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Labour market marginalisation among refugees from different countries of birth: a prospective cohort study on refugees to Sweden
  1. Magnus Helgesson1,
  2. Mo Wang1,
  3. Thomas Niederkrotenthaler2,
  4. Fredrik Saboonchi1,3,
  5. Ellenor Mittendorfer-Rutz1
  1. 1 Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
  2. 2 Center for Public Health, Department of Social and Preventive Medicine, Unit Suicide Research & Mental Health Promotion, Medical University of Vienna, Vienna, Austria
  3. 3 The Swedish Red Cross University, College, Stockholm, Sweden
  1. Correspondence to Dr Magnus Helgesson, Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm SE-171 77, Sweden; magnus.helgesson{at}


Background The aim was to elucidate if the risk of labour market marginalisation (LMM), measured as long-term unemployment, long-term sickness absence, disability pension and a combined measure of these three measures, differed between refugees and non-refugee migrants with different regions of birth compared with native Swedes.

Methods All non-pensioned individuals aged 19–60 years who were resident in Sweden on 31 December 2009 were included (n=4 441 813, whereof 216 930 refugees). HRs with 95% CIs were computed by Cox regression models with competing risks and time-dependent covariates with a follow-up period of 2010–2013.

Results Refugees had in general a doubled risk (HR: 2.0, 95% CI 1.9 to 2.0) and non-refugee migrants had 70% increased risk (HR: 1.7, 95% CI 1.7 to 1.7) of the combined measure of LMM compared with native Swedes. Refugees from Somalia (HR: 2.7, 95% CI 2.6 to 2.8) and Syria (HR: 2.5, 95% CI 2.5 to 2.6) had especially high risk estimates of LMM, mostly due to high risk estimates of long-term unemployment (HR: 3.4, 95% CI 3.3 to 3.5 and HR: 3.2, 95% CI 3.1 to 3.2). African (HR: 0.7, 95% CI 0.6 to 0.7) and Asian (HR: 1.0, 95% CI 1.0 to 1.1) refugees had relatively low risk estimates of long-term sickness absence compared with other refugee groups. Refugees from Europe had the highest risk estimates of disability pension (HR: 1.9, 95% CI 1.8 to 2.0) compared with native Swedes.

Conclusion Refugees had in general a higher risk of all measures of LMM compared with native Swedes. There were, however, large differences in risk estimates of LMM between subgroups of refugees and with regard to type of LMM. Actions addressing differences between subgroups of refugees is therefore crucial in order to ensure that refugees can obtain as well as retain a position on the labour market.

  • disability pension
  • sick leave
  • unemployment
  • immigrants
  • labour-market marginalisation
  • refugees

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  • Contributors MH and EMR conceived and designed the study, with support from MW, TN and FS. MH, MW and EMR were involved in the statistical analysis. MH drafted the manuscript. All authors gave input to drafts and approved the final manuscript.

  • Funding This study was funded by the Swedish Research Council for Health, Working Life and Welfare, grant number 2016-07194.

  • Competing interests None declared.

  • Ethics approval This project was evaluated and approved by the regional ethical review board in Stockholm, Sweden. The ethical committee approval number is 2007/762-31. The ethical review board approved the study and waived the requirement that informed consent of research subjects should be obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data that support the findings of this study are available from Statistics Sweden, Swedish Social Insurance Agency and The Swedish National Board of Health and Welfare. Restrictions apply to the availability of these data, which were used with ethical permission for the current study and therefore are not publicly available.

  • Patient consent for publication Not required.