scholarly journals Mortality and major disease risk among migrants of the 1991–2001 Balkan wars to Sweden: A register-based cohort study

PLoS Medicine ◽  
2020 ◽  
Vol 17 (12) ◽  
pp. e1003392
Author(s):  
Edda Bjork Thordardottir ◽  
Li Yin ◽  
Arna Hauksdottir ◽  
Ellenor Mittendorfer-Rutz ◽  
Anna-Clara Hollander ◽  
...  
Keyword(s):  
Cohort Study ◽  
Health Outcomes ◽  
Psychiatric Disorders ◽  
Disease Risk ◽  
Mortality Data ◽  
Post Traumatic Stress ◽  
Individual Level ◽  
Adverse Health Outcomes ◽  
Balkan Wars ◽  
National Patient

Background In recent decades, millions of refugees and migrants have fled wars and sought asylum in Europe. The aim of this study was to quantify the risk of mortality and major diseases among migrants during the 1991–2001 Balkan wars to Sweden in comparison to other European migrants to Sweden during the same period. Methods and findings We conducted a register-based cohort study of 104,770 migrants to Sweden from the former Yugoslavia during the Balkan wars and 147,430 migrants to Sweden from 24 other European countries during the same period (1991–2001). Inpatient and specialized outpatient diagnoses of cardiovascular disease (CVD), cancer, and psychiatric disorders were obtained from the Swedish National Patient Register and the Swedish Cancer Register, and mortality data from the Swedish Cause of Death Register. Adjusting for individual-level data on sociodemographic characteristics and emigration country smoking prevalence, we used Cox regressions to contrast risks of health outcomes for migrants of the Balkan wars and other European migrants. During an average of 12.26 years of follow-up, being a migrant of the Balkan wars was associated with an elevated risk of being diagnosed with CVD (HR 1.39, 95% CI 1.34–1.43, p < 0.001) and dying from CVD (HR 1.45, 95% CI 1.29–1.62, p < 0.001), as well as being diagnosed with cancer (HR 1.16, 95% CI 1.08–1.24, p < 0.001) and dying from cancer (HR 1.27, 95% CI 1.15–1.41, p < 0.001), compared to other European migrants. Being a migrant of the Balkan wars was also associated with a greater overall risk of being diagnosed with a psychiatric disorder (HR 1.19, 95% CI 1.14–1.23, p < 0.001), particularly post-traumatic stress disorder (HR 9.33, 95% CI 7.96–10.94, p < 0.001), while being associated with a reduced risk of suicide (HR 0.68, 95% CI 0.48–0.96, p = 0.030) and suicide attempt (HR 0.57, 95% CI 0.51–0.65, p < 0.001). Later time period of migration and not having any first-degree relatives in Sweden at the time of immigration were associated with greater increases in risk of CVD and psychiatric disorders. Limitations of the study included lack of individual-level information on health status and behaviors of migrants at the time of immigration. Conclusions Our findings indicate that migrants of the Balkan wars faced considerably elevated risks of major diseases and mortality in their first decade in Sweden compared to other European migrants. War migrants without family members in Sweden or with more recent immigration may be particularly vulnerable to adverse health outcomes. Results underscore that persons displaced by war are a vulnerable group in need of long-term health surveillance for psychiatric disorders and somatic disease.

scholarly journals Study protocol for the ABERRANT study: antibiotic-induced disruption of the maternal and infant microbiome and adverse health outcomes — a prospective cohort study among children born at term

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e036275
Author(s):  
Maryse Volery ◽  
Valentin Scherz ◽  
William Jakob ◽  
Diane Bandeira ◽  
Vanessa Deggim-Messmer ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Cohort Study ◽  
Breast Milk ◽  
Health Outcomes ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Intestinal Microbiome ◽  
Metagenomic Sequencing ◽  
Adverse Health Outcomes ◽  
Registration Number

