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Published in: BMC Public Health 1/2011

Open Access 01-12-2011 | Research article

A registry-based follow-up study, comparing the incidence of cardiovascular disease in native Danes and immigrants born in Turkey, Pakistan and the former Yugoslavia: do social inequalities play a role?

Authors: Nana F Hempler, Finn B Larsen, Signe S Nielsen, Finn Diderichsen, Anne H Andreasen, Torben Jørgensen

Published in: BMC Public Health | Issue 1/2011

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Abstract

Background

This study compared the incidence of cardiovascular disease (CVD) and acute myocardial infarction (AMI) between native Danes and immigrants born in Turkey, Pakistan and the former Yugoslavia. Furthermore, we examined whether different indicators of socioeconomic status (SES), such as employment, income and housing conditions influenced potential differences.

Methods

In this registry-based follow-up study individuals were identified in a large database that included individuals from two major regions in Denmark, corresponding to about 60% of the Danish population. Incident cases of CVD and AMI included fatal and non-fatal events and were taken from registries. Using Cox regression models, we estimated incidence rates at 5-year follow-up.

Results

Immigrant men and women from Turkey and Pakistan had an increased incidence of CVD, compared with native Danish men. In the case of AMI, a similar pattern was observed; however, differences were more pronounced. Pakistanis and Turks with a shorter duration of residence had a lower incidence, compared with those of a longer residence. Generally, no notable differences were observed between former Yugoslavians and native Danes. In men, differences in CVD and AMI were reduced after adjustment for SES, in particular, among Turks regarding CVD. In women, effects were particularly reduced among Yugoslavians in the case of CVD and in Turks in the case of CVD and AMI after adjustment for SES.

