Objective: Ethnic minorities constitute a growing part of the Danish population but little is known about ethnic disparity in early life mortality in this population. The aim of this study was to investigate ethnic disparities in stillbirth risk and infant mortality in Denmark from 1981 to 2003. Methods: From population-covering registries, all live and stillbirths of women from the five largest ethnic minority groups and of women from the (Danish) majority population (N = 1 333 452) were identified. The liveborn were followed up for vital status to the age of 1 year. Log-binomial regression was used to estimate relative risks according to ethnic group. The main outcome measure was stillbirth and infant death. Results: Compared with the majority population, the relative risks of stillbirth were 1.28 (95% CI: 1.07 to 1.53) for Turkish, 1.62 (1.25 to 2.09) for Pakistani and 2.11 (1.60 to 2.77) for Somali women. The relative risks of infant mortality were 1.41 (1.22 to 1.63), 1.88 (1.53 to 2.30) and 1.39 (1.03 to 1.89) for children born to Turkish, Pakistani and Somali mothers respectively. The fetal and infant mortality in offspring of Lebanese and Former Yugoslavian women was not different from the mortality in the Danish group. The differences found were, in general, not attributable to ethnic differences in socioeconomic position. Turkish, Pakistani and Somali children had an excess relative risk of infant death due to congenital malformations and the risk of death from perinatal causes was increased among the Pakistani offspring. Conclusion: Among the five largest ethnic minorities, the Turkish. Pakistani and Somali population had substantially higher fetal and infant mortality compared with the Danish majority population, while the Lebanese and Former Yugoslavian minorities were at the same level as the majority population. The excess risk was not attributable to socioeconomic conditions.

Objective To explore ehealth literacy, ability to actively engage with healthcare providers and health system navigation among pregnant immigrant women and their descendants compared with women of Danish origin. Design and setting A cross-sectional survey at antenatal clinics in 2016, Denmark. Participants Pregnant women attending antenatal care (n=405). Outcome measures The eHealth Literacy Questionnaire (eHLQ) and two domains from the Health Literacy Questionnaire (HLQ): ability to actively engage with healthcare providers and health system navigation. Range of response options for eHLQ (1–4) and HLQ (1–5). With mixed-effect linear regressions, eHLQ and HLQ among immigrants and their descendants compared with women of Danish origin were assessed. Results The response rate was 75%. The overall trend was lower ehealth literacy and HLQ domains among immigrants and their descendants compared with women of Danish origin. For ehealth literacy, the results suggest that challenges related more to digital abilities than motivation, trust and access to technology. The mean ability to engage with digital services was 3.20 (SD 0.44) for women of Danish origin. Non-Western descendants (−0.14, 95% CI −0.31 to 0.02), non-Western (−0.20, 95% CI −0.34 to −0.06) and Western (−0.22, 95% CI −0.39 to −0.06) immigrants had lower adjusted means of this outcome. No differences in motivation to engage with digital services were found for descendants (−0.00, 95% CI −0.17 to 0.17), non-Western (0.03, 95% CI −0.11 to 0.18) or Western (−0.06, 95% CI −0.23 to 0.10) immigrants compared with the mean of the reference (2.85, SD 0.45). Lower ability to engage with healthcare providers was found for non-Western born immigrants (−0.15, CI 95% −0.30 to −0.01) compared with the mean of women with Danish origin (4.15, SD 0.47). Conclusion Generally, descendant and immigrant women had lower levels of ehealth literacy and health literacy than women of Danish origin. These differences are potentially antecedents of adverse birth outcomes and could inform structural efforts to mitigate health inequalities.

Background: Diverse early-life mortality outcomes have been documented in immigrant populations in northern Europe. A recent meta-analysis has suggested that national integration policy is a key factor in understanding this heterogeneous pattern. In this study, we investigated the variation of stillbirth and neonatal mortality between societies in northern Europe in one minority population, the Turkish. Method: Data on stillbirth and neonatal deaths in 239 387 births during 1990–2005, where the mother was of Turkish origin, was drawn from birth registries or surveys in nine northern European countries. Rates were compared with births from mothers who were born in the society of residence. Logistic regression was used to calculate odds ratios adjusted for year of birth of the offspring. Results: The risks for stillbirth were, or tended to be, elevated for Turkish mothers in all countries compared with the native population, with the highest risk in Austria (odds ratio (OR) 1.7; 95% confidence interval (CI) 1.4–2.1) and Switzerland (OR 1.6; 1.4–1.9). For neonatal mortality the results were heterogeneous, indicating no excess risk for Turkish-born children in the Netherlands, the UK and Norway, and elevated risks in Denmark (OR 1.3; 1.0–1.6), Switzerland (OR 1.3; 1.1–1.5), Austria (OR 1.4; 1.0–1.8) and Germany (OR 1.3; CI 1.2-1.5). Conclusion: This study suggests that preventable society-specific determinants are important for early-life mortality in Turkish migrants in Europe. An active integration policy is consistent with a favourable neonatal mortality outcome in continental Europe, but not with patterns in Scandinavia and the UK.