Mortality differences between immigrant and native children and youths in Denmark: a nationwide cohort study focusing on refugees and family-reunified immigrants

Abstract Immigrant children and youths represent a growing population in Europe, yet studies on their health are scarce. Mortality is an indicator of both morbidity and healthcare access. This national register-based study aimed to compare all-cause and cause-specific mortality between natives and immigrants under 25 in Denmark. Using the Danish Migrant Cohort, we followed 82,461 immigrant and 473,244 native children and youths from 1993 to 2015 and from 2020 to 2022. Incidence rate (IR) was used to describe mortality by sex and age (in both groups) and by region of origin, migrant status, and length of stay (among immigrants). We used sex-stratified, age-adjusted Cox proportional hazard ratios (HR) to compare all-cause and cause-specific mortality between natives and immigrants overall and by region of origin and migrant status. We identified 156 deaths (IR = 3.20 per 10,000 person-years) and 815 deaths (IR = 2.49 per 10,000 person-years) among immigrant and native children and youths, respectively. Immigrants had higher overall mortality risk (HR 1.27, 95% CI 1.07–1.51). Group analyses showed elevated mortality in (i) males originating from Sub-Saharan Africa, (ii) male asylum seekers, and (iii) quota refugees of both sexes. Cause-specific mortality analyses showed higher suicide mortality in females from North Africa and Middle East and higher neurological disorder mortality in female quota refugees. With longer residence, mortality rates among immigrants decreased. Conclusions : Immigrant children and youths in Denmark face excess mortality risks that diminish with longer stay. More research is needed to understand these differences and to reduce mortality among young immigrants. What is Known: • Adult immigrants often show an overall mortality advantage compared with natives, but evidence on mortality for immigrant children and youths is limited and inconsistent. What is New: • This nationwide Danish register–based cohort study shows that immigrant children and youths have higher all-cause mortality than natives.