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ABSTRACT: The aim of this study on cancer mortality among Turkish immigrants, for the first time, traditional comparisons in migrant health research have been extended simultaneously in two ways. First, comparisons were made to cancer mortality from the immigrants' country of origin and second, cancer mortality among Turkish immigrants across four host countries (Belgium, Denmark, France and the Netherlands) was compared. Population-based cancer mortality data from these countries were included. Age-standardized mortality rates were computed for the local-born and Turkish population of each country. Relative differences in cancer mortality were examined by fitting country-specific Poisson regression models. Globocan data on cancer mortality in Turkey from 2008 were used in order to compare mortality rates of Turkish immigrants with those from their country of origin. Turkish immigrants had lower all-cancer mortality than the local-born populations of their host countries, and mortality levels comparable to all-cancer mortality rates in Turkey. In the Netherlands and France breast cancer mortality was consistently lower in Turkish immigrants women than among local-born women. Lung cancer mortality was slightly lower in Turkish immigrants in the Netherlands and France but varied considerably between migrants in these two host countries. Stomach cancer mortality was significantly higher in Turkish immigrants when compared to local-born French and Dutch. Our findings indicate that exposures both in the country of origin and in the host country can have an effect on the cancer mortality of immigrants. Despite limitations affecting any cross-country comparison of mortality, the innovative multi-comparison approach is a promising way to gain further insights into determinants of trends in cancer mortality of immigrants.
European Journal of Epidemiology 11/2012; · 4.71 Impact Factor
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ABSTRACT: Stillbirth is a sensitive indicator for access to, and quality of health care and social services in a society. If a particular population group e.g. migrants experiences higher rates of stillbirth, this might be an indication of social deprivation or barriers to health care. This study examines differences in risk of stillbirth for women of different regions of origin compared to women from Germany in order to identify high risk groups/target groups for prevention strategies.
We used the BQS dataset routinely compiled to examine perinatal outcomes in Germany nationwide. Participation of hospitals and completeness of data has been about 98% in recent years. Data on all live births and stillbirths were obtained for the period 2004 to 2007 (N = 2,670,048). We calculated crude and stratified mortality rates as well as corresponding relative mortality risks.
A significantly elevated stillbirth rate was found for women from the Middle East and North Africa (incl. Turkey) (RR 1.34, CI 1.22-1.55). The risk was slightly attenuated for low SES. An elevated risk was also found for women from Asia (RR 1.18, CI 1.02-1.65) and from Mediterranean countries (RR 1.14, CI 0.93-1.28). No considerable differences either in use and timing of antenatal care or preterm birth and low birthweight were observed between migrant and non-migrant women. After stratification for light for gestational age, the relative risk of stillbirth for women from the Middle East/North Africa increased to 1.63 (95% CI 1.25-2.13). When adjusted for preterm births with low birthweight, women from Eastern Europe and the Middle East/North Africa experienced a 26% (43%) higher risk compared with women from Germany.
We found differences in risk of stillbirth among women from Middle East/North Africa, especially in association with low SES and low birthweight for gestational age. Our findings suggest a need for developing and evaluating socially and culturally sensitive health promotion and prevention programmes for this group. The findings should also stimulate discussion about the quality and appropriateness of antenatal and perinatal care of pregnant women and newborns with migrant backgrounds.
BMC Pregnancy and Childbirth 09/2011; 11:63. · 2.83 Impact Factor
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ABSTRACT: ABSTRACT: Empirical findings show that morbidity and mortality risks of migrants can differ considerably from those of populations in the host countries. However, while several explanatory models have been developed, most migrant studies still do not consider explicitly the situation of migrants before migration. Here, we discuss an extended approach to understand migrant health comprising a life course epidemiology perspective.The incorporation of a life course perspective into a conceptual framework of migrant health enables the consideration of risk factors and disease outcomes over the different life phases of migrants, which is necessary to understand the health situation of migrants and their offspring. Comparison populations need to be carefully selected depending on the study questions under consideration within the life course framework.Migrant health research will benefit from an approach using a life course perspective. A critique of the theoretical foundations of migrant health research is essential for further developing both the theoretical framework of migrant health and related empirical studies.
