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??