Health of refugees and humanitarian entrants in Australia

Causes of death by time since arrival in Australia

The age-standardised mortality rate for humanitarian entrants and other permanent migrants increases with time spent in Australia (Figure 5.6). All mortality rates for the period since arrival are lower for permanent migrants than those in humanitarian entrants.

For humanitarian entrants, based on year of arrival and year of death, the mortality rate for those who died less than 5 years since arrival (275 deaths per 100,000 person years) is 20% less than those who died within 5–10 years since arrival (345 per 100,000) and 25% less than those who died more than 10 years since arrival (370 per 100,000). A similar pattern is seen for other permanent migrants.

The mortality rates for specific causes in humanitarian entrants differ with time since arrival in Australia. Suicide mortality rates increase with increased time since arrival in Australia (4.2 deaths per 100,000 person years for less than 5 years since arrival, 7.3 per 100,000 for 5–10 years since arrival, 11 per 100,000 for more than 10 years since arrival). Deaths due to coronary heart disease are lowest for humanitarian entrants who have been in Australia longer (31 deaths per 100,000 person years for less than 5 years since arrival, 38 per 100,000 for 5–10 years since arrival, 33 per 100,000 for more than 10 years since arrival).

The mortality rates by time since arrival for specified causes of death can be seen in supplementary data table S4.2. For more information about reporting by time since arrival in Australia see Data sources and methods.

Figure 5.6: Age-standardised all-cause mortality rate by time since arrival in Australia, by population group, 2007–2020

Causes of death by country of birth

The age-standardised mortality rate was highest in humanitarian entrants born in South Sudan (9,800 deaths per 100,000 person years), followed by Serbia (4,100 per 100,000) and Republic of Congo (590 per 100,000).

When looking at specific causes of death in humanitarian entrants:

• The highest number of deaths due to suicide, assault, accidental poisoning, and land transport accidents was in humanitarian entrants from Sudan (32 deaths, 14 deaths, 14 deaths and 24 deaths respectively).
• The rate of suicide was 31 deaths per 100,000 person years among humanitarian entrants born in Ethiopia and 11 per 100,000 among humanitarian entrants born in Sudan.

For more information about reporting by country of birth see Data sources and methods.

Causes of death with high rates for humanitarian entrants

When comparing age-standardised rates across population groups, the mortality rates due to liver cancer and accidental drowning among humanitarian entrants were significantly higher than the rest of the Australian population.

Liver cancer

The age-standardised mortality rate due to liver cancer in humanitarian entrants was:

• 2.1 times as high as other permanent migrants and 1.5 times as high as the rest of the Australian population
• 2.3 times as high in males as females
• increased with increased time spent in Australia (8.1 deaths per 100,000 person years for less than 5 years since arrival, 10.7 per 100,000 for 5–10 years since arrival, 11.2 per 100,000 for more than 10 years since arrival).

High rates of liver cancer in humanitarian entrants may be related to high rates of diabetes (see Long-term health conditions – Diabetes) and chronic viral hepatitis (Cancer Australia 2022; Mantovani and Targher 2017; Rajkumar et al. 2022) in this population as these conditions are known risk factors for liver cancer.

Accidental drowning

The mortality rate due to accidental drowning in humanitarian entrants was:

• 2.8 times as high as other permanent migrants and 2.4 times as high as the rest of the Australian population, after standardising for age.
• highest in humanitarian entrants who had lived in Australia for more than 10 years in terms of rates (3.0 deaths per 100,000 person years for more than 10 years since arrival compared with 2.2 per 100,000 for less than 5 years since arrival and 1.4 per 100,000 for 5–10 years since arrival). Note the rate has not been adjusted for age.
• not concentrated to humanitarian entrants from a specific country of birth.

Migrants are at higher risk of drowning in Australia due to factors such as inadequate knowledge of water safety and aquatic environments and lack of swimming and water safety skills (Willcox-Pidgeon et al. 2021). There was a higher rate of accidental drownings in humanitarian entrants, but this was not observed in other permanent migrants, consistent with previous findings from Australian research (Willcox-Pidgeon et al. 2021). Also consistent with this Australian research, there was a male predominance in drowning deaths with males accounting for 90% of accidental drowning deaths in humanitarian entrants.

Potentially avoidable deaths

Potentially avoidable deaths (PAD) are deaths among people younger than 75 that are potentially avoidable within the present health care system. They include deaths from conditions that are potentially preventable through individualised care and/or treatable through existing primary or hospital care.

In 2007–2020 the age-standardised rate of potentially avoidable deaths was 65 deaths per 100,000 person years for humanitarian entrants, 31 per 100,000 for other permanent migrants and 110 per 100,000 for the rest of the Australian population.

Of the potentially avoidable deaths for humanitarian entrants:

• two thirds were in males and one third was in females (66% in males, 34% in females)
• just over a quarter were within 5 years since arrival (27% within 5 years, 38% 5-10 years, 36% for more than 10 years).