Article

Trends in the gap in life expectancy between Arabs and Jews in Israel between 1975 and 2004

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Abstract

To examine trends in the Arab-Jew life expectancy gap in Israel during 1975-2004 and to determine the contribution of age groups and causes of death to changes in the gap. Data on life expectancy and mortality rates by cause of death, for Arabs and Jews, were obtained from the Israel Central Bureau of Statistics. Standard life table techniques were used for decomposition analysis to explore the contribution to changes in the life expectancy gap. While life expectancy of Arabs was lower than Jews during 1975-2004, there was a decline in this gap during 1975-98. However, during the following years the gap increased and the difference in 2004 was 3.2 years for men and 4 years for women. During 2000-04, the main causes of death contributing to the gap in life expectancy were chronic diseases, mainly heart disease and diabetes. Heart disease mortality contributed mostly to the overall life expectancy gap for males and females, accounting for 0.89 and 1.17 years, respectively. The age group >65 years contributed most to the gap (1.33 years among males, and 2.42 years among females). Following a period of reduction, the gap in life expectancy at birth between Arabs and Jews in Israel has started to widen. These findings indicate the need for increased attention to primary prevention and disease management in the Arab population. Reducing social and individual risk factors for major causes of death should be a national priority.

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... among women [12]. In a study that examined the trends in the gap in life expectancy between Arabs and Jews in Israel between 1975 and 2004, Na'amnih et al. found that the average mortality rates from heart disease decreased between 1980 and 2004 in men and women among both Arab and Jewish popula- tions [13]. However, the decline in heart disease mortality was greater in Jewish men and women than in Arab men and women. ...
... The average mortality rates from T2D, however, increased between 1980 and 2004, in both men and women, regardless of ethnicity. In 2000–2004 the average ageadjusted rates per 100,000 from T2D were highest among Arab women followed by Arab men, Jewish men and finally , Jewish women (52.9, 48.9, 21.3, and 15.8, respectively) [13]. A prevalence interview study of CHD, T2D and hypertension was conducted among 1,159 adults (aged 35 years and above) from the Negev Jewish population [14]. ...
... A prevalence interview study of CHD, T2D and hypertension was conducted among 1,159 adults (aged 35 years and above) from the Negev Jewish population [14]. In contrast to the study mentioned above [13], men had twice the prevalence of myocardial infarction and underwent more invasive cardiac procedures than women. The highest prevalence of myocardial infarction and hypertension were found in those born in central and eastern Europe, while the highest prevalence of T2D was found in those born in western Europe. ...
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Israel is a small country with a highly diverse population in terms of ethnicity, religion, genetics and lifestyle, which all have an impact on coronary heart disease (CHD) and metabolic risk factors. This review focuses on gender and ethnic group differences in the risk factors associated with CHD. Using the metabolic syndrome (MetSyn) as a guiding theoretical framework, 30 empirical studies from Israel published after the year 2000 were reviewed to elicit trends. Overall, the MetSyn framework appears to be less appropriate for women than for men in predicting CHD morbidity. In addition, ethnic minorities are more likely to have earlier and more severe risk factor profiles, and women are almost always disproportionately affected. Over a period of 5 to 15 years after arrival in Israel, immigrants from the former Soviet Union and Ethiopia show an increase in obesity. Recent intervention studies to reduce CHD risk have shown encouraging results when the programs are culturally tailored.
... However, life expectancy for the Palestinian minority has continually stood at 3 to 4 years less than that of the Jewish majority (see Figure 1) (Central Bureau of Statistics, 2020b). This LE gap began to decline in the 1970s and 1980s, but since the early 1990s, it has been gradually widening again (Na'amnih et al., 2010). The LE gap's growth has been largely driven by increasing mortality inequalities among ages 50 and older (Saabneh, 2016). ...
... Typically, studies that investigate this case of health inequalities (between Palestinians and Jews) rely on comparisons at the national level (e.g., Na'amnih et al., 2010;Saabneh, 2016). To determine the role played by spatial segregation, I examine these data on two different levels. ...
... Results of the decomposition offer additional insight on the nature of the observed life expectancy gaps. They show that larger gaps are found among older ages (50 and above), partly due to mortality gaps that had already existed two decades ago and partly reflecting trends of growing gaps, especially among men, consistent with previous findings (Na'amnih et al., 2010;Saabneh, 2016). Among women, however, the results indicate a mild decline in the old-age mortality gap in recent years (after 2010), a trend that had not been previously observed. ...
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This paper examines the significance of how spatial inequality explains the health inequalities between Palestinians and Jews in Israel. Israeli policies have created extreme spatial segregation between Palestinians and Jews that is a defining feature of Jewish–Palestinian relations. Furthermore, spatial segregation of Palestinians constitutes a structural condition that limits chances of individual social mobility and socio-economic achievements. This paper seeks to encourage consideration of how spatial inequalities contribute to health inequalities by examining gaps in life expectancy between Palestinians and Jews in Israel. The findings show that the highest level of life expectancy in Israel is among Jews living in dominantly Jewish regions, where only small numbers of Palestinians reside. In the space shared by Jews and Palestinians, where most of the Palestinians reside, Jews have higher life expectancy than Palestinians, yet lower than Jews in the dominantly Jewish regions. The lowest life expectancy is observed among Palestinians living in the shared space. The paper concludes that the lower life expectancy among Palestinians relative to Jews is a result, in part, to their confinement to segregated, peripheral places, characterised by a low level of socio-economic development.
... For example, an Israeli study found that Arabs reported a higher number of visits to primary care physician (PCP) compared to Jews, whereas the Jews utilize more specialists than the Arabs [4]. Further, Arabs have poorer health status compared to Jews, with higher rates of chronic diseases such as obesity [5], Diabetes [6], and poorer life expectancy [6]. Previous studies have examined the role of primary care in patient health and identified the high importance of the PCPs' performance on health outcomes [3,7], as well as on improved patient's satisfaction [8]. ...
... For example, an Israeli study found that Arabs reported a higher number of visits to primary care physician (PCP) compared to Jews, whereas the Jews utilize more specialists than the Arabs [4]. Further, Arabs have poorer health status compared to Jews, with higher rates of chronic diseases such as obesity [5], Diabetes [6], and poorer life expectancy [6]. Previous studies have examined the role of primary care in patient health and identified the high importance of the PCPs' performance on health outcomes [3,7], as well as on improved patient's satisfaction [8]. ...
... Non-Adherence to treatment is a major public health concern and is associated with disease deterioration, poor prognosis, increase health care costs, and death [33]. This might further worsen the disparities in health status between Jews and Arabs, where Arabs have higher rates of obesity [5,34], diabetes, [35,36] sedentary behavior [37], smoking [38], and shorter life expectancy [6]. ...
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Background: A key component of the quality of health care is patient satisfaction, particularly in regard to Primary Care Physician (PCP), which represents the first contact with health care services. Patient satisfaction is associated with ethnic, regional and socio-demographic differences, due to differences in service quality, patient-doctor communication, and the patient's perceptions. The aim of this study was to evaluate patients' satisfaction related to primary care physicians' (PCP) performance and to explore potential differences by ethnicity in a multicultural population. Methods: A national cross-sectional telephone survey was conducted, among a random sample of the Israeli population aged ≥25 years. Satisfaction level from performance of PCP was assessed using a validated questionnaire (30 items; 6 different domains). Results: The final sample included (n = 827 Jews; n = 605 Arabs, mean age 54.7(±14.9). In the adjusted logistic regression models, Arabs reported lower general satisfaction related to PCPs' performance as compared to Jews (adjusted odds ratio (AOR), 0.63; (95% CI: 0.40-0.98). Arabs reported lower satisfaction related to PCPs' performance across the following domains: communication skills (AOR, 0.42; 95% CI, 0.22-0.82); interpersonal manners (AOR, 0.37; 95% CI, 0.24-0.58); and time spent with the patients (AOR, 0.60; 95% CI, 0.43-0.85). Conclusions: Jews and Arabs were very satisfied with PCPs' performance. However, there are ethnic differences in the extent of satisfaction level related to the performance of PCP. Satisfaction from PCPs' performance may be achieved by improving the communication skills of the PCP, encouraging interpersonal interaction between the PCP and the patient, and devoting more time to the patient during the visits.
... Nevertheless, it has been shown that the prevalence of type 2 diabetes is much higher among the Arab population compared with the Jewish population in Israel [18], partly explained by the higher prevalence of obesity among Israeli Arabs population compared with Jews and especially among women [19,20]. Diabetes mortality is one of the [21]. A more recent analysis demonstrated very low rates of diabetes mortality in the 1980s that increased drastically in the 1990s and 2000s, in both Jews and non-Jews; however, steeper increases were shown among Arab men and women. ...
... A more recent analysis demonstrated very low rates of diabetes mortality in the 1980s that increased drastically in the 1990s and 2000s, in both Jews and non-Jews; however, steeper increases were shown among Arab men and women. Among Arab women, diabetes mortality became the major contributor to the Arab-Jewish gap in life expectancy at age 45 [21], although even in this latter study, the beginning of a declining trend was starting to show. The most recent publication by the Israeli Central Bureau of Statistics has demonstrated the smallest Jewish-Arab gap in life expectancy at age 45 among women since 2000 [22]. ...
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Background: Israel is one of the few countries that have a national program for quality assessment of community healthcare. We aimed to evaluate whether improved performance in diabetes care was associated with improved health of diabetic patients on a national level. Methods: We conducted a nationwide ecological study estimating improvements in diabetes-related quality indicators and health outcomes. We estimated both correlations between composite measures of diabetes-related quality indicators and selected outcomes, and assessed through a joinpoint analysis whether trends in selected outcomes changed 4 years after the inception of the national program. Results: Between 2002 and 2010, the prevalence of diabetes in Israeli adults increased from 4.8% to 7.4%. During these years, an improvement was noticed in most quality indicators (from 53% to 75% for the composite score). Declines were noted in rates of blindness, diabetes-related end-stage kidney disease, lower limbs amputations and diabetes-related mortality. Significant accelerations in decline were noted for amputations in men and diabetes-related mortality in both Arab men and women 4 years after the inception of the national program. Conclusion: This study suggests that Israel's national program for quality indicators in diabetes care in the community has probably had a significant impact on the health status of the whole population and may have contributed to narrowing gaps in life expectancy between Israeli Jews and Arabs. Future studies based on individual-level data are needed to confirm these results.
... 3 Nonetheless, life expectancy is consistently higher among Jews than Arabs, and despite earlier narrowing, the life expectancy gap has widened during the past 20 years (figure 2). 18,19 The widening in the life expectancy gap between Jews and Arabs has been attributed to mortality from NCDs, mainly heart disease, diabetes, cancer, and external injuries. 18,19 Regional variations within Israel in life expectancy have also been observed (appendix). ...
... 18,19 The widening in the life expectancy gap between Jews and Arabs has been attributed to mortality from NCDs, mainly heart disease, diabetes, cancer, and external injuries. 18,19 Regional variations within Israel in life expectancy have also been observed (appendix). 5 ...
Article
Israel is a high-income country with an advanced health system and universal health-care insurance. Overall, the health status has improved steadily over recent decades. We examined differences in morbidity, mortality, and risk factors for selected non-communicable diseases (NCDs) between subpopulation groups. Between 1975 and 2014, life expectancy in Israel steadily increased and is currently above the average life expectancy for the Organisation for Economic Co-operation and Development countries. Nevertheless, life expectancy has remained lower among Israeli Arabs than Israeli Jews, and this gap has recently widened. Age-adjusted mortality as a result of heart disease, stroke, or diabetes remains higher in Arabs, whereas age-adjusted incidence and mortality of cancer were higher among Jews. The prevalence of obesity and low physical activity in Israel is considerably higher among Arabs than Jews. Smoking prevalence is highest for Arab men and lowest for Arab women. Health inequalities are also evident by the indicators of socioeconomic position and in subpopulations, such as immigrants from the former Soviet Union, ultra-Orthodox Jews, and Bedouin Arabs. Despite universal health coverage and substantial improvements in the overall health of the Israeli population, substantial inequalities in NCDs persist. These differences might be explained, at least in part, by gaps in social determinants of health. The Ministry of Health has developed comprehensive programmes to reduce these inequalities between the major population groups. Sustained coordinated multisectoral efforts are needed to achieve a greater impact and to address other social inequalities.
... In 2017, life expectancy at birth was 3.7 years lower in Arab than Jewish men: 77.5 and 81.2 years, respectively, and 3.0 years lower in Arab vs. Jewish women; 82.0 vs. 85.0 years [13]. The higher mortality rates of heart diseases, stroke and diabetes among the Arab population [10] contribute substantially to the gap in life expectancy between the two population groups [14,15]. ...
... Moreover, the percentage of hospitalizations increased significantly already by age 50 years among Arab patients, while among Jewish patients a significant increase was observed from age 70 years. This likely reflects higher NCD burden in Arab patients and greater prevalence of smoking in Arab men; these factors are considered to explain disparities in life expectancy between the Arab and Jewish populations in Israel [10,14,15]. Ethnicity was highly correlated with residential SES; therefore, it is difficult to tease-out the specific role of ethnicity vs. SES, especially given the lack of individual level SES indicators in the database. ...
