International migrants are increasingly shaping the population health of high-income countries, yet existing research has treated immigrants as a single, homogenous group when estimating their impact on national life expectancy. Moreover, European research has only studied the impact of immigrants up until 2019—before the COVID-19 pandemic. Using Swedish total population administrative register data from 2010 to 2023, we calculate period life expectancy at age 1 for immigrant subpopulations defined by permit status (refugee; other permit) and for permit status by region of birth (Nordic, Other European, and non-European), applying the Arriaga decomposition to estimate each subgroup's contribution to national life expectancy. From 2010 to 2019, refugees were the primary driver of the positive impact of immigrants on Sweden’s national life expectancy, exhibiting consistently higher life expectancy than both non-migrants and immigrants with other permits. In 2020, COVID-19 struck refugees disproportionately hard. They exhibited life expectancy losses up to four times higher than non-migrants and other permit migrants, and their positive effect on life expectancy was temporarily reversed. The reversal was most pronounced among non-European refugees. Life expectancy recovery among refugees was achieved by 2023 but lagged 2-years behind non-migrants and other permit migrants. Demographic and public health research should routinely disaggregate immigrant populations accordingly. COVID-19 showed that the positive contribution of refugees is fragile. Targeted policies are required to protect refugee populations, particularly during periods of national crisis, if the positive and growing contribution of immigrants to Sweden’s life expectancy is going to be sustained.

Research regularly reports lower mortality among migrants, leading to conclusions of a “Healthy Immigrant Effect”. However, evidence on migrant health is less consistent, suggesting a disconnect between mortality and health outcomes. This highlights the need to examine both health and mortality simultaneously rather than relying on single-outcome measures. We estimate life expectancy (LE) and disability-free life expectancy (DFLE) at age 50 for 37 countries of birth in England and Wales. Life tables were constructed using whole-population mortality data from 2000–02, 2010–12 and 2020–22, while DFLE was estimated using the Sullivan method and self-reported limiting long-term illness data from the 2001, 2011 and 2021 censuses. By comparing LE and DFLE with those of the England and Wales-born population across three time points, we assessed differences in both mortality and disability and examined how these changed over time. We find substantial heterogeneity in migrant health. Most migrant populations consistently experienced a “healthy migrant effect”, with higher LE and DFLE than the England and Wales-born population at all three time points. In contrast, several of the largest migrant groups exhibited an “unhealthy migrant effect”, characterised by lower LE and DFLE (including those born in Scotland, the Republic of Ireland, and men born in Poland and Lithuania), while others experienced longer lives but greater disability burdens, with higher LE but lower DFLE (including women born in Pakistan and Bangladesh). These findings demonstrate that migrant populations are far from homogeneous and some groups face elevated burdens of disability and/or premature mortality and would benefit from targeted public health interventions.

Background  Children of immigrants in Europe have higher infant and early-adult mortality, compared with non-immigrants or their children. We aim to establish whether they have an increased risk of child mortality, focussing on the case of Sweden.

Methods  We use Cox proportional hazards regression models to estimate hazard ratios (HRs) using Swedish total-population administrative data from 1990 to 2019. We estimate all-cause mortality for children aged 0–14, overall and separately for ages 0, 1–4, and 5–14. We do this for Swedish-born children of immigrants with either one or two foreign-born parents, across a wide range of origins. HRs are reported with reference to child mortality for Swedish-born children with two Swedish-born parents.

Findings  We find persistently higher mortality for children of immigrants with two parents born in the Middle East & Northern Africa (HR ages 0–14 = 1.22 for mother's country of birth (95% CI: 1.13–1.33)). Inequalities exist at all childhood ages but we find scant evidence of higher mortality risks in the same origin groups when only one parent is foreign-born.

Interpretation  A higher risk of childhood death in these groups is the result of specific factors that interact uniquely across ages and origins. While mortality at these ages is low in absolute terms, each death is a tragedy that represents decades of life lost and has far-reaching social consequences.

Introduction Younger working age children of migrants have higher mortality risks relative to younger working age non-migrants in Europe. Yet, these are unique ages of mortality where the absolute risk of death is low and driven by external causes (ie, accidents, injuries and suicides). It remains unclear whether this higher mortality risk presents among older working age children of migrants—ages at which the absolute risk of death begins to increase exponentially and becomes dictated by chronic morbidities. We aim to fill this gap.

Methods We fit survival models on Swedish total population register data using an extended, competing risks approach. We investigate all-cause and mortality from natural causes and external causes, drugs and alcohol among the children of migrants, migrants and non-migrants aged 15–44 and 45–64 from 1990 to 2023. We report both HRs and regression-standardised cumulative probabilities of death.

