Behavioral risks and quality of life of Ukrainian refugees versus the Estonian general population

Abstract Background Refugees constitute a vulnerable group that often experiences a lower health-related quality of life (HRQoL) than the general population. This study examines the association between HRQoL and behavioral risk profiles among Ukrainian female refugees and females from the Estonian general population. Methods The sample included female respondents aged 18-64 years from two population-based surveys from Estonia covering Ukrainian refugees (n = 713) and general population (n = 755). Risk behaviors (daily smoking, alcohol use, physical inactivity, overweight/obesity, high screen time) were assessed both as an index variable (range 0-5) and via behavioral risk profiles identified using latent class analysis (LCA). HRQoL was measured using the EQ-5D-3L. Tobit regression models were used to examine the association between multiple risk behaviors and HRQoL. Results The mean number of behavioral risk factors was higher among refugees (2.03±0.96), compared to general population (1.78±1.02; p < 0.001). Refugees had lower HRQoL index value compared to general population, but the difference was statistically insignificant. In both groups, each additional risk behavior was associated with a significant 0.04 decrease in the EQ-5D-3L utility. LCA resulted in four behavioral classes: lower risk (13.2% refugees; 49.4% general population), multiple risk (11.1%; 14.6%), overweight and inactive (41.4%; 18.3%), and physically inactive (34.4%; 17.7%). Belonging to the overweight and inactive class was associated with lower HRQoL in both populations (p < 0.05), while belonging to the multiple risk class was associated with lower HRQoL scores only among the general population (p < 0.05). Conclusions Ukrainian female refugees demonstrate more adverse health behaviors, associated with poorer HRQoL. Health interventions targeting refugees should address multiple behavioral risks to improve HRQoL and wellbeing. Key messages • Compared to the Estonian general population, Ukrainian female refugees show more adverse health behaviors that are assocaited with lower HRQoL, highlighting the need for targeted health interventions. • Compared to the general population, refugees often face greater vulnerability and reduced health-related quality of life.