Mortality among non-western migrants in The Netherlands

Mortality among 10 groups of non-western migrants to The Netherlands, observed in the period 1995-2000, is compared with mortality among people who were born in and whose parents were born in The Netherlands. The migrant groups concerned consisted of people who were born in, or whose parents were born in Turkey, Morocco, Surinam, The Netherlands Antilles, Ghana, Somalia, Iraq, Iran, Afghanistan and Vietnam. Differences in mortality were adjusted for age, marital status, region, degree of urbanization, and socioeconomic status. Despite the fact that most migrants originate from countries with a substantially higher mortality rate than The Netherlands, most groups had similar or more favourable total mortality rates than native Dutch people. Men from Turkey and Surinam had slightly elevated mortality rates and men and women from Somalia had a notably higher mortality rate than native Dutch people. The generally favourable mortality rates among migrants are the result of two compensating phenomena: higher mortality among young migrants than among young native Dutch people, and lower mortality among elderly migrants than among elderly native Dutch people. An analysis of cause-of-death patterns revealed relatively low mortality from cardiovascular diseases, cancer and respiratory diseases in most migrant groups, and relatively high mortality from infectious diseases and injuries. These findings are unlikely to have been influenced by incomplete registration of mortality. Selective migration may play a role--some migrant groups have a relatively high level of education for example. Also some of the findings may be explained by a difference in timing between the health benefits and the health risks of migration. Migrant health could be benefiting from the favourable socioeconomic, public health and health-care conditions in The Netherlands, but not yet be affected by the higher risks of cancer and cardiovascular disease associated with prosperity.     

Imported skin diseases

In two Dutch subjects who had been on holiday in the tropics, a woman aged 32 and a man of Surinam descent aged 52 years, and in two men aged 21 and 38 years who had arrived from the tropics in the Netherlands, one recently and one 15 years previously, import skin diseases were diagnosed: larva migrans cutanea, cutaneous leishmaniasis, mycetoma and lobomycosis. The diagnosis was based on the anamnesis, the clinical picture and histopathological findings. The patients were cured by administration of antimicrobial agents and (or) excision. When travellers or immigrants from the tropics present with skin lesions, an imported skin disease should be considered.     

Assessment of dietary intake among Moroccan women and Surinam men

Objective. To establish a method for food consumption data collection in ethnic groups in the Netherlands. Methods. Two pilot studies have been carried out, one among Moroccan women and one among Surinam men. First, focus group discussions were held to obtain background information from members of the target population. For food consumption assessment 2 2 24-h recall was chosen. Furthermore, background information on age, place of birth, frequency of visits to Morocco or Surinam, Dutch language skills, meal pattern, food purchases and antropometric measurements were taken. Results. It was found that the diets of both Moroccan women and Surinam men tended to approach the recommended daily intake of macronutrients more than the average intake of a Dutch person. However, reported energy and micronutrient intake on the second day of the dietary recall was lower than on the first recall day. Conclusion. The 24-h recall is a suitable method for food consumption measurements among Moroccan and Surinam people. On the other hand, the interviewer must be aware of potential under-reporting, especially during the second recall.     

Suicide among migrant populations and native Dutch in The Netherlands

OBJECTIVE: To determine the differences in suicide mortality between native Dutch and migrant groups in the Netherlands from different countries and regions of origin, taking the differences in age structure into account. DESIGN: Retrospective. METHODS: Data from the statistics on causes of death from the Dutch Central Bureau of Statistics, Statistics Netherlands (CBS), based on the causes of death given in the certificates from the doctor or forensic pathologist, were coupled to the reports of death from the Municipal Population Registration (GBA). In this way, the country of origin of the deceased could be determined. The confidentiality of these data is regulated by law. For the period 1996-2004, all 13,737 persons were selected who had committed suicide (International classification of diseases (ICD)-10-codes X60-X84). The country of origin was determined on the basis of data on the country of birth of the deceased and his or her parents. Someone is a 'migrant' ('foreign') according to the definition of the CBS if at least one of the parents was born outside the Netherlands. RESULTS: There were substantial differences in suicide mortality between migrant groups in the Netherlands. These differences reflected, to some extent, suicide mortality patterns in the countries and regions of origin. On the whole, migrants originating from western countries showed suicide mortality rates that were well above the average rate for native Dutch. High suicide rates were seen in male migrants from southern and eastern Europe. On the other hand, suicide mortality was significantly lower among Turks and Moroccans than among native Dutch. Only young adult males of non-western origin, with the exception of Moroccans, were much more likely to commit suicide than native Dutch. CONCLUSION: Although much attention has recently been paid to the elevated rates of attempted suicide among young women from Surinam, their suicide mortality was increased less than that of men from Surinam up to middle age. These increased suicide rates may reflect high levels of mental illness, identity problems, disappointments related to the process of migration, high expectations with respect to education, work and income, and the responsibilities for a family.     