Results Younger working age children of migrants from an array of origins exhibit higher external, drug and alcohol mortality relative to non-migrants that drives their higher all-cause mortality risk. Older working age children of migrants from multiple origins also present with a higher risk of external, drug and alcohol mortality, but only exhibit comparable all-cause mortality to non-migrants, owing to their similar to lower mortality from natural causes. Disparities in socioeconomic background largely attenuate these risks. A diverse range of younger and older working age migrants exhibit lower all-cause, natural, and external, drug and alcohol mortality than non-migrants do.

Conclusions Interventions should be made to address the elevated avoidable and preventable external, drugs and alcohol mortality that presents among both older and younger working age children of migrants. Doing so will generate reductions in their all-cause mortality risk.

Introduction: Empirical evidence on migrant morbidity suggests that migrant populations have a higher burden of disease compared to non-migrants in high-income destination countries. Yet, empirical evidence on migrant mortality typically shows a lower risk of death compared to non-migrants. Migrants might be living longer lives in worse health—a ‘migrant “morbidity-mortality” paradox’.

Sources of data: Peer-reviewed, English-language publications.

Areas of agreement: The paradox has been reported in different destinations, across different migrant groups, and across different health outcomes. It presents most consistently among migrants and women born in low and middle-income countries, and/or when morbidity is self-reported.

Areas of controversy: The majority of the evidence is based upon unlinked, aggregated, cross-sectional prevalence data that has well-known limitations. Nearly all the studies to date have been descriptive, and there is a lack of understanding concerning what might explain this paradox among migrants.

Growing points: That migrants are living longer subject to a higher burden of diseases is a social and public health concern that needs to be further explored and understood through more research.

Areas timely for developing research: We need more evidence of the paradox based upon linked individual-level, incidence-based data that compares the morbidity and mortality risks of the same migrant and non-migrant populations using objective data on morbidity from primary care (general practitioners) or secondary care (hospitalizations). We need to know how widespread the paradox is, which migrant populations are most affected by it, and the potential mechanisms responsible for it.

International migrants and their children represent increasing shares of the populations of major host countries and have growing potential to affect estimates of national mortality. Yet, while many studies have observed mortality differences between migrants, their children, and the majority population, few have progressed beyond this point to quantify the actual impact of these differences upon national life expectancy levels. Studies that have, reveal that migrants increasingly enhance national life expectancy, but do not progress beyond a single average generational effect. Here, using established demographic methods, we aim to quantify and unpack the impact of migrants and the children of migrants on national life expectancy in Sweden, with emphasis on potential differences by age, generations, and migration background. Going “against the grain” relative to other countries, we reveal an initial negative effect of first-generation migrants on national life expectancy levels in Sweden, followed by a gradual waning and disappearance of this effect over time. This change is attributable to the transformation in origin composition of Sweden's migrant population from migrants born in Nordic countries (that have higher mortality than the majority population) to migrants born in non-Western countries (that have lower mortality than the majority population), particularly at working ages. For children of migrants, nearly all ages and migrant backgrounds contribute to an increasingly negative effect on national life expectancy over time. The unique and disparate mortality risks of migrants, the children of migrants, and the majority population suggest a need to monitor their mortality separately so as to maximise potential future gains in national life expectancy in Sweden.

Introduction The native-born children of migrants represent one of the fastest-growing and most diverse young populations in the world today. A growing body of research highlights an elevated young adult mortality risk in this ‘second generation’ (G2) relative to the majority population at the same ages. Previous studies have tried to understand this increased risk by examining its association with inequality in the adult socioeconomic background (SEB) of the G2. Here, we instead analyse the association of second-generation status with childhood SEB.

Methods We use administrative register data from Sweden to fit multistate, competing-risk, flexible parametric survival models on a data set of 13404 deaths in 2.35million young adults. We examine mortality from all causes and specific causes of death at the generational level and by parental region of birth, both before and after having adjusted for childhood SEB.

Results The G2 have higher all-cause mortality hazard rates (HR=1.29 (95% CIs=1.23 to 1.34)) than the majority population before adjusting for childhood SEB. Following adjustment, the size of the hazard rate is smaller, but remains higher than the majority population (aHR=1.16 (95% CIs=1.11 to 1.21)). The G2 additionally experience persistent and higher hazard rates of mortality from suicide (aHR=1.29 (95% CIs=1.20 to 1.39)), substance misuse (aHR=1.41 (95% CIs=1.26 to 1.58)) and assault (aHR=2.54 (95% CIs=2.02 to 3.20)). By parental origins, similar patterns to those described are documented among G2 that have at least one parent born in Finland, the other Nordic countries, former Yugoslavia, the rest of Europe, sub-Saharan Africa, Northern Africa, and Iran and Iraq. However, higher all-cause (aHR=1.42 (95% CIs=1.33 to 1.51)) and external-cause hazard rates of mortality (aHR=1.59 (95% CIs=1.48 to 1.72)) only persist among G2 with parent(s) born in Finland.

