Coronary heart disease incidence among non-Western immigrants compared to Danish-born people: effect of country of birth, migrant status, and income
Coronary heart disease incidence among non-Western immigrants compared to Danish-born people: effect of country of birth, migrant status, and income
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DOI：
10.1177/2047487314551538
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发表时间：
2015-10-01
影响因子：
8.3
通讯作者：
Norredam, Marie
中科院分区：
文献类型：
--
作者：
Bo, Anne;Zinckernagel, Line;Norredam, Marie
背景：全球移民的增加使移民健康成为世界范围内的一个重要话题。我们研究了出生国、移民身份（难民/家庭团聚）和收入对冠心病 (CHD) 发病率的影响。设计：这是一项基于历史登记的前瞻性队列研究。方法：研究队列由来自非西方国家的 18 岁以上移民组成，他们从 1 月 1 日起以难民身份 (n = 29,045) 或家庭团聚移民 (n = 28,435) 在丹麦获得居留许可1993 年至 1999 年 12 月 31 日和丹麦出生的参考人群 (n = 229,918)。确定了1993年1月1日至2007年12月31日期间的首次冠心病发病率。使用Cox回归分析估计了11个移民群体的发病率。结果：来自阿富汗、伊拉克、土耳其、东欧和中亚、南亚、前南斯拉夫、中东和北非的移民的冠心病发病率显着较高（风险比（HR）= 1.36；95%置信区间（CI）： 1.05-1.75 至 HR = 2.86；95% CI：2.01-4.08）与丹麦出生的人相比。来自索马里、南美洲和中美洲、撒哈拉以南非洲的移民以及来自东亚和太平洋地区的女性与丹麦出生的人没有显着差异，而来自东亚和太平洋地区的男性移民的发病率明显较低（HR = 0.32；95% CI：0.17-0.62）。当也包括移民身份时，较高的发生率有所降低。男性难民（HR = 1.35；95% CI：1.11-1.65）和女性难民（HR = 1.33；95% CI：1.08-1.65）的 CHD 发病率显着高于家庭团聚移民。当同时考虑移民身份和收入时，大多数移民群体的冠心病发病率下降到微不足道的水平。结论：大多数非西方移民群体的冠心病发病率高于丹麦出生的人。研究表明，移民身份和收入是出生国对先心病影响的重要潜在机制。
Background: Increasing global migration has made immigrants' health an important topic worldwide. We examined the effect of country of birth, migrant status (refugee/family-reunified) and income on coronary heart disease (CHD) incidence.Design: This was a historical prospective register-based cohort study.Methods: The study cohort consisted of immigrants above 18 years from non-Western countries who had obtained a residence permit in Denmark as a refugee (n = 29,045) or as a family-reunified immigrant (n = 28,435) from 1 January 1993-31 December 1999 and a Danish-born reference population (n = 229,918). First-time CHD incidence was identified from 1 January 1993-31 December 2007. Incidence ratios for 11 immigrant groups were estimated using Cox regression analysis.Results: Immigrants from Afghanistan, Iraq, Turkey, Eastern Europe and Central Asia, South Asia, the Former Yugoslavia, and the Middle East and North Africa had significantly higher incidences of CHD (hazard ratio (HR) = 1.36; 95% confidence interval (CI): 1.05-1.75 to HR = 2.86; 95% CI: 2.01-4.08) compared with Danish-born people. Immigrants from Somalia, South and Middle America, Sub-Saharan Africa and women from East Asia and the Pacific did not differ significantly from Danish-born people, whereas immigrant men from East Asia and the Pacific had a significantly lower incidence (HR = 0.32; 95% CI: 0.17-0.62). When also including migrant status, the higher incidences were reduced. Refugee men (HR = 1.35; 95% CI: 1.11-1.65) and women (HR = 1.33; 95% CI: 1.08-1.65) had a significantly higher incidence of CHD than family-reunified immigrants. When migrant status and income were included simultaneously, the incidences decreased to an insignificant level for most immigrant groups.Conclusions: Most non-Western immigrant groups had a higher incidence of CHD than Danish-born people. The study revealed that migrant status and income are important underlying mechanisms of the effect of country of birth on CHD.