Systematic home screening for Chlamydia trachomatis infections of asymptomatic men and women in family practice by means of mail-in urine samples]

OBJECTIVE: To determine the prevalence and determinants of Chlamydia trachomatis (CT) infections among asymptomatic men and women in general practice. To determine participation rates in a systematic screening programme in general practice, using home obtained mailed urine samples. DESIGN: Cross-sectional study. METHODS: In 15 general practices in Amsterdam, the Netherlands, a sample of 11,005 persons (5541 women and 5464 men), aged 15-40 were invited to send in a urine sample and a completed questionnaire by mail. The urine samples were tested using the ligase chain reaction for DNA amplification. Patients diagnosed with CT were treated and partner notification was performed. RESULTS: 33% of invited males (1809/5464) and 50% of females (2751/5541) sent in the study material. Older patients participated more frequently than younger patients. Participation rates among persons with a Dutch background were higher than rates among persons from other ethnic groups. In 42 men and 79 women a CT infection was identified (2.3% and 2.9% respectively). Infections were more prevalent in patients from Surinam and the Dutch Antilles and in the age category 21-25 years. Type of health insurance as a proxy measure of socioeconomic status was not an indicator of infection. CONCLUSION: The participation in this systematic screening using mail-sent urine samples was 33% in men and 50% in women. The CT prevalences among asymptomatic men and women were 2.3% and 2.9% respectively.     

Increase of malaria among migrants in Amsterdam-Zuidoost

In a general practice in Amsterdam Southeast in 1998 a delayed first attack of Plasmodium ovale infection was diagnosed in a 13-year-old girl from Ghana, malaria tropica with a low parasitaemia index in a 43-year-old Ghanaian man and a 8-year-old Ghanaian girl, and Plasmodium vivax infection in a 44-year-old Surinam woman. The Ghanaian patients had visited their native country, the Surinam woman had contracted the infection during a visit to India. All patients responded well to antimalaria medication. These patients were among a total of 6 patients of non-Dutch origin diagnosed with malaria in 1998 in this general practice. Four patients had not taken any prophylactic drug and two had not used the drugs properly. A relative increase of malaria in immigrants has been seen in the Netherlands and elsewhere in Europe in recent years. Underestimation of the risks and lack of knowledge of malaria and of the changing epidemiology make people of ethnic minorities travel without taking appropriate precautions. New, creative ways of communication and information will have to be explored to reach these migrant communities.     

Hidden explanations for ethnic differences in suicidal behaviour

A recent study indicates that there are substantial differences in suicide mortality between native Dutch and migrant groups in the Netherlands. Of the major non-western migrant groups in the Netherlands, suicide mortality was significantly lower among Turks and Moroccans, whereas it was higher among migrants from Surinam. Suicide figures were higher in men than in women, but the ethnic groups differed in this respect. The determinants of these differences are largely unknown. We can only speculate as to why the incidence is so markedly above or below average in certain groups. The mental, cultural and social factors that play a role here are presumably multiple and mutually interconnected, so that only further and more detailed research can provide an answer. The numbers and patterns do, however, call for extra attention and alertness.     

