Showing papers by "Oliver Razum published in 2009"

Changes in smoking prevalence among first- and second-generation Turkish migrants in Germany - an analysis of the 2005 Microcensus.

Abstract: Background Compared to the majority population of a host country, migrants tend to have different health risks and health behaviour. We have hypothesised that these differences diminish with time passed since migration. We tested this hypothesis by examining smoking behaviour among Turkish migrants and their children born in Germany (second-generation migrants), stratified by educational level and, for the first generation, length of residence.

Diesel motor emissions and lung cancer mortality--results of the second follow-up of a cohort study in potash miners.

Abstract: International health authorities have graded diesel motor emissions (DME) as probably cancerogenic in human beings. There are gaps in epidemiological evidence regarding exact exposure quantification, confounder control and the investigation of highly exposed populations. We investigated the association of DME ana lung cancer mortality in a historical cohort study of 5,862 German potash miners who were followed from 1970 to 2001. Cumulative exposure (CE) was measured by representative concentrations of total carbon multiplied with exposure years from the mines' medical records. Exposure and smoking behavior were validated by interviews of 3,087 participants. We computed standardized mortality ratios (SMR, external comparison) and performed Cox regression (internal comparison). The relative risk estimates (RR) with 95%-confidence intervals were adjusted for age and smoking. Vital status and causes of death were confirmed for 98.1% of participants. Sixty-one lung cancer deaths occurred. SMR-analysis showed lower than expected lung cancer mortality (healthy-worker-effect). Internal comparisons revealed risk elevations from moderate to risk doubling depending oil the exposure categories used (dichotomized: up to RR 1.43[0.67-3.03] for a CE of 4.90[mg/m(3)]*years as compared with less exposure; quintiles: RR 1.13[0.46-2.75], 2.47[1.02-6.02], 1.50[0.56-4.04] and 2.28[0.87-5.97] for a CE up to 2.04, 2.73, 3.90 and >3.90, respectively, as compared with the reference of <1.29[mg/m(3)] *years). Additional adjustment of length of follow-up leads to further RR increases and indicates healthy-worker-survivor-phenomena. The analyses of a sub-cohort (n = 3,335) with particularly accurate exposure measurement revealed a nonsignificant dose-response-relationship. Our results support an association of DME and lung cancer mortality. (C) 2008 Wiley-Liss, Inc.

Stomach cancer mortality in two large cohorts of migrants from the Former Soviet Union to Israel and Germany: are there implications for prevention?

Abstract: Objectives Prevention and early detection are key elements for the reduction of stomach cancer mortality. To apply pertinent measures effectively, high-risk groups need to be identified. With this aim, we assessed stomach cancer mortality among migrants from the Former Soviet Union (FSU), a high-risk area, to Germany and Israel. Methods We calculated standardized mortality ratios (SMRs) comparing stomach cancer mortality in two retrospective migrant cohorts from the FSU to Germany (n=34393) and Israel (n=589 388) to that in the FSU and the host country. The study period ranges from 1990 to 2005 in Germany and from 1990 to 2003 in Israel. Vital status and cause of death were retrieved from municipal and state registries. To assess secular mortality trends, we calculated annual age-standardized mortality rates in the cohorts, the FSU, and the two host countries and conducted Poisson regression modeling. Results SMRs (95% confidence intervals) for men in the German migrant cohort were 0.51 (0.36-0.70) compared with the FSU population and 1.44 (1.04-1.99) compared with the German population, respectively. For women, SMRs were 0.73 (0.49-1.03) compared with the FSU population and 1.40 (0.98-1.99) compared with the German population. SMRs for men in the Israeli migrant cohort were 0.49 (0.45-0.53) compared with the FSU population and 1.79 (1.65-1.94) compared with the Israeli population. SMRs for women in the Israeli cohort were 0.65 (0.59-0.72) compared with the FSU population and 1.82 (1.66-1.99) compared with the Israeli population. Poisson modeling showed a secular decrease in all populations with a time lag of 4-5 years between migrants and 'natives' in Germany and converging rates between migrants and the general population in Israel. Conclusion Stomach cancer mortality in migrants from the FSU remains elevated after migration to Germany and Israel but is much lower than in the FSU. Due to a secular decline, it can be expected that mortality among migrants from the FSU reaches within a few years levels similar to those of the host countries today. Therefore, migrant-specific prevention and early detection measures cannot be recommended. Detailed risk factor profiles, however, need to be obtained through further studies. Eur J Gastroenterol Hepatol 21:319-326 (C) 2009 Wolters Kluwer Health / Lippincott Williams & Wilkins.

Krankheitsbewältigung bei Menschen mit Migrationshintergrund im Kontext von Kultur und Religion

Abstract: Menschen mit Migrationshintergrund unterscheiden sich in ihrem Gesundheits- und ihrem Nutzungsverhalten im deutschen Gesundheitswesen von der einheimischen deutschen Bevolkerung. Kultur und Religion spielen neben Faktoren wie der sozialen Lage eine grose Rolle. Sie beeinflussen die wahrgenommene Bedeutung und Bewertung einer Erkrankung, sich daraus ergebende Anpassungsaufgaben und die Wahl von Bewaltigungsstrategien, was sich im Versorgungsalltag in Zugangsbarrieren manifestieren kann. Am Beispiel von turkisch-muslimischen und kurdisch-yezidischen Menschen zeigen wir die Notwendigkeit einer kultur- und religionssensiblen Versorgung. Auch innerhalb einer Nationalitatengruppe kann eine grose Heterogenitat hinsichtlich Kultur und Religion und von Gesundheitsbedurfnissen bestehen. Bisherige Modelle der Krankheitsbewaltigung berucksichtigen Kultur und Religion im Migrationskontext nicht ausreichend. Daher zeigen wir zunachst auf, wie Kultur und Religion die Krankheitswahrnehmung und -interpretation sowie das Gesundheitsverhalten beeinflussen konnen. Hieraus leiten wir Implikationen fur die Versorgung von Personen mit Migrationshintergrund und kulturellen Minderheiten ab. Nur wenn kulturelle und religiose Besonderheiten im Sinne eines Diversity Managements im klinischen Alltag berucksichtigt werden, kann eine gesundheitliche Versorgung bedarfs- und bedurfnisgerecht sein.