Conclusions

In conclusion, country of birth-related differences in the incidence of CVD and AMI were observed. At least some of the differences that we uncovered were results of a socioeconomic effect. Duration of residence also played a certain role. Future studies should collect and test different indicators of SES in studies of CVD among immigrants.
Literature
1.
go back to reference Rafnsson SB, Bhopal RS: Large-scale epidemiological data on cardiovascular diseases and diabetes in migrant and ethnic minority groups in Europe. Eur J Public Health. 2009, 19: 484-491. 10.1093/eurpub/ckp073.CrossRefPubMed Rafnsson SB, Bhopal RS: Large-scale epidemiological data on cardiovascular diseases and diabetes in migrant and ethnic minority groups in Europe. Eur J Public Health. 2009, 19: 484-491. 10.1093/eurpub/ckp073.CrossRefPubMed
2.
go back to reference Balarajan R: Ethnic differences in mortality from ischaemic heart disease and cerebrovascular disease in England and Wales. BMJ. 1991, 302: 560-564. 10.1136/bmj.302.6776.560.CrossRefPubMedPubMedCentral Balarajan R: Ethnic differences in mortality from ischaemic heart disease and cerebrovascular disease in England and Wales. BMJ. 1991, 302: 560-564. 10.1136/bmj.302.6776.560.CrossRefPubMedPubMedCentral
3.
go back to reference Bos V, Kunst AE, Keij-Deerenberg IM, Garssen J, Mackenbach JP: Ethnic inequalities in age- and cause-specific mortality in The Netherlands. Int J Epidemiol. 2004, 33: 1112-1119. 10.1093/ije/dyh189.CrossRefPubMed Bos V, Kunst AE, Keij-Deerenberg IM, Garssen J, Mackenbach JP: Ethnic inequalities in age- and cause-specific mortality in The Netherlands. Int J Epidemiol. 2004, 33: 1112-1119. 10.1093/ije/dyh189.CrossRefPubMed
4.
go back to reference Harding S, Rosato M, Teyhan A: Trends for coronary heart disease and stroke mortality among migrants in England and Wales, 1979-2003: slow declines notable for some groups. Heart. 2008, 94: 463-470.CrossRefPubMed Harding S, Rosato M, Teyhan A: Trends for coronary heart disease and stroke mortality among migrants in England and Wales, 1979-2003: slow declines notable for some groups. Heart. 2008, 94: 463-470.CrossRefPubMed
5.
go back to reference Razum O, Akgun S, Tezcan S: Cardiovascular mortality patterns in Turkey: what is the evidence?. Soz Praventivmed. 2000, 45: 46-51. 10.1007/BF01358998.CrossRefPubMed Razum O, Akgun S, Tezcan S: Cardiovascular mortality patterns in Turkey: what is the evidence?. Soz Praventivmed. 2000, 45: 46-51. 10.1007/BF01358998.CrossRefPubMed
6.
go back to reference Wild SH, Fischbacher C, Brock A, Griffiths C, Bhopal R: Mortality from all causes and circulatory disease by country of birth in England and Wales 2001-2003. J Public Health (Oxf). 2007, 29: 191-198. 10.1093/pubmed/fdm010.CrossRef Wild SH, Fischbacher C, Brock A, Griffiths C, Bhopal R: Mortality from all causes and circulatory disease by country of birth in England and Wales 2001-2003. J Public Health (Oxf). 2007, 29: 191-198. 10.1093/pubmed/fdm010.CrossRef
7.
go back to reference Gadd M, Johansson SE, Sundquist J, Wandell P: Morbidity in cardiovascular diseases in immigrants in Sweden. J Intern Med. 2003, 254: 236-243. 10.1046/j.1365-2796.2003.01178.x.CrossRefPubMed Gadd M, Johansson SE, Sundquist J, Wandell P: Morbidity in cardiovascular diseases in immigrants in Sweden. J Intern Med. 2003, 254: 236-243. 10.1046/j.1365-2796.2003.01178.x.CrossRefPubMed
8.
go back to reference Gadd M, Johansson SE, Sundquist J, Wandell P: The trend of cardiovascular disease in immigrants in Sweden. Eur J Epidemiol. 2005, 20: 755-760. 10.1007/s10654-005-1047-2.CrossRefPubMed Gadd M, Johansson SE, Sundquist J, Wandell P: The trend of cardiovascular disease in immigrants in Sweden. Eur J Epidemiol. 2005, 20: 755-760. 10.1007/s10654-005-1047-2.CrossRefPubMed
