Background: Increasing global migration has made immigrants’ health an important topic worldwide.We examined the
effect of country of birth, migrant status (refugee/family-reunified) and income on coronary heart disease (CHD)
incidence.
Design: This was a historical prospective register-based cohort study.
Methods: The study cohort consisted of immigrants above 18 years from non-Western countries who had obtained a
residence permit in Denmark as a refugee (n¼29,045) or as a family-reunified immigrant (n¼28,435) from 1 January
1993–31 December 1999 and a Danish-born reference population (n¼229,918). First-time CHD incidence was identified
from 1 January 1993–31 December 2007. Incidence ratios for 11 immigrant groups were estimated using Cox
regression analysis.
Results: Immigrants from Afghanistan, Iraq, Turkey, Eastern Europe and Central Asia, South Asia, the Former Yugoslavia,
and the Middle East and North Africa had significantly higher incidences of CHD (hazard ratio (HR)¼1.36; 95% confidence
interval (CI): 1.05–1.75 to HR¼2.86; 95% CI: 2.01–4.08) compared with Danish-born people. Immigrants from
Somalia, South and Middle America, Sub-Saharan Africa and women from East Asia and the Pacific did not differ significantly
from Danish-born people, whereas immigrant men from East Asia and the Pacific had a significantly lower incidence
(HR¼0.32; 95% CI: 0.17–0.62). When also including migrant status, the higher incidences were reduced. Refugee
men (HR¼1.35; 95% CI: 1.11–1.65) and women (HR¼1.33; 95% CI: 1.08–1.65) had a significantly higher incidence of
CHD than family-reunified immigrants. When migrant status and income were included simultaneously, the incidences
decreased to an insignificant level for most immigrant groups.
Conclusions: Most non-Western immigrant groups had a higher incidence of CHD than Danish-born people. The study
revealed that migrant status and income are important underlying mechanisms of the effect of country of birth on CHD.