IJE Advance Access originally published online on May 27, 2004
International Journal of Epidemiology 2004 33(5):1112-1119; doi:10.1093/ije/dyh189
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IJE vol.33 no.5 © International Epidemiological Association 2004; all rights reserved.
Article |
Ethnic inequalities in age- and cause-specific mortality in The Netherlands
1 Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands.
2 Statistics Netherlands, PO Box 4000, 2270 JM Voorburg, The Netherlands
Correspondence: Vivian Bos MSc, Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands. E-mail: v.bos{at}erasmusmc.nl
Background By describing ethnic differences in age- and cause-specific mortality in The Netherlands we aim to identify factors that determine whether ethnic minority groups have higher or lower mortality than the native population of the host country.
Methods We used data for 1995–2000 from the municipal population registers and cause of death registry. All inhabitants of The Netherlands were included in the study. The mortality of people who themselves or whose parent(s) were born in Turkey, Morocco, Surinam, or the Dutch Antilles/Aruba was compared with that of the native Dutch population. Mortality differences were estimated by Poisson regression analyses and by directly standardized mortality rates.
Results Compared with native Dutch men, mortality was higher among Turkish (relative risk [RR] = 1.21, 95% CI: 1.16, 1.26), Surinamese (RR = 1.24, 95% CI: 1.19, 1.29), and Antillean/Aruban (RR = 1.25, 95% CI: 1.15, 1.36) males, and lower among Moroccan males (RR = 0.85, 95% CI: 0.81, 0.90). Among females, inequalities in mortality were small. In general, mortality differences were influenced by socio-economic and marital status. Most minority groups had a high mortality at young ages and low mortality at older ages, a high mortality from ill-defined conditions (which is related to mortality abroad) and external causes, and a low mortality from neoplasms. Cardiovascular disease mortality was low among Moroccan males (RR = 0.51, 95% CI: 0.44, 0.59) and high among Surinamese males (RR = 1.13, 95% CI: 1.05, 1.21) and females (RR = 1.14, 95% CI: 1.06, 1.23). Homicide mortality was elevated in all groups.
Conclusion Socio-economic factors and marital status were important determinants of ethnic inequalities in mortality in The Netherlands. Mortality from cardiovascular diseases, homicide, and mortality abroad were of particular importance for shifting the balance from high towards low all-cause mortality.
Keywords Ethnicity, mortality, inequality, cause of death, socio-economic status, marital status, The Netherlands
Accepted 4 March 2004
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