Ethnic Inequalities in Mortality in the Netherlands And the Role of Socioeconomic Status The publication of this thesis is financially supported by the Netherlands Institute of Health Promotion and Disease Prevention (NIGZ) and the Department of Public Health, Erasmus MC, who I gratefully acknowledge for their contribution. Bos, Vivian Ethnic Inequalities in Mortality in the Netherlands and the Role of Socioeconomic Status. Thesis Erasmus MC, University Medical Center Rotterdam – with references – with summary in Dutch ISBN 90-9019558-0 Printed by: Ipskamp, Enschede Cover photograph by: Joost van den Broek Cover design by: Vivian Bos and Jeroen Steen © 2005, Vivian Bos No part of this publication may be reproduced or transmitted in any form or by any means without written permission of the copyright owner. Ethnic Inequalities in Mortality in the Netherlands and the Role of Socioeconomic Status Etnische verschillen in sterfte in Nederland en de rol van sociaal-economische status Proefschrift ter verkrijging van de graad van doctor aan de Erasmus Universiteit Rotterdam op gezag van de rector magnificus Prof.dr. S.W.J. Lamberts en volgens besluit van het College voor Promoties. De openbare verdediging zal plaatsvinden op donderdag 30 juni 2005 om 13.30 uur door Vivian Bos geboren te Nagele Promotiecommissie Promotor: Prof.dr. J.P. Mackenbach Overige leden: Prof.dr. H.B. Entzinger Prof. R. Bhopal Prof.dr. S.A. Reijneveld Copromotor: Dr. A.E. Kunst VOOR MIJN OUDERS Contents 1. Introduction…………………………………………………………………………….………………..…………..9 Ethnic Inequalities in Mortality in the Netherlands 2. Mortality differences between native Dutch and people of Turkish, Moroccan, Surinamese, and Antillean/Aruban origin…………………………………………………...…..…19 3. Mortality differences between native Dutch and refugees from Asian and African countries…………………..……………………...…………………………………………………….33 4. Mortality differences between people native Dutch and people of Indonesian origin…………………………………………………………………………………………………………………..45 5. Immigrant mortality by duration of residence: the role of the healthy migrant effect and acculturation………………………………………………………..……………………………59 6. Ethnic inequalities in avoidable mortality: the role of the healthcare system……73 And the Role of Socioeconomic Status 7. Trends in socioeconomic inequalities in mortality in six Western European countries……………………………………………………………………………………………………………..87 8. Socioeconomic inequalities in mortality in the Netherlands: analyses on the basis of measures at the neighbourhood level………………………..….………………….103 9. Socioeconomic inequalities in mortality measured at the neighbourhood level: comparison with estimates based on individual level data……………………………..119 10. Socioeconomic inequalities in mortality within ethnic groups ….…………………..133 11. General discussion…………………..…………………………………………………………….…………149 References…………………………………………………………………………………………………………………………..171 Summary, Samenvatting, List of Tables and Figures, Dankwoord, Curriculum vitae and Other publications/manuscripts by the author….……………………………………………………...………187 Publications and manuscripts reprinted in this thesis Chapter 2: Bos V, Kunst AE, Keij-Deerenberg IM, Garssen J, Mackenbach JP. Ethnic Inequalities in age- and cause-specific mortality in The Netherlands. Int J. Epidemiol. 2004; 33(5):1112-9. Chapter 3: Bos V, Alabady K, Mackenbach JP, Kunst AE. Refugee mortality in the Netherlands, a population based study. Submitted Chapter 4: Ho L, Bos V, Kunst AE. Differences in Cause of Death Patterns between Native Dutch and Persons of Indonesian Descent living in the Netherlands. Submitted Chapter 5: Bos V, Kunst AE, Garssen J, Mackenbach JP. Consistent relation between duration of residence and immigrant mortality only observed in some immigrant groups; a study on mortality by duration of residence among Turkish, Moroccan, Surinamese and Antillean/Aruban immigrants living in the Netherlands. Submitted Chapter 6: Stirbu I, Mackenbach JP, Bos V, Kunst AE. Ethnic differences in avoidable mortality. Submitted Chapter 7: Mackenbach JP, Bos V, Andersen O, Cardano M, Costa G, Harding S, Reid A, Hemström O, Valkonen T, Kunst AE. Widening inequalities in mortality in Western Europe. Int J Epidemiol. 2003;32(5): 830-837 Chapter 8: Bos V, Kunst AE, Mackenbach JP. Sociaal-economische sterfteverschillen in Nederland: een analyse op basis van buurtgegevens. TSG, 2002; 80(3):158-165. Chapter 9: Bos V, Kunst AE, Mackenbach JP. De omvang van sociaal-economische sterfteverschillen gemeten op buurtniveau: vergelijking met schattingen op basis van informatie op individueel niveau. In: Stronks K, ed. Sociaal-economische gezondheidsverschillen 5: van verklaren naar verkleinen, Den Haag: ZonMW, 2001: 8-20. Chapter 10: Bos V, Kunst AE, Garssen J, Mackenbach JP. Socioeconomic inequalities in mortality within ethnic groups in the Netherlands, 1995-2000. J Epidemiol Community Health. 