Is being a refugee associated with increased 30-day mortality after visiting the emergency department? A register-based cohort study using Danish data

Abstract

Aim: Refugees face many challenges that could lead to disparity in quality of care from the health-care system compared with native Danes. These challenges could be language barriers, cultural differences, mental health co-morbidities and socio-economic status (SES). The aim of this study was to compare the 30-day mortality of refugees and native Danes after visiting the emergency department (ED) at Aarhus University Hospital, Denmark. Methods: In this register-based cohort study linking clinical and socio-demographic data, we included all visits to a major Danish ED from 1 January 2016 to 31 December 2018. According to the predefined analysis plan, we present non-parametric Kaplan–Meier plots and propensity score-weighted analysis. Results: We included 29,257 eligible unique patients of whom 631 were refugees. In the 30-day time period after discharge from the ED, 11 deaths occurred in the group of refugees, resulting in a Kaplan–Meier estimate of 1.8% (95% confidence interval (CI) 0.7–2.8), and 1638 deaths occurred in the group of Danes, resulting in a Kaplan–Meier estimate of 5.9% (95% CI 5.6–6.1). The adjusted 30-day mortality risk difference was 1.6 percentage points (95% CI −2.0 to −1.2 percentage points) lower for refugees compared to native Danes. The 30-day mortality risk difference decreased from approximately 4 to 1.6 percentage points in the adjusted analysis. Thus, there were 16 fewer deaths among refugees within 30 days per 1000 discharged from the ED compared with native Danes when adjusting for age, sex, SES and co-morbidities. Conclusions: This study shows that refugees had a lower 30-day mortality after visiting the ED compared with native Danes.