# Younger adults are not alright, but older adults are? Examining mortality disparities among the children of migrants aged 15–44 and 45–64 in Sweden, 1990–2023: a total-population cohort study

## TL;DR

The study finds that younger and older children of migrants in Sweden face higher risks of death from accidents, drugs, and alcohol compared to non-migrants, but these risks can be reduced with targeted interventions.

## Contribution

This study is the first to compare mortality disparities among younger and older working-age children of migrants in Sweden using a total-population cohort approach.

## Key findings

- Younger children of migrants have higher external, drug, and alcohol mortality compared to non-migrants.
- Older children of migrants also show elevated risks in these areas but have comparable all-cause mortality due to lower natural cause mortality.
- Socioeconomic disparities largely explain the increased mortality risks among children of migrants.

## Abstract

Younger working age children of migrants have higher mortality risks relative to younger working age non-migrants in Europe. Yet, these are unique ages of mortality where the absolute risk of death is low and driven by external causes (ie, accidents, injuries and suicides). It remains unclear whether this higher mortality risk presents among older working age children of migrants—ages at which the absolute risk of death begins to increase exponentially and becomes dictated by chronic morbidities. We aim to fill this gap.

We fit survival models on Swedish total population register data using an extended, competing risks approach. We investigate all-cause and mortality from natural causes and external causes, drugs and alcohol among the children of migrants, migrants and non-migrants aged 15–44 and 45–64 from 1990 to 2023. We report both HRs and regression-standardised cumulative probabilities of death.

Younger working age children of migrants from an array of origins exhibit higher external, drug and alcohol mortality relative to non-migrants that drives their higher all-cause mortality risk. Older working age children of migrants from multiple origins also present with a higher risk of external, drug and alcohol mortality, but only exhibit comparable all-cause mortality to non-migrants, owing to their similar to lower mortality from natural causes. Disparities in socioeconomic background largely attenuate these risks. A diverse range of younger and older working age migrants exhibit lower all-cause, natural, and external, drug and alcohol mortality than non-migrants do.

Interventions should be made to address the elevated avoidable and preventable external, drugs and alcohol mortality that presents among both older and younger working age children of migrants. Doing so will generate reductions in their all-cause mortality risk.