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Refugees and family-reunified immigrants have a high incidence of HIV diagnosis and late presentation compared with Danish born: a nationwide register-based cohort study

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Abstract

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.

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Funding

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Author information

Authors and Affiliations

  1. Section of Immigrant Medicine, Department of Infectious Disease, Copenhagen University Hospital, Kettegård Alle 30, 2650, Hvidovre, Denmark

    Laura Deen & Marie Norredam

  2. Department of Infectious Disease Epidemiology, Statens Serum Institut, Artillerivej 5, 2300, Copenhagen S, Denmark

    Susan Cowan

  3. Department of Public Health, Centre for Global Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark

    Christian Wejse

  4. Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark

    Christian Wejse

  5. Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark

    Jørgen Holm Petersen

  6. Danish Research Centre for Migration, Ethnicity and Health (MESU), Department of Public Health, Section for Health Services Research, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark

    Marie Norredam

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  1. Laura Deen
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Consortia

ESCMID Study Group for Infections in Travellers and Migrants

Corresponding author

Correspondence to Christian Wejse.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Standards

The project was approved by the Danish Protection Agency (No 2012-41-0065). Further ethical approval regarding registry-based research is not required in Denmark. The data set was made available and analysed in an anonymous form by remote online access to the data set stored at Statistics Denmark.

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Deen, L., Cowan, S., Wejse, C. et al. Refugees and family-reunified immigrants have a high incidence of HIV diagnosis and late presentation compared with Danish born: a nationwide register-based cohort study. Infection 46, 659–667 (2018). https://doi.org/10.1007/s15010-018-1167-8

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  • DOI: https://doi.org/10.1007/s15010-018-1167-8

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