Do Roma have a comparable or worse health status than non-Roma?
Assoc. Prof. JP van Dijk MD PhDDepartment of Community & Occupational Health
University Medical Centre GroningenUniversity of GroningenThe Netherlands
Do Roma have a comparable or worse health status than non-Roma?
Assoc. Prof. Jitse P van Dijk MD PhDSenior Lecturer ‘Social Determinants of Health’Olomouc University Society & Health InstitutePalacky UniversityOlomoucCzech Republic
Do Roma have a comparable or worse health status than non-Roma?
Jitse P. van Dijk, Peter Kolarcik, Katarina Rosicova, Gabriel Kolvek, Adriana Sudzinova
Graduate School Kosice Institute for Society and HealthMedical FacultySafarik University, Košice Slovak Republic
Outline
1 Introduction; aim
2 Samples & measures
3 Results from several studies
4 Conclusion / discussion
Introduction
Findings on Roma health status are contrasting:* no health differences compared to non-Roma; * significantly worse health
A clear explanation is lacking.
Introduction
A few years ago: Field was understudiedMethodological problems with existing
studies* Small numbers* No comparison at all* If comparison, then with total population
- Roma included- Low SES Roma compared with average
SES non-Roma
Introduction
Also in our own findings we met problems; they could not be attributed anymore to the methodological quality of the studies
Aim is to contribute to the explanation of the contrasting findings.
Samples & Measures
Adolescents 15 yrs330 Roma; 722 non-Roma
Self-rated healthHealthcare utilizationInjuriesHealth complaintsChildren’s mental health (SDQ)
prosocial scaletotal difficulties scale
P Kolarcik et al., To what extent does socioeconomic status explain differences in health between Roma and non-Roma adolescents in Slovakia? Social Science & Medicine 68 (2009) 1279–1284
Results: Adolescent’s health
after adjustment for gender, SES & social desirability
non Roma
1
2
3
***
*
*
Samples & Measures
Adolescents 15 yrs330 Roma; 722 non-Roma
SmokingDrunkennessPhysical inactivity
P Kolarcik et al., Predictors of health-endangering behaviour among Roma and non-Roma adolescents in Slovakia by gender. J Epidemiol Community Health 2010;64:1043-1048
Results: Adolescent’s HRB
after adjustment for SES & social desirabilityboys
girls
**
2
1
2
1
*
Samples & measures
Total population
Life expectancy Roma & non-Roma
K Rosicova, Data from 1) Statistical Office of the Slovak Republic; and 2) Projection of Roma population in Slovakia until 2025
Results: Life expectancy
At birth in 2010
Males Females
Samples & Measures
Population 0-1 yrsPer district
Infant mortality, all cause
EducationIncomeUnemployment% of Roma in a district
K Rosicova et al. Regional socioeconomic indicators and ethnicity as predictors of regional infant mortality rate in Slovakia. International Journal of Public Health 2011; 56: 523-531
Results: Infant mortality 0-1
All-cause mortality 0-1
-1 0 +1
R2 = 36 %
Education elementary
Uncompleted elementary
Unemployment rate
Income
% Roma
not measurable
Samples & Measures
Population 20-64 yrsPer district:
All-cause mortality
EducationIncomeUnemployment% of RomaK Rosicova et al., Socioeconomic indicators and ethnicity as determinants of regionalmortality rates in Slovakia, Int J Public Health 54 (2009) 274–282
Results: All-cause mortality 20-64
All-cause mortality Females 20-64 Males 20-64
-1 0 +1
R2 = 33 %R2 = 8 %
Education third
Unemployment rate
Income
% Roma
Samples & Measures
Roma & non-Roma patients with ESRDAll tertiary pediatric clinics + all (adult) Fresenius clinics
Comparison ESRD:* Dialysis* Transplantation
G Kolvek et al., End-stage renal disease among Roma and non-Roma: Roma are at risk, Int J Public Health, DOI 10.1007/s00038-012-0365-x
Results: ESRD
Non Roma
Samples & Measures
Patients after Coronary Angiography (CAG)Roma & non-Roma
Mortality due to all causes;5 yrsNot adjusted
A Sudzinova et al., Mortality in non-Roma and Roma patients who underwent coronary angiography,
Results: Mortality after CAG
5 years mortality in 162 Roma and 646 non-Roma patients after coronary angiography (log-rank test: χ2=16.69, p<0.001)
Discussion
Aim was to contribute to the explanation of the contrasting findings regarding Roma.
* Roma adolescent’s health: picture is mixed
* Roma adolescent’s HRB: •M/F: no difference / less smoking, •M/F: no difference drunkenness, •M/F: no difference / more physical inactivity
* Life expectancy Roma: M/F: shorter
Discussion
Adults:
* All-cause mortality: no contribution % Roma
* ESRD: higher chance Roma in all age categories
* 5 yrs all-cause mortality after CAG: Roma higher
Discussion
For the moment:
* No big difference Roma/non-Roma adolescents
* Significant difference Roma/non-Roma adults
* Adolescents / adults
* Gender pattern?
Thank you for your attention!
QUESTIONS??