IntroductionThere is compositional overlap between the maternal intestinal microbiome, the breast milk microbiome and the infant oral and intestinal microbiome. Antibiotics cause profound changes in the microbiome. However, the effect of intrapartum and early-life antibiotics on the maternal intestinal and breast milk microbiome, and the infant oral and intestinal microbiome, and whether effects are only short term or persist long term remain uncertain.Methods and analysesIn this prospective cohort study, we will use metagenomic sequencing to determine: (1) the effect of intrapartum antibiotics on the composition of the breast milk, and the infant oral and intestinal microbiome, including the development and persistence of antibiotic resistance; (2) the effect of antibiotic exposure in the first year of life on the composition of the infant oral and intestinal microbiome, including the development and persistence of antibiotic resistance; (3) the effect of disruption of the infant oral and intestinal microbiome on health outcomes and (4) the compositional overlap between the maternal intestinal microbiome, the breast milk microbiome and the infant oral and intestinal microbiome.Ethics and disseminationThe ABERRANT study has been approved by the commission cantonale d’éthique de la recherche sur l’être humain (CER-VD) du Canton de Vaud (#2019–01567). Outcomes will be disseminated through publication and will be presented at scientific conferences.Trial registration numberNCT04091282.

scholarly journals Healthy migrant effect in the Swedish context: a register-based, longitudinal cohort study.

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e026972 ◽  
Author(s):  
Magnus Helgesson ◽  
Bo Johansson ◽  
Tobias Nordquist ◽  
Eva Vingård ◽  
Magnus Svartengren
Keyword(s):  
Cohort Study ◽  
Health Outcomes ◽  
Psychiatric Disorders ◽  
Reference Population ◽  
Longitudinal Cohort Study ◽  
Healthy Migrant Effect ◽  
Swedish Population ◽  
Longitudinal Cohort ◽  
Health Measures ◽  
Time Periods

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.

scholarly journals Association between patterns of alcohol consumption (beverage type, frequency and consumption with food) and risk of adverse health outcomes: a prospective cohort study

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Bhautesh Dinesh Jani ◽  
Ross McQueenie ◽  
Barbara I. Nicholl ◽  
Ryan Field ◽  
Peter Hanlon ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Cohort Study ◽  
Alcohol Consumption ◽  
Health Outcomes ◽  
Prospective Cohort ◽  
Red Wine ◽  
Average Amount ◽  
Adverse Health Outcomes ◽  
Beverage Type ◽  
Risk Of Mortality

Abstract Background Alcohol consumption is a leading contributor to death and disability worldwide, but previous research has not examined the effects of different patterns of alcohol consumption. The study objective was to understand the relationship between different alcohol consumption patterns and adverse health outcomes risk, adjusting for average amount consumed among regular drinkers. Methods This was a prospective cohort study of UK Biobank (UKB) participants. Abstainers, infrequent alcohol consumers or those with previous cancer, myocardial infarction (MI), stroke or liver cirrhosis were excluded. We used beverage type, consumption with food and consumption frequency as exposures and adjusted for potential confounding. All-cause mortality, major cardiovascular events-MACE (MI/stroke/cardiovascular death), accidents/injuries, liver cirrhosis, all-cause and alcohol-related cancer incidence over 9-year median follow-up period were outcomes of interest. Results The final sample size for analysis was N = 309,123 (61.5% of UKB sample). Spirit drinking was associated with higher adjusted mortality (hazard ratio (HR) 1.25; 95% confidence intervals (CI) 1.14–1.38), MACE (HR 1.31; 95% CI 1.15–1.50), cirrhosis (HR 1.48; 95% CI 1.08–2.03) and accident/injuries (HR 1.10; 95% CI 1.03–1.19) risk compared to red wine drinking, after adjusting for the average weekly alcohol consumption amounts. Beer/cider drinkers were also at a higher risk of mortality (HR 1.18; 95% CI 1.10–1.27), MACE (HR 1.16; 95% CI 1.05–1.27), cirrhosis (HR 1.36; 95% CI 1.06–1.74) and accidents/injuries (HR 1.11; 95% CI 1.06–1.17). Alcohol consumption without food was associated with higher adjusted mortality (HR 1.10; 95% CI 1.02–1.17) risk, compared to consumption with food. Alcohol consumption over 1–2 times/week had higher adjusted mortality (HR 1.09; 95% CI 1.03–1.16) and MACE (HR 1.14; 95% CI 1.06–1.23) risk, compared to 3–4 times/week, adjusting for the amount of alcohol consumed. Conclusion Red wine drinking, consumption with food and spreading alcohol intake over 3–4 days were associated with lower risk of mortality and vascular events among regular alcohol drinkers, after adjusting for the effects of average amount consumed. Selection bias and residual confounding are important possible limitations. These findings, if replicated and validated, have the potential to influence policy and practice advice on less harmful patterns of alcohol consumption.

