Showing papers by "Oliver Razum published in 2002"

Time travel with Oliver Twist--towards an explanation foa a paradoxically low mortality among recent immigrants.

Abstract: First-generation immigrant populations in industrialized countries frequently have a lower mortality than the host population, a finding that is unexpected and often dismissed as the result of bias. We propose an alternative explanation for a real, albeit temporal, mortality advantage. We base our argument on two premises: First, that there are differences in the progression of the health transition between the immigrants’ countries of origin and industrialized host countries; and, second, that there are differences in the speed at which changes in mortality from various causes occur after migration. Mortality from treatable communicable and maternal conditions, still high in many countries of origin, quickly declines to levels close to those of the host country. Mortality from ischaemic heart disease, the most common cause of death in the host countries, takes years or decades to rise to comparable heights. This is because of the time lag between increases in risk factor levels and an increased risk of coronary death. Hence, first-generation immigrants may initially experience a lower mortality than the host population, a point that has so far been under-appreciated in discussions of immigrant mortality. After adopting a western lifestyle immigrants face an increasing risk of ischaemic heart disease. The increase occurs on top of a persisting risk from conditions associated with childhood deprivation, e.g. stomach cancer and stroke – the unfinished agenda of the health transition that immigrants experience.

Towards an explanation for a paradoxically low mortality among recent immigrants

Abstract: Summary First-generation immigrant populations in industrialized countries frequently have a lower mortality than the host population, a finding that is unexpected and often dismissed as the result of bias. We propose an alternative explanation for a real, albeit temporal, mortality advantage. We base our argument on two premises: First, that there are differences in the progression of the health transition between the immigrants’ countries of origin and industrialized host countries; and, second, that there are differences in the speed at which changes in mortality from various causes occur after migration. Mortality from treatable communicable and maternal conditions, still high in many countries of origin, quickly declines to levels close to those of the host country. Mortality from ischaemic heart disease, the most common cause of death in the host countries, takes years or decades to rise to comparable heights. This is because of the time lag between increases in risk factor levels and an increased risk of coronary death. Hence, first-generation immigrants may initially experience a lower mortality than the host population, a point that has so far been under-appreciated in discussions of immigrant mortality. After adopting a western lifestyle immigrants face an increasing risk of ischaemic heart disease. The increase occurs on top of a persisting risk from conditions associated with childhood deprivation, e.g. stomach cancer and stroke ‐ the unfinished agenda of the health transition that immigrants experience.

[The healthy migrant effect: role of selection and late entry bias].

Abstract: BACKGROUND First-generation immigrants frequently have a lower mortality than the host population, in spite of a low socio-economic status. This is usually explained by (self-) selection into migration. If this were the case, the immigrants' mortality risk would increase with time under observation. A persistently low mortality could be due to a late entry bias: if migrants are enrolled in a study years after immigration, sick or socio-economically unsuccessful individuals may already have returned to their countries of origin. Mortality risk would then be inversely associated with length of stay in the host country before enrollment. METHODS We assessed the mortality risk of immigrants from Mediterranean countries to Germany in the German Socio-economic Panel, in relation to time under observation (1-15 years) and length of stay in Germany before enrollment (0-34 years), using the Cox regression. RESULTS In 1984-98, 2624 immigrants aged 16-83 years accrued 21,858 person years; 59 died. The hazard ratio, adjusted for age, sex and marital status, for each additional year under observation was 0.93 (95 % CI: 0.87-0.99); and for each additional 10 years in Germany before enrollment 0.49 (95 % CI: 0.27-0.89) in the age group >/= 50 years. CONCLUSIONS We found no evidence for a mortality increase with time under observation, suggesting that the healthy migrant effect is not primarily due to (self-)selection. The initial mortality advantage could be due to international differences in mortality patterns. A late entry bias does contribute to the persisting mortality advantage of older immigrants.

Drug use and HIV risk in Trinidad and Tobago: qualitative study.

Abstract: Crack use is an important risk factor for HIV infection because of its association with unsafe sexual practices. We investigated factors promoting the initiation of crack cocaine use; the sexual behaviour of crack users; and their rehabilitation care seeking behaviour in Trinidad and Tobago. We conducted 40 in-depth interviews with drug users. Respondents frequently reported a history of parental desertion, alcohol abuse, and physical abuse within the family. They perceived peer pressure and drug use in the family as important factors promoting first drug use. Exchanging sex for drugs was common, and practising oral sex was considered safe. Female drug users rarely seek rehabilitative care because of stigmatization and lack of care for their children. In Trinidad, attitudes towards drugs in society and families need to be changed. Campaigns promoting safer sex should emphasize the risk of oral sex. Rehabilitation facilities caring for female drug users should offer child care.

Editorial: A farewell to polio vaccination? Not anytime soon

Abstract: Paralytic poliomyelitis is quickly disappearing from the world. In June, the European Region of WHO was certified to be polio-free. This followed similar achievements in the Americas and the Western Pacific Region which had been certified polio-free in 1994 and 2000, respectively (WHO 2002a). Last year, less than 500 confirmed cases of polio were reported world-wide (WHO 2002b). Transmission of the polio wild virus has been restricted to 10 countries, among them India, Pakistan and Nigeria (Global Polio Eradication Initiative 2002). This is an enormous accomplishment. Not long ago, paralytic polio was a dreaded affliction of young people everywhere. For example, 50 years ago, in the summer and autumn of 1952, Germany was hit by the most severe polio outbreak the country ever experienced. Almost 10 000 cases were recorded in a single year, of whom 800 resulted in death (Pöhn & Rasch 1993). Over the following 10 years, polio outbreaks in industrialized countries ceased, thanks to successful mass immunization campaigns. In developing countries, childhood immunization coverage improved markedly through the Expanded Programme on Immunization. Notwithstanding, there were still 350 000 people affected by poliomyelitis in 1988. In that year, the World Health Assembly resolved to eradicate polio from the world. This goal is today being pursued by the Global Polio Eradication Initiative, an alliance of WHO, Rotary International, CDC, UNICEF and others. The WHO defines eradication as the achievement of a status whereby no further cases of a disease occur anywhere, and continued control measures are unnecessary (Last 1995). Technically, polio eradication appears to be feasible: an effective vaccine is available, and there exists no natural reservoir of polio virus outside humans. Recent developments, however, indicate that the eradication effort faces substantial problems. I shall discuss two of them in more detail. The first one relates to the attenuated live vaccine, the second one to the organization of immunization programmes.