Mortality of ethnic German immigrants from the former Soviet Union in Germany – The AMOR study
Project team: Volker Winkler, Heiko Becher, Simone Kaucher, Valentina Leier
former members: Andreas Deckert, Ema Kuhrs
Funding: own funds
Funding period: 2000-ongoing
Since the breakdown of the communist regimes in Eastern Europe in the late 1980s, almost 2.9 million Ethnic Germans, so-called Spätaussiedler, and their descendants migrated from Eastern European countries to Germany. Factors potentially influencing the health of the Aussiedler in Germany are:
· The high mortality in Eastern Europe and especially in the countries of the Former Soviet Union (FSU).
· Their presumed socio-economical disadvantage compared to native Germans
· The high mortality from external causes especially suicide among males in the FSU.
Thus, it can be expected that their health status is worse compared to the entire German population, confirmed by a higher mortality, especially for the aforementioned causes. This hypothesis was tested within a large epidemiological study, the first of its kind on the health of this population group. We established a cohort of 34,393 out of 218,356 eligible Aussiedler who settled in North Rhine Westphalia (NRW) from the FSU between 1990 and 2001 and accomplished first follow-up until 31.12.2002. Overall, 1805 deaths were observed with 2004,2 expected, yielding an SMR of 0.90 (95% CI: 0.85-0.95). Thus, the overall mortality was significantly lower than expected.
We observed 104 deaths from external causes (23 females and 81 males) with an SMR of 1.60 and 1.04, respectively, which is a significant increase in males. In a further analysis, number of residential changes after migration was analyzed to be a predictor for suicide and other external cause mortality. We found that the risk to die from external causes increases with number of residential changes which could be caused by social disintegration. Regression analysis also shows that time to death from suicide is 2.5 times shorter than death from other causes.
With regard to cardiovascular diseases 731 cohort members had died of CVD. The cause-specific SMR was 0.79 (95%CI 0.71-0.88) in males and 0.86 (95%CI 0.78-0.95) in females. In contrast to our hypothesis, CVD mortality among Aussiedler was lower than in Germany’s general population.
Males have comparable overall cancer mortality to the German population while females have lower mortality. The respective SMR are 0.98 (95% CI: 0.88-1.11) and 0.77 (95% CI: 0.67-0.87). However, the SMR for all cancers does not reflect differences in SMR for different cancer sites as shown. The SMR for lung cancer in males and for stomach cancer are greater than one. In contrast, SMR for cancers of the reproductive system is less than one and significantly for cancers of prostate and breast (females).
Today research is based on three different cohort studies further investigating mortality trends among Aussiedler.
Ronellenfitsch U, Razum O: Deteriorating health satisfaction among immigrants from Eastern Europe to Germany. Int J Equity Health 2004;3:4.
Ronellenfitsch U, Kyobutungi C, Becher H, Razum O: Large-scale, population-based pidemiological studies with record linkage can be done in Germany. Eur J Epidemiol 2004;19:1073-1074.
Kyobutungi C, Ronellenfitsch U, Razum O, Becher H: Mortality from cancer among ethnic German immigrants from the Former Soviet Union, in Germany. Eur J Cancer 2006;42:2577-84.
Kyobutungi C, Ronellenfitsch U, Razum O, Becher H: Mortality from external causes among ethnic German immigrants from former Soviet Union countries, in Germany. European Journal of Public Health 2006;16:376-382.
Ronellenfitsch U, Kyobutungi C, Becher H, Razum O: All-cause and Cardiovascular mortality among ethnic German immigrants from the Former Soviet Union: A cohort study. BMC Public Health 2006;Jan 26;6:16.
Becher H, Razum O, Kyobutungi C, Laki J, Ott JJ, Ronellenfitsch U, Winkler V. Mortalität von Aussiedlern aus der ehemaligen Sowjetunion: Ergebnisse einer Kohortenstudie. Deutsches Ärzteblatt 2007; 104: A:1655-61
Ott JJ, Winkler V, Kyobutungi C, Laki J, Becher H: Effects of residential changes and time patterns on external cause mortality in migrants: Results of a German cohort study. Scandinavian Journal of Public Health 2008; 36:524-31.