Torture and healthcare service utilization in Syrian refugees resettled in Norway – a longitudinal, registry-based study

Background: Torture, banned under international treaties such as the UN Convention Against Torture, remains a widespread violation with profound health consequences. The Istanbul Protocol (IP) sets global standards for the medical documentation of torture highlighting the important role of healthcare providers. A limitation of existing research on torture's health impacts is that studies are largely cross-sectional and reliant on self-reported clinical data. Norway's detailed healthcare registry data offers a robust opportunity to conduct longitudinal, population-based studies, advancing our understanding of torture's long-term effects on refugees and its public health implications. Objectives: This study has two main aims: (1) to examine the frequency of torture-related diagnostic codes and the factors associated with their use in primary and specialized care among adult Syrian refugees resettled in Norway, and (2) to link self-report data on torture exposure in adult refugees from Syria with data on HCSU over a 6-year follow-up to explore group differences in utilization patterns. Methods: Study participants include the RBMI cohort (N = 14,350), comprised of all adult refugees from Syria resettled in Norway in 2015–2017; and the REFUGE cohort – a subsample of the RBMI cohort – comprised of those in the RBMI cohort who participated in a nationwide survey study in 2018. Aim 1 will be addressed using data (2015–2024) from the Norwegian Registry for Primary Health Care (KPR) and the Norwegian Patient Registry (NPR), which contain information on all contacts with primary- and specialized healthcare services throughout Norway (e.g. date of contact, diagnostic code given). To address aim 2, we will link 2018 survey data on torture exposure to the abovementioned registry data on HCSU. In addition to descriptive statistics, multivariable, two-part hurdle regression models will be used to analyse data since we expect zero inflation and overdispersion of the outcomes (HCSU). Stage of study: This manuscript reports Stage 1 of a Registered Report; analyses will be conducted after in-principle acceptance. Refugees and asylum seekers who have been exposed to torture are vulnerable to both somatic and mental health problems.This study links survey data on torture exposure among adult refugees from Syria resettled in Norway with longitudinal registry data on healthcare service utilization to examine patterns of health-seeking behaviour and service use in torture-exposed vs. non-exposed refugees.The study further explores the use of torture-related diagnostic codes at primary – and specialized care level by healthcare personnel in Norway during the provision of care to Syrian refugees.Portions of the text were refined using generative AI (ChatGPT5, Le Chat Pro) for grammar and style. The authors reviewed and take full responsibility for the content. Refugees and asylum seekers who have been exposed to torture are vulnerable to both somatic and mental health problems. This study links survey data on torture exposure among adult refugees from Syria resettled in Norway with longitudinal registry data on healthcare service utilization to examine patterns of health-seeking behaviour and service use in torture-exposed vs. non-exposed refugees. The study further explores the use of torture-related diagnostic codes at primary – and specialized care level by healthcare personnel in Norway during the provision of care to Syrian refugees. Portions of the text were refined using generative AI (ChatGPT5, Le Chat Pro) for grammar and style. The authors reviewed and take full responsibility for the content.