Emerging Themes in Epidemiology 08/2011; 8(1):6. · 2.59 Impact Factor
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ABSTRACT: In Germany, the proportion of foreign national residents receiving an invalidity pension is higher than that of Germans. Lower utilization and effectiveness of medical rehabilitation are presumed to be the main reasons. We aimed to examine whether differences in utilization and effectiveness of medical rehabilitation between Germans and foreign nationals are attributable to differences in socio-demography, socio-economic background and health status. Utilization of rehabilitation was analyzed for household members aged 18 years or above enrolled in the German Socio-Economic Panel in 2002-2004 (n = 19,521). Effectiveness of rehabilitation was defined by the occupational performance at the end of rehabilitation. It was examined by using an 80% random sample of all completed medical rehabilitations in the year 2006 funded by the German Statutory Pension Insurance Scheme (n = 634,529). Our study shows that foreign nationals utilize medical rehabilitation less often than Germans (OR = 0.68; 95%-CI = 0.50; 0.91). For those who do, medical rehabilitation is less effective (OR for low occupational performance = 1.50; 95%-CI = 1.46; 1.55). Both findings are only partially attributable to socio-demographic, socio-economic and health characteristics: After adjusting for these factors, ORs for utilization and low occupational performance were 0.66 (95%-CI = 0.49; 0.90) and 1.20 (95%-CI = 1.16; 1.24), respectively. It can be concluded that differences in the utilization and effectiveness of medical rehabilitation between Germans and foreign nationals cannot be explained only by socio-economic differences or poorer health before rehabilitation. In addition, factors such as the ability of the rehabilitative care system to accommodate clients with differing expectations, and migrant-specific characteristics such as cultural differences, seem to play a role.
European Journal of Epidemiology 09/2010; 25(9):651-60. · 4.71 Impact Factor
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Nature 07/2010; 466(7304):315. · 36.28 Impact Factor
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ABSTRACT: A large and increasing part of the European population has a history of migration. Germany, for example, is home to about 15 million people with migrant background, which amounts to 19% of its population. Migrants may have differences in their lifestyle, health beliefs and risk factors compared to the autochthonous populations.
As for example studies on children's participation in routine prevention activities have shown, these differences can have a relevant impact on the access of migrants to the health care system and are likely to lower their participation in prevention programs compared to the autochthonous population. To increase the uptake of prevention programs, barriers to access must be identified and approaches to reduce them must be developed.
Taking the example of Germany, a need exists for prevention programs that include (migrant sensitive) and specifically address (migrant specific) migrants. These should be of sufficient scale, evidence-based, sustainable and evaluated at regular intervals.
BMC Public Health 02/2010; 10:92. · 2.00 Impact Factor
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ABSTRACT: It can be assumed that resettlers (ethnic German immigrants from the Former Soviet Union) show similar smoking patterns as persons in their countries of origin at the time of migration. We analysed how the smoking prevalence among resettlers differs from that among the general population of Germany and whether the prevalence differs between groups with increasing duration of stay.
To estimate the smoking prevalence we used the scientific-use-file (n = 477,239) of the German 2005 microcensus, an annual census representing 1% of all German households. Participation in the microcensus is obligatory (unit-nonresponse <7%). We stratified the prevalence of smoking among resettlers and the comparison group (population of Germany without resettlers) by age, sex, educational level and duration of stay. In total, 14,373 (3% of the total) persons were identified as resettlers.
Female resettlers with short duration of stay had a significantly lower smoking prevalence than women in the comparison group. With increasing duration of stay their smoking prevalence appears to converge to that of the comparison group (e.g.: high educational level, age group 25-44 years: short duration of stay 15%, long duration of stay 24%, comparison group 28%). In contrast, the smoking prevalence among male resettlers with short duration of stay was significantly higher than that among men in the comparison group, but also with a trend towards converging (e.g.: high educational level, age group 25-44 years: short duration of stay 44%, long duration of stay 35%, comparison group 36%). Except for female resettlers with short duration of stay, the participants with low educational level had on average a higher smoking prevalence than those with a high educational level.