9.
go back to reference Hedlund E, Lange A, Hammar N: Acute myocardial infarction incidence in immigrants to Sweden. Country of birth, time since immigration, and time trends over 20 years. Eur J Epidemiol. 2007, 22: 493-503. 10.1007/s10654-007-9147-9.CrossRefPubMed Hedlund E, Lange A, Hammar N: Acute myocardial infarction incidence in immigrants to Sweden. Country of birth, time since immigration, and time trends over 20 years. Eur J Epidemiol. 2007, 22: 493-503. 10.1007/s10654-007-9147-9.CrossRefPubMed
10.
go back to reference Fischbacher CM, Bhopal R, Povey C, Steiner M, Chalmers J, Mueller G, Jamieson J, Knowles D: Record linked retrospective cohort study of 4.6 million people exploring ethnic variations in disease: myocardial infarction in South Asians. BMC Public Health. 2007, 7: 142-10.1186/1471-2458-7-142.CrossRefPubMedPubMedCentral Fischbacher CM, Bhopal R, Povey C, Steiner M, Chalmers J, Mueller G, Jamieson J, Knowles D: Record linked retrospective cohort study of 4.6 million people exploring ethnic variations in disease: myocardial infarction in South Asians. BMC Public Health. 2007, 7: 142-10.1186/1471-2458-7-142.CrossRefPubMedPubMedCentral
11.
go back to reference Heuschmann PU, Grieve AP, Toschke AM, Rudd AG, Wolfe CD: Ethnic group disparities in 10-year trends in stroke incidence and vascular risk factors: the South London Stroke Register (SLSR). Stroke. 2008, 39: 2204-2210. 10.1161/STROKEAHA.107.507285.CrossRefPubMed Heuschmann PU, Grieve AP, Toschke AM, Rudd AG, Wolfe CD: Ethnic group disparities in 10-year trends in stroke incidence and vascular risk factors: the South London Stroke Register (SLSR). Stroke. 2008, 39: 2204-2210. 10.1161/STROKEAHA.107.507285.CrossRefPubMed
12.
go back to reference Stewart JA, Dundas R, Howard RS, Rudd AG, Wolfe CD: Ethnic differences in incidence of stroke: prospective study with stroke register. BMJ. 1999, 318: 967-971.CrossRefPubMedPubMedCentral Stewart JA, Dundas R, Howard RS, Rudd AG, Wolfe CD: Ethnic differences in incidence of stroke: prospective study with stroke register. BMJ. 1999, 318: 967-971.CrossRefPubMedPubMedCentral
13.
go back to reference Wolfe CD, Rudd AG, Howard R, Coshall C, Stewart J, Lawrence E, Hajat C, Hillen T: Incidence and case fatality rates of stroke subtypes in a multiethnic population: the South London Stroke Register. J Neurol Neurosurg Psychiatry. 2002, 72: 211-216. 10.1136/jnnp.72.2.211.CrossRefPubMedPubMedCentral Wolfe CD, Rudd AG, Howard R, Coshall C, Stewart J, Lawrence E, Hajat C, Hillen T: Incidence and case fatality rates of stroke subtypes in a multiethnic population: the South London Stroke Register. J Neurol Neurosurg Psychiatry. 2002, 72: 211-216. 10.1136/jnnp.72.2.211.CrossRefPubMedPubMedCentral
14.
go back to reference Khan FA, Zia E, Janzon L, Engstrom G: Incidence of stroke and stroke subtypes in Malmo, Sweden, 1990-2000: marked differences between groups defined by birth country. Stroke. 2004, 35: 2054-2058. 10.1161/01.STR.0000135761.18954.0b.CrossRefPubMed Khan FA, Zia E, Janzon L, Engstrom G: Incidence of stroke and stroke subtypes in Malmo, Sweden, 1990-2000: marked differences between groups defined by birth country. Stroke. 2004, 35: 2054-2058. 10.1161/01.STR.0000135761.18954.0b.CrossRefPubMed
15.
go back to reference Sundquist K, Li X: Coronary heart disease risks in first- and second-generation immigrants in Sweden: a follow-up study. J Intern Med. 2006, 259: 418-427. 10.1111/j.1365-2796.2006.01630.x.CrossRefPubMed Sundquist K, Li X: Coronary heart disease risks in first- and second-generation immigrants in Sweden: a follow-up study. J Intern Med. 2006, 259: 418-427. 10.1111/j.1365-2796.2006.01630.x.CrossRefPubMed
16.
