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Institute of Public Health, University of PJ Safarik, Medical Faculty, Kosice, Slovakia Roma and non-Roma health in EU - main priorities Kvetoslava Rimárová

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Presentation on theme: "Institute of Public Health, University of PJ Safarik, Medical Faculty, Kosice, Slovakia Roma and non-Roma health in EU - main priorities Kvetoslava Rimárová"— Presentation transcript:

1 Institute of Public Health, University of PJ Safarik, Medical Faculty, Kosice, Slovakia Roma and non-Roma health in EU - main priorities Kvetoslava Rimárová MEHO PROJECT WP 10 "This project is funded under the framework of Public Health Programme 2003-2008 of the European Commission (contract number 2005122)"


3 Overview: Roma communities around Europe create estimated amount of 8 – 10 millions Roma people living prevalently in Eastern and Central Europe Identifying Roma as an ethnic group brings the problem due the national policy in former CEE countries where nationality is voluntary in the census and the person can conceive a nationality as a personal feeling Roma people themselves do not like to be called Roma or Gypsies, most of identification is coming from external observers featuring main visible signs

4 Estimated amount of Roma in CCE (%) Percentage in population

5 Geographic distribution of Roma population in Slovakia (official statistics by nationality) Region Citizens total Official number of Roma national Percentage of Roma (%) Bratislavský kraj599 0157550,13 Trnavský kraj551 0033 1630,57 Trenčiansky kraj605 5821 5740,26 Nitriansky kraj713 4224 7410,66 Žilinský kraj692 3322 7950,4 Banskobystrický kraj662 12115 4632,34 Prešovská kraj *789 96831 6534,01 Košický kraj766 01229 8033,89 Slovak Republic5 379 45589 9471,67 Source: Infostat Slovakia

6 reproductive health parameters cardiovascular health parameters infectious diseases Main issues for MEHO:

7 Slovak republic Czech republic Hungary, versus Romania, depends on existing data Countries

8 no national register voluntary nationality not valid (see previous graphs) no birth register no birth place identification surname classification no possible different internal categorization, some countries use also integrated, semi-, non-integrated Roma Main differences between migrants and Roma:

9 indicators possible to compare with national data or semi/country data or regional data misclassification f.e. in national registry are Roma as well as in the both of groups -- in control and in exposed, the same Roma persons are also in most cross/sectional studies questionnaires and self/evaluation very problematic different transcultral issues Indicators development:

10 Kosice, Slovakia


12 REPRODUCUTIVE HEALTH possibilities to evaluate many indicators including gender issues and woman health issues discrimination issues teenage pregnancies classical gynecological, pregnancy and newborn outcomes

13 REPRODUCTIVE PARAMETERS Sample 947 Roma and 2713 non-Roma mothers cross-sectional study data collection: 7 centre s in Slovakia, Faculty Hospital, Kosice in years 2004-2008 ongoing Underlying determinants SES, marital status, education, employment, residency Proximate determinants smoking, drinking alcohol, coffee, weight gain during pregnancy, teenage pregnancy

14 Methods 2 Mothers reproductive outcomes preterm delivery gestational age aborts spontaneous / arteficialis type of delivery spontaneous vs. other or Caesarean parity complications during pregnancy Outcomes Newborn medical outcomes newborns parameters sex of newborn birth weight / length/LBW chest / head circumference Apgar score for newborn vitality

15 Dichotomisation of variables LOW: Birth weight< 2500 g Birth length< 45 cm Chest circumference< 30 cm Head circumference< 32 cm Apgar newborn score< 9 Gestational age< 38 weeks Mothers weight increase< 10 kg Abortus spontaneous 1 Abortus artificialis 1 Primipara - 1 st delivery vs. multipara - 2 nd or other delivery Spontaneous delivery vs. Caesar section or other complications

16 Frequency of SES underlying factors between Roma and Non-Roma *** p<0,001 n.s. = not significant ***

17 Risk factorOR95% CI Rel. Risk Stat. sign. Unemployment 27,3520,2 - 37,072,44*** Elementary education 247,84175 – 35012,73*** Marital status 6,085,14 – 7,192,43*** Rural residence 3,753,19 – 4,41,88*** OR of SES – underlying factors for Roma mothers