This is the first study estimating the smoking prevalence among resettlers by duration of stay. The results support the hypothesis that resettlers brought different smoking habits from their countries of origin shortly after migration. The observed convergence of the smoking habits with increasing duration of stay is in line with the hypothesis of migration as 'health transition'. However, due to the cross-sectional design of the study, further research is needed to confirm these findings.
International Journal for Equity in Health 01/2010; 9:15. · 1.71 Impact Factor
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ABSTRACT: The aim of this study was to estimate cancer incidence rate ratios for Turkish migrants in Hamburg, Germany. We used a name-based approach and identified 1346 cases with Turkish names (as a proxy of Turkish origin) among 140,249 cases of cancer registered in the cancer registry Hamburg during 1990-2005. To estimate the size of the denominator population, we applied the name-based approach to the population of Hamburg as well. The cancer incidence of specific cancer sites was compared between Turkish and non-Turkish cases using incidence rate ratios (IRR), stratified by gender and birth cohort. Our main findings are that cancer of the respiratory organs is diagnosed less frequent among Turkish men in older birth cohorts but with higher frequency in the younger birth cohorts. Malignant neoplasms of lymphoid, haematopoietic and related tissues are slightly higher in most male Turkish men birth cohorts, and even considerably higher for the birth cohort 1961 to <1971 (IRR=1.8). Among women, incidence rates for Turkish women are lower than for non-Turkish women for cancer of the respiratory system, skin cancer and cancer of genital organs. Also, breast cancer incidence rates of Turkish women are lower than for non-Turkish women, especially in older birth cohorts. Incidence rate ratios of neoplasms of lymphoid, haematopoietic and related tissues are low in the 1931 to <1941 cohort (IRR=0.71) but increase in younger birth cohorts. In conclusion, we found differences in cancer risks between cases with and without Turkish names for specific cancer sites. These results are consistent with the findings of studies from other countries.
Cancer epidemiology. 11/2009; 33(6):413-8.
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ABSTRACT: Compared to the majority population of a host country, migrants tend to have different health risks and health behaviour. We have hypothesised that these differences diminish with time passed since migration. We tested this hypothesis by examining smoking behaviour among Turkish migrants and their children born in Germany (second-generation migrants), stratified by educational level and, for the first generation, length of residence.
We estimated the prevalence of smoking based on the representative 2005 Mikrozensus, an annual survey including 1% of Germany's households. The 2005 Microcensus was the first to provide information that makes it possible to differentiate between first- and second-generation Turkish migrants. In total, 12,288 Turkish migrants and 421,635 native-born Germans were included in our study. The unit non-response is generally low (about 6% in 2005) because participation in the Microcensus is obligatory.
We found the prevalence of smoking in second-generation male Turkish migrants to be lower than in the first-generation group: 47.0% of first-generation Turkish migrants with a high level of education were smokers, in contrast to only 37.6% in the second generation. Within the German reference population, 29.9% were smokers. The percentage of Turkish women in our sample who smoked was generally smaller, but was not significantly lower in the second generation. In fact, the prevalence of smoking was highest among Turkish women of the second generation with a low level of education (40.9%), similar to younger second-generation German women with the same level of education.
We present the first representative data on changes in the prevalence of a risk factor for many chronic diseases among Turkish migrants in Germany. Male Turkish migrants (with a high level of education) showed a decrease over the generations while smoking prevalences of female Turkish migrants increased. In the second generation, prevalences partly converged with those of the German reference population or were even higher. Our hypothesis - that migration can be interpreted as a "health transition" - was thus partly confirmed.
International Journal for Equity in Health 08/2009; 8:26. · 1.71 Impact Factor
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ABSTRACT: Little is known about the effect of migrant status on childhood cancer survival. We studied cancer survival among children of Turkish descent in the German Cancer Childhood Registry, one of the largest childhood cancer registries worldwide.
We identified children of Turkish descent among cancer cases using a name-based approach. We compared 5-year survival probabilities of Turkish and other children in three time periods of diagnosis (1980-87, 1988-95, 1996-2005) using the Kaplan-Meier method and log-rank tests.