Changing risk profile of hepatitis A in The Netherlands: a comparison of seroprevalence in 1995-1996 and 2006-2007

The prevalence of antibodies to hepatitis A virus (HAV) was assessed in a nationwide sample (n=6229) in The Netherlands in 2006-2007, and compared to the seroprevalence in a similar study in 1995-1996 (n=7376). The overall seroprevalence increased from 34% in 1995-1996 to 39% in 2006-2007, mainly due to vaccination of travellers and an increased immigrant population. Risk factors remain travelling to, and originating from, endemic regions, and vaccination is targeted currently at these risk groups. Our results show a trend of increasing age of the susceptible population. These people would also benefit from HAV vaccination because they are likely to develop clinically serious symptoms after infection, and are increasingly at risk of exposure through imported viruses through foods or travellers. The cost-effectiveness of adding elderly people born after the Second World War as a target group for prophylactic vaccination to reduce morbidity and mortality after HAV infection should be assessed.     

Use of health care services by ethnic minorities in The Netherlands: do patterns differ?

BACKGROUND: This article examines the nature of ethnic differences in health care utilisation by assessing patterns of use in addition to single service utilisation. METHODS: Data were derived from the Second Dutch National Survey of General Practice. A nationally representative sample of 104 general practices participated in this survey. Data on health and health service utilisation were collected through face-to-face interviews. Based on a random sample per practice, a total of 12 699 Dutch-speaking people were interviewed, regardless of ethnic background. An additional study among a random sample of 1339 people from the four largest minority groups in The Netherlands was conducted. These four groups comprised people from Turkey, Surinam, Morocco, and The Netherlands Antilles. Multilevel analyses were performed to investigate ethnic differences in health care utilisation, adjusting for socio-economic status, health status, and level of urbanisation. RESULTS: Differences in utilisation patterns were particularly marked for people with a Moroccan, Turkish, or Antillean background. Compared to the other groups, Surinamese were more likely to have had contact with any professional health care service. No evidence was found that the gate keeping role of general practitioners in The Netherlands functions less effectively among the ethnic minority groups as compared to the indigenous population. CONCLUSION: The analysis of patterns of utilisation proved to supply useful information concerning the relationship between ethnicity and use of health care services in addition to figures concerning single service use only.     

Sexually transmissible disorders in allochtonous population groups; a pilot study

In the registration of sexually transmitted diseases (STD) carried out by the nursing staff in the STD clinics the share of the immigrant populations of Turkish, Moroccan, Surinam and Antilles origin was investigated for the period 1986-89. In the total population of STD patients the immigrants appear to be overrepresented. Their share has increased from one-eight to one-fifth of the total number of STD cases. The STD rates (number of cases per 1000) for the Turkish and Moroccan populations are high, even after adjusting for population size and age. High STD rates are most apparent among males, especially among Turkish males. In comparison with the Dutch population more gonorrhoea is found among immigrants, in particular penicillinase producing Neisseria gonorrhoeae (PPNG). Turkish males (and prostitutes) contributed much to this relatively high prevalence. Further research is to be initiated in order to obtain better insight into the occurrence of STD among immigrant populations in The Netherlands, especially in connection with a potentially increased risk of infection with Human Immunodeficiency Virus (HIV).     

Iodide excretion before and after revision of goiter prophylaxis (Dutch Nutrition Surveillance System).

To assess the iodine supply in The Netherlands after the revision of the goiter prophylaxis measures (Bread Act of 1982, with an increase of iodine content of bread salt) the data of a nationwide survey among Dutch elderly people conducted in 1984/1985 were analysed. Iodide excretion in 24 h urine samples was used as the main iodine status indicator. The data were compared with data on iodine nutriture obtained among an elderly population in The Netherlands before the revision of goiter prophylaxis. High prevalences (greater than or equal to 37%) of low iodine excretion (less than 0.78 mumol/24 h; 100 micrograms/24 h) were found for Dutch elderly people. Mean urinary iodide excretion was 0.95 mumol/24 h (121 micrograms/24 h) for men and 0.79 mumol/24 h (100 micrograms/24 h) for women which is low, especially among women, in comparison with the United States recommended dietary allowance (118 mumol/day = 150 micrograms/day). Consistent positive associations of iodide excretion were found with urinary potassium and sodium excretion, bread consumption and total iodine intake. Bread, as the iodine carrier chosen for goiter prophylaxis in The Netherlands, was found to be the main dietary iodine source. No improvement in iodine nutrition was found among the elderly studied in 1984/1985 in comparison with an elderly population seen in 1981. Therefore, it is concluded that the present measures regarding goiter prophylaxis in The Netherlands might be of limited effectiveness.     

