Health status of migrants in Europe. Mortality WP

1. Health status of migrants in Europe.Mortality WP JP Mackenbach AE Kunst I Stirbu "This project is funded under the framework of Public Health Programme 2003-2008 of the European Commission (contract number 2005122)"

2. Objectives • To generate a first overview of (available data sources on) mortality of ethnic or migrant minorities in Europe • To identify and describe existing data bases with information on mortality according to ethnic or migrant status • Assess the coverage, completeness and quality of these databases and to identify databases useful for studying mortality in relation to ethnicity or migrant status • Collect data and analyse levels of mortality in ethnic or migrant minorities compared to the majority populations

3. Structure • Overview of previous studies in different European countries • Inventory of data sources that are available to monitor migrant’s mortality • In-depth mortality analysis for selected countries

4. Literature review • Criteria for study selection • European country as a host country • Outcome - mortality • Published in recent years • Including non-western migrants and ethnic groups • Total – 44+ studies

5. Literature review • Netherlands (7) • Years: 1995-2000-2006 • Data source(s): Statistics Netherlands (population and mortality linked data) • Ethnic groups: Turkish, Moroccans, Surinamese, Antillean/Aruban, Indonesian, refugee groups (Africa &Asia) • Definition of ethnicity: country of birth of the person and parents • Distinction by generation is possible • Causes of death: all major causes of death and specific for migrant groups causes of death are covered

6. Literature review • UK (13) • Years: 1970-2003 (only a few studies covered recent years) • Data source(s): ONS mortality longitudinal study (1% population of England and Wales), Census+mortality registries (unlinked cross-sectional studies), specific registries (cancer) • Ethnic groups: Caribbean, South Asian, East/West Africa, • Definition of ethnicity: country of birth, name • Distinction by generation - ? • Causes of death: all major causes of death and specific for migrant groups causes of death are covered

7. Literature review • Germany (6) • Years: 1980-2002 (most studies covered recent years) • Data source(s): local population registries and state statistical office • Ethnic groups: Turkish, Russian Aussiedler • Definition of ethnicity: Nationality • Distinction by generation is possible (for some groups) • Causes of death: all major causes of death

8. Literature review • France (4) • Years: 1979-1991 • Data source(s): mortality registry (INSEE) and population registry (INSERM) • Ethnic groups: North and Sub-Saharan Africa • Definition of ethnicity: Country of birth and nationality • Distinction by generation - ? • Causes of death: Major causes of death, extensively cancer mortality

9. Literature review • Israel (8) • Years: 1950-2000 • Data source(s): CBS, cancer registries, Live birth notification & death certificates • Ethnic groups: Jewish, Arab • Definition of ethnicity: religious • Causes of death: Major causes of death

10. Literature review • Other countries • Estonia (1): years 1989-2000, Russian minority, data from National mortality registry+census, Total and major cause-specific mortality • Latvia (1): transition years, Russian minority, total mortality and life expectancy • Belgium: a few old studies published around 1980-85 • Italy: all studies focused on internal migrants • Spain (2): injury mortality of foreign workers and Roma population • Roma population: Spain, Czech Republic and Slovak Republic, combined

11. Literature review, Main conclusions • In terms of information over mortality among migrants: • Well covered (NL, UK, Germany) • Partially covered (France, Israel, Estonia) • Hardly covered (Italy, Spain, Poland, Belgium, Latvia, Hungary, Czech Republic, Slovak Republic, Romania) • No general overviews, no comparative studies • Data on ethnicity are available in some countries

12. Research proposal • Aim: to describe the mortality patterns of ethnic minority groups in Europe • Research questions: • To what extent the total and cause-specific mortality of ethnic minority populations differs from the total and cause-specific mortality of host population in all European countries separately? • How different are the mortality patterns of the same ethnic groups living in different host countries?

13. Data sources • Germany • Netherlands • UK • France • Sweden • Denmark • Belgium • Italy • Spain • Israel Poland Latvia Estonia Czech Republic Slovak Republic Hungary Romania

14. Variables • Demographic and social characteristics • Sex, age (5-year age-groups), socio-economic status (if possible) • Ethnicity • All ethnic groups with enough data • Causes of death • Total mortality, • Large grouped causes of death (all infectious, cardio-vascular, cancer, external, other) • Large single causes of death (TB, IHD, Stroke, Diabetes, Lung, Breast cancers, specific for ethnic group causes of death) • Infant and child mortality

15. Next steps • Detailed inventory of existing data • Years • Ethnic groups and and their definition • Type of data • Socio-demographic characteristics available • Causes of death • Selecting countries and ethnic groups based on criteria • Number of cause-specific deaths • Number of countries where a particular ethnic group is present • Validity of data • Conducting analysis

16. Challenges • Definition of ethnicity in different countries • Various types of data from different countries (cross-sectional, longitudinal, ecological) • Small numbers • 1% population in France, UK • Small ethnic groups • Small specific causes of death "Disclaimer: The study has received funding from the European Commission under the Public Health Programme 2003-2008. However, the sole responsibility for the study lies with the author and the European Commission is not responsible for any use that may be made of the information contained therein."