The 5-year survival probability for all cancers among 1774 cases of Turkish descent (4.76% of all 37.259 cases) was 76.9% compared to 77.6% in the comparison group (all other cases; p = 0.15). We found no age- or sex-specific survival differences (p-values between p = 0.18 and p = 0.90). For the period 1980-87, the 5-year survival probability among Turkish children with lymphoid leukaemia was significantly lower (62% versus 75.8%; p < 0.0001), this remains unexplained. For more recently diagnosed leukaemias, we saw no survival differences for Turkish and non-Turkish children.
Our results suggest that nowadays Turkish migrant status has no bearing on the outcome of childhood cancer therapies in Germany. The inclusion of currently more than 95% of all childhood cancer cases in standardised treatment protocols is likely to contribute to this finding.
BMC Cancer 12/2008; 8:355. · 3.01 Impact Factor
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ABSTRACT: Cancer risks of migrants might differ from risks of the indigenous population due to differences in socioeconomic status, life style, or genetic factors. The aim of this study was to investigate cancer patterns among children of Turkish descent in Germany.
We identified cases with Turkish names (as a proxy of Turkish descent) among the 37,259 cases of childhood cancer registered in the German Childhood Cancer Registry (GCCR) during 1980-2005. As it is not possible to obtain reference population data for children of Turkish descent, the distribution of cancer diagnoses was compared between cases of Turkish descent and all remaining (mainly German) cases in the registry, using proportional cancer incidence ratios (PCIRs).
The overall distribution of cancer diagnoses was similar in the two groups. The PCIRs in three diagnosis groups were increased for cases of Turkish descent: acute non-lymphocytic leukaemia (PCIR 1.23; CI (95%) 1.02-1.47), Hodgkin's disease (1.34; 1.13-1.59) and Non-Hodgkin/Burkitt lymphoma (1.19; 1.02-1.39). Age, sex, and period of diagnosis showed no influence on the distribution of diagnoses.
No major differences were found in cancer patterns among cases of Turkish descent compared to all other cases in the GCCR. Slightly higher proportions of systemic malignant diseases indicate that analytical studies involving migrants may help investigating the causes of such cancers.
BMC Public Health 02/2008; 8:152. · 2.00 Impact Factor
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ABSTRACT: Abstract
Background
Little is known about the effect of migrant status on childhood cancer survival. We studied cancer survival among children of Turkish descent in the German Cancer Childhood Registry, one of the largest childhood cancer registries worldwide.
Methods
We identified children of Turkish descent among cancer cases using a name-based approach. We compared 5-year survival probabilities of Turkish and other children in three time periods of diagnosis (1980–87, 1988–95, 1996–2005) using the Kaplan-Meier method and log-rank tests.
Results
The 5-year survival probability for all cancers among 1774 cases of Turkish descent (4.76% of all 37.259 cases) was 76.9% compared to 77.6% in the comparison group (all other cases; p = 0.15). We found no age- or sex-specific survival differences (p-values between p = 0.18 and p = 0.90). For the period 1980–87, the 5-year survival probability among Turkish children with lymphoid leukaemia was significantly lower (62% versus 75.8%; p < 0.0001), this remains unexplained. For more recently diagnosed leukaemias, we saw no survival differences for Turkish and non-Turkish children.
Conclusion
Our results suggest that nowadays Turkish migrant status has no bearing on the outcome of childhood cancer therapies in Germany. The inclusion of currently more than 95% of all childhood cancer cases in standardised treatment protocols is likely to contribute to this finding.
BMC Cancer. 01/2008;
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ABSTRACT: Obwohl die Bevölkerungsgruppe mit türkischem Migrationshintergrund in Deutschland zurzeit noch ein vergleichsweise niedriges
Durchschnittsalter aufweist, wächst der Anteil älterer Menschen unter den türkischen Migrantinnen und Migranten. Vor diesem
Hintergrund gewinnen Fragen zur Pflegeversorgung dieser Bevölkerungsgruppe stark an Bedeutung, über die bisher in Deutschland
kaum wissenschaftlich abgesicherte Erkenntnisse existieren. Das folgende Kapitel beschreibt die besondere Situation von Menschen
mit türkischem Migrationshintergrund, die in Deutschland leben, und gibt so erste Einblicke in dieses noch junge aber wichtige
Forschungsfeld und stellt einen Einstieg in die weitere Forschung zu diesem Thema dar.