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Background: Disparities in non-communicable diseases (NCDs) may affect health care utilization. We compared the correlates of hospitalizations in internal medicine divisions, of adults with NCDs, between the main population groups in Israel. Methods: A cross-sectional study was conducted among Jews (N = 17,952) and Arabs (N = 10,441) aged ≥40 years with diabetes, hypertension or cardiovascular diseases, utilizing the computerized database of the largest health maintenance organization in Israel. Information was retrieved on sociodemographics, background diseases, hospitalizations and utilizations of other health services. Multivariable log binomial regression models were performed. Results: Overall, 3516 (12.4%) patients were hospitalized at least once during a one-year period (2008). Hospitalization in internal medicine divisions was more common among Arab than Jewish patients; prevalence ratio 1.24 (95% CI 1.14-1.35), and increased with age (P<0.001). An inverse association was found between residential socioeconomic status and hospitalization among Jewish patients, but not among Arab, who lived mostly in low socioeconomic status communities. In both population groups, congestive heart failure, arrhythmias, heart surgery, cardiac catheterization, kidney disease, asthma, neurodegenerative diseases, mental illnesses, smoking (in men) and disability were positively related to hospitalization in internal medicine divisions, which was more common also in patients who consulted any specialist and a specialist in cardiology. Emergency room visits, consulting with an ophthalmologist and performing cancer screening tests were inversely related to hospitalizations among Jewish patients only (P = 0.009 and P = 0.067 for interaction, respectively). Conclusions: In a country with universal health insurance, the correlates of hospitalizations included sociodemographics, multi-morbidity, health behaviors and health services use patterns. Socioeconomic disparities might account for ethnic differences in hospitalizations. Individuals with several NCDs, rather than one specific disease, disability and smoking should be targeted to reduce healthcare costs related to hospitalizations.
... The Arab population in Israel is in transition, marked by continuous improvement in educational level and in health indicators, such as increased life expectancy and declines in infant mortality and cardiovascular disease mortality. Despite this progress, disparities remain in SES and non-communicable diseases as compared to the Jewish population in Israel [17,18]. The Arab population is also characterized by a high proportion of consanguineous marriages, up to 31% [19,20]. ...
... In previous studies, we have shown that the Arab population in Israel is disproportionately affected by cardiovascular disease and diabetes mellitus as compared to the Jewish population [17], and that these disparities significantly contribute to gaps in life expectancy between the two populations [18]. The current study sheds light on early childhood origins that might affect risks of cardiometabolic diseases, including modifiable factors, such as dietary intake and obesity. ...
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Understanding the role in pediatric obesity of early life feeding practices and dietary intake at school age is essential for early prevention. The study aimed to examine associations of early life feeding practices, environmental and health-related exposures, and dietary intake at school age as determinants of obesity in children aged 10–12 years. In an earlier study of 233 healthy infants in two Arab towns in northern Israel, neonatal history, feeding practices, and health information were obtained up to age 18 months. This follow-up study assessed dietary intake and anthropometric measurements at age 10–12 years using the 24 h recall method. Overall, 174 children participated in this study. Almost all (98%) the children were breastfed. The prevalence of obesity at school age was 42%. A multivariable model adjusted for energy intake and socioeconomic status showed positive associations of total fat intake and of weight-for-height z score, but not feeding practices in infancy, with obesity. Higher gestational age at birth was associated with lower odds of obesity at age 10–12 years. In conclusion, in a population with near universal breastfeeding, gestational age at birth, weight indicators but not feeding practices in infancy, and total fat intake at school age were associated with increased likelihood of obesity.
... When comparing the veteran-Jewish majority to Arab-Israelis and to the FSU immigrants, several disparities emerge in the realms of SES, education, and health (Okun and Friedlander 2005;Baron-Epel et al. 2010;Na'amnih et al. 2010). Specifically, older Arab-Israelis and FSU immigrants experience higher rates of functional limitations compared to the veteran-Jewish population (Osman and Walsemann 2013) and are at higher risk of health deterioration over time (Spalter et al. 2014). ...
... Finally, the results underscore that minority status is not only related to lower initial QOL, but also to greater decline in this well-being outcome measure. It should be noted as well that, as described earlier, the two minority groups addressed in this study are subject to inequality in the domains of socioeconomic status and health (Okun and Friedlander 2005;Baron-Epel et al. 2010;Na'amnih et al. 2010;Osman and Walsemann 2013;Spalter et al. 2014). Therefore, the results of the present study follow those from previous studies that suggest that people in minority groups who are disempowered and subject to inequality have a lower level of QOL (House et al. 1994). ...
Article
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This study explores minority group status in relation to change in quality of life (QOL) among three population groups in Israel—Veteran-Jews, Arab–Israelis, and immigrants from the Former Soviet Union (FSU)—controlling for a set of known predictors. The study uses panel data from two waves (2009/10 and 2013) of the Israeli component of the Survey of Health, Ageing, and Retirement in Europe, (N = 1590). A set of Ordinary Least Squares regressions is used to predict positive QOL change over the two waves. Interaction terms in a number of selected areas are considered. The results show that minority group status (Arab–Israelis and FSU immigrants) is negatively related to positive QOL change, compared to the majority group (veteran-Jews). Moreover, being employed was found to improve QOL for older FSU immigrants, underscoring the realm of work in the well-being of this population group. In comparison, it was exchange with family members that had a positive effect on QOL change among the Arab–Israelis, emphasizing the importance of that particular aspect of their lives in older age. In sum, the results highlight the risk of minority group status to well-being in late life and confirm the observation that positive QOL change correlates with characteristically different factors among different population groups.
... Israel is another outlier in the region, with a life expectancy trajectory similar to those observed in Western Europe or North America (Na'amnih et al. 2010). Having started from a level of 68.9 years in 1950-55, life expectancy in Israel has increased in a near linear fashion, reaching a value of 80.7 in 2005-10. ...
... The current study also revealed in one side that the majority of Arab elderly suffer from chronic health problems. This results support findings from previous studies that have shown that Arabs in Israel suffer from chronic diseases more than Jewish Israelis, from symptoms of poor health, long term health problems with their consequent physical limitations, and a shorter life expectancy (Na'amnih et al. 2010). ...
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Socioeconomic inequalities in health are well documented. Recently, researchers have shown interest in exploring the mechanisms by which measures of SES operate through it to impact SRH, such as material, psychosocial and behavioral factors. To examine the relationships between SES indicators and self-rated health (SRH); and to determine whether health behaviors and obesity mediate the association between SES indicators and SRH. A secondary analysis of data previously collected through the third survey of socioeconomic and health status of the Arab population in Israel, in which the SRH of 878 Arab-Israelis age 50 or older were analyzed using logistic regression. The results showed that higher education level and current employment in old age are associated with better SRH. However, neither subjective economic status nor family income was associated with SRH. Greater physical activity was found to be related to good\very good SRH, while obesity was associated with less than good SRH. Finally, health behaviors (physical activity) and obesity were revealed as mediators between SES indicators (education and employment status) and SRH. The results highlight the importance of high education level and employment status in old age to reduce health inequalities. The findings also show that the relationship between SES and SRH can operate through behavioral mechanisms (i.e., physical activity) and their consequences (i.e., obesity), that can, however, be changed in old age.
... By 2000, life expectancy at birth was 74.6 years for Arab men and 77.9 years for Arab women, compared to 77.1 and 81.2 years among Israeli Jewish men and women, respectively [19,20]. Heart disease and diabetes for both sexes, and stroke for women, were identified as the main contributors to the life expectancy gaps [21,22]. ...
Article
Background: Poor cardiovascular health (CVH) among ethnic/racial minorities, studied primarily in the USA, may reflect lower access to healthcare. We examined factors associated with minority CVH in a setting of universal access to healthcare. Methods and results: CVH behaviors and factors were evaluated in a random population sample (551 Arabs, 553 Jews) stratified by sex, ethnicity and age. More Jews (10%) than Arabs (3%) had 3 ideal health behaviors. Only one participant had all four. Although ideal diet was rare (≤1.5%) across groups, Arabs were more likely to meet intake recommendations for whole grains, but less likely to meet intake recommendations for fruits/vegetables and fish. Arabs had lower odds of attaining ideal levels for body mass index and physical activity. Smoking prevalence was 57% among Arab men and 6% among Arab women. Having four ideal health factors (cholesterol, blood pressure, glucose, smoking) was observed in 2% and 8% of Arab and Jewish men, respectively, and 13% of Arab and Jewish women. Higher prevalence of ideal total-cholesterol corresponded to lower high-density lipoprotein cholesterol among Arabs. No participant met ideal levels for all 7 metrics and only 1.8% presented with 6. Accounting for age and lower socioeconomic status, Arabs were less likely to meet a greater number of metric goals (odds ratio (95% confidence interval): 0.62 (0.42-0.92) for men, and 0.73 (0.48-1.12) for women). Conclusions: Ideal CVH, rare altogether, was less prevalent among the Arab minority albeit universal access to healthcare. Health behaviors were the main contributors to the CVH disparity.
... Such a study is necessary to examine if the particular circumstances of Israel's past and present yield different results about the relationships between SES and health indicators, on the one hand, and depression in later life, on the other hand, compared to other populations around the world. Such research on this topic in Israel is warranted due to the considerable and unique disparities that exist in many aspects of life in this country (Baron-Epel et al. 2005;Na'amnih et al. 2010;Okun and Friedlander 2005). ...
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The aim of the current study was to investigate the factors associated with depression statuses in a 10-year follow-up of community-dwelling older adults in Israel. Longitudinal data were used from the Israeli sample of the Survey of Health, Aging and Retirement in Europe, assessing the depressive symptoms in 1042 respondents, aged 50 or above, at three time points: 2004/2005 (Wave I); 2009/2010 (Wave II); and 2014/2015 (Wave III). Multinomial logistic regression was used to determine the relationships among explanatory variables and depression statuses (no-depression, intermittent depression, or persistent depression). Some 46.5 % of the participants suffered from intermittent or persistent depression. Five factors were associated with increasing the probability of both intermittent and persistent depression: being female, unemployed, less educated, physically disabled, and in poor health. Five other explanatory variables were associated only with a higher risk for persistent depression: low family income, widowhood, physical inactivity, more than two chronic diseases, and cognitive dysfunction. According to these findings, depression is common among older people in Israel. Low socio-economic status and poor subjective and physical health are significant determinants of depression statuses over time, underlining the importance of taking measures to improve these conditions in order to reduce the risk of depression in old age.
... There are ethnic disparities in health outcomes, disease risk factors, and mortality rates in Israel [9,14,15]. The indigenous Arab minority population (which makes up approximately 21% of the total population, and has a poverty rate of 52.6%, compared to that of 13.6% among Israeli Jews [16]) exhibits higher age-adjusted chronic morbidity and mortality, and shorter life expectancy, than the majority Jewish population [8,9,[17][18][19]. In addition to this ethnic disparity, the Jewish majority is comprised of groups that differ by ethnicity, and/or nativity/immigration status, across which health disparities have been found. ...
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Background: Health disparities are a persistent problem in many high-income countries. Health policymakers recognize the need to develop systematic methods for documenting and tracking these disparities in order to reduce them. The experience of the U.S., which has a well-established health disparities monitoring infrastructure, provides useful insights for other countries. Main body: This article provides an in-depth review of health disparities monitoring in the U.S. Lessons of potential relevance for other countries include: 1) the integration of health disparities monitoring in population health surveillance, 2) the role of political commitment, 3) use of monitoring as a feedback loop to inform future directions, 4) use of monitoring to identify data gaps, 5) development of extensive cross-departmental cooperation, and 6) exploitation of digital tools for monitoring and reporting. Using Israel as a case in point, we provide a brief overview of the healthcare and health disparities landscape in Israel, and examine how the lessons from the U.S. experience might be applied in the Israeli context. Conclusion: The U.S. model of health disparities monitoring provides useful lessons for other countries with respect to documentation of health disparities and tracking of progress made towards their elimination. Given the persistence of health disparities both in the U.S. and Israel, there is a need for monitoring systems to expand beyond individual- and healthcare system-level factors, to incorporate social and environmental determinants of health as health indicators/outcomes.
... Few studies about differences in mortality between Arabs and Jews in Israel focused on infant mortality 9,10 or examined differences in life expectancy between localities. 11 Na'amnih et al. 12 estimated the contribution of specific causes of death to the A-J total gap in life expectancy without, however, considering opposing trends of the gap within age groups-an increasing gap among the elderly and a decreasing one among younger people. This is the first study that provides a systematic assessment of the A-J gap in life expectancy and examines differences in cause-specific old-age mortality. ...
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Background: Studies about the health status of ethnic minorities in the Middle East are rare. This article examines changes in the life expectancy gap during 1970-2010 between the Arab-Palestinian minority and the Jewish majority in Israel, a persistent gap that has widened over the last 20 years. It examines the gap in a period over which the minority group was undergoing an epidemiological transition and demonstrates consequences of the transition on changes in the main causes of death contributing to the life expectancy gap. Methods: Decomposition methods estimate the contribution of specific age groups and causes of death to the total gap in life expectancy at any given year and changes in these contributions over the studied period. Results: The contribution of mortality differentials at ages <45 years to the Arab-Jewish gap in life expectancy declined while that of differentials at ages >45 has been gradually growing reaching >70% of the total gap. For both males and females, trends in cancer and diabetes mortality differentials contributed to widening the gap among the elderly. Trends in heart mortality lead to increasing the gap among males but to decreasing it among females. Conclusions: While differences in infant and child mortality have declined, old-age (>45) mortality differentials have emerged and have been gradually widening. These findings calls for a special attention to the various factors responsible for the widening mortality gap including social inequality between Arabs and Jews and higher levels of smoking and obesity among the Arab population.
... For Jewish men, it was 80.5 years, compared to 76.3 years for Palestinian men (a gap of 4.2 years) (Israel Central Bureau of Statistics 2010). While in the 1970s and 1980s lower Palestinian, life expectancy was mainly due to gaps in infant and child mortality, in the last decade, steadily growing inequalities among the elderly (ages [ 50) has became the primary contributor to this mortality disparity (Na'amnih et al. 2010). Similar gaps in morbidity and disability are also recorded (Israel Ministry of Health 2010; Israel Center for Disease Control 2005; Osman and Walsemann 2013). ...