go back to reference Statistics Denmark: News from Statistics Denmark: Immigrants and descendents as well as foreign citizens. Copenhagen. 2010 Statistics Denmark: News from Statistics Denmark: Immigrants and descendents as well as foreign citizens. Copenhagen. 2010
17.
go back to reference Statistics Denmark: Indvandrere i Danmark (Immigrants in Denmark). Copenhagen. 2010 Statistics Denmark: Indvandrere i Danmark (Immigrants in Denmark). Copenhagen. 2010
18.
go back to reference Folmann NB, Jørgensen T: Etniske minoriteter - sygdom og brug af sundhedsvæsenet (ethnic minorities - chonic diseases and use of healthcare services). 2007, National Board of Health. Copenhagen Folmann NB, Jørgensen T: Etniske minoriteter - sygdom og brug af sundhedsvæsenet (ethnic minorities - chonic diseases and use of healthcare services). 2007, National Board of Health. Copenhagen
19.
go back to reference Mackenbach JP, Bos V, Andersen O, Cardano M, Costa G, Harding S, Reid A, Hemstrom O, Valkonen T, Kunst AE: Widening socioeconomic inequalities in mortality in six Western European countries. Int J Epidemiol. 2003, 32: 830-837. 10.1093/ije/dyg209.CrossRefPubMed Mackenbach JP, Bos V, Andersen O, Cardano M, Costa G, Harding S, Reid A, Hemstrom O, Valkonen T, Kunst AE: Widening socioeconomic inequalities in mortality in six Western European countries. Int J Epidemiol. 2003, 32: 830-837. 10.1093/ije/dyg209.CrossRefPubMed
20.
go back to reference Agyemang C, van V, Hosper K, Nicolaou M, van den Born BJ, Stronks K: Educational inequalities in metabolic syndrome vary by ethnic group: evidence from the SUNSET study. Int J Cardiol. 2010, 141: 266-274. 10.1016/j.ijcard.2008.12.023.CrossRefPubMed Agyemang C, van V, Hosper K, Nicolaou M, van den Born BJ, Stronks K: Educational inequalities in metabolic syndrome vary by ethnic group: evidence from the SUNSET study. Int J Cardiol. 2010, 141: 266-274. 10.1016/j.ijcard.2008.12.023.CrossRefPubMed
21.
go back to reference Bhopal R, Hayes L, White M, Unwin N, Harland J, Ayis S, Alberti G: Ethnic and socioeconomic inequalities in coronary heart disease, diabetes and risk factors in Europeans and South Asians. J Public Health Med. 2002, 24: 95-105. 10.1093/pubmed/24.2.95.CrossRefPubMed Bhopal R, Hayes L, White M, Unwin N, Harland J, Ayis S, Alberti G: Ethnic and socioeconomic inequalities in coronary heart disease, diabetes and risk factors in Europeans and South Asians. J Public Health Med. 2002, 24: 95-105. 10.1093/pubmed/24.2.95.CrossRefPubMed
22.
go back to reference Bos V, Kunst AE, Garssen J, Mackenbach JP: Socioeconomic inequalities in mortality within ethnic groups in the Netherlands, 1995-2000. J Epidemiol Community Health. 2005, 59: 329-335. 10.1136/jech.2004.019794.CrossRefPubMedPubMedCentral Bos V, Kunst AE, Garssen J, Mackenbach JP: Socioeconomic inequalities in mortality within ethnic groups in the Netherlands, 1995-2000. J Epidemiol Community Health. 2005, 59: 329-335. 10.1136/jech.2004.019794.CrossRefPubMedPubMedCentral
23.
go back to reference Nielsen CP: Immigrants overeducation: Evidence from Denmark. 2007, Danish Institute of Governmental ResearchCrossRef Nielsen CP: Immigrants overeducation: Evidence from Denmark. 2007, Danish Institute of Governmental ResearchCrossRef
24.
go back to reference Everson-Rose SA, Lewis TT: Psychosocial factors and cardiovascular diseases. Annu Rev Public Health. 2005, 26: 469-500. 10.1146/annurev.publhealth.26.021304.144542.CrossRefPubMed Everson-Rose SA, Lewis TT: Psychosocial factors and cardiovascular diseases. Annu Rev Public Health. 2005, 26: 469-500. 10.1146/annurev.publhealth.26.021304.144542.CrossRefPubMed
25.