scholarly journals Exploring Strategies for Investigating the Mechanisms Linking Climate and Individual-Level Child Health Outcomes: An Analysis of Birth Weight in Mali

Demography ◽  
2021 ◽  
Vol 58 (2) ◽  
pp. 499-526
Author(s):  
Kathryn Grace ◽  
Andrew Verdin ◽  
Audrey Dorélien ◽  
Frank Davenport ◽  
Chris Funk ◽  
...  
Keyword(s):  
Birth Weight ◽  
Child Health ◽  
Health Outcomes ◽  
Weather Conditions ◽  
Weather Variability ◽  
Individual Level ◽  
Child Health Outcomes ◽  
Adverse Health Outcomes ◽  
Weight Outcomes ◽  
Infant Birth

Abstract The goal of this article is to consider data solutions to investigate the differential pathways that connect climate/weather variability to child health outcomes. We apply several measures capturing different aspects of climate/weather variability to different time periods of in utero exposure. The measures are designed to capture the complexities of climate-related risks and isolate their impacts based on the timing and duration of exposure. Specifically, we focus on infant birth weight in Mali and consider local weather and environmental conditions associated with the three most frequently posited potential drivers of adverse health outcomes: disease (malaria), heat stress, and food insecurity. We focus this study on Mali, where seasonal trends facilitate the use of measures specifically designed to capture distinct aspects of climate/weather conditions relevant to the potential drivers. Results indicate that attention to the timing of exposures and employing measures designed to capture nuances in each of the drivers provides important insight into climate and birth weight outcomes, especially in the case of factors impacted by precipitation. Results also indicate that high temperatures and low levels of agricultural production are consistently associated with lower birth weights, and exposure to malarious conditions may increase likelihood of nonlive birth outcomes.

Subjective measures of binge drinking and alcohol-specific adverse health outcomes: a prospective cohort study

Addiction ◽  
2011 ◽  
Vol 107 (2) ◽  
pp. 323-330 ◽  
Author(s):  
Tapio Paljärvi ◽  
Pia Mäkelä ◽  
Kari Poikolainen ◽  
Sakari Suominen ◽  
Josip Car ◽  
...  
Keyword(s):  
Cohort Study ◽  
Health Outcomes ◽  
Binge Drinking ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Subjective Measures ◽  
Adverse Health ◽  
Adverse Health Outcomes

scholarly journals Associations Between Post-migration Stressors and Psychiatric Disorders in Adult Refugees in European High Income Countries. A Systematic Review

2021 ◽  
Author(s):  
Anna Christina Nowak ◽  
Victoria Sophie Boettcher ◽  
Lea-Marie Gehrlein ◽  
Claudia Hornberg
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Health Outcomes ◽  
Psychiatric Disorders ◽  
Legal Status ◽  
Stress Disorder ◽  
High Income ◽  
Mental Health Outcomes ◽  
Post Traumatic Stress ◽  
High Prevalence

Abstract Background: Refugees and asylum seekers have a high prevalence of psychiatric disorders such as posttraumatic stress disorder (PTSD), anxiety and depression. Associations between the number of traumatic events and psychiatric disorders have been reported in literature, but knowledge on the influence of post-migration stressors on mental health outcomes in host countries remains scarce. Method: Four databases in the field of public and mental health were systematically searched. From a total of 2,456 studies found, 1,777 were included for title and abstract screening and 61 full texts were separately screened for eligibility by 2 authors. Out of these studies, 23 studies were included in this systematic review. A narrative synthesis was undertaken.Results: The overall findings showed that post-migration stressors have a significant impact on mental health outcomes. Especially uncertain legal status, missing social support and unemployment were shown to negatively influence mental health, but results vary among the different psychiatric disorders, i.e. post-traumatic stress disorder, depression and anxiety. Discussion: Post-migration stressors can contribute to the high prevalence rates of psychiatric disorders in refugees in European high-income countries. However, results must be interpreted with caution because of the heterogeneous study populations included and the variety of post-migration stressors. None of the studies considered the effect of mental disorders on the perceived severity of post-migration stressors.

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