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Differences in uptake of immunisations and health examinations among refugee children compared to Danish-born children: a cohort study


Refugee children and their families constitute a vulnerable group regarding health and access to care. In a register-based cohort design, we examined differences in uptake of immunisations and child health examinations between refugee children and Danish-born children, including predictors of uptake among refugee children. Refugee children (n = 16,701) who, between January 1993 and December 2010, obtained residency permits in Denmark were included and matched in a 1:6 ratio on age and sex with Danish-born children (n = 100,206). Personal identification numbers were cross-linked to the National Danish Health Service Register, identifying all contacts for immunisation and child health examinations. We estimated hazard ratios (HR) of uptake. Refugee children had a lower uptake of all immunisations compared to Danish-born children. The lowest uptake was found for immunisation against diphtheria, tetanus, pertussis and polio (HR = 0.50; 95 % confidence interval (CI) 0.48–0.51). Participation in child health examinations was also lower among refugee children with the lowest at the last child health examination at age 5 (HR = 0.48; 95 % CI 0.47–0.50). Adjusting the analysis for parental income increased the HRs by 10–20 %.

Conclusion: This Danish register-based study using nationwide data revealed a lower uptake of routine immunisations and child health examinations among refugee children compared to Danish-born children.

What is Known:
Uptake of immunisation and child health examination is associated with low household income, unemployment and low educational status among the parents.
Uptake may be even lower among refugee families as they constitute a vulnerable group regarding access to healthcare.
What is New:
Refugee children had lower uptake of immunisations and child health examinations compared to Danish-born children.
Several predictors of uptake were identified including region of origin and duration of residence.

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Fig. 1



child health examination


immunisation against diphtheria, tetanus, pertussis and polio


general practitioner


hazard ratio


immunisation against measles, mumps and rubella


socioeconomic position


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Authors’ contributions

S. Pagh Moller and M. Norredam originated the idea and the design of the study. M. Norredam established the population, and S. Pagh Moller analysed the data in consultation with A. Hjern, A. Nybo Andersen and M. Norredam. All authors contributed to the interpretation of the results. S. Pagh Moller wrote the first draft, and all authors were involved in revising the manuscript for important intellectual content. All authors contributed to the writing and approval of the final article.

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Correspondence to Sanne Pagh Moller.

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Ethical standards

The manuscript does not contain clinical studies or patient data, and Danish law does not require that register-based studies are approved by an ethical committee.

Ethical approval

For this type of study, formal consent is not required. This article does not contain any studies with human participants or animals performed by any of the authors.

Conflict of interest

The authors declare that they have no conflict of interests.

Additional information

Communicated by Peter de Winter

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Moller, S.P., Hjern, A., Andersen, A.N. et al. Differences in uptake of immunisations and health examinations among refugee children compared to Danish-born children: a cohort study. Eur J Pediatr 175, 539–549 (2016). https://doi.org/10.1007/s00431-015-2663-9

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  • Access
  • Child healthcare
  • Immunisations
  • Refugee
  • Children
  • Register-based
  • Migration