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Health inequalities between ethnic groups are found in many multiethnic societies. A widely used model for explaining these inequalities posits that social inequalities among ethnic groups account for a large portion of differences in their health statuses. By analyzing gaps in morbidity in Israel between the Palestinian minority and the Jewish majority, this study applies this model in a context characterized by large social inequalities. Propensity score matching is applied to form two ethnic groups, minority and majority, with similar social positions, using data from the Israel Health Survey 1999–2000. The matched groups are then compared in prevalence of two chronic diseases: diabetes and heart disease. In addition, reduction in the ethnic health gap is decomposed into two components: size of social inequalities between the two groups and strength of the socioeconomic gradient of health among the majority group. Results show that social inequality may only partially account for higher morbidity among the Palestinian minority. Reduction in the female gap was higher than that in the male gap, which reflects larger social inequalities between females in addition to a stronger female socioeconomic gradient of health. Results also show that matching was not completely successful in forming comparable minority and majority groups, which indicates that in societies characterized by high inequality there is a methodological limitation in estimating the role of social inequalities in explaining ethnic health gaps.
... Inequalities in health remain a worldwide problem both within and between countries 1 , and have also been identified across different ethnic groups. [2][3][4][5][6][7][8][9] The factors underlying ethnic health inequalities (EHI) are disputed. 10;11 Early attempts at elucidating these relationships focussed on genetic differences, 11 with cultural differences and culturally-patterned disparities in lifestyle 12;13 being subsequent theories. ...
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Background The objective of this study was to examine the relative contribution of factors explaining ethnic health inequalities (EHI) in poor self-reported health (pSRH) and limiting long-standing illness (LLI) between Health Survey for England (HSE) participants. Method Using HSE 2003–2006 data, the odds of reporting pSRH or of LLI in 8573 Bangladeshi, Black African, Black Caribbean, Chinese, Indian, Irish and Pakistani participants was compared with 28 470 White British participants. The effects of demographics, socioeconomic position (SEP), psychosocial variables, community characteristics and health behaviours were assessed using separate regression models. Results Compared with White British men, age-adjusted odds (OR, 95% CI) of pSRH were higher among Bangladeshi (2.05, 1.34 to 3.14), Pakistani (1.77, 1.34 to 2.33) and Black Caribbean (1.60, 1.18 to 2.18) men, but these became non-significant following adjustment for SEP and health behaviours. Unlike Black Caribbean men, Black African men exhibited a lower risk of age-adjusted pSRH (0.66, 0.43 to 1.00 (p=0.048)) and LLI (0.45, 0.28 to 0.72), which were significant in every model. Likewise, Chinese men had a lower risk of age-adjusted pSRH (0.51, 0.26 to 1.00 (p=0.048)) and LLI (0.22, 0.10 to 0.48). Except in Black Caribbean women, adjustment for SEP rendered raised age-adjusted associations for pSRH among Pakistani (2.51, 1.99 to 3.17), Bangladeshi (1.85, 1.08 to 3.16), Black Caribbean (1.78, 1.44 to 2.21) and Indian women (1.37, 1.13 to 1.66) insignificant. Adjustment for health behaviours had the largest effect for South Asian women. By contrast, Irish women reported better age-adjusted SRH (0.70, 1.51 to 0.96). Conclusions SEP and health behaviours were major contributors explaining EHI. Policies to improve health equity need to monitor these pathways and be informed by them.
... Inequalities in health remain a worldwide problem within and between countries, 1 and have also been identified across different ethnic groups. [2][3][4][5][6][7][8][9] The factors underlying ethnic health inequalities (EHI) are disputed. 8 10 11 Early attempts at elucidating these relationships focussed on genetic differences, 11 with culturally patterned disparities in lifestyle 12 13 being subsequent theories. ...
Article
Background Although ethnic health inequalities remain a worldwide problem, underlying factors remain contested. Theories include genetic differences, culturally-patterned behavioural disparities, disadvantageous environmental exposures, and discrimination – as a psychosocial stressor and barrier to community and remunerative resources. A conceptual model was designed to explore the association between such factors and ethnic inequalities in self-rated health (SRH). Methods Data: The Health Survey for England 2004, a nationally representative, random general population sample of 4445 men and 5682 women, including boost samples from major minority ethnic groups in England. SRH was dichotomised into very good/good health versus fair/bad/very bad health, the latter classified as poor SRH (pSRH). Inequalities in the odds of pSRH were compared across seven ethnic groups relative to the White British population. Analyses: Potential correlates were grouped and tested separately using age-adjusted logistic regression models. These groups included demographic (religion, marital status, household size), socio-economic (education, equivalised family income, economic activity), psychosocial (anxiety/depression, social/emotional support), and health behaviour variables (fruit/vegetable intake, smoking status, frequency of alcohol consumption and physical activity), plus community characteristics (community participation, social capital, perceived neighbourhood quality). Analyses were stratified by sex, with final models created using backward selection. Results Indian (OR 1.80 [95% CI 1.36, 2.37], Pakistani (1.81 [1.34, 2.43]) and Bangaldeshi (2.49 [1.92, 3.24]) men had raised age-adjusted odds of pSRH. These were attenuated by adjustment for psychosocial and community factors, and rendered non-significant following adjustment for demographic factors. Black African men showed lower odds of pSHR after adjustment for socio-economic (0.57 [0.39, 0.85]) and lifestyle (0.57 [0.37, 0.86]) factors. The final model adjusted for age, education, equivalised income, household size, economic activity, anxiety/depression, smoking, and physical activity. Black African men showed lower odds (0.64 [0.42, 0.98]) while Indian men had higher odds (1.78 [1.25, 2.53]) of pSRH relative to White British men. Ethnic health inequalities were greater among women. Irish women reported better age-adjusted SRH (0.70 [0.96, 1.51]) but black Caribbean (2.19 [1.72, 2.78]), Indian (1.47 [1.15, 1.87]), Pakistani (2.46 [1.87, 3.24]) and Bangladeshi (3.07 [2.35, 4.01]) women had worse SRH than White British women. The final model (adjusted as for men, plus marital status, social capital, and neighbourhood quality) attenuated risks among Pakistani (1.57 [1.06, 2.33]) and Bangladeshi (1.63 [1.09, 2.43]) women, but had little effect on pSRH in Irish, Black Caribbean or Indian women. Conclusion Inequality in pSRH was greatest among ethnic minority women, while differences in demographic, socio-economic and health behaviour variables accounted for most ethnic health inequalities among Indian, Pakistani and Bangladeshi men.
... Previous findings with regard to CVD morbidity and mortality differentials between the two minority groups and the LTR showed generally poorer cardiac health in both minority groups (Brodov et al. 2002;Gad et al. 2002;Ministry of Health 2011). Increased prevalence of risk factors, such as diabetes mellitus, among Arab Israeli women was linked to their higher death rate (Na'amnih et al. 2010). Recent data showed that mortality rates from heart diseases were significantly higher among Arab women than among Jewish women from 1979 to 2007 (Ministry of Health 2011). ...
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The current investigation aimed to assess levels of knowledge about risk factors for heart disease among midlife Israeli women, and to evaluate the relationship of knowledge to personal risk factors and vulnerability to heart disease. Face-to-face interviews with women aged 45-64 years were conducted during 2004-2006 within three population groups: Long-term Jewish residents (LTR), Immigrants from the former Soviet Union, and Arab women. The survey instrument included six knowledge statements relating to: the risk after menopause, family history, elevated cholesterol level, diabetes, obesity and warning signs of a heart attack. The findings showed wide disparities in knowledge by educational level and between Immigrants and LTR, after taking into account personal risk factors and education. Personal risk factors were not significantly related to the knowledge items, except for personal history of cardiovascular disease, which was associated with knowledge about "warning signs of a heart attack" and "family history'. Women who perceived themselves as more vulnerable to heart disease were more likely to identify several risk factors correctly. These findings stress the need to increase knowledge about heart disease, especially among less educated and minority women, and to emphasize the risk of patients' personal status by health providers.
... Despite sharing similarities in their genetic backgrounds [20,21], Palestinian Arab and Israeli Jewish populations show extensive phenotypic differences including health behaviors [22,6], cardiometabolic characteristics including considerable differences in T2D occurrence [23,6] and HDL-cholesterol concentrations [23], coronary heart disease incidence [24] and mortality [25], and life expectancy [26]. Considering these diverse phenotypes and the different lifestyles of the populations from which the samples were drawn, it is striking that FTO methylation is associated with T2D in both populations. ...
Article
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Type 2 diabetes mellitus (T2D) is highly prevalent in Middle-Eastern and North African Arab populations, but the molecular basis for this susceptibility is unknown. Altered DNA methylation levels were reported in insulin-secreting and responding tissues, but whether methylation in accessible tissues such as peripheral blood is associated with T2D risk remains an open question. Age-related alteration of DNA methylation level was reported in certain methylation sites, but no association with T2D has been shown. Here we report on a population-based study of 929 men and women representing the East Jerusalem Palestinian (EJP) Arab population and compare with the findings among Israeli Ashkenazi Jews. This is the first reported epigenetic study of an Arab population with a characteristic high prevalence of T2D. We found that DNA methylation of a prespecified regulatory site in peripheral blood leukocytes (PBLs) is associated with impaired glucose metabolism and T2D independent of sex, body mass index, and white blood cell composition. This CpG site (Chr16: 53,809,231-2; hg19) is located in a region within an intron of the FTO gene, suspected to serve as a tissue-specific enhancer. The association between PBL hypomethylation and T2D varied by age, revealing differential patterns of methylation aging in healthy and diabetic individuals and between ethnic groups: T2D patients displayed prematurely low methylation levels, and this hypomethylation was greater and occurred earlier in life among Palestinian Arabs than Ashkenazi Jews. Our study suggests that premature DNA methylation aging is associated with increased risk of T2D. These findings should stimulate the search for more such sites and may pave the way to improved T2D risk prediction within and between human populations.
... In the HDS sample, hypertension awareness was lower among Arabs than Jews, who, in addition to their lingualcultural differences from the Jewish majority population, are also characterized by a lower socioeconomic status 34 and higher cardiovascular mortality rates. 35 Internationally, lower hypertension awareness has been found among other low socioeconomic status minority groups, particularly if their language differs from that of the majority population. 4,5 Although differences in BP patterns, treatment, and control have been observed in numerous low socioeconomic status and ethnic/racial minority groups, 4,5,36 in the HDS sample there were no differences in the rates of BP treatment or control between Jewish and Arab participants who were aware of their hypertension. ...
Article
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Population-based studies about factors associated with blood pressure (BP) levels and hypertension awareness and control are lacking in Israel. We aimed to identify covariables of BP level (across the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) categories) and hypertension awareness and control. Participants (n = 763; aged 25-74 years) were randomly selected from the population registry and stratified by sex, age, and ethnicity (Arab or Jewish). Sociodemographic, lifestyle, chronic morbidity, drug therapy, and measured anthropometric and BP data were collected. Hypertension was defined as physician diagnosis, antihypertension drug therapy, or systolic BP ≥140mm Hg or diastolic BP ≥90mm Hg. Standardized hypertension prevalence was 32.5%. Age and body mass index were positively associated with being in a higher JNC-7 category. In multivariable analysis, the association between gender and JNC-7 category depended upon marital status. Of those with hypertension (n = 315), 66.0% were aware of their status, and 26.0% exhibited adequate BP control. Using "aware-and-controlled" as the outcome reference category, the odds ratio (OR) of being aware and uncontrolled was 1.9 (95% confidence interval (CI) = 1.3-2.9) for 10-year age increment. The OR of being unaware and uncontrolled was 5.6 (95% CI = 2.0-15.8) for Arabs vs. Jews, 5.6 (95% CI = 1.4-22.3) for single/divorced vs. married participants, 3.9 (95% CI = 1.7-9.2) for those with <3 visits to the family physician per year, and 0.1 (95% CI = 0.02-0.4) for those with self-reported cardiovascular disease. Sociodemographic factors and primary healthcare service utilization are associated with hypertension awareness and control. Specially focused outreach may be needed to improve hypertension awareness among Arabs, certain subgroups not traditionally considered to be at high risk, and those who have less contact with the healthcare system.
... This high prevalence seems to be higher than observed in Arab countries or in Arab immigrants to the USA or Western Europe. The unique situation of this population calls for both studies and intervention on a national level to promote health and prevent the consequences of the metabolic perturbation [6]. ...
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Aims. To seek high risk population for diabetes and to improve their health care by investigating the characteristics and outcome of hospitalization in hospitals with predominant Arab patients in Northern Israel. Methods. Retrospective analysis of the prevalence of diabetes and the outcome of diabetic in comparison to nondiabetic patients hospitalized in the internal medicine and intensive cardiac units in two major hospitals with one-year postdischarge data between 1.1.2009 and 31.12.2009. Results. Thirty-nine percent of the patients were diagnosed with diabetes. The preponderance of women in the diabetes group was noted. Diabetic patients had an increase in the duration of hospitalization (P = 0.0008), with one hospital having a high readmission rate for the diabetic patients. The average glycemia during hospitalization exceeded the recommended threshold of 180 mg% without major changes in the therapeutic regimens in comparison to preadmission regimens. Conclusions. Arab populations, women in particular, in westernizing societies are at high risk for diabetes which exemplifies as high rate of patients with diabetes among hospitalized patients. Areas for intervention during hospitalization and at predischarge have been identified to improve health outcomes and prevent readmissions.
