Abstract
Circulatory disease mortality inequalities by country of birth (COB) have been demonstrated for some EU countries but pan-European analyses are lacking. We examine inequalities in circulatory mortality by geographical region/COB for six EU countries. We obtained national death and population data from Denmark, England and Wales, France, the Netherlands, Scotland and Sweden. Mortality rate ratios (MRRs) were constructed to examine differences in circulatory, ischaemic heart disease (IHD) and cerebrovascular disease mortality by geographical region/COB in 35-74 years old men and women. South Asians in Denmark, England and Wales and France experienced excess circulatory disease mortality (MRRs 1.37-1.91). Similar results were seen for Eastern Europeans in these countries as well as in Sweden (MRRs 1.05-1.51), for those of Middle Eastern origin in Denmark (MRR = 1.49) and France (MRR = 1.15), and for East and West sub-Saharan Africans in England and Wales (MRRs 1.28 and 1.39) and France (MRRs 1.24 and 1.22). Low ratios were observed for East Asians in France, Scotland and Sweden (MRRs 0.64-0.50). Sex-specific analyses showed results of similar direction but different effect sizes. The pattern for IHD mortality was similar to that for circulatory disease mortality. Two- to three-fold excess cerebrovascular disease mortality was found for several foreign-born groups compared with the local-born populations in some countries. Circulatory disease mortality varies by geographical region/COB within six EU countries. Excess mortality was observed for some migrant populations, less for others. Reliable pan-European data are needed for monitoring and understanding mortality inequalities in Europe's multiethnic populations.
Highlights
Circulatory disease mortality varies by geographical region/country of birth (COB) within six EU countries
Coronary heart disease (CHD) and stroke are two major causes of morbidity and mortality in Europe,[1] which vary by ethnic group—this is likely to reflect differences in access to and quality of health care, psychosocial, lifestyle and physiological factors, and possibly genetics, operating before, during and after migration.[2,3]
National death registers are available in most EU countries and information on country of birth (COB) of the deceased person is usually recorded on the death certificate
Summary
Coronary heart disease (CHD) and stroke are two major causes of morbidity and mortality in Europe,[1] which vary by ethnic group—this is likely to reflect differences in access to and quality of health care, psychosocial, lifestyle and physiological factors, and possibly genetics, operating before, during and after migration.[2,3] As a result of net immigration during the second half of the 20th century,[4] Europe has become a multi-ethnic continent that is faced with important public health and health care challenges—one major task is the routine collection and production of ethnically disaggregated, national-level data on morbidity and mortality from chronic diseases, including circulatory diseases.[5,6] Such data are essential for generating aetiological hypotheses, for supporting public health policies and for informing health care strategies targeting migrant and minority ethnic populations.[7]Ethnic group-coded, routine data on circulatory diseases in EU countries are scarce, and when available, often lack cross-country comparability regarding how ethnicity and outcomes are defined.[8]National death registers are available in most EU countries and information on country of birth (COB) of the deceased person is usually recorded on the death certificate. Circulatory disease mortality inequalities by country of birth (COB) have been demonstrated for some EU countries but pan-European analyses are lacking. Methods: We obtained national death and population data from Denmark, England and Wales, France, the Netherlands, Scotland and Sweden. Mortality rate ratios (MRRs) were constructed to examine differences in circulatory, ischaemic heart disease (IHD) and cerebrovascular disease mortality by geographical region/COB in 35–74 years old men and women. Results: South Asians in Denmark, England and Wales and France experienced excess circulatory disease mortality (MRRs 1.37–1.91). Similar results were seen for Eastern Europeans in these countries as well as in Sweden (MRRs 1.05–1.51), for those of Middle Eastern origin in Denmark (MRR = 1.49) and France (MRR = 1.15), and for East and West sub-Saharan Africans in England and Wales (MRRs 1.28 and 1.39) and France (MRRs 1.24 and 1.22). Reliable pan-European data are needed for monitoring and understanding mortality inequalities in Europe’s multiethnic populations
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