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We wish to study disparities in bloodstream infections in migrants and non-migrants by comparing the distribution of pathogens and their resistance patterns in long-term migrants with that in non-migrants in Denmark. The study is based on a cohort of migrants, who received residency in Denmark between 1993 and 2015 and a control group of non-migrants. The cohort was linked to a database of bloodstream infections from 2000 to 2015 covering two regions in Denmark. First-time bloodstream infections in individuals ≥18 years of age at the time of sampling were included. We calculated odds ratios adjusted for age, sex, year of sampling, comorbidity, and place of acquisition (hospital- or community-acquired). We identified 4,703 bloodstream infection cases. Family-reunified migrants and refugees had higher odds of Escherichia coli than non-migrants (OR 1.89 95%CI: 1.46–2.44 and OR 1.55 95%CI: 1.25–1.92) and lower odds of Streptococcus pneumoniae (OR 0.38 95%CI: 0.21–0.67 and OR 0.52 95%CI: 0.34–0.81). Differences in pathogen distribution were only prevalent in community-acquired bloodstream infections. Refugees had higher odds of Escherichia coli resistant to piperacillin-tazobactam, ciprofloxacin, and gentamicin compared with non-migrants. Family-reunified migrants had higher odds of Escherichia coli and other Enterobacterales resistant to ciprofloxacin. Migrants had a higher proportion of community-acquired bloodstream infections with Escherichia coli as well as higher odds of bloodstream infections with resistant Escherichia coli compared with non-migrants. These novel results are relevant for improving migrant health by focussing on preventing and treating infections especially with Escherichia coli such as urinary tract and abdominal infections. [ABSTRACT FROM AUTHOR]

Objective: To investigate differences in bacterial distribution and resistance patterns of relevant pathogens in skin and tissue infections among migrants compared to nonmigrants. Methods: The population is based on a cohort of migrants who obtained residence as refugees or family‐reunited migrants in Denmark between January 1993 and December 2015. The cohort was linked to positive swabs and tissue cultures collected from hospitals and general practitioners between the years 2000 and 2016 at the Department of Microbiology, University Hospital Hvidovre, Denmark. We calculated odds ratios for pathogen distribution and resistance patterns using logistic regression by comparing migrants with nonmigrants. Results: In total, 43,770 pathogens from 37,276 individuals were included, with Staphylococcus aureus being the most common bacterium. Migrants had higher odds of infections with Enterobacterales than nonmigrants (OR 1.42, 95% CI: 1.23–1.63) and lower odds of beta‐haemolytic Streptococci (OR 0.79, 95% CI: 0.73–0.86). Family‐reunited migrants and refugees had higher odds of methicillin‐resistant S. aureus (MRSA) than nonmigrants (OR 5.01, 95% CI: 3.73–6.73 and OR 3.66, 95% CI: 2.61–5.13). This was more pronounced in female migrants. The odds of ciprofloxacin‐resistant Enterobacterales were higher in both family‐reunited migrants and refugees than in nonmigrants (OR 2.21, 95% CI: 1.34–3.64 and OR 2.17, 95% CI: 1.34–3.52). Conclusions: The prevalence of MRSA and ciprofloxacin‐resistant Enterobacterales was higher among family‐reunited migrants and refugees than in nonmigrants. Our findings suggest an increased awareness for AMR in migrants. [ABSTRACT FROM AUTHOR]

Not being in employment, education or training (NEET) as a youth consistently predicts adverse educational, labour market and health outcomes. School-aged refugee children are known to be particularly vulnerable within each of these domains. Yet little is known about how these outcomes have evolved over time. This study explores trends in the risk of youth NEET status during the early twenties for refugees and their non-refugee peers in Denmark from 1995 to 2014 by utilising national registry data on demographics, income, education and diagnoses covering the full population. The analysis shows that the inequality in the probability of youth NEET status has diminished considerably from up to 20 percentage points among the oldest cohorts to less than 5 percentage points among the youngest. This development was robust to compositional differences, although much more so for girls than boys. For refugee girls, the change in the probability of youth NEET status coincided with changes in timing of family formation, but was not explained by it. In addition, the correlation between family formation and youth NEET status became considerably weaker over time. The findings suggest that some circumstances surrounding the incorporation of refugee school children into their new social contexts have improved. [ABSTRACT FROM AUTHOR]