Limited tuberculin screening participation amongst travellers to countries with high tuberculosis incidence; reason to consider BCG vaccination for some travellers

OBJECTIVE: To determine the compliance amongst Dutch travellers to high tuberculosis-incidence countries with a screening procedure involving a tuberculin skin test before and after the trip. DESIGN: Prospective study. METHOD: Nine hundred and eighty-eight tuberculin-negative Dutch people who travelled to high tuberculosis-incidence countries for 3 to 12 months were studied for their compliance with an advised screening procedure of repeat tuberculin skin testing 2 to 4 months after return. At 2 of the 4 participating health services, data were also collected on extra calls made and the pertinent time investments. RESULTS: Five hundred and ninety-nine travellers (61%) were compliant with the screening procedure. Of those for whom the data was available (n = 417), 33% (98/300) of the compliant travellers required extra calls. These took an average of 30 min per extra traveller tested as a result. Compliance varied according to health service and was better amongst travellers to Africa. In addition, non-compliance was independently associated with male sex, work being the main travel purpose, and an undecided duration of travel on departure. CONCLUSIONS: Compliance of Dutch travellers with tuberculin skin-test screening is limited, particularly if no extra calls are issued. Bacillus Calmette-Guérin vaccination appears to be preferable for travellers with undecided travel duration and persons travelling for work on a frequent basis.     

Sustained low prevalence of meticillin-resistant Staphylococcus aureus upon admission to hospital in The Netherlands

The prevalence of meticillin-resistant Staphylococcus aureus (MRSA) carriage at hospital admission in The Netherlands was 0.03% in 1999–2000. The aim of the present study was to assess whether the prevalence of MRSA carriage in The Netherlands has changed over the last few years. In five Dutch hospitals, 6496 unique patients were screened for nasal S. aureus carriage at hospital admission by microbiological culture between 1 October 2005 and 7 June 2007. In total, 2036 of 6496 (31.3%) patients carried S. aureus in their nose, and seven of 6496 (0.11%) patients were nasal carriers of MRSA. Compared with 1999–2000, the prevalence of MRSA carriage in the Dutch population at hospital admission has increased more than three fold; however, this increase was not significant (P = 0.06, Fisher’s exact test). This prevalence is still among the lowest in the world, probably as a result of the stringent Dutch infection control policy, and the restrictive use of antibiotics in The Netherlands.     

The prevalence of type 2 diabetes and gestational diabetes mellitus in an inner city multi-ethnic population

'Zeeburg', a multiethnic town borough in the Amsterdam-East region, has one of the city's highest rates of immigrants. In the total population of 19,825 Surinam (mainly Creole), Turkish, Moroccan, and Dutch adults the prevalence of known type 2 diabetes in 1994 and of gestational diabetes mellitus (GDM) between January 1992 and January 1997 was investigated. Based on World Health Organization (WHO) criteria of 1985, the age-standardized prevalence of type 2 diabetes was similar in men (6.4%; 95% confidence interval [CI]: 5.6–7.2) and women (6.4%; 95% CI: 5.8–7.0) for all ethnic groups combined. However, the age- and sex-standardized prevalence of type 2 diabetes was significantly greater in the non-Dutch inhabitants than in the Dutch inhabitants (17.3% [95% CI: 12.9–21.6] in Surinam inhabitants, 10.9% [95% CI: 9.7–12.2] in Turkish inhabitants, 12.4% [95% CI: 9.7–15.0] in Moroccan inhabitants, and 3.6% [95% CI: 3.2–3.9] in Dutch inhabitants. The odds ratios for type 2 diabetes for the separate immigrant groups relative to the Dutch group were 5.88 (95% CI: 4.54–7.69) for Surinam inhabitants, 4.00 (95% CI: 2.86–5.55) for Turkish inhabitants, and 4.17 (95% CI: 3.03–5.55) for Moroccan inhabitants. GDM was present in 2.59% of women of non-Dutch origin compared with 0.62% of women of Dutch origin. A significant positive association was found between the non-Dutch origin and the occurrence of GDM (²=6.7; p < 0.01). The study highlights a high prevalence of known type 2 diabetes and GDM in the immigrant inhabitants and emphasizes that appropriate interventions are necessarily with implications for health targets and capitation based budgets.     

