Mortality Rate and Causes of Death Among Refugees Resettled in Washington State, 2006–2016

  • Natalie M. Linton
  • Charla DeBolt
  • Laura P. NewmanEmail author
  • Azadeh Tasslimi
  • Jasmine Matheson
Original Paper


Cause of death among refugees resettled in the United States is not well documented. This evaluation determined cause of death among refugees who resettled to and died in Washington State. Records of refugees who arrived in Washington State from 2006 to 2016 were linked to state death records for the same period. Rates and proportions of death were calculated and compared to those for all Washingtonians. From 2006 to 2016, 171 of 30,243 refugees (0.6%) resettled to and died in Washington. The age-adjusted all-cause mortality rate was 3.93 (95% CI 3.12–4.75) per 1000 refugees, compared to 6.98 (95% CI 6.96–7.00) per 1000 Washingtonians. Malignant neoplasms and heart disease were the leading causes of death for both refugees and Washingtonians. Determining cause of death among refugee populations can identify emerging trends in mortality. This information can be used to help inform disease and injury prevention interventions for refugee communities.


Refugees Mortality Migrant Washington State 



We thank Amy Poel and Eric Ossiander of the Washington State Department of Health for their contributions to the article.


  1. 1.
    United Nations High Commissioner on Refugees (UNHCR). Resettlement in the United States.
  2. 2.
    Refugee Processing Center (RPC). Admissions and arrivals.
  3. 3.
    Office of Refugee Resettlement. Refugees.
  4. 4.
    Cochran J, Geltman PL, Ellis H, Brown C, Montour J, Vargas M, et al. Suicide and suicidal ideation among Bhutanese refugees—United States, 2009–2012. MMWR. 2013;62(26):533–4.Google Scholar
  5. 5.
    Ao T, Shetty S, Sivilli TI, Blanton C, Ellis H, Geltman PL, et al. Suicidal ideation and mental health of Bhutanese refugees in the United States. J Immigr Minor Health. 2016;18(4):828–35.CrossRefGoogle Scholar
  6. 6.
    Centers for Disease Control and Prevention (CDC). Sudden, unexpected, nocturnal deaths among Southeast Asian refugees. MMWR. 1981;30:581–4.Google Scholar
  7. 7.
    Centers for Disease Control and Prevention (CDC). Update: Sudden unexplained death syndrome among Southeast Asian refugees—United States. MMWR. 1988;37:568–70.Google Scholar
  8. 8.
    Aldridge RW, Nellums LB, Bartlett S, Barr AL, Patel P, Burns R, et al. Global patterns of mortality in international migrants: a systematic review and meta-analysis. Lancet. 2018;392(10164):2553–66. Scholar
  9. 9.
    Norredam M, Olsbjerg M, Petersen JH, Bygbjerg I, Krasnik A. Mortality from infectious diseases among refugees and immigrants compared to native Danes: a historical prospective cohort study. Trop Med Int Health. 2012;17(2):223–30.CrossRefGoogle Scholar
  10. 10.
    Norredam M, Olsbjerg M, Petersen JH, Juel K, Krasnik A. Inequalities in mortality among refugees and immigrants compared to native Danes—a historical prospective cohort study. BMC Public Health. 2012;12:757.CrossRefGoogle Scholar
  11. 11.
    Norredam M, Olsbjerg M, Petersen JH, Laursen B, Krasnik A. Are there differences in injury mortality among refugees and immigrants compared with native-born? Inj Prev. 2013;9(2):100–5.CrossRefGoogle Scholar
  12. 12.
    Hollander A, Bruce D, Ekberg J, Burstro B. Longitudinal study of mortality among refugees in Sweden. Int J Epidemiol. 2012;41:1153–61.CrossRefGoogle Scholar
  13. 13.
    Hollander A-C. Social inequalities in mental health and mortality among refugees and other immigrants to Sweden–epidemiological studies of register data. Glob Health Action. 2013;6(1):21059.CrossRefGoogle Scholar
  14. 14.
