{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T02:02:51Z","timestamp":1789351371439,"version":"build-2803163510"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"vor","delay-in-days":13,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100019180","name":"European Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100019180","id-type":"DOI","asserted-by":"publisher"}]},{"name":"European Union\u2019s Horizon 2020","award":["787592-MIGPACT"],"award-info":[{"award-number":["787592-MIGPACT"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Evidence is inconclusive on whether immigrants are at higher risk of substance use disorders compared to non-immigrants. We investigated the risk of drug and alcohol use disorder (DUD and AUD) in first- and second-generation immigrants with refugee and non-refugee backgrounds using the nationwide Swedish longitudinal healthcare and legal registers. We included 798\u00a0141 males and 756\u00a0903 females who turned 16\u2009years of age between 2005 and 2020. DUD and AUD were identified between ages 16 and 25\u2009years using healthcare and legal registers. Immigrants were categorized into first- and second-generation refugees and non-refugees. Cox proportional hazard models estimated DUD and AUD risk in relation to immigrant status (non-immigrants as reference), adjusting for covariates. Sensitivity analyses were conducted using healthcare register data only. DUD risks were higher among most refugee and non-refugee immigrants compared to non-immigrants, i.e. hazard ratios (HRs) ranged from HR: 1.05, 95% CI: 0.95\u20131.15 (first-generation female refugees) to HR: 2.63, 95% CI: 2.54\u20132.73 (first-generation male refugees). AUD risks among immigrants were lower or similar to non-immigrants, i.e. HRs ranged from HR: 0.55, 95% CI: 0.49\u20130.62 (first-generation female refugees) to HR: 1.17, 95% CI: 1.03\u20131.34 (first-generation male non-refugees). Sensitivity analyses restricted to healthcare registers yielded somewhat attenuated associations for DUD, particularly among first-generation male refugees. Refugee and non-refugee immigrants in Sweden were generally at elevated risk of DUD, whereas AUD risks were largely similar to or lower than that of non-immigrants. The findings were broadly robust in analyses restricted to healthcare data.<\/jats:p>","DOI":"10.1093\/eurpub\/ckag152","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T11:56:05Z","timestamp":1786017365000},"source":"Crossref","is-referenced-by-count":0,"title":["Substance use disorders among refugee and non-refugee immigrants in Sweden"],"prefix":"10.1093","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5540-0325","authenticated-orcid":false,"given":"Kenta","family":"Okuyama","sequence":"first","affiliation":[{"name":"Department of Clinical Sciences Malm\u00f6, Center for Primary Health Care Research, Lund University , Malm\u00f6,","place":["Sweden"]},{"name":"University Clinic Primary Care, Sk\u00e5ne University Hospital , Region Sk\u00e5ne,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Larsson L\u00f6nn","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Malm\u00f6, Center for Primary Health Care Research, Lund University , Malm\u00f6,","place":["Sweden"]},{"name":"University Clinic Primary Care, Sk\u00e5ne University Hospital , Region Sk\u00e5ne,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ardavan M","family":"Khoshnood","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Malm\u00f6, Center for Primary Health Care Research, Lund University , Malm\u00f6,","place":["Sweden"]},{"name":"University Clinic Primary Care, Sk\u00e5ne University Hospital , Region Sk\u00e5ne,","place":["Sweden"]},{"name":"Department of Clinical Sciences Malm\u00f6, Emergency Medicine, Lund University, Sk\u00e5ne University Hospital , Malm\u00f6,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shervin","family":"Assari","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Charles R. Drew University of Medicine and Science , Los Angeles, CA,","place":["United States"]},{"name":"Department of Family Medicine, Charles R. Drew University of Medicine and Science , Los Angeles, CA,","place":["United States"]},{"name":"Department of Urban Public Health, Charles R. Drew University of Medicine and Science , Los Angeles, CA,","place":["United States"]},{"name":"Marginalization Related Diminished Returns Research Center , Los Angeles, CA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7228-5015","authenticated-orcid":false,"given":"Jan","family":"Sundquist","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Malm\u00f6, Center for Primary Health Care Research, Lund University , Malm\u00f6,","place":["Sweden"]},{"name":"University Clinic Primary Care, Sk\u00e5ne University Hospital , Region Sk\u00e5ne,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8031-279X","authenticated-orcid":false,"given":"Kristina","family":"Sundquist","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Malm\u00f6, Center for Primary Health Care Research, Lund University , Malm\u00f6,","place":["Sweden"]},{"name":"University Clinic Primary Care, Sk\u00e5ne University Hospital , Region Sk\u00e5ne,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,17]]},"reference":[{"key":"2026091321120325300_ckag152-B1","volume-title":"World Migration Report 2024","author":"Mcauliffe","year":"2024"},{"key":"2026091321120325300_ckag152-B2","author":"World Health Organization","year":"2023"},{"key":"2026091321120325300_ckag152-B3","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1017\/S0033291719000035","article-title":"Migration and psychosis: a meta-analysis of incidence studies","volume":"50","author":"Selten","year":"2020","journal-title":"Psychol Med"},{"key":"2026091321120325300_ckag152-B4","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1192\/bjp.bp.116.181107","article-title":"Mood disorders in first- and second-generation immigrants: systematic review and meta-analysis","volume":"210","author":"Mindlis","year":"2017","journal-title":"Br J Psychiatry"},{"key":"2026091321120325300_ckag152-B5","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1016\/j.apnu.2016.07.014","article-title":"Mental health in immigrants versus native population: a systematic review of the literature","volume":"31","author":"Bas-Sarmiento","year":"2017","journal-title":"Arch Psychiatr Nurs"},{"key":"2026091321120325300_ckag152-B6","doi-asserted-by":"publisher","first-page":"987","DOI":"10.1016\/S2215-0366(18)30337-7","article-title":"The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990\u20132016: a systematic analysis for the global burden of disease study 2016","volume":"5","author":"Degenhardt","year":"2018","journal-title":"Lancet Psychiatry"},{"key":"2026091321120325300_ckag152-B7","doi-asserted-by":"publisher","first-page":"100341","DOI":"10.1016\/j.lanepe.2022.100341","article-title":"The burden of mental disorders, substance use disorders and self-harm among young people in Europe, 1990-2019: findings from the global burden of disease study 2019","volume":"16","author":"Castelpietra","year":"2022","journal-title":"Lancet Reg Health Eur"},{"key":"2026091321120325300_ckag152-B8","doi-asserted-by":"publisher","first-page":"e0159134","DOI":"10.1371\/journal.pone.0159134","article-title":"Epidemiology of substance use among forced migrants: a global systematic review","volume":"11","author":"Horyniak","year":"2016","journal-title":"PLoS One"},{"key":"2026091321120325300_ckag152-B9","author":"World Health Organization","year":"2023"},{"key":"2026091321120325300_ckag152-B10","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1016\/j.addbeh.2018.06.031","article-title":"Alcohol-related problem behaviors among Latin American immigrants in the US","volume":"87","author":"Salas-Wright","year":"2018","journal-title":"Addict Behav"},{"key":"2026091321120325300_ckag152-B11","doi-asserted-by":"publisher","first-page":"e1002944","DOI":"10.1371\/journal.pmed.1002944","article-title":"Substance use disorders in refugee and migrant groups in Sweden: a nationwide cohort study of 1.2 million people","volume":"16","author":"Harris","year":"2019","journal-title":"PLoS Med"},{"key":"2026091321120325300_ckag152-B12","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1111\/dar.13154","article-title":"Substance use prevalence rates among migrant and native adolescents in Europe: a systematic review","volume":"40","author":"van Dorp","year":"2021","journal-title":"Drug Alcohol Rev"},{"key":"2026091321120325300_ckag152-B13","doi-asserted-by":"publisher","first-page":"1564","DOI":"10.1007\/s10903-021-01313-5","article-title":"Understanding the healthy immigrant effect in the context of mental health challenges: a systematic critical review","volume":"24","author":"Elshahat","year":"2022","journal-title":"J Immigr Minor Health"},{"key":"2026091321120325300_ckag152-B14","doi-asserted-by":"publisher","first-page":"851","DOI":"10.1016\/j.healthpol.2019.02.007","article-title":"Mental health care utilisation and access among refugees and asylum seekers in Europe: a systematic review","volume":"123","author":"Satinsky","year":"2019","journal-title":"Health Policy"},{"key":"2026091321120325300_ckag152-B15","doi-asserted-by":"publisher","first-page":"e070744","DOI":"10.1136\/bmjopen-2022-070744","article-title":"Indications of alcohol