Dokumentation der ambulanten Morbus-Paget- Behandlung am Beispiel der Region Westfalen-Lippe

Abstract: Ziel Fur die Gesundheitsberichterstattung werden in Deutschland u. a. Daten der stationaren Krankenhausversorgung als Informationsquelle genutzt. Bei einer Vielzahl von Krankheiten spielt sich das Versorgungsgeschehen dagegen uberwiegend im ambulanten Sektor ab. Ziel der vorliegenden Untersuchung ist es, anhand ambulanter Versorgungsdaten einen ersten Uberblick uber die ambulante M.-Paget-Behandlung zu geben.

[Documentation of outpatient treatment of Paget's disease in Westphalia-Lippe. Descriptive analysis of statutory health insurance data for the year 2005].

Abstract: GOAL Inpatient health care data are often used as a source of information for health reporting in Germany, despite the fact that a lot of diseases are predominantly treated in the outpatient sector. This study provides a first overview of the outpatient care situation in relation to Paget's disease. METHOD Outpatient care data from the Association of Statutory Health Insurance Physicians constituted the database for a descriptive analysis, capturing the state of medical care for the rare rheumatic illness Paget's disease (Osteodystrophia deformans) in the region of East Westphalia-Lippe in 2005. RESULTS While the health report of North Rhine-Westphalia documents a total of 56 cases of M. Paget discharged from hospital for the year 2003, 166 patients suffering from Paget's disease consulted an practice-based physician in 2005 in the district of Detmold alone. The latter figure corresponds to 8.0 treated patients per 100.000 inhabitants. The treatment rates of men and women are comparable. The probability of treatment increases with advancing age. On average, patients with Paget's disease are 65.6 years old (SD=15.4 years). Almost 90% of the diagnoses of Paget's disease are classified as M88.9 according to ICD 10; more exact localisations are provided only for relatively few cases. Nearly a quarter of the cases (24.1%) are treated by general practitioners and internists. Anaesthetists treated 17.5% of the patients and orthopaedists 16.9%. In addition, ophthalmologists treat a considerable proportion of cases (12.0%). CONCLUSION Consistent with the rareness of Paget's disease, the treatment data are as low as expected. However, the results show that routinely collected health care data allow insights into morbidity structures within the outpatient sector. It follows that for statutory health insurants (approximately 90% of the population) there should be an extension of health reporting to diseases that are mainly treated in outpatient settings.

Migration und soziale Benachteiligung — Anforderungen an die gesundheitliche Versorgung

Abstract: Die soziale Position, die ein Mensch in der Gesellschaft einnimmt, und die daran geknupften strukturellen Vor- und Nachteile beeinflussen auch seine Gesundheit. Ein Leben in sozial benachteiligter Lage erhoht Krankheitsrisiken und verringert Gesundheitschancen. Seit den 1980er Jahren hat sich in Deutschland das Armutsrisiko der jungsten Bevolkerungs-gruppen sukzessiv erhoht. Da die Armut in den anderen Altersgruppen nicht in dem gleichen Mase gestiegen bzw. die Altersarmut eine Zeitlang sogar rucklaufig war, wird auch von einer »Infantilisierung der Armut« gesprochen. Die hochsten Armutsrisiken tragen Kinder mit 2 oder mehr Geschwistern, Kinder von allein erziehenden Muttern sowie Kinder und Jugendliche mit Migrationshintergrund (BMG — Bundesministerium fur Gesundheit, 2005).

Regionale Ungleichverteilung von Gesundheit und ihre Determinanten

Abstract: Zusammenfassung Die regionale Gleichwertigkeit der Lebensverhaltnisse ist ein sozialpolitisches Leitprinzip in Deutschland. Wahrend sich bei einem Ost-West-Vergleich Lebensverhaltnisse und gesundheitliche Situation tendenziell angleichen, zeigen sich unterhalb dieser grosraumigen Entitaten erhebliche Disparitaten. Diese haben mit groser Wahrscheinlichkeit Auswirkungen auf die Gesundheit der jeweiligen Bevolkerung. Die Analyse daraus resultierender gesundheitlicher Ungleichheiten erfordert kleinraumige sozialepidemiologische Untersuchungen. Die zentrale methodische Anforderung an solche Analysen besteht darin, gesundheitliche Ungleichheit als das Ergebnis eines kausalen Zusammenspiels sowohl okologischer als auch individueller Merkmale zu modellieren. Hierzu konnen gemischte Modelle eingesetzt werden, auch multilevel models genannt, erganzt um Verfahren der Raumlichen Statistik. Parallel dazu mussen theoretische Modelle zur Erklarung sozial bedingter gesundheitlicher Ungleichheit so weiterentwickelt werden...