... Israel is an example of a society in which, despite the availability of national health insurance since 1995 [10], gaps are evident in a wide range of indicators, such as life expectancy, infant mortality, prevalence of chronic diseases, and use of health care services [11][12][13][14][15][16][17]. To address these expanding gaps, in 2009 Clalit Health Services, Israel's largest non-for-profit insurer and provider of services, covering about 54% of the population, initiated an organization-wide program to reduce gaps between low-SES and minority populations and its general member population [2]. ...
Article
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Background Disparity-reduction programs have been shown to vary in the degree to which they achieve their goal; yet the causes of these variations is rarely studied. We investigated a broad-scale program in Israel’s largest health plan, aimed at reducing disparities in socially disadvantaged groups using a composite measure of seven health and health care indicators. Methods A realistic evaluation was conducted to evaluate the program in 26 clinics and their associated managerial levels. First, we performed interviews with key stakeholders and an ethnographic observation of a regional meeting to derive the underlying program theory. Next, semi-structured interviews with 109 clinic teams, subregional headquarters, and regional headquarters personnel were conducted. Social network analysis was performed to derive measures of team interrelations. Perceived team effectiveness (TE) and clinic characteristics were assessed to elicit contextual characteristics. Interventions implemented by clinics were identified from interviews and coded according to the mechanisms each clinic employed. Assessment of each clinic’s performance on the seven-indicator composite measure was conducted at baseline and after 3 years. Finally, we reviewed different context-mechanism-outcome (CMO) configurations to understand what works to reduce disparity, and under what circumstances. Results Clinics’ inner contextual characteristics varied in both network density and perceived TE. Successful CMO configurations included 1) highly dense clinic teams having high perceived TE, only a small gap to minimize, and employing a wide range of interventions; (2) clinics with a large gap to minimize with high clinic density and high perceived TE, focusing efforts on tailoring services to their enrollees; and (3) clinics having medium to low density and perceived TE, and strong middle-management support. Conclusions Clinics that achieved disparity reduction had high clinic density, close ties with middle management, and tailored interventions to the unique needs of the populations they serve.
... To our knowledge, Korea is the only other place where socioeconomic inequalities in life expectancy were decomposed: cancer, cardiovascular disease, digestive disease, transport injury, and suicide were important contributors to the Korean gap (Khang et al. 2010). Racial/ethnic gaps in life expectancy that were partitioned in the US suggest that cardiovascular disease, homicide, HIV and infant mortality were important contributors to the Black-White gap (Harper et al. 2007), and interestingly that cardiovascular disease in Israel was an important contributor to the Arab-Jewish gap (Na'amnih et al. 2010). Taken as a whole, the large contribution of cardiovascular disease and cancer to inequalities in life expectancy in these countries attests to the importance of tobacco use as a driver of not only socioeconomic but also racial/ethnic or cultural inequalities worldwide. ...
Article
Aim We evaluated the ages and causes of death contributing to life expectancy gaps between economically advantaged and disadvantaged Francophones and Anglophones of Montréal, a Canadian metropolitan centre. Subject and Methods We partitioned the life expectancy gap at birth between socioeconomically disadvantaged and advantaged Francophones and Anglophones of Montréal (Québec) into age and cause of death components for two periods (1989–1993, 2002–2006). Changes in the contributions of causes over time were evaluated. Results Life expectancy was lower for disadvantaged Francophones and Anglophones by 5 years in men and 1.6 years in women compared with advantaged individuals. Over time, the socioeconomic gap widened for Francophones (men 0.3 years, women 2.8 years), due to smaller reductions in mortality from tobacco-related causes (cardiovascular, cancer, respiratory) in disadvantaged than in advantaged Francophones, especially after age ≥65 years (except lung cancer mortality that increased, particularly in disadvantaged women). The socioeconomic gap narrowed, however, for Anglophones (men 1.0 year, women 0.6 years), due to greater reductions in cardiovascular mortality in disadvantaged than advantaged Anglophones. Conclusion Socioeconomic inequalities in life expectancy decreased for Anglophones but increased for Francophones in Montréal due to underlying trends in tobacco-related mortality. Despite strong tobacco control laws in Canada, socioeconomic inequality in tobacco-related mortality is widening for Francophones in Montréal.
... There are disparities in chronic disease morbidity and mortality between the Jewish majority and Arab minority populations in Israel. In the early 2000s, the coronary heart disease mortality rates of Arab men and women were 1.6 and 2.4 times higher than those of Jewish men and women and diabetes mortality rates were 2.3 and 3.4 times higher, respectively (13). ...
Article
The Jewish majority and Arab minority populations in Israel exhibit disparities in nutrition-related chronic diseases, but comparative, population-based dietary studies are lacking. We evaluated ethnic differences in dietary patterns in a population-based, cross-sectional study of Arab and Jewish urban adults (n = 1104; age 25-74 y). Dietary intake was assessed with an interviewer-administered, quantified FFQ. We used principal-component analysis to identify 4 major dietary patterns: Ethnic, Healthy, Fish and Meat Dishes, and Middle Eastern Snacks and Fast Food. The Ethnic and Healthy patterns exhibited major ethnic differences. Participants in the top Ethnic intake tertile (97% Arab) had modified Mediterranean-style Arabic dietary habits, whereas those in the bottom Ethnic tertile (98% Jewish) had central/northern European-style dietary habits. The Arab participants with less strongly ethnicity-associated dietary habits were younger [OR for 10-y decrease = 1.42 (95% CI: 1.21-1.68)] and male [OR = 2.23 (95% CI: 1.53-3.25)]. Jews with less strongly ethnicity-associated dietary habits were less recent immigrants [OR = 8.97 (95% CI: 5.05-15.92)], older [OR for 10-y decrease = 0.80 (95% CI: 0.69-0.92)], had post-secondary education [OR = 2.04 (95% CI: 1.06-3.94)], and reported other healthy lifestyle behaviors. In relation to the Healthy pattern, Arabs were less likely than Jews to be in the top intake tertile, but the magnitude of the difference was less in diabetic participants. Participants reporting other healthy lifestyle behaviors were more likely to have a high intake of the Healthy pattern. Substantial differences were found between Arabs and Jews in dietary patterns and suggest a need for culturally congruent dietary interventions to address nutrition-related chronic disease disparities.
... [5][6][7][8] There are known differences in resource allocation between eastern to western Jerusalem 2 and general disparities between the health of Jewish and Arab populations in Israel. 9,10 In the context of Israel's social welfare policy, disadvantaged populations usually receive more aid, and in Jerusalem, especially these communities, receive special attention. 5,11 A previous study 2 showed that fewer of Jerusalem's residents engage in any type of physical activity (PA) in comparison to the national average (33.8% vs. 56%), and a smaller proportion of them reached the recommended amount of 150 min/week (12.2% vs. 32.4%). ...
Article
Background: Health promotion programmes (HPPs) have the potential to influence individual health, depending on their quality and characteristics. Little is known about how they interact with built environment features and neighbourhood demographics in cities with substantial health disparities. Methods: Using the European Quality Instrument for Health Promotion (EQUIHP), we assessed the quality of HPPs, operating between 2016 and 2017, among adults aged 18-75 in Jerusalem. Areas were characterized by ethnicity and area socioeconomic level. Health information (body mass index, physical activity level) was obtained from the city profile survey. Geospatial information on the location and length of walking paths and bicycle lanes was obtained. Spearman correlations were used to assess associations among variables. Results: Ninety-three HPPs operating in 349 locations in Jerusalem were identified. Programmes were unevenly distributed across urban planning areas (UPAs), with the highest density observed in the southwest, areas populated mainly by non-orthodox Jewish residents. However, the best performing HPPs based on EQUIHP score were in the north and east UPAs, inhabited primarily by Arab residents. At a neighbourhood level, characteristics of the built environment positively correlated with higher total EQUIHP scores: the ratio between walking lane length to the neighbourhood's population size (r = 0.413, P < 0.001) and length of bicycle lane per population (r = 0.309, P = 0.5). Median EQUIHP score negatively correlated with the number of programmes per neighbourhood size (m2) (r = -0.327, P = 0.006) and neighbourhood average socioeconomic status (SES; r = -0.266, P = 0.027). Conclusions: Our findings suggest that higher quality HPPs were preferentially located in areas of lower SES and served minority populations in Jerusalem.
... The three comparison groups were: (1) immigrants from the FSU who did not originate in either of the exposed republics (i.e. neither Ukraine or Belarus); (2) other immigrants to Israel but not from the FSU and (3) native-born Israelis, excluding Bedouin Arabs whose morbidity profile is different from Jewish Israelis [40][41][42][43] Table 1). Other immigrants (not from FSU) were 39.7% from Asia-Africa, 31.1% from Europe and 29.2% from North or South America. ...
Article
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On April 26th, 1986 the nuclear reactor at Chernobyl, Ukraine exploded, causing the worst radiation disaster in history. The aim was to estimate hospitalization rates among exposed civilians who later immigrated to Israel. We conducted a historical follow-up study, among persons exposed to Chernobyl (n = 1128) using linked hospitalization records from Soroka University Medical Center (SUMC), compared with immigrants from other areas of the Former Soviet Union (FSU) (n = 11,574), immigrants not from FSU (n = 11,742) and native-born Israelis (n = 8351), matched on age and gender (N = 32,795). Hospitalizations for specific ICD-10 coded diagnostic groups were analyzed by exposure and comparison groups by gender and age at accident. In addition, the rate of hospitalization, and the duration of hospital days and the number of hospitalizations for these selected diagnostic groups was also calculated. Hospitalizations for specific ICD-10 coded diagnostic groups and for any hospitalization in these diagnostic groups in general were analyzed by exposure and comparison groups and by covariates (gender and age at accident). The rate of any hospitalization for the selected diagnostic groups was elevated in the low exposure Chernobyl group (51.1%), which was significantly higher than the immigrant (41.6%) and the Israel-born comparison group (35.1%) (p < .01) but did not differ from either the high exposure group (46.9%) or the FSU comparison group (46.4%), according to the post-hoc tests. The total number of hospitalizations in the low exposure Chernobyl group (2.35) differed from the immigrant (1.73) and Israel comparison group (1.26) (p < .01) but did not differ from the FSU comparison group (1.73) or the high exposure group (2.10). Low exposure women showed higher rates of circulatory hospitalizations (33.8%) compared to immigrants (22.8%) and Israeli born (16.5%), while high exposure women (27.5%) only differed from Israelis (p < .01). Neither exposure group differed from FSU immigrant women on the rate of circulatory hospitalizations. Post-hoc tests showed that among women in the low exposure group, there was a significant difference in rate of hospitalizations for neoplasms (28.6%) compared to the three comparison groups; FSU (18.6%), immigrants (15.7%) and Israel (13.1) (p < .01). Those among the low exposure group who were over the age of 20 at the time of the accident showed the higher rates of circulatory (51.2%) and neoplasm hospitalizations (33.3%), compared to the other immigrant groups (p < .01). When controlling for both age at accident and gender, hospitalizations for neoplasms were higher among Chernobyl-exposed populations (RR = 1.65, RR = 1.77 for high and low-exposure groups, respectively) compared to other FSU immigrants (RR = 1.31) other immigrants (RR = 1.11) and Israeli born (RR = 1.0) after controlling for gender and age at accident. High RRs attributable to Chernobyl exposure were also found for circulatory diseases compared to other immigrants and Israeli born (RRs = 1.50, 1.47 for high and low exposure compared to 1.11. and 1.0, other immigrants and Israeli born, respectively). Endocrine problems and disorders of the eye also showed elevated RR compared to the immigrant comparison groups. Respiratory and mental disorders did not show any consistent association with Chernobyl exposure. The findings support unique Chernobyl morbidity associations only in some diagnostic groups, particularly for low exposure women. General immigration effects on hospitalizations compared to the Israeli born population were found on all diagnostic groups. There is a need to improve the services and medical follow-up for these Chernobyl exposed groups in specific diagnostic groups.
... Our study did not find Arab background to be an independent risk factor for mortality. Previous studies reported higher rates of all-cause mortality among Arabs, particular with respect to cardiovascular diseases 22,23 . However, combined comorbidities as defined herein were not reported in those studies. ...
Article
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The burden of type 2 diabetes is growing, not only through increased incidence, but also through its comorbidities. Concordant comorbidities for type 2 diabetes, such as cardiovascular diseases, are considered expected outcomes of the disease or disease complications, while discordant comorbidities are not considered to be directly related to type 2 diabetes and are less extensively addressed under diabetes management. Here we show that the combination of concordant and discordant comorbidities appears frequently in persons with diabetes (75%). Persons with combined comorbidities visited family physicians more than persons with discordant, concordant or no comorbidity (17.3 ± 10.2, 11.6 ± 6.5, 8.7 ± 6.8, 6.3 ± 6.6 visits/person/year respectively, p < 0.0001). The risk of death during the study period was highest in persons with combined comorbidities and discordant only comorbidities (HR = 33.4; 95% CI 12.5–89.2 and HR = 33.5; 95% CI 11.7–95.8), emphasizing the contribution of discordant comorbidities to the outcome. Our study is unique as a long-term follow-up of an 11-year cohort of 9725 persons with new-onset type 2 diabetes. The findings highlight the contribution of discordant comorbidity to the burden of the disease. The high prevalence of the combination of both concordant and discordant comorbidities, and their appearance before the onset of type 2 diabetes, indicates a continuum of morbidity.
... The three comparison groups were: (1) immigrants from the FSU who did not originate in either of the exposed republics (i.e. neither Ukraine or Belarus); (2) other immigrants to Israel but not from the FSU and (3) native-born Israelis, excluding Bedouin Arabs whose morbidity profile is different from Jewish Israelis [40][41][42][43] Table 1). Other immigrants (not from FSU) were 39.7% from Asia-Africa, 31.1% from Europe and 29.2% from North or South America. ...
