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Substance use disorders among refugee and non-refugee immigrants in Sweden

Okuyama, Kenta LU ; Larsson Lönn, Sara LU ; Khoshnood, Ardavan M LU orcid ; Assari, Shervin ; Sundquist, Jan LU and Sundquist, Kristina LU (2026) In European Journal of Public Health 36(5).
Abstract

Evidence is inconclusive on whether immigrants are at higher risk of substance use disorders compared to non-immigrants. We investigated the risk of drug and alcohol use disorder (DUD and AUD) in first- and second-generation immigrants with refugee and non-refugee backgrounds using the nationwide Swedish longitudinal healthcare and legal registers. We included 798 141 males and 756 903 females who turned 16 years of age between 2005 and 2020. DUD and AUD were identified between ages 16 and 25 years using healthcare and legal registers. Immigrants were categorized into first- and second-generation refugees and non-refugees. Cox proportional hazard models estimated DUD and AUD risk in relation to immigrant status (non-immigrants as... (More)

Evidence is inconclusive on whether immigrants are at higher risk of substance use disorders compared to non-immigrants. We investigated the risk of drug and alcohol use disorder (DUD and AUD) in first- and second-generation immigrants with refugee and non-refugee backgrounds using the nationwide Swedish longitudinal healthcare and legal registers. We included 798 141 males and 756 903 females who turned 16 years of age between 2005 and 2020. DUD and AUD were identified between ages 16 and 25 years using healthcare and legal registers. Immigrants were categorized into first- and second-generation refugees and non-refugees. Cox proportional hazard models estimated DUD and AUD risk in relation to immigrant status (non-immigrants as reference), adjusting for covariates. Sensitivity analyses were conducted using healthcare register data only. DUD risks were higher among most refugee and non-refugee immigrants compared to non-immigrants, i.e. hazard ratios (HRs) ranged from HR: 1.05, 95% CI: 0.95-1.15 (first-generation female refugees) to HR: 2.63, 95% CI: 2.54-2.73 (first-generation male refugees). AUD risks among immigrants were lower or similar to non-immigrants, i.e. HRs ranged from HR: 0.55, 95% CI: 0.49-0.62 (first-generation female refugees) to HR: 1.17, 95% CI: 1.03-1.34 (first-generation male non-refugees). Sensitivity analyses restricted to healthcare registers yielded somewhat attenuated associations for DUD, particularly among first-generation male refugees. Refugee and non-refugee immigrants in Sweden were generally at elevated risk of DUD, whereas AUD risks were largely similar to or lower than that of non-immigrants. The findings were broadly robust in analyses restricted to healthcare data.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Humans, Sweden/epidemiology, Female, Refugees/statistics & numerical data, Male, Emigrants and Immigrants/statistics & numerical data, Adult, Substance-Related Disorders/epidemiology, Adolescent, Young Adult, Registries, Risk Factors, Proportional Hazards Models
in
European Journal of Public Health
volume
36
issue
5
publisher
Oxford University Press
external identifiers
  • pmid:42606567
ISSN
1101-1262
DOI
10.1093/eurpub/ckag152
language
English
LU publication?
yes
additional info
© The Author(s) 2026. Published by Oxford University Press on behalf of the European Public Health Association.
id
38664db2-ed0e-468b-8ce2-26df624c61da
date added to LUP
2026-08-18 08:53:51
date last changed
2026-08-18 08:55:13
@article{38664db2-ed0e-468b-8ce2-26df624c61da,
  abstract     = {{<p>Evidence is inconclusive on whether immigrants are at higher risk of substance use disorders compared to non-immigrants. We investigated the risk of drug and alcohol use disorder (DUD and AUD) in first- and second-generation immigrants with refugee and non-refugee backgrounds using the nationwide Swedish longitudinal healthcare and legal registers. We included 798 141 males and 756 903 females who turned 16 years of age between 2005 and 2020. DUD and AUD were identified between ages 16 and 25 years using healthcare and legal registers. Immigrants were categorized into first- and second-generation refugees and non-refugees. Cox proportional hazard models estimated DUD and AUD risk in relation to immigrant status (non-immigrants as reference), adjusting for covariates. Sensitivity analyses were conducted using healthcare register data only. DUD risks were higher among most refugee and non-refugee immigrants compared to non-immigrants, i.e. hazard ratios (HRs) ranged from HR: 1.05, 95% CI: 0.95-1.15 (first-generation female refugees) to HR: 2.63, 95% CI: 2.54-2.73 (first-generation male refugees). AUD risks among immigrants were lower or similar to non-immigrants, i.e. HRs ranged from HR: 0.55, 95% CI: 0.49-0.62 (first-generation female refugees) to HR: 1.17, 95% CI: 1.03-1.34 (first-generation male non-refugees). Sensitivity analyses restricted to healthcare registers yielded somewhat attenuated associations for DUD, particularly among first-generation male refugees. Refugee and non-refugee immigrants in Sweden were generally at elevated risk of DUD, whereas AUD risks were largely similar to or lower than that of non-immigrants. The findings were broadly robust in analyses restricted to healthcare data.</p>}},
  author       = {{Okuyama, Kenta and Larsson Lönn, Sara and Khoshnood, Ardavan M and Assari, Shervin and Sundquist, Jan and Sundquist, Kristina}},
  issn         = {{1101-1262}},
  keywords     = {{Humans; Sweden/epidemiology; Female; Refugees/statistics & numerical data; Male; Emigrants and Immigrants/statistics & numerical data; Adult; Substance-Related Disorders/epidemiology; Adolescent; Young Adult; Registries; Risk Factors; Proportional Hazards Models}},
  language     = {{eng}},
  month        = {{08}},
  number       = {{5}},
  publisher    = {{Oxford University Press}},
  series       = {{European Journal of Public Health}},
  title        = {{Substance use disorders among refugee and non-refugee immigrants in Sweden}},
  url          = {{http://dx.doi.org/10.1093/eurpub/ckag152}},
  doi          = {{10.1093/eurpub/ckag152}},
  volume       = {{36}},
  year         = {{2026}},
}