or drug use disorders in five different national registers in Sweden: a cross-sectional population-based study","volume":"13","author":"Lundin","year":"2023","journal-title":"BMJ Open"},{"key":"2026091321120325300_ckag152-B16","doi-asserted-by":"publisher","first-page":"1182","DOI":"10.1001\/jamapsychiatry.2018.2337","article-title":"Academic achievement and drug abuse risk assessed using instrumental variable analysis and co-relative designs","volume":"75","author":"Kendler","year":"2018","journal-title":"JAMA Psychiatry"},{"key":"2026091321120325300_ckag152-B17","doi-asserted-by":"publisher","first-page":"446","DOI":"10.15288\/jsad.2020.81.446","article-title":"Nature of the causal relationship between academic achievement and the risk for alcohol use disorder","volume":"81","author":"Kendler","year":"2020","journal-title":"J Stud Alcohol Drugs"},{"key":"2026091321120325300_ckag152-B18","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1007\/s10654-025-01221-0","article-title":"Diagnostic accuracy in the Swedish national patient register: a review including diagnoses in the outpatient register","volume":"40","author":"Everhov","year":"2025","journal-title":"Eur J Epidemiol"},{"key":"2026091321120325300_ckag152-B19","doi-asserted-by":"publisher","first-page":"450","DOI":"10.1186\/1471-2458-11-450","article-title":"External review and validation of the Swedish national inpatient register","volume":"11","author":"Ludvigsson","year":"2011","journal-title":"BMC Public Health"},{"key":"2026091321120325300_ckag152-B20","author":"Migrationsverket","year":"2023"},{"key":"2026091321120325300_ckag152-B21","doi-asserted-by":"publisher","first-page":"100108","DOI":"10.1016\/j.lanepe.2021.100108","article-title":"Sociodemographic factors and uncomplicated cystitis in women aged 15\u201350 years: a nationwide Swedish cohort registry study (1997\u20132018)","volume":"4","author":"Jans\u00e5ker","year":"2021","journal-title":"Lancet Reg Health Eur"},{"key":"2026091321120325300_ckag152-B22","first-page":"1887","article-title":"Robust causal inference using directed acyclic graphs: the R package \u2018Dagitty\u2019","volume":"45","author":"Textor","year":"2016","journal-title":"Int J Epidemiol"},{"key":"2026091321120325300_ckag152-B23","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1016\/j.cpr.2017.10.012","article-title":"Sex and gender differences in substance use disorders","volume":"66","author":"McHugh","year":"2018","journal-title":"Clin Psychol Rev"},{"key":"2026091321120325300_ckag152-B24","doi-asserted-by":"publisher","first-page":"108804","DOI":"10.1016\/j.drugalcdep.2021.108804","article-title":"Drinking cultures and socioeconomic risk factors for alcohol and drug use disorders among first- and second-generation immigrants: a longitudinal analysis of Swedish population data","volume":"226","author":"Cook","year":"2021","journal-title":"Drug Alcohol Depend"},{"key":"2026091321120325300_ckag152-B25","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1177\/0002716293530001006","article-title":"The new second generation: segmented assimilation and its variants","volume":"530","author":"Portes","year":"1993","journal-title":"Ann Am Acad Pol Soc Sci"},{"key":"2026091321120325300_ckag152-B26","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1016\/j.jadohealth.2021.09.021","article-title":"Meta-analysis on the relation between acculturation and alcohol use among immigrant youth","volume":"70","author":"Sirin","year":"2022","journal-title":"J Adolesc Health"},{"key":"2026091321120325300_ckag152-B27","doi-asserted-by":"publisher","first-page":"2189","DOI":"10.1017\/S0033291721000969","article-title":"Genetics of substance use disorders: a review","volume":"51","author":"Deak","year":"2021","journal-title":"Psychol Med"}],"container-title":["European Journal of Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eurpub\/article-pdf\/36\/5\/ckag152\/70665144\/ckag152.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurpub\/article-pdf\/36\/5\/ckag152\/70665144\/ckag152.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T01:12:09Z","timestamp":1789348329000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eurpub\/article\/doi\/10.1093\/eurpub\/ckag152\/8762543"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,4]]},"references-count":27,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,8,4]]}},"URL":"https:\/\/doi.org\/10.1093\/eurpub\/ckag152","relation":{},"ISSN":["1101-1262","1464-360X"],"issn-type":[{"value":"1101-1262","type":"print"},{"value":"1464-360X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,10]]},"published":{"date-parts":[[2026,8,4]]},"article-number":"ckag152"}}