Conclusions G2 with various parental origins have higher mortality rates than the majority population do, and this difference is partly explained by their childhood SEB.

Background: Explanations for the disproportional COVID-19 burden among immigrants relative to host-country natives include differential exposure to the virus and susceptibility due to poor health conditions. Prior to the pandemic, immigrants displayed deteriorating health with duration of residence that may be associated with increased susceptibility over time. The aim of this study was to compare immigrant–native COVID-19 mortality by immigrants’ duration of residence to examine the role of differential susceptibility. Methods: A population-based cohort study was conducted with individuals between 18 and 100 years old registered in Sweden between 1 January 2015 and 15 June 2022. Cox regression models were run to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results: Inequalities in COVID-19 mortality between immigrants and the Swedish-born population in the working-age group were concentrated among those of non-Western origins and from Finland with more than 15 years in Sweden, while for those of retirement age, these groups showed higher COVID-19 mortality HRs regardless of duration of residence. Both age groups of immigrants from Africa and the Middle East showed consistently higher COVID-19 mortality HRs. For the working-age population: Africa: HR<15: 2.46, 95%CI: 1.78, 3.38; HR≥15: 1.49, 95%CI: 1.01, 2.19; and from the Middle East: HR<15: 1.20, 95%CI: 0.90, 1.60; HR≥15: 1.65, 95%CI: 1.32, 2.05. For the retirement-age population: Africa: HR<15: 3.94, 95%CI: 2.85, 5.44; HR≥15: 1.66, 95%CI: 1.32, 2.09; Middle East: HR<15: 3.27, 95%CI: 2.70, 3.97; HR≥15: 2.12, 95%CI: 1.91, 2.34. Conclusions: Differential exposure, as opposed to differential susceptibility, likely accounted for the higher COVID-19 mortality observed among those origins who were disproportionately affected by the pandemic in Sweden.

Background: The number of confirmed COVID-19 deaths differed across countries and across waves of the pandemic. Patterns also differed between groups within a country.

Objective: We combine data on excess mortality with data on cause-of-death-specific mortality in the case of Sweden to identify which groups had excess mortality beyond what can be captured by analyses of COVID-19-specific deaths. We also explore the possibility that some groups may have benefited in terms of reduced all-cause mortality, potentially due to home-centered living conditions during the pandemic.

Methods: We produced and compared three sets of group-specific incidence rates: deaths from (1) any cause in 2020, (2) any cause in 2019, (3) any cause excluding COVID-19 in 2020. We compared rates across different socioeconomic profiles based on combinations of sex, age, marital status, education, and country of birth.

Contribution: We show that many of those who died during 2020 would not have done so in the absence of the pandemic. We find some evidence of COVID-19 mortality underestimation, mainly among individuals with a migration background. We also found groups for which mortality decreased during the pandemic, even when including COVID-19 mortality. Progression across the first and second waves of the pandemic shows that more groups appeared to become protected over time and that there was less underestimation of COVID-19 mortality in the second part of 2020.

Background: Children of immigrants often have excess mortality rates, in contrast to the low mortality typically exhibited by their parents’ generation. However, prior research has studied children of immigrants who were selected for migration, thereby rendering it difficult to isolate the intergenerational impact of migration on adult mortality.

Methods: We use semiparametric survival analysis to carry out a total population cohort study estimating all-cause and cause-specific mortality among all adult men and women from age of 17 years among all men and women born in 1953–1972 and resident in Finland in 1970–2020. We compare children of forced migrants from ceded Karelia, an area of Finland that was ceded to Russia during the Second World War, with the children of parents born in present-day Finland.

Results: Children with two parents who were forced migrants have higher mortality than children with two parents born in Northern, Southern, and Western Finland, but similar or lower mortality than the subpopulation of children whose parents were born in the more comparable areas of Eastern Finland. For women and men, a mortality advantage is largest for external causes and persists after controlling for socioeconomic factors.Conclusion: Our findings suggest that forced migration can have a beneficial impact on the mortality of later generations, at least in the case where forced migrants are able to move to contextually similar locations that offer opportunities for rapid integration and social mobility. The findings also highlight the importance of making appropriate comparisons when evaluating the impact of forced migration