Purpose: Migrants represent a considerable proportion of HIV diagnoses in Europe and are considered a group at risk of late presentation. This study examined the incidence of HIV diagnoses and the risk of late presentation according to migrant status, ethnic origin and duration of residence.Methods: We conducted a historically prospective cohort study comprising all adult migrants to Denmark between 1.1.1993 and 31.12.2010 (n = 114.282), matched 1:6 to Danish born by age and sex. HIV diagnoses were retrieved from the National Surveillance Register and differences in incidence were assessed by Cox regression model. Differences in late presentation were assessed by logistic regression.Results: Both refugees (HR = 5.61; 95% CI 4.45-7.07) and family-reunified immigrants (HR = 10.48; 95% CI 8.88-12.36) had higher incidence of HIV diagnoses compared with Danish born and the incidence remained high over time of residence for both groups. Migrants from all regions, except Western Asia and North Africa, had higher incidence than Danish born. Late presentation was more common among refugees (OR = 1.87; 95% CI 1.07-3.26) and family-reunified immigrants (OR = 2.30; 95% CI 1.49-3.55) compared with Danish born. Southeast Asia and Sub-Saharan Africa were the only regions with a higher risk of late presentation. Late presentation was only higher for refugees within 1 year of residence, whereas it remained higher within 10 years of residence for family-reunified immigrants.Conclusions: This register-based study revealed a higher incidence of HIV diagnoses and late presentation among migrants compared with Danish born and the incidence remained surprisingly high over time. [ABSTRACT FROM AUTHOR]

Aims: Suboptimal healthcare utilisation and lower satisfaction with the patient–doctor encounter among immigrants has been documented. Immigrants’ lack of familiarity with the healthcare system has been proposed as an explanation for this. This study investigated whether a systematic delivery of information affected immigrants’ knowledge of and satisfaction with the Danish healthcare system. Methods: A prospective, randomised intervention study of 1158 adult immigrants attending two language schools in Copenhagen was conducted. Two intervention groups received written information or a 12-hour course on the Danish healthcare system, while a control group received nothing. Survey data included self-assessed knowledge, true/false questions on access and questions relating to satisfaction with the healthcare system. Data were linked to socioeconomic registry data. Logistic regression analyses were performed. Results: The course improved knowledge of who to contact in the event of an accident (odds ratio (OR) = 2.67, 95% confidence interval (CI) = 1.56–4.59) but not in the event of illness. Further, it positively affected correct answers for nine out of 11 questions on the healthcare system (varying from OR = 1.87, 95% CI = 1.08–3.24 to OR = 3.11, 95% CI = 1.58–6.11). Written information positively affected correct answers for three out of 11 questions, but negatively affected one out of 11 compared with the control group. Neither intervention affected immigrants’ satisfaction with the healthcare system. Conclusions: Knowledge of the healthcare system is necessary for optimal healthcare-seeking behaviour. The results may form the basis of national and international changes in immigrant reception and optimise immigrants’ contact with the healthcare system. [ABSTRACT FROM AUTHOR]

Background: Antidepressant (AD) therapy is recommended for patients 4–12 months after remission from depression. The aim was to examine whether immigrants (refugees or family reunited immigrants) from non-Western countries are at greater risk than Danish-born residents of 1) not initiating AD therapy after discharge and 2) early AD discontinuation. Methods: A cohort of immigrants from non-Western countries (n = 132) and matched Danish-born residents (n = 396) discharged after first admission with moderate to severe depression between 1 January 1996 and 31 May 2008 was followed in the Danish registries. Logistic regression models were applied to explore AD initiation within 30 days after discharge, estimating odds ratio (OR) for immigrants versus Danish-born residents. Early discontinuation was explored by logistic regression, estimating OR for no AD dispensing within 180 days after the first dispensing, and by Cox regression, estimating hazard ratio (HR) for discontinuation (maximum drug supply gap) within 180 days. Results: Immigrants had higher odds for not initiating AD treatment after discharge than Danish-born residents (OR = 1.55; 95% CI: 1.01-2.38). When income was included in the model, the strength of the association was attenuated. Odds for early discontinuation was non-significantly higher among immigrants than Danish-born residents (OR = 1.80; 0.87-3.73). Immigrants also had a non-significantly higher hazard of early discontinuation (HR = 1.46; 95% CI: 0.87-2.45). Including income had only minor impact on these associations. Conclusion: Immigrants seem less likely to receive the recommended AD treatment after hospitalization with depression. This may indicate a need for a better understanding of the circumstances of this vulnerable group. [ABSTRACT FROM AUTHOR]