go back to reference Dhawan J, Bray CL, Warburton R, Ghambhir DS, Morris J: Insulin resistance, high prevalence of diabetes, and cardiovascular risk in immigrant Asians. Genetic or environmental effect?. Br Heart J. 1994, 72: 413-421. 10.1136/hrt.72.5.413.CrossRefPubMedPubMedCentral Dhawan J, Bray CL, Warburton R, Ghambhir DS, Morris J: Insulin resistance, high prevalence of diabetes, and cardiovascular risk in immigrant Asians. Genetic or environmental effect?. Br Heart J. 1994, 72: 413-421. 10.1136/hrt.72.5.413.CrossRefPubMedPubMedCentral
26.
go back to reference McKeigue PM, Shah B, Marmot MG: Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians. Lancet. 1991, 337: 382-386. 10.1016/0140-6736(91)91164-P.CrossRefPubMed McKeigue PM, Shah B, Marmot MG: Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians. Lancet. 1991, 337: 382-386. 10.1016/0140-6736(91)91164-P.CrossRefPubMed
27.
go back to reference Carrasco-Garrido P, Jimenez-Garcia R, Barrera VH, de Andres AL, de Miguel AG: Significant differences in the use of healthcare resources of native-born and foreign born in Spain. BMC Public Health. 2009, 9: 201-10.1186/1471-2458-9-201.CrossRefPubMedPubMedCentral Carrasco-Garrido P, Jimenez-Garcia R, Barrera VH, de Andres AL, de Miguel AG: Significant differences in the use of healthcare resources of native-born and foreign born in Spain. BMC Public Health. 2009, 9: 201-10.1186/1471-2458-9-201.CrossRefPubMedPubMedCentral
28.
go back to reference Gadd M, Sundquist J, Johansson SE, Wandell P: Do immigrants have an increased prevalence of unhealthy behaviours and risk factors for coronary heart disease?. Eur J Cardiovasc Prev Rehabil. 2005, 12: 535-541.CrossRefPubMed Gadd M, Sundquist J, Johansson SE, Wandell P: Do immigrants have an increased prevalence of unhealthy behaviours and risk factors for coronary heart disease?. Eur J Cardiovasc Prev Rehabil. 2005, 12: 535-541.CrossRefPubMed
29.
go back to reference Pudaric S, Sundquist J, Johansson SE: Major risk factors for cardiovascular disease in elderly migrants in Sweden. Ethn Health. 2000, 5: 137-150. 10.1080/713667448.CrossRefPubMed Pudaric S, Sundquist J, Johansson SE: Major risk factors for cardiovascular disease in elderly migrants in Sweden. Ethn Health. 2000, 5: 137-150. 10.1080/713667448.CrossRefPubMed
30.
go back to reference Uitewaal PJ, Manna DR, Bruijnzeels MA, Hoes AW, Thomas S: Prevalence of type 2 diabetes mellitus, other cardiovascular risk factors, and cardiovascular disease in Turkish and Moroccan immigrants in North West Europe: a systematic review. Prev Med. 2004, 39: 1068-1076. 10.1016/j.ypmed.2004.04.009.CrossRefPubMed Uitewaal PJ, Manna DR, Bruijnzeels MA, Hoes AW, Thomas S: Prevalence of type 2 diabetes mellitus, other cardiovascular risk factors, and cardiovascular disease in Turkish and Moroccan immigrants in North West Europe: a systematic review. Prev Med. 2004, 39: 1068-1076. 10.1016/j.ypmed.2004.04.009.CrossRefPubMed
31.
go back to reference Singhammer J: Etniske minoriteters Sundhed (The Health of Ethnic Minorities). Aarhus. 2008 Singhammer J: Etniske minoriteters Sundhed (The Health of Ethnic Minorities). Aarhus. 2008
32.
go back to reference Harding S: Mortality of migrants from the Indian subcontinent to England and Wales: effect of duration of residence. Epidemiology. 2003, 14: 287-292.PubMed Harding S: Mortality of migrants from the Indian subcontinent to England and Wales: effect of duration of residence. Epidemiology. 2003, 14: 287-292.PubMed
33.
go back to reference Bos V, Kunst AE, Garssen J, Mackenbach JP: Duration of residence was not consistently related to immigrant mortality. J Clin Epidemiol. 2007, 60: 585-592. 10.1016/j.jclinepi.2006.08.010.CrossRefPubMed Bos V, Kunst AE, Garssen J, Mackenbach JP: Duration of residence was not consistently related to immigrant mortality. J Clin Epidemiol. 2007, 60: 585-592. 10.1016/j.jclinepi.2006.08.010.CrossRefPubMed
34.