18 Frequency of proximate factors between Roma and Non-Roma ***p<0,001 n.s. = not significant *** n.s. ***

19 OR of proximate - intermediate factors for Roma mothers Risk factorOR95% CI Rel. risk Stat. sign. Teenage mothers <19 12,618,5 – 18,7910,97*** Smoking 8,527,18 – 10,113,98*** Coffe 0,560,48 – 0,650,71n.s. Alcohol 0,860,64 – 1,160,87n.s. Low weight increase 2,111,65 – 2,701,96*** Fathers age <20 5,793,70 – 9,085,47***

20 OR and 95% CI of Roma newborns risk parameters ***p<0,001 ** p<0,01 * p<0,05 n.s. = not significant *** n.s.

21 Ethnic differences in birth weight (g) (Roma vs. Non-Roma) ADJUSTMENT Diff. SEpStat.sign. CRUDE-401(20)<0,001*** GENDER-122(11)<0,001*** BIRTH ORDER-79(7)<0,05* EMPLOYMENT-121(10)<0,001*** EDUCATION (1)-356(16)<0,001*** SMOKING (2)-316(13)<0,001*** ALCOHOL-55(9)0,12n.s. SINGLE STATUS (3)-150(18)<0,001*** RESIDENCE RURAL-142(17)<0,001*** TEENAGE MOTHER-131(12)<0,001*** ALL COVARIATES-198(10)<0,001***

22 Ethnic differences in gestational age (weeks) (Roma vs. Non-Roma) ADJUSTMENT Diff.SEpStat.sign. CRUDE-2,2(0,13)0,001*** GENDER-0,63(0,09)0,523n.s BIRTH ORDER-0,5(0,03)0,568n.s. EMPLOYMENT (3)-1,3(0,08)<0,001*** EDUCATION (2)-1,4(0,06)<0,001*** SMOKING (1)-1,9(0,12)<0,001*** ALCOHOL-0,7(0,07)0,634n.s. SINGLE STATUS-1,2(0,03)<0,001*** RESIDENCE RURAL-0,4(0,01)0,928n.s. TEENAGE MOTHER-1,2(0,04)0,05* ALL COVARIATES -1,5(0,09)< 0,001***

23 Ethnic differences in low birth weight (logistic regression) ADJUSTMENT LBW OR95% CIpStat.sign. CRUDE4,7(2,3-6,8)<0,001*** GENDER4,6(2,2-6,7)<0,001*** EMPLOYMENT4,3(2,8-5,8)<0,001*** EDUCATION3,9(2,6-4,6)<0,001*** SMOKING2,5(1,9-3,4)<0,001*** ALCOHOL1,3(0,9-3,1)0,92n.s. SINGLE STATUS2,5(1,9-3,2)<0,01** RESIDENCE1,9(1,2-3,5)<0,001** TEENAGE MOTHER2,3(1,8-3,3)<0,001*** ALL1,9(1,1-2,6)<0,001***

24 Differences in selected indicators Roma and non-Roma (ANOVA) ParameterRoma (n=947) non-Roma (n=2713)t-test p- value MeanSDMeanSD Birth weight (g)2866.9452.33267.5538.512.99*** Birth length (cm)48.42.349.72.618.22*** Head circumference (cm)33.01.734.11.619.43*** Chest circumference (cm)*** Apgar score9. Gestational age37.01.539.21.622.67***

25 Outputs 1 Between Roma and non-Roma significant differences exist in: SES – distal factors (education, unemployment, single status, rural residence,) proximate factors (smoking, teenage pregnancy, low weight increase) pregnancy outcomes (preterm delivery, low gestational age) newborn characteristics (birth weight, birth length, chest and head circumference)

26 Outputs 2 proximate factors (drinking alcohol, coffee) pregnancy outcomes (number of abortions) newborn characteristics (Apgar score) positive issues for Roma frequency of spontaneous delivers, 4x lower frequency of Caesarean section, frequency of abortions, Apgar score Between Roma and non-Roma no significant differences in:

27 the most important risk factors for birth weight reduction are education, smoking and martial status for low gestational age the risk factors are smoking, education and unemployment LBW after adjustment for all possible variables is lower in Roma Conclusions 1

