adjusted for socio-demographic, LMM and morbidity factors. Results In multivariate analyses, HRs regarding suicide attempt and suicide in refugees, compared with Swedish-born, ranged from 0.38–1.25 and 0.16–1.20 according to country of birth, respectively. Results were either non-significant or showed lower risks for refugees. Exceptions were refugees from Iran (HR 1.25; 95% CI 1.14–1.41) for suicide attempt. The risk for suicide attempt in refugees compared with the Swedish-born diminished slightly across time periods. Conclusions Refugees seem to be protected from suicide attempt and suicide relative to Swedish-born, which calls for more studies to disentangle underlying risk and protective factors.