Cardiovascular diseases in immigrants in Sweden

Aims: The general aim with this project was to elucidate coronary heart disease (CHD) morbidity and mortality among immigrants in Sweden, by investigating the morbidity from CHD, comparing all-cause and CHD mortality between immigrants in Sweden and natives in the country of birth, analyzing the trend of CHD, and estimating the prevalence of CHD risk factors. Methods: The first study was designed as a follow-up study of the incidence of CHD among twelve immigrant groups. The second study was designed as a follow-up study on mortality from CHD among eight immigrant groups compared to their country of birth. The third study was designed as a follow-up study on the trend of CHD among eleven immigrant groups. In these three studies the material was based on the whole Swedish population. The fourth study was designed as a cross-sectional interview study of unhealthy behaviors and risk factors of CHD among eight immigrant groups in Sweden. Results: In the first study, the age-adjusted risk of CHD was higher in most foreign-born groups than in Swedes, e.g. in nine out of twelve male groups, and in seven out of twelve female groups. After adjustment for level of education and employment status, the risks were still high, but on a lower level. In the second study, the all-cause mortality risk was lower among seven out of eight male immigrant groups and among six out of eight female immigrant groups than in their country of birth. The CHD mortality risk was lower in four out of eight male immigrant groups, and among two out of eight female immigrant groups, than in their country of birth. In the third study, the morbidity trend of CHD decreased slightly among men from Sweden, Finland, and the OECD during the 1990s. The contrary was observed in women from Southern Europe, Turkey, and Iran, in whom CHD morbidity increased. In the remaining immigrant groups the morbidity was unchanged. In the fourth study, the age-adjusted risk of smoking, physical inactivity, and obesity was higher among immigrants than Swedes. In all of the male immigrant groups, and in three of the female ones, the frequency of smoking behavior was increased. Further, there was an increased frequency of obesity in three female and two male groups and of physical inactivity in six male and female immigrant groups. In a second model, also adjusting for education, unemployment, and social network, the increased frequency of smoking, obesity, and physical inactivity remained in almost all groups. Conclu