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Causes of death among undocumented migrants in Sweden, 1997-2010.

Wahlberg A, Källestål C, Lundgren A, Essén B - Glob Health Action (2014)

Bottom Line: Undocumented migrants had a statistically significant increased risk of dying from external causes (odds ratio [OR] 3.57, 95% confidence interval [CI]: 2.83-4.52) and circulatory system diseases (OR 2.20, 95% CI: 1.73-2.82) compared to residents, and a lower risk of dying from neoplasms (OR 0.07, 95% CI: 0.04-0.14).We found inequity in health as substantial differences in causes of death between undocumented migrants and residents were seen.Legal ambiguities regarding health care provision must be addressed if equity in health is to be achieved in a country otherwise known for its universal health coverage.

View Article: PubMed Central - PubMed

Affiliation: Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden; anna.wahlberg@kbh.uu.se.

ABSTRACT

Background: Undocumented migrants are one of the most vulnerable groups in Swedish society, where they generally suffer from poor health and limited health care access. Due to their irregular status, such migrants are an under-researched group and are not included in the country's Cause of Death Register (CDR).

Objective: To determine the causes of death among undocumented migrants in Sweden and to ascertain whether there are patterns in causes of death that differ between residents and undocumented migrants.

Design: This is a cross-sectional study of death certificates issued from 1997 to 2010 but never included in the CDR from which we established our study sample of undocumented migrants. As age adjustments could not be performed due to lack of data, comparisons between residents and undocumented migrants were made at specific age intervals, based on the study sample's mean age at death±a half standard deviation.

Results: Out of 7,925 individuals surveyed, 860 were classified as likely to have been undocumented migrants. External causes (49.8%) were the most frequent cause of death, followed by circulatory system diseases, and then neoplasms. Undocumented migrants had a statistically significant increased risk of dying from external causes (odds ratio [OR] 3.57, 95% confidence interval [CI]: 2.83-4.52) and circulatory system diseases (OR 2.20, 95% CI: 1.73-2.82) compared to residents, and a lower risk of dying from neoplasms (OR 0.07, 95% CI: 0.04-0.14).

Conclusions: We believe our study is the first to determine national figures on causes of death of undocumented migrants. We found inequity in health as substantial differences in causes of death between undocumented migrants and residents were seen. Legal ambiguities regarding health care provision must be addressed if equity in health is to be achieved in a country otherwise known for its universal health coverage.

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How the study sample of undocumented migrants was identified. aDeath certificates of stillbirths are not collected by the Swedish National Board of Health and Welfare, but the Swedish National Board of Forensic Medicine had n=6.
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Figure 0001: How the study sample of undocumented migrants was identified. aDeath certificates of stillbirths are not collected by the Swedish National Board of Health and Welfare, but the Swedish National Board of Forensic Medicine had n=6.

Mentions: Our first task was to extract the study sample of undocumented migrants from the whole group of deaths not included in the CDR (Fig. 1). We excluded Swedish emigrants (death certificates of Swedish emigrants are often sent back to Sweden even though the deceased are no longer Swedish residents, or the Swedish emigrant dies while in Sweden on a visit), as well as delayed Swedish and foreign death certificates of Swedish residents (sometimes it takes years for the death certificate to reach the SNBHW, making it unfeasible to include it in the yearly statistics), duplicates or supplements, and stillbirths. To be identified as a Swedish resident or emigrant and subsequently excluded, at least two of the following pieces of information had to be present in the death certificate: a Swedish national identification number, a Swedish address, or a name of Swedish origin. People were also excluded if they were listed in the Swedish Death Index, a register of most deaths of residents that occurred in Sweden between 1901 and 2009, which includes data on emigrants. In addition, people from countries classified by WHO as group A (Table 1) (14), indicating that their child and adult mortality strata is very low, were excluded. We also made case-by-case assessments so that if information on a death certificate ruled out an undocumented migrant, for example truck drivers passing through Sweden, that person was excluded. If we thought someone might be an undocumented migrant, that individual was included. Thus, if nothing was known about the deceased except the cause of death, the person was included.