Article
Full-text available
On April 26th, 1986 the nuclear reactor at Chernobyl, Ukraine exploded, causing the worst radiation disaster in history. The aim was to estimate hospitalization rates among exposed civilians who later immigrated to Israel. We conducted a historical follow-up study, among persons exposed to Chernobyl (n = 1128) using linked hospitalization records from Soroka University Medical Center (SUMC), compared with immigrants from other areas of the Former Soviet Union (FSU) (n = 11,574), immigrants not from FSU (n = 11,742) and native-born Israelis (n = 8351), matched on age and gender (N = 32,795). Hospitalizations for specific ICD-10 coded diagnostic groups were analyzed by exposure and comparison groups by gender and age at accident. In addition, the rate of hospitalization, and the duration of hospital days and the number of hospitalizations for these selected diagnostic groups was also calculated. Hospitalizations for specific ICD-10 coded diagnostic groups and for any hospitalization in these diagnostic groups in general were analyzed by exposure and comparison groups and by covariates (gender and age at accident). The rate of any hospitalization for the selected diagnostic groups was elevated in the low exposure Chernobyl group (51.1%), which was significantly higher than the immigrant (41.6%) and the Israel-born comparison group (35.1%) (p < .01) but did not differ from either the high exposure group (46.9%) or the FSU comparison group (46.4%), according to the post-hoc tests. The total number of hospitalizations in the low exposure Chernobyl group (2.35) differed from the immigrant (1.73) and Israel comparison group (1.26) (p < .01) but did not differ from the FSU comparison group (1.73) or the high exposure group (2.10). Low exposure women showed higher rates of circulatory hospitalizations (33.8%) compared to immigrants (22.8%) and Israeli born (16.5%), while high exposure women (27.5%) only differed from Israelis (p < .01). Neither exposure group differed from FSU immigrant women on the rate of circulatory hospitalizations. Post-hoc tests showed that among women in the low exposure group, there was a significant difference in rate of hospitalizations for neoplasms (28.6%) compared to the three comparison groups; FSU (18.6%), immigrants (15.7%) and Israel (13.1) (p < .01). Those among the low exposure group who were over the age of 20 at the time of the accident showed the higher rates of circulatory (51.2%) and neoplasm hospitalizations (33.3%), compared to the other immigrant groups (p < .01). When controlling for both age at accident and gender, hospitalizations for neoplasms were higher among Chernobyl-exposed populations (RR = 1.65, RR = 1.77 for high and low-exposure groups, respectively) compared to other FSU immigrants (RR = 1.31) other immigrants (RR = 1.11) and Israeli born (RR = 1.0) after controlling for gender and age at accident. High RRs attributable to Chernobyl exposure were also found for circulatory diseases compared to other immigrants and Israeli born (RRs = 1.50, 1.47 for high and low exposure compared to 1.11. and 1.0, other immigrants and Israeli born, respectively). Endocrine problems and disorders of the eye also showed elevated RR compared to the immigrant comparison groups. Respiratory and mental disorders did not show any consistent association with Chernobyl exposure. The findings support unique Chernobyl morbidity associations only in some diagnostic groups, particularly for low exposure women. General immigration effects on hospitalizations compared to the Israeli born population were found on all diagnostic groups. There is a need to improve the services and medical follow-up for these Chernobyl exposed groups in specific diagnostic groups.
... Significant health disparities amongst Arabs and Israelis in regards to life expectancy in general and 44 cardiovascular morbidity and mortality in particular are well documented [1,2]. In the context of the global 45 epidemic of obesity affecting the Middle East in particular[3], these disparities are even more relevant. ...
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Background: Palestinians exhibit a substantially greater prevalence of type 2 diabetes mellitus, cardiovascular disease (CVD) incidence and CVD mortality in comparison to Israelis. In view of Palestinians' increased insulin resistance, known to be associated with an adverse lipoprotein profile, we aimed at showing lipoprotein variations between Palestinian and Israelis residing in Jerusalem. Methods: The study included, 968 Palestinians and 707 Israelis, ages 25-74 years, who underwent fasting and 2h post oral challenge plasma glucose determinations. We evaluated metabolic risk by measuring sub-populations of VLDL, LDL and HDL particles, using nuclear magnetic resonance spectroscopic analysis. Results: Palestinians exhibit higher levels of very large VLDL including chylomicrons, in comparison to their Israeli counterparts, whereas levels of medium and small VLDL were similar between the two populations. Small oxidized LDL levels were higher among Palestinians while intermediate and large LDL were similar between the two groups. Levels of large HDL were higher among Israelis while levels of medium and small HDL were similar between the two populations. Small oxidized LDL levels were higher among Palestinians in comparison to Israeli participants. Levels of large HDL were higher among Israelis in comparison to Palestinians. Limiting the analysis to young participants with normal glucose tolerance, showed greater levels of large VLDL including chylomicrons, medium and small VLDL and oxidized LDL in Palestinians. Conclusions: Palestinians, including healthy young participants, exhibit an adverse pro-atherogenic lipid profile compared to Israelis. These findings may explain the increased CVD morbidity and mortality observed in Palestinians.
... The Muslim Arab population is an ethnically homogeneous group that has a high birth rate, an unusually high level of consanguinity, and a low rate of intermarriage compared with other population groups in Israel [45]. While systematic research on ethnic differences in perceived satisfaction of health-care services is still scarce, studies suggest that Arabs suffer from poorer health status compared to Jews and reported higher number of visits to primary care physician [46][47][48]. ...
Article
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Background: Previous studies of minority groups in times of emergency have tended to focus on risk reduction or on individual resilience, overlooking the community factors that could be bolstered to promote better health and safety outcomes. The current study aimed to examine the role of health-care services in the perceived community resilience of urban and suburban Arab communities in Israel during the COVID-19 outbreak. Method: The study included 196 adults age 17-76 years, who filled out on-line questionnaires in May 2020; 112 participants lived in an urban community and 84 lived in a suburban community. Community resilience was evaluated using the Conjoint Community Resiliency Assessment Measure (CCRAM), a validated five-factor multidimensional instrument. Results: Residents of the suburban community reported higher community resilience than residents of the urban community. This difference was related to increased preparedness levels and strength of place attachment in the suburban community. Residents of suburban communities were also more satisfied and confident in health-care services than those of urban communities. Regression analysis showed that the satisfaction with primary health-care services, and not community type, significantly predicted community resilience. Conclusions: Our results support the pivotal role of primary health care in building community resilience of minority communities in times of emergency and routine.
... The repercussions on disease progress and prognosis, and on life expectancy and quality are evident. Following years of leveling off, from 2000, the gap in life expectancy between Israeli Arabs and Jews increased; such trend is mainly due to differences between the populations in the prevalence of chronic diseases, such as heart disease and diabetes [16]. ...
... This inconsistency may have occurred for two reasons. First, prior research finds higher rates of premature mortality among Arab Israelis (Na'amnih et al., 2010), which may have resulted in nonsignificant differences in our sample given that persons with the most severe health problems are selected out of the population, making the population that was initially disadvantaged appear better off (). Second, having limitations in ADLs was rather rare in our sample across all groups, which is potentially a function of the age composition of our sample. ...
Article
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We examined the contribution of socioeconomic disadvantage and traumatic life events to ethnic disparities in disability among Israeli adults. We used data from the Survey of Health, Aging and Retirement in Europe (SHARE-Israel), a sample of Israeli adults aged 50 or older (N = 1,546). Disability measures included functional limitations, limitations in activities of daily living (ADL), and limitations in instrumental activities of daily living (IADL). Arabs and immigrants from the Former Soviet Union (FSU) experienced higher rates of functional limitations and limitations in IADLs compared to veteran Jews. The rate of having limitations in ADLs was similar for Arabs and veteran Jews, but was higher for FSU immigrants compared to veteran Jews. Inclusion of education, income, and traumatic life events attenuated, but did not eliminate ethnic disparities in disability. Identifying factors driving ethnic health disparities in Israel is imperative if we hope to achieve health equity.
... In addition, "traditional" gender relations have been emphasized and women (mis)used as symbols to secure sectarian and national collective identities (Al-Ali and Pratt 2009). The intersectionality and interplay between gender and other identities also intensified the impact wars and conflict had on particular women groups, such as the female Arab population in Israel and the Kurdish women of Turkey, compared to the rest of the population (Na'amnih et al. 2010). ...
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Wars and conflicts have had a profound impact on women and gender in the Middle East. In this article, we aim to highlight the various ways in which the ongoing oppression and conflict in the Middle East shape the responses of the Iraqi, Palestinian and Kurdish women of Turkey and the object of their struggles. We go beyond the ‘Orientalist’ discourse, which depicts Middle Eastern women in armed conflicts as solely vulnerable and helpless victims, to discuss the resisting roles played by the Iraqi, Palestinian and Kurdish women of Turkey. Middle Eastern women have played and continue to play major roles in responding to society, gender and state oppression. While the Iraqi women in this study voice their resistance through conventional actions and wide civil-society activism that transcends the local level, the Palestinian women engage in unconventional unarmed or peaceful resistance through Sumud and cultural resistance as well as armed/non-peaceful acts of resistance. Finally, in the face of Turkish state oppression, the Kurdish women of Turkey also deploy non-peaceful resistance through becoming active fighters and engaging leadership positions in the Kurdistan Workers’ Party.
... Recently, a westernized lifestyle was adopted by most of the Arab population in Israel [18]. It was found that the main causes of death that might contribute to the lower age of Arabs compared to Jews could be due to chronic diseases, especially ischemic heart disease and diabetes [19]. A local study showed that the prevalence of diabetes was 21% in Arabs while it was 12% in Jews, however, Arabs developed diabetes 11 years earlier than Jews [20]. ...
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Background: Type 2 Diabetes Mellitus (T2DM) is becoming increasingly prevalent and is considered to be a major public health threat worldwide. Behavioral and sociodemographic factors associated with T2DM vary within different societies. Objective: The aim of this study is to determine the various behavioral and sociodemographic factors associated with T2DM in the Arab society in Israel. Methods: A cross-sectional study was conducted based on data from 1,894 residents over the age of 21 belonging to the Arab population in Israel. The data collected from the subjects were subjected to statistical analyses using the SPSS program. Findings: Of the total sample population, 13.7% were found to be affected with T2DM. The prevalence of T2DM increased sharply in the successive age groups of both men and women. The prevalence of T2DM was found to increase progressively particularly in women with an increase in BMI (~20%, 37% and 44% respectively), while, in men it increased sharply (from 25% to ~50%) until a BMI of 29.9; it then decreased drastically (to ~24%) for a BMI of ≥30. About 85% of the men affected with T2DM were physically inactive, while 97% of the affected women were physically inactive. Almost half of the participants with diabetes have a family history of the disease in both genders. In the multivariate analysis, it was found that age, obesity, physical inactivity and family history of the disease were the significant factors associated with the prevalence of diabetes. Conclusions: It could be concluded that age, obesity, family history and physical inactivity were the significant factors associated with the prevalence of T2DM within the Arab society in Israel.
... Sub-populations within countries also experience different life expectancy rates. For instance, life expectancy for the Arab population in Israel has traditionally been lower than for the Jewish population (Na'amnih et al. 2010) (see Figures 1 and 2). ...
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This report offers a "map" of the diverse situations of women in the post-2011 MENA region. It shows that there have been tremendous achievements and improvements in the lives of women in health and education but less progress in employment; and that legal inequalities remain widespread, as do limitations on women's participation in politics and civil society. The report analyses the impact of recent events, particularly the conflicts, but also the political opportunities that came about as a result of the 2011 Arab uprisings. It also touches on the situation of LGBT (lesbian, gay, bisexual and transgender) individuals, and specifically their mobilization and changing attitudes towards their rights. The report ends by focusing on Western gender policy in the region. It argues for an approach that balances the ethical demands of individual and collective rights, and for a liberal position that respects and supports women's and LGBT rights without being overly prescriptive about the values and choices that should govern the lives of individuals.
... Furthermore, in recent years the Arab population of Israel has experienced a rapid change towards a westernized lifestyle (Treister-Goltzman and Peleg, 2015). The life expectancy of Arabs in Israel was lower than that for Jews, the main causes of death that might contribute to this gap between the two communities could be due to chronic diseases; especially ischemic heart disease and diabetes (Na'amnih et al., 2010). A study which was conducted on 1100 Arab and Jewish urban patients older than the age of 20 from the central area of Israel, showed that the prevalence of diabetes was 21% in Arabs while it was 12% in Jews. ...
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In recent years, type 2 diabetes mellitus (T2DM) had become a worrying pandemic disease. Its prevalence was increasing in almost all societies worldwide, particularly in Arab populations. The aim of the current study is to determine the prevalence and trend of T2DM, during two successive periods of time, among Arab population in Israel, in relation to various sociodemographic variables. Data were collected from cross-sectional surveys during two periods (2005 and 2015). Databases were created and statistical analysis was carried out. Our results indicated that the incidence rate of T2DM was increasing significantly from 11.3% to 17.7% (p<0.05) during the periods surveyed, with a progressive increase with age in both genders. The high incidence rate among females in the first period was reversed to males during the second period. We conclude that recent changes in socioeconomic status and lifestyle in our community could be responsible for the increased occurrence of T2DM. Therefore, it is recommended to implement an intervention program for a systemic decrease in this alarming trend.