12/2007: pages 396-422;
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ABSTRACT: A large and increasing part of the German population has a migrant background. These persons may show major differences in their lifestyle, health beliefs and risk factors compared to the autochthonous German population. This can have a significant impact on the access of migrants to the health system and their participation in prevention programs. To increase the uptake of prevention programs, barriers must be identified and approaches to reduce them should be developed. In Germany, there is a need for prevention programs addressing migrants that are large-scale, evidence-based, sustainable and regularly evaluated.
Medizinische Klinik 07/2007; 102(6):451-6. · 0.34 Impact Factor
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ABSTRACT: Ein großer und wachsender Anteil der in Deutschland lebenden Menschen hat einen Migrationshintergrund. Diese Menschen können
sich hinsichtlich ihrer Lebensweisen und ihrer Risikofaktoren mehr oder minder stark von der Allgemeinbevölkerung unterscheiden.
Beim Zugang zum Gesundheitssystem, bei den Anforderungen an Gesundheitsdienstleister oder dem Verständnis von Krankheit und
Gesundheit gibt es gegenüber der einheimischen Bevölkerung z. T. erhebliche Unterschiede, welche sich auch bei der Nutzung
von Praventions- und Vorsorgeangeboten zeigen. Für Migranten gibt es spezifische Barrieren, die erforscht und abgebaut werden
müssen. Bisherige migrantensensible bzw. migrantenspezifische Präventionsprogramme stellen meist befristete Einzelinitiativen
dar, so dass ein Bedarf für nachhaltige und evaluierte Programme im Bereich Prävention besteht.
A large and increasing part of the German population has a migrant background. These persons may show major differences in
their lifestyle, health beliefs and risk factors compared to the autochthonous German population. This can have a significant
impact on the access of migrants to the health system and their participation in prevention programs. To increase the uptake
of prevention programs, barriers must be identified and approaches to reduce them should be developed. In Germany, there is
a need for prevention programs addressing migrants that are large‑scale, evidence‑based, sustainable and regularly evaluated.
05/2007; 102(6):451-456.
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ABSTRACT: It is still under debate whether occupational exposure to radio frequency/microwave electromagnetic fields (RF/MW-EMF) contributes to the development of brain tumors. This analysis examined the role of occupational RF/MW-EMF exposure in the risk of glioma and meningioma. A population-based, case-control study including 381 meningioma cases, 366 glioma cases, and 1,494 controls aged 30-69 years was performed in three German regions in 2000-2003. An exposure matrix for occupational activity was constructed by using information on RF/MW-EMF exposure collected in a computer-assisted personal interview. "High" exposure was defined as an occupational exposure that may exceed the RF/MW-EMF exposure limits for the general public recommended by the International Commission on Non-Ionizing Radiation Protection. Multiple conditional logistic regressions were performed separately for glioma and meningioma. No significant association between occupational exposure to RF/MW-EMF and brain tumors was found. For glioma, the adjusted odds ratio for highly exposed persons compared with persons not highly exposed was 1.21 (95% confidence interval: 0.69, 2.13); for meningioma, it was 1.34 (95% confidence interval: 0.64, 2.81). However, the slight increase in risk observed with increasing duration of exposure merits further research with larger sample sizes.
American Journal of Epidemiology 10/2006; 164(6):538-48. · 5.22 Impact Factor
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ABSTRACT: Epidemiologic research on migration and health in Germany is increasingly focusing on chronic diseases. Migrant studies can help to identify causes of diseases. They also help to identify health inequalities and can thus contribute to improvements in health care. With regard to cancer, descriptive studies among Turkish migrants and ethnic German immigrants from the Former Soviet Union have shown overall low, but slowly increasing cancer rates as compared to autochthonous Germans. For individual cancer sites such as stomach cancer, migrants appear to experience higher risks than the comparison population. Epidemiologic approaches studying cancer care and services for migrants, as well as analytic studies that allow assessing the particular temporal dynamics of cancer risks among migrant groups, are scarce in Germany. Thus, major challenges for cancer epidemiology among migrants exist in Germany.