2005; 59 (4):329-35 For other publications and manuscripts by the author see page 207. 1 Introduction INTRODUCTION 1.1 Background Studies on the health of ethnic minority populations can provide clues about the aetiology of diseases, can shed light on fundamental health inequalities that exist within one country and may therefore be informative for people responsible for the provision and planning of health care(1). For these reasons, a considerable number of studies on ethnic inequalities in health have been performed during the last few decades(2-9). Mortality figures are an interesting source of information on the health of ethnic minorities because they are objective figures that can provide a broad image of the health situation of group of interest. Surveys form an alternative source of information on the health of ethnic minorities. These have, however, as a disadvantage that they are susceptible to distortion due to cultural differences in reporting behaviour (10). In Table 1.1 we summarise the results of a review of migrant mortality performed in 2003 by McKay, Macintyre and Ellawaya (4). The picture that emerges from this review is one of gross variations between studies. Migrants did not seem to have a consistently higher or lower mortality than the native population of the host country and did also not seem to have a consistently higher or lower mortality than the native population of the countries of origin. This holds both for total/cardiovascular mortality and for cancer mortality. Table 1.1 Migrant mortality compared to mortality among native inhabitants of the host country and compared to mortality among inhabitants of the country of origin(4). Number of studies in which migrant mortality is Better Similar Worse Compared to native inhabitants of host country total/cardiovascular mortality 10 4 12 cancer mortality 10 6 7 Compared to inhabitants in the country of origin total/cardiovascular mortality 7 5 5 cancer mortality 5 7 6 This does not imply that ethnic inequalities in mortality are small, but rather, that that the direction of the inequalities differs between ethnic groups and causes of death. In the United Status, black men have for example been reported to have an 8-year shorter life expectancy than white men. There, the life expectancy for black men has remained at a nearly constant level between 1980 and 1996, while it increased among white men(11). In a Groups included in this review originated both from western and non-western countries of origin and migrated to industrialised countries. 11 CHAPTER 1 New Zealand, Maori have been reported to have a 10 years shorter life expectancy than people of Anglo-European descent(12). Mortality rates for some other ethnic minority populations have, in contrast, been reported to be more favourable than for white inhabitants. This is for example the case for Latino’s and Asian Americans living in the US and for Caribbeans in the UK(2, 13, 14). In these groups, the reported migrant mortality risk is sometimes only 50% of the risk of the white population(14). Ethnic differences in cause specific mortality may also be large, even in cases where differences in all cause mortality between ethnic groups are small. For Pakistani living in the UK for example, strongly elevated rates of mortality from ischemic heart disease and strongly reduced mortality rates from lung cancer and suicide have been found. Their total mortality figures have, however, been reported to be equal to that of whites(2). In 1999, the year that we started conducting the studies that we report on in this thesis, information on the health of ethnic minorities living in the Netherlands was incomplete. Information that was obtained in health interview surveys often showed a worse self-reported health for ethnic minorities(15, 16) but this may have been due to cultural differences in reporting behaviour. There were some studies available on migrant mortality. These found elevated levels of perinatal deaths among ethnic minorities(17, 18), elevated levels of mortality among infants and children of foreign origin (19-21), elevated levels of mortality for Surinamese (20, 21), Turkish males and females and for Moroccan females(22). They observed a reduced mortality for Moroccan males(22). But because these studies were carried out at the local level(20, 23), covered only few age groups(18, 19), excluded groups that were of foreign origin but that had Dutch nationality(22), and covered only some of the largest immigrant groups, they failed to provide a detailed overview of patterns of mortality among ethnic minority groups living in the Netherlands. The international literature did