... However, since 1998 the gap has increased again and the difference in 2004 was 3.2 years more for Israeli Jewish men and 4 years more for Israeli Jewish women. The main causes of death that lead to the gap in life expectancy are chronic diseases, especially ischemic heart disease and diabetes [11] . The Arab community of Israel is characterized by a high rate of consanguinity. ...
Article
This review surveys the literature published on the characteristics and implications of pre-diabetes and type 2 diabetes mellitus (T2DM) for the Arab and Bedouin populations of Israel. T2DM is a global health problem. The rapid rise in its prevalence in the Arab and Bedouin populations in Israel is responsible for their lower life expectancy compared to Israeli Jews. The increased prevalence of T2DM corresponds to increased rates of obesity in these populations. A major risk group is adult Arab women aged 55-64 years. In this group obesity reaches 70%. There are several genetic and nutritional explanations for this increase. We found high hospitalization rates for micro and macrovascular complications among diabetic patients of Arab and Bedouin origin. Despite the high prevalence of diabetes and its negative health implications, there is evidence that care and counseling relating to nutrition, physical activity and self-examination of the feet are unsatisfactory. Economic difficulties are frequently cited as the reason for inadequate medical care. Other proposed reasons include faith in traditional therapy and misconceptions about drugs and their side effects. In Israel, the quality indicators program is based on one of the world's leading information systems and deals with the management of chronic diseases such as diabetes. The program's baseline data pointed to health inequality between minority populations and the general population in several areas, including monitoring and control of diabetes. Based on these data, a pilot intervention program was planned, aimed at minority populations. This program led to a decrease in inequality and served as the basis for a broader, more comprehensive intervention that has entered the implementation stage. Interventions that were shown to be effective in other Arabic countries may serve as models for diabetes management in the Arab and Bedouin populations in Israel.
... Arabs and Jews in Israel show a persistent gap in life expectancy that has been maintained since the mid-70s. Part of this gap is explained in recent years by a greater mortality due to cardiovascular disease and type 2 diabetes [17]. While specific risk factors such as a greater prevalence of cigarette smoking in men [18], lower physical activity and obesity [19] have been shown in Palestinians, our findings suggest that independent of increased obesity, i.e. across BMI and waist circumference categories, the Palestinians display greater TG/HDL. ...
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To evaluate differences in the triglyceride to HDL-cholesterol ratio (TG/HDL), thought to be a proxy measure of insulin resistance, between Palestinian and Israeli adults in view of the greater incidence of coronary heart disease and high prevalence of diabetes in Palestinian Arabs. A population-based observational prevalence study of cardiovascular and diabetes risk factors in Jerusalem. Participants (968 Palestinians, 707 Israelis, sampled at ages 25-74 years) underwent fasting and 2h post-75g oral challenge plasma glucose determinations. Metabolic risk was assessed using the surrogate index TG/HDL. Sex-specific comparisons were stratified by categories of body mass index and sex-specific waist circumference quartiles, adjusted by regression for age, glucose tolerance status and use of statins. Prevalence of overweight and obesity was substantially larger in Palestinians (p = 0.005). Prevalence of diabetes was 2.4 and 4 fold higher among Palestinian men and women, respectively (p<0.001). Adjusted TG/HDL was higher in Palestinians than Israelis across BMI and waist circumference categories (p<0.001 for both). Higher TG/HDL in Palestinians persisted in analyses restricted to participants with normal glucose tolerance and off statins. Notably, higher TG/HDL among Palestinians prevailed at a young age (25-44 years) and in normal weight individuals of both sexes. Palestinians have a higher TG/HDL ratio than Israelis. Notably, this is evident also in young, healthy and normal weight participants. These findings indicate the need to study the determinants of this biomarker and other measures of insulin resistance in urban Arab populations and to focus research attention on earlier ages: childhood and prenatal stages of development.
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Purpose Life expectancy is used to measure population health, but large differences in mortality can be masked even when there is no life expectancy gap. We demonstrate how Arriaga’s decomposition method can be used to assess inequality in mortality between populations with near equal life expectancy. Methods We calculated life expectancy at birth for Quebec and the rest of Canada from 2005-2009 using life tables, and partitioned the gap between both populations into age and cause-specific components using Arriaga’s method. Results The life expectancy gap between Quebec and Canada was negligible (<0.1 years). Decomposition of the gap showed that higher lung cancer mortality in Quebec was offset by cardiovascular mortality in the rest of Canada, resulting in identical life expectancy in both groups. Lung cancer in Quebec had a greater impact at early ages, whereas cardiovascular mortality in Canada had a greater impact at older ages. Conclusions Despite the absence of a gap, we demonstrate using decomposition analyses how lung cancer at early ages lowered life expectancy in Quebec, whereas cardiovascular causes at older ages lowered life expectancy in Canada. We provide SAS/Stata code and an Excel spreadsheeet to facilitate application of Arriaga’s method to other settings.
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This article examines the impact of sociodemographic trends in marriage, divorce, and rising life expectancy in different districts in Israel on the increase in the number of households and, in turn, on the rising house prices in each of the districts. The findings show that in 2008–17, the Tel Aviv, Jerusalem, and Central districts, which had higher marriage, divorce, and life expectancy rates compared to other districts not only had the largest annual increment in the total number of households but also saw a particularly steep rise in house prices compared to a more moderate rise in the other districts and outlying areas. This state of affairs requires the formulation of a public policy capable of influencing demand and supply pressures in the house market in the various districts, with the aim of regulating house prices in accordance with national needs and government strategies for spreading the population throughout the country.
Book
From the first hospitals to pioneering pharmacy techniques, the early history of medicine reflects the groundbreaking contributions of Islamic physicians and scientists. Less recognized, however, is the impact of Islam on the health and daily health practices of modern day Muslims. Meticulously documented with current research sources and relevant religious texts, Health and Well-Being in Islamic Societies sheds light on the relationships between Muslim beliefs and physical, psychological, and social health. Background chapters trace Muslim thought on health and healing as it has evolved over the centuries to the present. The authors provide even-handed comparisons with Christianity as the two traditions approach medical and ethical questions, and with Christian populations in terms of health outcomes, assuring coverage that is not only objective but also empirically sound and clinically useful. And as the concluding chapters show, understanding of these similarities and differences can lead to better care for clients, cost-effective services for communities, and healthier Muslim populations in general. Included among the book's topics: Muslim beliefs about health, healing, and healthcare Similarities and differences between Muslim and Christian health beliefs Impact of religion on physical, mental, and community health in Muslims Understanding how Islam influences health Applications for clinical practice Implications for public health Cultural awareness is critical to improving both individual client health and public health on a global scale. Health and Well-Being in Islamic Societies is essential reading for clinical and health psychologists, psychiatrists, social workers, and nurses, and will be informative for the general reader as well. © Springer International Publishing Switzerland 2014. All rights are reserved.
Chapter
Dietary acculturation occurs in a society when members of a minority group adopt the food choices/dietary patterns of the majority group. Evidence suggests that this is a complex, multidimensional process ranging from using traditional foods in new ways and/or using new ingredients to make traditional foods/meals to replacing traditional foods with new foods [1]. The process is affected by socioeconomic, demographic, and cultural factors, as well as by the extent of exposure to mainstream culture.
Chapter
This chapter examines how religious involvement affects physical health and influences longevity. If religiosity has any effect on mental and social health, then it ought to influence physical health as well, since our bodies and minds are intimately interconnected, as the latest research in mind–body medicine and psychoneuroimmunology is showing. We review here research in Muslim populations on relationships between religiosity and heart disease, hypertension, stroke, Alzheimer’s disease, diabetes, metabolic disorders, cancer, immune function, endocrine function, perceptions of overall health, and mortality. Besides examining relationships with religiosity, we also compare the physical health of Muslims and non-Muslims and review studies on how fasting during Ramadan influences health and disease management.
Chapter
In northern Israel, many patients with cancer from the Muslim, Christian Arab, and Druze communities tend to use complementary and traditional medicine (CTM), mainly herbal remedies, during the period in which they receive chemotherapy and active oncology treatment. CTM integration within the oncology department, when based on a research-oriented approach and nonjudgmental communication skills of physicians and practitioners with dual training in CTM and supportive care, may provide patients with safe and efficacious tools to improve their well-being and ameliorate gastrointestinal and emotional concerns and chemotherapy-induced side effects. Modeling integrative care to patients who encounter cancer diagnosis and treatment is a challenging undertaking. In this chapter, we present the narratives of four patients referred to integrative medicine consultation provided free of charge to patients receiving chemotherapy at the Lin Medical Center’s oncology service, Haifa, Israel. Challenges and barriers to integrative care provision are discussed and recommendations to tailor therapy goals to patients’ needs are suggested in this chapter.
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Background: Biochemical laboratory values are an essential tool in medical diagnosis, treatment, and follow-up; however, they are known to vary between populations. Establishment of ethnicity-adjusted reference values is recommended by health organizations. Aim: To investigate the ethnicity element in biochemical lab values studying women of different ethnic groups. Methods: Biochemical lab values (n = 27) of 503 adult Israeli women of three ethnicities (Jewish Ashkenazi, Jewish Sephardic, and Bedouin Arab) attending a single medical center were analyzed. Biochemical data were extracted from medical center records. Ethnic differences of laboratory biochemicals were studied using ANCOVA to analyze the center of the distribution as well as quartile regression analysis to analyze the upper and lower limits, both done with an adjustment for age. Results: Significant ethnic differences were found in almost half (n = 12) of the biochemical laboratory tests. Ashkenazi Jews exhibited significantly higher mean values compared to Bedouins in most of the biochemical tests, including albumin, alkaline phosphatase, calcium, cholesterol, cholesterol LDL and HDL, cholesterol LDL calc., folic acid, globulin, and iron saturation, while the Bedouins exhibited the highest mean values in the creatinine and triglycerides. For most of these tests, Sephardic Jews exhibited biochemical mean levels in between the two other groups. Compared to Ashkenazi Jews, Sephardic Jews had a significant shift to lower values in cholesterol LDL. Conclusions: Ethnic subpopulations have distinct distributions in biochemical laboratory test values, which should be taken into consideration in medical practice enabling precision medicine.
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Purpose: We sought to extend research into the health effects of discrimination to a non-Western context. We examined the associations between interpersonal and institutional ethnic discrimination, and anxiety and depression among Palestinian-Arab minority men citizens of Israel. Methods: We used data from a nationwide stratified random sample of 964 Arab men in Israel, current or former smokers (age 18-64), who were interviewed as part of a 2012-2013 study on cessation. The questionnaire included an adapted Arabic version of the Experiences of Discrimination scale and a new scale on perceived institutional group discrimination. Logistic regression models estimated the effects of both forms of discrimination on depressive symptoms (Center for Epidemiological Studies Depression Scale) and anxiety (State-Trait Anxiety Inventory), while adjusting for socio-demographic and economic factors. Results: The prevalence of depressive symptoms was 24.7% and anxiety 45.5%. Approximately 42% of men reported experiencing interpersonal discrimination, and 50.8% reported perceived institutional group discrimination. Controlling for covariates, experiencing interpersonal discrimination was associated with higher odds for depressive symptoms [OR = 2.36, 95% confidence intervals (CI) = 1.69-1.57] and anxiety (OR = 1.92, 95% CI = 1.45-2.55). Perceived institutional group discrimination was associated only with anxiety (OR = 1.76, 95% CI = 1.32-2.35). Introducing both forms of discrimination into the same model slightly attenuated these associations. Conclusions: Interpersonal and institutional forms of ethnic discrimination are independently associated with poorer mental health among Arab minority men current and former smokers in Israel. Future research is warranted into both forms of discrimination in the general Arab population in Israel, including women.
Article
Objectives: Colorectal cancer (CRC) is an important cause of morbidity and mortality worldwide. Clear ethnic disparities in the incidence of CRC and its outcomes have been observed globally, but only few research efforts have been invested so far in the unique ethnic scene of Israeli population. This study aims to compare the clinico-pathologic features, tumor's characteristics and prognosis between Arab and Jewish CRC patients as well as among Jewish subgroups living within the same central coastal region in Israel. Methods: In this retrospective, single center study, a total of 401 patients with pathologically confirmed CRCs diagnosed during the years 2008–2015 were included. These were divided into Jewish (n = 334) and Arab (n = 67) groups. Data collected included demographics, country of birth, clinical presentation and family history. Tumor stage, location, histologic grade and mortality rate were compared retrospectively between both groups and within Jewish sub-populations. Results: Arabs were significantly younger at diagnosis (62.7 ± 12.9 vs. 69.3 ± 13.01; P < 0.01), presented more frequently with rectal bleeding, and were less likely to be diagnosed due to positive fecal occult blood test (9% vs. 22.6%; P = 0.012). Tumor distribution through the colon was comparable between both groups and characterized by a distal predominance. Arabs had a significantly higher rate of advanced stage at diagnosis (58% vs. 50.5%, OR = 2.454, 95%CI = 1.201–5.013; P = 0.02) when compared to Jews. Mortality rates were comparable between both groups. In the Jewish subpopulation analysis, we found that immigrants, especially those born in the former USSR, presented with significantly advanced tumor stages when compared to native Israelis (55% vs. 37.5%; P = 0.02). Conclusion: CRC in two major ethnic populations in Israel, Arabs and Jews, varied in terms of age at diagnosis, clinical presentation and stage at diagnosis. Similar findings were documented within a non-native Jewish subpopulation, raising the possibility of a low utilization of screening programs in these groups.