Causes of death among undocumented migrants in Sweden, 1997-2010.

Wahlberg A, Källestål C, Lundgren A, Essén B - Glob Health Action (2014)

How the study sample of undocumented migrants was identified. aDeath certificates of stillbirths are not collected by the Swedish National Board of Health and Welfare, but the Swedish National Board of Forensic Medicine had n=6.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4048596&req=5

Figure 0001: How the study sample of undocumented migrants was identified. aDeath certificates of stillbirths are not collected by the Swedish National Board of Health and Welfare, but the Swedish National Board of Forensic Medicine had n=6.
Mentions: Our first task was to extract the study sample of undocumented migrants from the whole group of deaths not included in the CDR (Fig. 1). We excluded Swedish emigrants (death certificates of Swedish emigrants are often sent back to Sweden even though the deceased are no longer Swedish residents, or the Swedish emigrant dies while in Sweden on a visit), as well as delayed Swedish and foreign death certificates of Swedish residents (sometimes it takes years for the death certificate to reach the SNBHW, making it unfeasible to include it in the yearly statistics), duplicates or supplements, and stillbirths. To be identified as a Swedish resident or emigrant and subsequently excluded, at least two of the following pieces of information had to be present in the death certificate: a Swedish national identification number, a Swedish address, or a name of Swedish origin. People were also excluded if they were listed in the Swedish Death Index, a register of most deaths of residents that occurred in Sweden between 1901 and 2009, which includes data on emigrants. In addition, people from countries classified by WHO as group A (Table 1) (14), indicating that their child and adult mortality strata is very low, were excluded. We also made case-by-case assessments so that if information on a death certificate ruled out an undocumented migrant, for example truck drivers passing through Sweden, that person was excluded. If we thought someone might be an undocumented migrant, that individual was included. Thus, if nothing was known about the deceased except the cause of death, the person was included.

Bottom Line: Undocumented migrants had a statistically significant increased risk of dying from external causes (odds ratio [OR] 3.57, 95% confidence interval [CI]: 2.83-4.52) and circulatory system diseases (OR 2.20, 95% CI: 1.73-2.82) compared to residents, and a lower risk of dying from neoplasms (OR 0.07, 95% CI: 0.04-0.14).We found inequity in health as substantial differences in causes of death between undocumented migrants and residents were seen.Legal ambiguities regarding health care provision must be addressed if equity in health is to be achieved in a country otherwise known for its universal health coverage.

View Article: PubMed Central - PubMed

Affiliation: Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden; anna.wahlberg@kbh.uu.se.

ABSTRACT

Background: Undocumented migrants are one of the most vulnerable groups in Swedish society, where they generally suffer from poor health and limited health care access. Due to their irregular status, such migrants are an under-researched group and are not included in the country's Cause of Death Register (CDR).

Objective: To determine the causes of death among undocumented migrants in Sweden and to ascertain whether there are patterns in causes of death that differ between residents and undocumented migrants.

Design: This is a cross-sectional study of death certificates issued from 1997 to 2010 but never included in the CDR from which we established our study sample of undocumented migrants. As age adjustments could not be performed due to lack of data, comparisons between residents and undocumented migrants were made at specific age intervals, based on the study sample's mean age at death±a half standard deviation.

Results: Out of 7,925 individuals surveyed, 860 were classified as likely to have been undocumented migrants. External causes (49.8%) were the most frequent cause of death, followed by circulatory system diseases, and then neoplasms. Undocumented migrants had a statistically significant increased risk of dying from external causes (odds ratio [OR] 3.57, 95% confidence interval [CI]: 2.83-4.52) and circulatory system diseases (OR 2.20, 95% CI: 1.73-2.82) compared to residents, and a lower risk of dying from neoplasms (OR 0.07, 95% CI: 0.04-0.14).

Conclusions: We believe our study is the first to determine national figures on causes of death of undocumented migrants. We found inequity in health as substantial differences in causes of death between undocumented migrants and residents were seen. Legal ambiguities regarding health care provision must be addressed if equity in health is to be achieved in a country otherwise known for its universal health coverage.

Show MeSH
Related in: MedlinePlus