Torture and healthcare service utilization in Syrian refugees resettled in Norway – a longitudinal, registry-based study

<b>Background</b>: Torture, banned under international treaties such as the UN Convention Against Torture, remains a widespread violation with profound health consequences. The Istanbul Protocol (IP) sets global standards for the medical documentation of torture highlighting the important role of healthcare providers. A limitation of existing research on torture's health impacts is that studies are largely cross-sectional and reliant on self-reported clinical data. Norway's detailed healthcare registry data offers a robust opportunity to conduct longitudinal, population-based studies, advancing our understanding of torture's long-term effects on refugees and its public health implications.<b>Objectives</b>: This study has two main aims: (1) to examine the frequency of torture-related diagnostic codes and the factors associated with their use in primary and specialized care among adult Syrian refugees resettled in Norway, and (2) to link self-report data on torture exposure in adult refugees from Syria with data on HCSU over a 6-year follow-up to explore group differences in utilization patterns.<b>Methods</b>: Study participants include the RBMI cohort (<i>N</i> = 14,350), comprised of all adult refugees from Syria resettled in Norway in 2015-2017; and the REFUGE cohort - a subsample of the RBMI cohort - comprised of those in the RBMI cohort who participated in a nationwide survey study in 2018. Aim 1 will be addressed using data (2015-2024) from the Norwegian Registry for Primary Health Care (KPR) and the Norwegian Patient Registry (NPR), which contain information on all contacts with primary- and specialized healthcare services throughout Norway (e.g. date of contact, diagnostic code given). To address aim 2, we will link 2018 survey data on torture exposure to the abovementioned registry data on HCSU. In addition to descriptive statistics, multivariable, two-part hurdle regression models will be used to analyse data since we expect zero inflation and overdispersion of the outcomes (HCSU).<b>Stage of study:</b> This manuscript reports Stage 1 of a Registered Report; analyses will be conducted after in-principle acceptance.