1. Do Roma have a comparable or worse health status than non-Roma? Assoc. Prof. JP van Dijk MD PhD Department of Community & Occupational Health University Medical Centre Groningen University of Groningen The Netherlands

2. Do Roma have a comparable or worse health status than non-Roma? Assoc. Prof. Jitse P van Dijk MD PhD Senior Lecturer ‘Social Determinants of Health’ Olomouc University Society & Health Institute Palacky University Olomouc Czech Republic

3. Do Roma have a comparable or worse health status than non-Roma? Jitse P. van Dijk, Peter Kolarcik, Katarina Rosicova, Gabriel Kolvek, Adriana Sudzinova Graduate School Kosice Institute for Society and Health Medical Faculty Safarik University, Košice Slovak Republic

4. Outline 1Introduction; aim 2Samples & measures 3Results from several studies 4Conclusion / discussion

5. Introduction Findings on Roma health status are contrasting: * no health differences compared to non-Roma; * significantly worse health A clear explanation is lacking.

6. Introduction A few years ago: Field was understudied Methodological problems with existing studies * Small numbers * No comparison at all * If comparison, then with total population - Roma included - Low SES Roma compared with average SES non-Roma

7. Introduction Also in our own findings we met problems; they could not be attributed anymore to the methodological quality of the studies Aim is to contribute to the explanation of the contrasting findings.

8. Samples & Measures Adolescents 15 yrs 330 Roma; 722 non-Roma Self-rated health Healthcare utilization Injuries Health complaints Children’s mental health (SDQ) prosocial scale total difficulties scale P Kolarcik et al., To what extent does socioeconomic status explain differences in health between Roma and non-Roma adolescents in Slovakia? Social Science & Medicine 68 (2009) 1279–1284

9. Results: Adolescent’s health after adjustment for gender, SES & social desirability non Roma 1 2 3 *** * *

10. Samples & Measures Adolescents 15 yrs 330 Roma; 722 non-Roma Smoking Drunkenness Physical inactivity P Kolarcik et al., Predictors of health-endangering behaviour among Roma and non-Roma adolescents in Slovakia by gender. J Epidemiol Community Health 2010;64:1043-1048

11. Results: Adolescent’s HRB after adjustment for SES & social desirability boys girls ** 2121 2121 *

12. Samples & measures Total population Life expectancy Roma & non-Roma K Rosicova, Data from 1) Statistical Office of the Slovak Republic; and 2) Projection of Roma population in Slovakia until 2025

13. Results: Life expectancy At birth in 2010 Males Females

14. Samples & Measures Population 0-1 yrs Per district Infant mortality, all cause Education Income Unemployment % of Roma in a district K Rosicova et al. Regional socioeconomic indicators and ethnicity as predictors of regional infant mortality rate in Slovakia. International Journal of Public Health 2011; 56: 523-531

15. Results: Infant mortality 0-1 All-cause mortality 0-1 -1 0 +1 R 2 = 36 % Education elementary Uncompleted elementary Unemployment rate Income % Roma not measurable

16. Samples & Measures Population 20-64 yrs Per district: All-cause mortality Education Income Unemployment % of Roma K Rosicova et al., Socioeconomic indicators and ethnicity as determinants of regional mortality rates in Slovakia, Int J Public Health 54 (2009) 274–282

17. Results: All-cause mortality 20-64 All-cause mortality Females 20-64 Males 20-64 -1 0 +1 R 2 = 33 % R 2 = 8 % Education third Unemployment rate Income % Roma

18. Samples & Measures Roma & non-Roma patients with ESRD All tertiary pediatric clinics + all (adult) Fresenius clinics Comparison ESRD: * Dialysis * Transplantation G Kolvek et al., End-stage renal disease among Roma and non-Roma: Roma are at risk, Int J Public Health, DOI 10.1007/s00038-012-0365-x

19. Results: ESRD Non Roma

20. Samples & Measures Patients after Coronary Angiography (CAG) Roma & non-Roma Mortality due to all causes; 5 yrs Not adjusted A Sudzinova et al., Mortality in non-Roma and Roma patients who underwent coronary angiography,

21. Results: Mortality after CAG 5 years mortality in 162 Roma and 646 non-Roma patients after coronary angiography (log-rank test: χ 2 =16.69, p<0.001)

22. Discussion Aim was to contribute to the explanation of the contrasting findings regarding Roma. * Roma adolescent’s health: picture is mixed * Roma adolescent’s HRB: M/F: no difference / less smoking, M/F: no difference drunkenness, M/F: no difference / more physical inactivity * Life expectancy Roma: M/F: shorter

23. Discussion Adults: * All-cause mortality: no contribution % Roma * ESRD: higher chance Roma in all age categories * 5 yrs all-cause mortality after CAG: Roma higher

24. Discussion For the moment: * No big difference Roma/non-Roma adolescents * Significant difference Roma/non-Roma adults * Adolescents / adults * Gender pattern?

25. Thank you for your attention!

26. QUESTIONS??