Mortality in children aged 0–14 years born to immigrant parents in Sweden: a total-population cohort study

Background: Children of immigrants in Europe have higher infant and early-adult mortality, compared with non-immigrants or their children. We aim to establish whether they have an increased risk of child mortality, focussing on the case of Sweden. Methods: We use Cox proportional hazards regression models to estimate hazard ratios (HRs) using Swedish total-population administrative data from 1990 to 2019. We estimate all-cause mortality for children aged 0-14, overall and separately for ages 0, 1-4, and 5-14. We do this for Swedish-born children of immigrants with either one or two foreign-born parents, across a wide range of origins. HRs are reported with reference to child mortality for Swedish-born children with two Swedish-born parents. Findings: We find persistently higher mortality for children of immigrants with two parents born in the Middle East & Northern Africa (HR ages 0-14 = 1.22 for mother's country of birth (95% CI: 1.13-1.33)). Inequalities exist at all childhood ages but we find scant evidence of higher mortality risks in the same origin groups when only one parent is foreign-born. Interpretation: A higher risk of childhood death in these groups is the result of specific factors that interact uniquely across ages and origins. While mortality at these ages is low in absolute terms, each death is a tragedy that represents decades of life lost and has far-reaching social consequences. Funding: European Research Council, United Kingdom Research and Innovation (through the Horizon Europe Guarantee programme), Swedish Research Council, Swedish Research Council for Health, Working Life and Welfare, and the Scottish Graduate School of Social Science-Scottish Funding Council.