PPmP - Psychotherapie · Psychosomatik · Medizinische Psychologie 58(3-4):130-5. · 1.02 Impact Factor
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ABSTRACT: Background A large and increasing part of the European population has a history of migration. Germany, for example, is home to about 15 million people with migrant background, which amounts to 19% of its population. Migrants may have differences in their lifestyle, health beliefs and risk factors compared to the autochthonous populations. Discussion As for example studies on children's participation in routine prevention activities have shown, these differences can have a relevant impact on the access of migrants to the health care system and are likely to lower their participation in prevention programs compared to the autochthonous population. To increase the uptake of prevention programs, barriers to access must be identified and approaches to reduce them must be developed. Summary Taking the example of Germany, a need exists for prevention programs that include (migrant sensitive) and specifically address (migrant specific) migrants. These should be of sufficient scale, evidence-based, sustainable and evaluated at regular intervals.
BMC Public Health, 10:92.
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ABSTRACT: Background: Compared to the majority population of a host country, migrants tend to have different health risks and health behaviour. We have hypothesised that these differences diminish with time passed since migration. We tested this hypothesis by examining smoking behaviour among Turkish migrants and their children born in Germany (second-generation migrants), stratified by educational level and, for the first generation, length of residence. Methods: We estimated the prevalence of smoking based on the representative 2005 Mikrozensus, an annual survey including 1% of Germany's households. The 2005 Microcensus was the first to provide information that makes it possible to differentiate between first- and second-generation Turkish migrants. In total, 12,288 Turkish migrants and 421,635 native-born Germans were included in our study. The unit non-response is generally low (about 6% in 2005) because participation in the Microcensus is obligatory. Results: We found the prevalence of smoking in second-generation male Turkish migrants to be lower than in the first-generation group: 47.0% of first-generation Turkish migrants with a high level of education were smokers, in contrast to only 37.6% in the second generation. Within the German reference population, 29.9% were smokers. The percentage of Turkish women in our sample who smoked was generally smaller, but was not significantly lower in the second generation. In fact, the prevalence of smoking was highest among Turkish women of the second generation with a low level of education (40.9%), similar to younger second-generation German women with the same level of education. Conclusion: We present the first representative data on changes in the prevalence of a risk factor for many chronic diseases among Turkish migrants in Germany. Male Turkish migrants (with a high level of education) showed a decrease over the generations while smoking prevalences of female Turkish migrants increased. In the second generation, prevalences partly converged with those of the German reference population or were even higher. Our hypothesis that migration can be interpreted as a ''health transition'' was thus partly confirmed.
International Journal for Equity in Health, 8:26.
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ABSTRACT: Background: Little is known about the effect of migrant status on childhood cancer survival. We studied cancer survival among children of Turkish descent in the German Cancer Childhood Registry, one of the largest childhood cancer registries worldwide. Methods: We identified children of Turkish descent among cancer cases using a name-based approach. We compared 5-year survival probabilities of Turkish and other children in three time periods of diagnosis (198087, 198895, 19962005) using the Kaplan-Meier method and log-rank tests. Results: The 5-year survival probability for all cancers among 1774 cases of Turkish descent (4.76% of all 37.259 cases) was 76.9% compared to 77.6% in the comparison group (all other cases; p = 0.15). We found no age- or sex-specific survival differences (p-values between p = 0.18 and p = 0.90). For the period 198087, the 5-year survival probability among Turkish children with lymphoid leukaemia was significantly lower (62% versus 75.8%; p < 0.0001), this remains unexplained. For more recently diagnosed leukaemias, we saw no survival differences for Turkish and non-Turkish children. Conclusion: Our results suggest that nowadays Turkish migrant status has no bearing on the outcome of childhood cancer therapies in Germany. The inclusion of currently more than 95% of all childhood cancer cases in standardised treatment protocols is likely to contribute to this finding.
BMC Cancer, 8:355.