28 Conclusion the results show that between Roma and non-Roma significant differences exist in, proximate and distal factors influencing on pregnancy and newborn outcomes AVAILABLE INDICATORS: birth weight and other parameters gestational age not so precise namely in Roma IUGR intrauterine growth retardation SES status

29 CARDIOVASCULAR HEALTH BMI index and others growth parameters body parameters food consumption survey evaluation of blood cholesterol triglycerides and other risk parameters risk factors as smoking, alcohol, difficult task to follow classic

30 RESULTS FROM NUTRITIONAL SURVEY cross-sectional study 2007 150 Roma school-children interview and regulated questionnaires SES smoking food frequency in the family healthy food opinions

31 Number of smoked cigarettes per family in Roma group of children CIGARETTESFREQUENCY PERCENTAGE (%) 0 - 10 cigarettes 1812,00% 10 – 20 cigarettes 6946,00% 20 and more cigarettes 6342,00% Total amount150100,00% CIGARETTES

32 Frequency of vegetables and fruit intake per week FRUIT AND VEGETABLES INTAKE FREQUENCY PERCENTAGE (%) 5 times weekly21,30% 3 times weekly4228,00% 2 times weekly7952,70% No2718,00% Total amount150100,00% FRUIT AND VEGETABLES INTAKE

33 Frequency of daily food FREQUENCY OF DAILY FOOD FREQUENCY PERCENTAGE (%) 5 times per day2617,30% 3 times per day10268,00% less than 3 times 2214,70% Total amount150100,00% FREQUENCY OF DAILY FOOD

34 Anthropometric studies cross-sectional anthropometrical survey, including basic body parameters 2007 subjects were Roma preschool and schoolchildren aged 3-12 years 710 Roma (332 boys, 378 girls), semi- segregated group compared to National Anthropometric Survey Results from 2001 (no SES) part of group TCH total cholestrol blood pressure

35 Ethnic differences in height (boys) SR - 2001Roma - 2006 Agen(cm)s (cm)n(cm)s (cm)Diff.P(95%)Sig. 3772101.135.8610 93.306.80 7.830.0054** 4477107.845.9016 100.164.21 7.680.0001*** 5581115.226.2217 105.265.10 9.960.0001*** 6492123.156.1658 111.279.17 11.880.0001*** 7884127.466.5567 111.3010.53 16.160.0001*** 8982132.726.4655 120.158.90 12.570.0001*** 9816138.536.6260 122.7010.09 15.830.0001*** 10747143.477.3638 133.046.55 10.430.0001*** 11782148.617.4918 136.836.95 11.780.0001*** 12813155.038.393 140.332.52 14.700.0097** *p<0.05 ; ** p<0.01 ; *** p<0.001

36 Conclusions use of body parameters if there is a national anthropometric survey use of local comparison and Roma possibilities to compare between countries new databases results are showing minimal difference in TCH / total cholesterol and blood pressure in Roma and local non Roma but confirming difference in body parameters

37 Problems in Roma health evaluation cross country comparison most of data are different in different countries most of data - questionnaires data medical records data not legal since policy and discrimination social factors data, level of integration planning Roma health conference sept. 2009 small monograph trying to compare Roma health data data

38 INFECTIOUS DISEASES precise vaccination survey in primary health care center 2006-2008 cross-sectional study 18 years old Roma children (300 medical vaccination reports) the Roma have 87- 92 % shots which should be done in the age of 18 delay in vaccination schedule very common between 2 shots question of antibody booster and outbreak of infection antibodies not measured Conclusion: support in regular visit of primary health care centers vaccination os mandatory, parents can be prosecuted

39 Acknowledgements Roma health research part was supported by the EU grant Public health 2007-2009 MEHO and national VEGA grant No.1231605, Slovak Republic Address for correspondence Kvetoslava Rimarova, MD, PhD. Institute of Public Health Medical Faculty University of P.J. Safarik Srobarova 2 040 01 Kosice, Slovakia "Disclaimer: The study has received funding from the European Commission under the Public Health Programme 2003-2008. However, the sole responsibility for the study lies with the author and the European Commission is not responsible for any use that may be made of the information contained therein."

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