    Swerdlow AJ. Mortality and cancer incidence in Vietnamese refugees in England and Wales: a follow-up study. Int J Epidemiol. 1991;20(1):13–9.CrossRefGoogle Scholar
  15. 15.
    DesMeules M, Gold J, McDermott S, Cao Z, Payne J, Lafrance B, et al. Disparities in mortality patterns among Canadian immigrants and refugees, 1980–1998: results of a national cohort study. J Immigr Health. 2005;7(4):221–32.CrossRefGoogle Scholar
  16. 16.
    Beiser M. The health of immigrants and refugees in Canada. Can J Public Health. 2005;96(S2):S30–44.CrossRefGoogle Scholar
  17. 17.
    Refugee Processing Center (RPC). About Us.
  18. 18.
    Washington State Department of Health. Death Data.
  19. 19.
    Dusetzina SB, Tyree S, Meyer A-M, Meyer A, Green L, Carpenter WR. Linking data for health services research: a framework and instructional guide. Rockville, MD: Agency for Healthcare Research and Quality (US); 2014.Google Scholar
  20. 20.
    SAS Institute Inc. SAS Version 9.4. 2015.Google Scholar
  21. 21.
    National Center for Health Statistics. ICD–10 cause-of-death lists for tabulating mortality statistics (updated March 2011 to include WHO updates to ICD–10 for data year 2011). In: NCHS instruction manual, part 9. Hyattsville, MD; 2011.Google Scholar
  22. 22.
    Klein RJ, Schoenborn CA. Age adjustment using the 2000 projected U.S. population. Healthy People 2010 Stat Notes. 2001;(20):1–10.Google Scholar
  23. 23.
    Washington State Department of Health. Department of Health Agency Standards for Reporting Data with Small Numbers. 2018;1–24.Google Scholar
  24. 24.
    Anson J. The migrant mortality advantage: a 70 month follow-up of the Brussels population. Eur J Popul. 2004;20(3):191–218.CrossRefGoogle Scholar
  25. 25.
    Razum O, Zeeb H, Akgün HS, Yilmaz S. Low overall mortality of Turkish residents in Germany persists and extends into a second generation: merely a healthy migrant effect? Trop Med Int Health. 1998;3(4):297–303.CrossRefGoogle Scholar
  26. 26.
    Vandenheede H, Willaert D, De Grande H, Simoens S, Vanroelen C. Mortality in adult immigrants in the 2000s in Belgium: a test of the “healthy-migrant” and the “migration-as-rapid-health-transition” hypotheses. Trop Med Int Health. 2015;20(12):1832–45.CrossRefGoogle Scholar
  27. 27.
    United States Department of State. U.S. Refugee Admissions Program FAQs. 2017.Google Scholar
  28. 28.
    Karimi N, Beiki O, Mohammadi R. Risk of fatal unintentional injuries in children by migration status: a nationwide cohort study with 46 years’ follow-up. Inj Prev. 2015;21(e1):e80–7.CrossRefGoogle Scholar
  29. 29.
    Schyllander J, Janson S, Nyberg C, Eriksson U-B, Ekman SD. Case analyses of all children’s drowning deaths occurring in Sweden 1998–2007. Scand J Public Health. 2013;41(2):174–9.CrossRefGoogle Scholar
  30. 30.
    Saunders NR, Lee H, Macpherson A, Guan J, Guttmann A. Risk of firearm injuries among children and youth of immigrant families. CMAJ. 2017;189(12):E452–8.CrossRefGoogle Scholar
  31. 31.
    Razum O, Zeeb H, Rohrmann S. The “healthy migrant effect”—not merely a fallacy of inaccurate denominator figures. Int J Epidemiol. 2000;29(1):191–2.CrossRefGoogle Scholar
  32. 32.
    Hollander AC, Dal H, Lewis G, Magnusson C, Kirkbride JB, Dalman C. Refugee migration and risk of schizophrenia and other non-affective psychoses: cohort study of 1.3 million people in Sweden. BMJ. 2016;352:1–8.Google Scholar

Copyright information

© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply  2019

Authors and Affiliations

  1. 1.Office of Communicable Disease Epidemiology, Washington State Department of HealthShorelineUSA
  2. 2.CDC/CSTE Applied Epidemiology FellowshipShorelineUSA
  3. 3.Department of Global HealthUniversity of WashingtonSeattleUSA

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