Article
Health inequality can affect economic productivity, labor force participation, or the intergenerational transmission of poverty. Health disparities based on socioeconomic ranking are widely documented, but there is also growing evidence of disparities based on geographic locality. This paper investigates a potential contributing factor to socioeconomic and geographic-based health inequality: access to secondary health care. We exploit bus line introductions to Arab towns in Israel, which substantially increased secondary health care access among a mostly disadvantaged population, and find that older adult reporting of chronic health conditions increased in the short term. However, this effect fades away in the long run. We argue that greater chronic condition rates in the short term reflect higher diagnosis rates resulting from increased access to health care professionals rather than health deterioration. This effect weakens in the long run when the benefits of greater access to health care offset the higher diagnosis rates.
Article
Background: Two distinct ethnic groups live in Southern Israel: urban Jews and rural Bedouin Arabs. These groups differ in their socioeconomic status, culture and living environment, and are treated in a single regional tertiary care hospital. We hypothesized that these two ethnic groups have different patterns of sepsis-related intensive care admissions. Methods: The study included all adult patients admitted to the Soroka University Medical Center Intensive Care Units between January 2002 and December 2008, with a diagnosis of sepsis. Demographic data, medical history, and hospitalization and outcomes data were obtained. Primary outcome was all-cause mortality. Results: Jewish patients admitted to the ICU (1343, 87%) were on average 17 years older than Bedouin Arabs (199, 13%). For the population <65 years, Bedouin Arabs had slightly higher age-adjusted prevalence of ICU sepsis admissions than Jewish patients (39.5 vs. 43.0, p=0.25), while for the population >65 years there was a reverse trend (21.8 vs. 19.8 p=0.49). There were no differences in the type of organ failure, sepsis severity or length of hospitalization between the two groups. Twenty eight days/in-hospital mortality was 33.9% in Bedouin Arabs vs. 45.5% in Jews, p=0.004. Following adjustment for comorbidities, age and severity of the disease, survival was unrelated to ethnicity, both at 28 days (odds ratio for Bedouin Arabs 0.86, 95% CI 0.66-1.24) and following hospital discharge (hazard ratio 0.86, 95% 0.67-1.09). Conclusions: Sepsis-related ICU admissions are more prevalent among Bedouin Arabs at younger age compared with the Jewish population. Adjusted for confounders, ethnicity does not influence prognosis.
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The aim of this paper was to assess some of the important variable factors concerning health care in United Arab Emirates (UAE), with special emphasis on primary health care (PHC). Other aspects considered are the population per bed, population per physician, population per dentist, population per pharmacist and population per nurse, all of which influence health care delivery in the UAE. There is a gradual improvement in health status, which can be seen by the increase of life expectancy in both males and females, and decrease in leading cause of death from infectious diseases. The health strategy of 1986-1991 has achieved its goals and has been reviewed and the new 5 year strategy has been formalized to adopt some major aspects in the development of health care delivery. Overall results showed that every 1235 people will be served by one physician and other health service indicators are bed/doctor 3.9; bed/nurse 1.3; population/dentist 15,763; population/pharmacist 13,174; and population/nurse 438. Also, a very good coverage of PHC has been achieved throughout the country so that no more than 200 people live in an area > 30 km away from health service or without a PHC clinic. All PHC clinics provide curative, preventive and promotive services with a small percentage of rehabilitation services. The government has adopted the PHC approach as the long-term strategy for achieving the goal of health for all by the year 2000. This was supported by the ministerial decree no. 139/86 in 1986. Recommendations are also made for improving health services and performance as well as better meeting the specific medical care needs of the people through expansion of PHC services.
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During the 1980s, at a time that life expectancy at birth in western Europe has increased by 2.5 years, it has stagnated or, for some groups, declined in the former socialist countries of central and eastern Europe. A study was carried out to ascertain the contribution of deaths at different age groups and from different causes to changes in life expectancy at birth in Czechoslovakia, Hungary and Poland between 1979 and 1990. Improvements in infant mortality have been counteracted by deteriorating death rates among young and middle-aged people, with the deterioration commencing as young as late childhood in Hungary but in the thirties or forties in Czechoslovakia and Poland. The leading contributors to this deterioration are cancer and circulatory disease but, in Hungary, cirrhosis and accidents have also been of great importance. The patterns observed in each country differ in the age groups affected and the causes of death. Further work is required to explain these differences.
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This study assessed the trends in the health status of Bahraini women from the early 1980s to the mid 1990s through review of census data and health data. Sociodemographic characteristics, reproductive health, mortality, morbidity and lifestyle patterns were studied. The implications of the data and measures needed to be taken to further improve the health and health care services of women are discussed.
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Overweight and obesity in adulthood are linked to an increased risk for death and disease. Their potential effect on life expectancy and premature death has not yet been described. To analyze reductions in life expectancy and increases in premature death associated with overweight and obesity at 40 years of age. Prospective cohort study. The Framingham Heart Study with follow-up from 1948 to 1990. 3457 Framingham Heart Study participants who were 30 to 49 years of age at baseline. Mortality rates specific for age and body mass index group (normal weight, overweight, or obese at baseline) were derived within sex and smoking status strata. Life expectancy and the probability of death before 70 years of age were analyzed by using life tables. Large decreases in life expectancy were associated with overweight and obesity. Forty-year-old female nonsmokers lost 3.3 years and 40-year-old male nonsmokers lost 3.1 years of life expectancy because of overweight. Forty-year-old female nonsmokers lost 7.1 years and 40-year-old male nonsmokers lost 5.8 years because of obesity. Obese female smokers lost 7.2 years and obese male smokers lost 6.7 years of life expectancy compared with normal-weight smokers. Obese female smokers lost 13.3 years and obese male smokers lost 13.7 years compared with normal-weight nonsmokers. Body mass index at ages 30 to 49 years predicted mortality after ages 50 to 69 years, even after adjustment for body mass index at age 50 to 69 years. Obesity and overweight in adulthood are associated with large decreases in life expectancy and increases in early mortality. These decreases are similar to those seen with smoking. Obesity in adulthood is a powerful predictor of death at older ages. Because of the increasing prevalence of obesity, more efficient prevention and treatment should become high priorities in public health.
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Physical activity is associated with a reduced risk of developing diabetes and with reduced mortality among diabetic patients. However, the effects of physical activity on the number of years lived with and without diabetes are unclear. Our aim is to calculate the differences in life expectancy with and without type 2 diabetes associated with different levels of physical activity. Using data from the Framingham Heart Study, we constructed multistate life tables starting at age 50 years for men and women. Transition rates by level of physical activity were derived for three transitions: nondiabetic to death, nondiabetic to diabetes, and diabetes to death. We used hazard ratios associated with different physical activity levels after adjustment for age, sex, and potential confounders. For men and women with moderate physical activity, life expectancy without diabetes at age 50 years was 2.3 (95% CI 1.2-3.4) years longer than for subjects in the low physical activity group. For men and women with high physical activity, these differences were 4.2 (2.9-5.5) and 4.0 (2.8-5.1) years, respectively. Life expectancy with diabetes was 0.5 (-1.0 to 0.0) and 0.6 (-1.1 to -0.1) years less for moderately active men and women compared with their sedentary counterparts. For high activity, these differences were 0.1 (-0.7 to 0.5) and 0.2 (-0.8 to 0.3) years, respectively. Moderately and highly active people have a longer total life expectancy and live more years free of diabetes than their sedentary counterparts but do not spend more years with diabetes.
Article
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The crude birth rate in 2004 was 14.0 births per 1000 population, the second lowest ever reported for the United States. The number of births and the fertility rate (66.3) increased slightly (by <1%) from 2003 to 2004. Fertility rates were highest for Hispanic women (97.7), followed by Asian or Pacific Islander (67.2), non-Hispanic black (66.7), Native American (58.9), and non-Hispanic white (58.5) women. The birth rate for teen mothers continued to fall, dropping 1% from 2003 to 2004 to 41.2 births per 1000 women aged 15 to 19 years, which is another record low. The teen birth rate has fallen 33% since 1991; declines were more rapid for younger teens aged 15 to 17 (43%) than for older teens aged 18 to 19 (26%). The proportion of all births to unmarried women is now slightly higher than one third. Smoking during pregnancy declined slightly from 2003 to 2004. In 2004, 29.1% of births were delivered by cesarean delivery, up 6% since 2003 and 41% since 1996 (20.7%). The primary cesarean delivery rate has risen 41% since 1996, whereas the rate of vaginal birth after a previous cesarean delivery has fallen 67%. The use of timely prenatal care was 84.0% in both 2003 and 2004. The percentage of preterm births rose to 12.5% in 2004 from 10.6% in 1990 and 9.4% in 1981. The percentage of low birth weight births also increased to 8.1% in 2004, up from 6.7% in 1984. Twin birth rate and triplet/+ birth rates increased by 1% and <1%, respectively, from 2002 to 2003. Multiple births accounted for 3.3% of all births in 2003. The infant mortality rate was 7.0 per 1000 live births in 2002 compared with 6.8 in 2001. The ratio of the infant mortality rate among non-Hispanic black infants to that for non-Hispanic white infants was 2.4 in 2002, the same as in 2001. The United States continues to rank poorly in international comparisons of infant mortality. Expectation of life at birth reached a record high of 77.6 years for all gender and race groups combined. Death rates in the United States continue to decline, with death rates decreasing for 8 of the 15 leading causes. Death rates for children < or =19 years of age declined for 7 of the 10 leading causes in 2003. The death rates did not increase for any cause, and rates for heart disease, influenza, and pneumonia and septicemia did not change significantly for children as a group. A large proportion of childhood deaths, however, continue to occur as a result of preventable injuries.
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To identify the causes of the gap in life expectancy between Indigenous and non-Indigenous populations of the Northern Territory and how the causes have evolved over time. Analysis of NT death data over four 5-year periods, 1 January 1981 to 31 December 2000 inclusive. A decomposition method using discrete approximations (Vaupel and Romo) was applied to abridged life tables for the Indigenous and non-Indigenous populations of the NT. Contribution of causes of death, grouped according to global burden of disease groups and categories, to the life expectancy gap. The gap between the life expectancy of Indigenous and non-Indigenous people in the NT did not appear to narrow over time, but there was a marked shift in the causes of the gap. In terms of disease groups, the contribution of communicable diseases, maternal, perinatal and nutritional conditions halved during the 20 years to 2000. Meanwhile, the contribution of non-communicable diseases and conditions increased markedly. The contribution of injuries remained static. In terms of disease categories, the contribution of infectious diseases, respiratory infections and respiratory diseases declined considerably; however, these gains were offset by significantly larger increases in the contribution of cardiovascular diseases and diabetes for Indigenous women and cardiovascular diseases, cancers and digestive diseases for Indigenous men. The main contributors to the gap in life expectancy between the Indigenous and non-Indigenous populations were non-communicable diseases and conditions, which are more prevalent in ageing populations. With the life expectancy of Indigenous people in the NT expected to improve, it is important that public health initiatives remain focused on preventing and managing chronic diseases.
Article
This study assessed the trends in the health status of Bahraini women from the early 1980s to the mid 1990s through review of census data and health data. Sociodemographic characteristics, reproductive health, mortality, morbidity and lifestyle patterns were studied. The implications of the data and measures needed to be taken to further improve the health and health care services of women are discussed
Article
Cet article présente l'évolution de la mortalité de 1960 à 1989 au Maroc, en Algérie, en Tunisie et en Egypte. La procédure a consisté à rassembler, pays par pays, le maximum de données et de résultats, à en examiner les méthodes de collecte et de mesure, à en vérifier la cohérence spatiale ou chronologique avant de finalement choisir les meilleures estimations. Dans la région, la transition de mortalité est réelle et dans l'ensemble rapide au cours des 20 derniéres années: les espérances de vie qui étaient de 50 à 52 ans en 1970 atteignent désormais prés de 70 ans en Tunisie, 66 ou 67 ans en Algérie et au Maroc et 64 ans en Egypte.
Article
This World Development Report examines the transition of countries with alternative systems of centrally planned economies back to a market orientation. These countries seceded from the world market economy between 1917 and 1950 and now face a massive restructuring task. This transition goes beyond typical reforms because the change is deep and systemic, requiring the establishment of key market institutions. This report analyzes two sets of overarching questions. The first series focuses on the initial challenges of transition and how different countries have responded. It examines: (i) whether differences in transition policies and outcomes reflect different reform strategies, or whether they reflect primarily country-specific factors such as economic structure, the level of development, or the impact of simultaneous political changes; (ii) whether strong liberalization and stabilization policies are needed up front, or if other reforms can progress equally well without them; (iii) whether privatization is necessary early in the reform process or at all; and (iv) whether there has to be a gulf between winners and losers from transition. The second set of questions looks beyond these challenges to the longer-term agenda of consolidating the reforms by developing the institutions and policies that will help the new market system to flourish. It focuses on: (i) how countries in transition should develop and strengthen the rule of law and control corruption and organized crime; (ii) how they can build effective financial systems; (iii) how governments should restructure themselves to meet the needs of a market system; (iv) how countries can preserve and adapt their human skills base; (v) why international integration is so vital for transition, and what the implications are for trading partners and capital flows; and (vi) how external assistance can best support countries in transition.
Article
This study attempts to estimate potential gains in life expectancy in 1984 through partial and complete elimination of infectious and parasitic diseases among Kuwaiti nationals. For deriving these estimates, a multiple decrement life table approach was applied. The results of the study show that complete elimination of infectious and parasitic disease mortality would further add 0.45 years to the life expectancy at birth of Kuwaiti males and 0.54 yr to that of Kuwaiti females. A partial reduction by 50% would result in gains of just one-half of the years gained through complete elimination of these causes. Also, as partial reduction is increased from 10% to 90%, the gains in life expectancy at birth would go up from 0.04 yr to 0.40 yr in the case of Kuwaiti males and 0.06 to 0.48 yr for Kuwaiti females.