go back to reference Razum O, Zeeb H, Akgun HS, Yilmaz S: Low overall mortality of Turkish residents in Germany persists and extends into a second generation: merely a healthy migrant effect?. Trop Med Int Health. 1998, 3: 297-303. 10.1046/j.1365-3156.1998.00233.x.CrossRefPubMed Razum O, Zeeb H, Akgun HS, Yilmaz S: Low overall mortality of Turkish residents in Germany persists and extends into a second generation: merely a healthy migrant effect?. Trop Med Int Health. 1998, 3: 297-303. 10.1046/j.1365-3156.1998.00233.x.CrossRefPubMed
35.
go back to reference Razum O, Zeeb H: Inequity, acculturation and the 'Mediterranean paradox'. Int J Epidemiol. 2004, 33: 1411-1412. 10.1093/ije/dyh244.CrossRefPubMed Razum O, Zeeb H: Inequity, acculturation and the 'Mediterranean paradox'. Int J Epidemiol. 2004, 33: 1411-1412. 10.1093/ije/dyh244.CrossRefPubMed
36.
go back to reference Andersen TF, Madsen M, Jorgensen J, Mellemkjoer L, Olsen JH: The Danish National Hospital Register. A valuable source of data for modern health sciences. Dan Med Bull. 1999, 46: 263-268.PubMed Andersen TF, Madsen M, Jorgensen J, Mellemkjoer L, Olsen JH: The Danish National Hospital Register. A valuable source of data for modern health sciences. Dan Med Bull. 1999, 46: 263-268.PubMed
37.
go back to reference Madsen M, Davidsen M, Rasmussen S, Abildstrom SZ, Osler M: The validity of the diagnosis of acute myocardial infarction in routine statistics: a comparison of mortality and hospital discharge data with the Danish MONICA registry. J Clin Epidemiol. 2003, 56: 124-130. 10.1016/S0895-4356(02)00591-7.CrossRefPubMed Madsen M, Davidsen M, Rasmussen S, Abildstrom SZ, Osler M: The validity of the diagnosis of acute myocardial infarction in routine statistics: a comparison of mortality and hospital discharge data with the Danish MONICA registry. J Clin Epidemiol. 2003, 56: 124-130. 10.1016/S0895-4356(02)00591-7.CrossRefPubMed
38.
go back to reference Adamson J, Ben-Shlomo Y, Chaturvedi N, Donovan J: Ethnicity, socio-economic position and gender--do they affect reported health-care seeking behaviour?. Soc Sci Med. 2003, 57: 895-904. 10.1016/S0277-9536(02)00458-6.CrossRefPubMed Adamson J, Ben-Shlomo Y, Chaturvedi N, Donovan J: Ethnicity, socio-economic position and gender--do they affect reported health-care seeking behaviour?. Soc Sci Med. 2003, 57: 895-904. 10.1016/S0277-9536(02)00458-6.CrossRefPubMed
39.
go back to reference Chaturvedi N, Rai H, Ben-Shlomo Y: Lay diagnosis and health-care-seeking behaviour for chest pain in south Asians and Europeans. Lancet. 1997, 350: 1578-1583. 10.1016/S0140-6736(97)06243-0.CrossRefPubMed Chaturvedi N, Rai H, Ben-Shlomo Y: Lay diagnosis and health-care-seeking behaviour for chest pain in south Asians and Europeans. Lancet. 1997, 350: 1578-1583. 10.1016/S0140-6736(97)06243-0.CrossRefPubMed
40.
go back to reference Hedemalm A, Schaufelberger M, Ekman I: Symptom recognition and health care seeking among immigrants and native Swedish patients with heart failure. BMC Nurs. 2008, 7: 9-10.1186/1472-6955-7-9.CrossRefPubMedPubMedCentral Hedemalm A, Schaufelberger M, Ekman I: Symptom recognition and health care seeking among immigrants and native Swedish patients with heart failure. BMC Nurs. 2008, 7: 9-10.1186/1472-6955-7-9.CrossRefPubMedPubMedCentral
Metadata
Title
A registry-based follow-up study, comparing the incidence of cardiovascular disease in native Danes and immigrants born in Turkey, Pakistan and the former Yugoslavia: do social inequalities play a role?
Authors
Nana F Hempler
Finn B Larsen
Signe S Nielsen
Finn Diderichsen
Anne H Andreasen
Torben Jørgensen
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2011
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-11-662

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