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Immigration Status and Substance Use Disorder-related Mortality in Sweden

A National Longitudinal Registry Study

Lundgren, Lena PhD; Padyab, Mojgan PhD; Lucero, Nancy M. PhD; Blom-Nilsson, Marcus PhD; Nyström, Siv PhD; Carver-Roberts, Tabitha MA; Sandlund, Mikael MD

doi: 10.1097/ADM.0000000000000524
Original Research: PDF Only

Objectives: First-generation immigrants, in many countries, are healthier than their native counterparts. This study examined the association between first- and second-generation immigrant status and alcohol- or drugs other than alcohol-related (primarily opioids) mortality for those with risky substance use.

Methods: A Swedish longitudinal, 2003 to 2017, registry study combined Addiction Severity Index (ASI) assessment data with mortality data (n = 15 601). Due to missing data, the analysis sample for this study was 15 012. Multivariate models tested the relationship between immigration status and drugs other than alcohol or alcohol-related mortality, controlling for demographics and the 7 ASI composite scores (CS).

Results: Age, a higher ASI CS for alcohol, a lower ASI CS family and social relationship, a lower ASI CS for drug use and a higher ASI CS for health significantly predicted mortality because of alcohol-related causes. Higher ASI CS for drugs other than alcohol, employment, and health, age, male sex, and immigration status predicted drugs other than alcohol, related mortality. Individuals born in Nordic countries, excluding Sweden, were 1.76 times more likely to die of drugs other than alcohol compared with their Swedish counterparts. Individuals born outside a Nordic country (most common countries: Iran, Somalia, Iraq, Chile) were 61% less likely to die of drugs other than alcohol compared with their Swedish counterparts. Those with parents born outside Nordic countries were 54% less likely to die of drugs other than alcohol.

Discussion: Research is needed on why people with risky substance use from Nordic countries (not Sweden) residing in Sweden, have higher mortality rates because of drugs other than alcohol (primarily opioids drugs other than alcohol compared with the other population groups in our study). Findings indicate that ASI CSs are strong predictors of future health problems including mortality due to alcohol and other drug-related causes.

This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Butler Institute of Families, Graduate School of Social Work, University of Denver, Denver, CO (LL, NML,TCR); Department of Social Work, Umeå University, Umeå, Sweden (LL, MBN, MP); Centre for Demography and Ageing Research (CEDAR), Umeå University, Umeå, Sweden (MP); National Board of Health and Welfare, Stockholm, Sweden (SN); Department of Psychiatry, School of Medicine, Umea University, Umeå, Sweden (MS).

Send correspondence to Lena Lundgren, PhD, Executive Director, Butler Institute for Families, Professor, Graduate School of Social Work, University of Denver, 2148 S. High Street, Denver, CO. E-mail:

Received 6 October, 2018

Accepted 2 February, 2019

The authors declare no conflicts of interest.

© 2019 American Society of Addiction Medicine