Article
A set of new indices for interpreting change in life expectancies, as well as a technique for explaining change in life expectancies by change in mortality at each age group are presented in the paper. The indices, as well as the new technique for explaining the differences in life expectancies, have been tested and examples using United States life tables are presented. The technique for explaining life expectancy differentials can be used for analyzing change in mortality or mortality differentials by sex, ethnicity, region, or any other subpopulations. The technique can be applied to life expectancies at birth or temporary life expectancies between any desirable ages.
Article
In this paper, the evolution of mortality since 1960 has been reconstructed for Morocco, Algeria, Tunisia and Egypt. The procedure has been to collect in each country all the existing data (population register, surveys, etc.), to check chronological and spatial cohesion and to estimate reliability, before making a final choice of the best estimates. The mortality transition has started. On the whole, progress has been remarkable during the last 20 years. In 1970 life expectancy was only from 50 to 52 years in the region; today it reaches nearly 70 years in Tunisia, 66 years in Algeria and Morocco, and 64 years in Egypt. Infant mortality has decreased considerably. Differences with regard to child mortality increased between countries. Tunisia maintained first place with the lowest rates. Algerian rates, however, are decreasing and have approached those of Tunisia within the last 10 years. Morocco is still in an intermediate position, and Egypt lags behind. Infant mortality ranges from 55 per 1000 in Tunisia to 80 per 1000 in Egypt. Female overmortality was one of the important characteristics of the region in the years 1960 and 1970. There is a tendency towards a decrease and a concentration in the first years of life (between 1 month and 5 years). But it still exists, denoting a certain sexual discrimination. Progress in North Africa during the 1950s and 1960s has resulted in an intermediate position regarding mortality levels.
Article
This paper provides an overview of the Black Report, published in Britain in 1980. It outlines its place in the history of British concern about socio-economic differentials in death rates since the mid-19th century, and suggests continuities in suggested explanations for these, a particularly persistent thread being debates between environmentalists, hereditarians, and those emphasising personal ignorance or irresponsibility. It introduces a distinction between "hard" "soft" versions of the Black Report's four explanatory models for inequalities in health (artefact, selection, behavioural and materialist), points out that the working group rejected the "hard" rather than the "soft" versions of the first three and espoused the "soft" version of the last, and suggests that the rather polarised debate about these explanations that followed can be understood in the light of the contemporary political context and a tendency to confuse the "hard" and "soft" versions. Methodological and empirical developments since the report are summarised, attention being drawn to seven themes which raise important issues for future research: the ubiquity of socio-economic differentials across industrialised countries, continuing or increasing differentials, stepwise gradients, interest in psychosocial mechanisms, the hypothesis of biological programming in utero or infancy, controls for behaviour, and evaluations of interventions. The overall conclusion is that we need more detailed studies of the mechanisms which generate and maintain social inequalities in health, and of interventions to reduce such inequalities.
Article
This paper examined whether international variations in absolute and relative gender differences in mortality are related to the overall mortality rates, and whether the international variation in gender gap in mortality can in part be explained by smoking. I used data on mortality from all causes in 32 European countries published by the World Health Organisation, and indirect estimates of mortality attributable to smoking in the age band 35-69 years by Peto et al. The main analyses were restricted to the age band 35-69 years but results for mortality at all ages were virtually identical. The overall mortality rates (both sexes combined) were strongly related to absolute gender differences (r = 0.91) but only weakly to relative differences (r = 0.35). The gender gap was larger in eastern than in western Europe for rate differences (1005 vs. 530 per 100,000, respectively), but it was similar for rate ratios (2.3 vs. 2.1, respectively). Both absolute and relative gender differences in mortality were strongly related to the difference between men and women in the proportion of all deaths attributed to tobacco (partial correlations, after controlling for the overall death rates, were 0.59 and 0.66, respectively). Excluding tobacco-related deaths attenuated the associations between the overall mortality rates with absolute differences (r = 0.70) and reduced the difference in the absolute gender gap between eastern and western Europe. More importantly, excluding tobacco-related deaths eliminated entirely the association with relative differences (r = -0.15) as well as any suggestion that the relative gender gap is larger in eastern than in western Europe. These results show that tobacco plays an important role in generating international differences in the size of gender gap in mortality. The much discussed association between' the overall life expectancy and the gender gap in life expectancy is a numerical product of absolute death rates (differences in life expectancy are driven by differences in rates). The association of overall mortality with male/female mortality ratios is much weaker.
Article
The objective of this article is to provide estimates of life expectancy for White, Black, and Hispanic populations by socioeconomic factors. Effects of educational, income, employment, and marital status on life expectancy are presented and interpreted. The National Longitudinal Mortality Study, consisting of a number of Current Population Surveys (CPS) linked to mortality information obtained from the National Death Index, provides data to construct life tables for various socioeconomic and demographic groups. Probabilities of death are estimated using a person-year approach to accommodate the aging of the population over 11 years of follow up. Across various ethnicity-race-sex groups, longer life expectancy was observed for individuals with higher levels of education and income, and for those who were married and employed. The differences in life expectancy between levels of the socioeconomic characteristics tended to be larger for men than for women. Also, differences were found to be larger for the non-Hispanic Black population compared to the non-Hispanic White population. Hispanic White men exhibited patterns similar to those of non-Hispanic White and Black men. For selected ethnicity-race-sex groups, the impact of socioeconomic variables on life expectancy is dramatic. The shorter life expectancy observed among the poor, the less educated, the unmarried, and those not in the labor force, highlights the impact of socioeconomic disadvantage on survival. Further, the substantial 14-year differential favoring the employed over those not in the labor force may be partially explained by unemployment due to poor health. Another reason may be that employed individuals have greater access to health care than do those not in the labor force.
Article
The infant mortality rate is a health status indicator. To analyze the differences in infant mortality rates between Jews and Arabs in Israel between 1975 and 2000. Data were used from the Central Bureau of Statistics and the Department of Mother, Child and Adolescent Health in the Ministry of Health. The IMR in 2000 was 8.6 per 1,000 live births in the Israeli Arab population as compared to 4.0 in the Jewish population. Between 1970 and 2000 the IMR decreased by 78% among Moslems, 82% among Druze, and 88% among Christians, as compared to 79% in the Jewish population. In 2000, in the Arab population, 40% of all infant deaths were caused by congenital malformations and 29% by prematurity, compared to 23% and 53%, respectively, in the Jewish population. Between 1970 and 2000 the rate of congenital malformations declined in both the Arab and Jewish populations. In the 1970s the rate was 1.4 times higher in the Arab community than in the Jewish community, and in 2000 it was 3.7 times higher. As in the Jewish population, the IMR in the Arab community has decreased over the years, although it is still much higher than that in the Jewish community. Much remains to be done to reduce the incidence of congenital malformations among Arabs, since this is the main cause of the high IMR in this population.
Article
Life expectancy at birth in Israel in 2001 was 77.7 years for males and 81.6 years for females among Jews, and 74.5 and 77.8 years for males and females, respectively, among Israeli Arabs. In spite of vast improvements in health conditions of the two populations since Israel's statehood in 1948, persistent disparities in life expectancy between the two groups have challenged the Israeli socialized health care system. These disparities are influenced primarily by differences between the two population groups in infant and child mortality rates. This early study suggests that the distribution of life expectancy across localities in Israel reflects the distribution of those localities' socio-economic condition index (not including health and medical care), and the distribution of medical services. The positive association between life expectancy and the index is pronounced, however, only within the Jewish population but not among Arabs. While there may be no significant difference in life expectancy among Jews and Arabs living in poorer communities, there are fewer Arabs living in relatively affluent communities. Thus, persistent higher concentration of poverty among Arabs than among Jews has sufficed to maintain the gap in life expectancy between them. In addition, however, there are population-specific effects: wealth and education are more protective among Jews than among Arabs, while medical services are more protective among Arabs.
Article
Since the early 1980s, the black-white gap in life expectancy at birth increased sharply and subsequently declined, but the causes of these changes have not been investigated. To determine the contribution of specific age groups and causes of death contributing to the changes in the black-white life expectancy gap from 1983-2003. US vital statistics data from the US National Vital Statistics System, maintained by the National Center for Health Statistics. Standard life table techniques were used to decompose the change in the black-white life expectancy gap by combining absolute changes in age-specific mortality with relative changes in the distribution of causes of death. The gap in life expectancy at birth between blacks and whites. Among females, the black-white life expectancy gap increased 0.5 years in the period 1983-1993, primarily due to increased mortality from human immunodeficiency virus (HIV) (0.4 years) and slower declines in heart disease (0.1 years), which were somewhat offset by relative improvements in stroke (-0.1 years). The gap among males increased by 2 years in the period 1983-1993, principally because of adverse changes in HIV (1.1 years), homicide (0.5 years), and heart disease (0.3 years). Between 1993 and 2003, the female gap decreased by 1 year (from 5.59 to 4.54 years). Half of the total narrowing of the gap among females was due to relative mortality improvement among blacks in heart disease (-0.2 years), homicide (-0.2 years), and unintentional injuries (-0.1 years). The decline in the life expectancy gap was larger among males, declining by 25% (from 8.44 to 6.33 years). Nearly all of the 2.1-year decline among males was due to relative mortality improvement among blacks at ages 15 to 49 years (-2.0 years). Three causes of death accounted for 71% of the narrowing of the gap among males (homicide [-0.6 years], HIV [-0.6 years], and unintentional injuries [-0.3 years]), and lack of improvement in heart disease at older ages kept the gap from narrowing further. After widening during the late 1980s, the black-white life expectancy gap has declined because of relative mortality improvements in homicide, HIV, unintentional injuries, and, among females, heart disease. Further narrowing of the gap will require concerted efforts in public health and health care to address the major causes of the remaining gap from cardiovascular diseases, homicide, HIV, and infant mortality.
Center for disease control, Ministry of Health
  • Israel
Israel: Center for disease control, Ministry of Health, 2006 (in Hebrew).
Changing trends in mortality decline during the last decades
  • Arriaga
Arriaga EE. Changing trends in mortality decline during the last decades. In: Ruzicka L, Wunsch G, Kane P (eds). Differential Mortality: Methodological Issues and Biosocial Factors. Oxford, UK: Clarendon Press; International Studies in Demography, 1989, pp. 105-29.
Health Status of the Arab Population in Israel
  • J Tarabeia
Tarabeia J. Health Status of the Arab Population in Israel, 2004. Publication No. 226. Israel: Center for Disease Control, 2005 (in Hebrew).
Changing trends in mortality decline during the last decades Differential Mortality: Methodological Issues and Biosocial Factors
  • Ee Arriaga
Arriaga EE. Changing trends in mortality decline during the last decades. In: Ruzicka L, Wunsch G, Kane P (eds). Differential Mortality: Methodological Issues and Biosocial Factors. Oxford, UK: Clarendon Press; International Studies in Demography, 1989, pp. 105–29.
Variations in life expectancy in the world today. Global Oneness
  • Life
Life expectancy. Variations in life expectancy in the world today. Global Oneness. http://www.experiencefestival.com/life_expectancy_variations (13 October 2008, date last accessed).
13 Central Bureau of Statistics. Statistical Abstract of Israel
13 Central Bureau of Statistics. Statistical Abstract of Israel. Jerusalem: CBS, 2006.
Ministry of Health. http://www.health.gov.il/download/forms
  • Y Amity
Amity Y. Infant Mortality Report, 2005. Ministry of Health. http://www.health.gov.il/download/forms/a2913_ch_d_ 2005.pdf. Published December 20, 2006 (8 July 2007, date last accessed).
Unhealthy Societies: the Afflictions of Inequality. London: Routledge, 1996. 34 Singth GK, Siahpush M. Widening socioeconomic inequalities in US life expectancy
  • Rg Wilkinson
33 Wilkinson RG. Unhealthy Societies: the Afflictions of Inequality. London: Routledge, 1996. 34 Singth GK, Siahpush M. Widening socioeconomic inequalities in US life expectancy, 1980-2000. Int J Epidemiol 2006;35:969–79.
United States Department of Health and Human Services (HHS)
United States Department of Health and Human Services (HHS). Centers for Disease Control and Prevention, 2003.
Infant Mortality Report
  • Y Amity
Amity Y. Infant Mortality Report, 2005. Ministry of Health. http://www.health.gov.il/download/forms/a2913_ch_d_ 2005.pdf. Published December 20, 2006 (8 July 2007, date last accessed).
  • J Tarabeia
  • Y Amitai
  • M Green
Tarabeia J, Amitai Y, Green M et al. Differences in infant mortality rates between Jews and Arabs in Israel, 1975-2000. Isr Med Assoc J 2004;6:403-7.
Publication No. 313. Israel: Center for disease control, Ministry of Health
Annual Israeli Smoking Report, 2007-2008. Publication No. 313. Israel: Center for disease control, Ministry of Health, 2006 (in Hebrew).
Obesity in adulthood and its consequences for life expectancy: a life-table analysis
  • A Peeters
  • J J Barendregt
  • F Winiekens
  • J P Mackenbach
Peeters A, Barendregt JJ, Winiekens F, Mackenbach JP. Obesity in adulthood and its consequences for life expectancy: a life-table analysis. Ann Intern Med 2003;138: 24-33.
Widening socioeconomic inequalities in US life expectancy
  • G K Singth
  • M Siahpush
Singth GK, Siahpush M. Widening socioeconomic inequalities in US life expectancy, 1980-2000. Int J Epidemiol 2006;35:969-79.
  • Hertzman
2007-2008. Publication No. 313
  • Annual Israeli Smoking Report
The Health Situation in the European region
  • World Health Organization Report
Infant Mortality Report, 2005
  • Amity