Hepatitis B and C: in view of the treatment options, priority should be given to reaching the groups at risk

There are now effective treatments for both hepatitis B and C. For hepatitis B, a highly effective vaccine is available that is in common use in the Netherlands for the prevention of infection in the children of HBsAg-positive mothers. In the Dutch policy regarding viral hepatitis, a key role is given to contact with the groups at risk. The problem with this is that an individual must first acknowledge, on the basis of the information that is available and known to him or her, that he or she is at risk before becoming eligible for the next step, such as vaccination or a screening study. Immigration, sexual transmission and trips to endemic areas are important factors in the dissemination of hepatitis B in the Netherlands. For a vaccination policy that is based on the approach to groups at risk, the challenge is to achieve at least 80% coverage of the relevant groups, such as travellers and homosexual men. The situation is comparable for hepatitis C: a hepatitis that progresses slowly in the course of 20-30 years but is still asymptomatic at the beginning can be completely cured, provided that drug treatment is started on time. The challenge here is again to reach the highly varied groups at risk. Specifically for hepatitis C, a major campaign, supported by the Dutch Health Council, was started in 2007.     

Contributions of the Netherlands and its colonies to the knowledge of the cause of leprosy in the 19th century

OBJECTIVE: To determine the Dutch contributions to the formulation of the concept that leprosy is an infectious disease. DESIGN: Literature study. METHOD: A search for relevant publications was made in the Nederlands Tijdschrift voor Geneeskunde (Dutch journal of Medicine; NTvG) and the Geneeskundig Tijdschrift voor Nederlandsch-Indi? (Medical Journal of the Dutch Indies; GTNI) with the aid of the search terms 'lepra [leprosy]', 'lepra Arabum [Arab leprosy]', 'melaatsheid [leprosy]' and 'elephantiasis Graecorum [Greek elephantiasis]'. In addition, on the basis of references in the publications in the NTvG and the GTNI, as well as via searches in the catalogues of the Royal Library in The Hague and the libraries of Dutch universities, an inventory was made of the Dutch medical dissertations and other monographs on leprosy, as well as the medical historical review articles, from the 19th century. RESULTS: For a long time, physicians described the aetiology of leprosy in terms of 'a substrate' to which all sorts of mixtures of infection, heredity and hygiene contributed. From the middle of the 19th century onwards, this explanatory model with multiple possible solutions gave way to a controversy between two explanatory models: heredity as an 'anti-contagious' principle versus contagiosity. These two explanatory models were mutually exclusive in their universal aspirations. The debate in the Netherlands took place in the field of tension between European concepts on the one hand and on the other hand ideas and practices resulting from the interaction between the Netherlands and its colonies. Inspired in part by the writings of the Dutch physician C L Drognat Landré, who based his contagion theory on observations in Surinam, the Norwegian G. H. A. Hansen discovered the leprosy bacillus in 1873. It was not until 1897, at the international leprosy conference in Berlin, however, that consensus was to be reached on leprosy being an infectious disease. CONCLUSION: An essential contribution to the development of the contemporary ideas as to the cause of leprosy was made from the Netherlands.     

Ethnic inequalities in age- and cause-specific mortality in The Netherlands

BACKGROUND: By describing ethnic differences in age- and cause-specific mortality in The Netherlands we aim to identify factors that determine whether ethnic minority groups have higher or lower mortality than the native population of the host country. METHODS: We used data for 1995-2000 from the municipal population registers and cause of death registry. All inhabitants of The Netherlands were included in the study. The mortality of people who themselves or whose parent(s) were born in Turkey, Morocco, Surinam, or the Dutch Antilles/Aruba was compared with that of the native Dutch population. Mortality differences were estimated by Poisson regression analyses and by directly standardized mortality rates. RESULTS: Compared with native Dutch men, mortality was higher among Turkish (relative risk [RR] = 1.21, 95% CI: 1.16, 1.26), Surinamese (RR = 1.24, 95% CI: 1.19, 1.29), and Antillean/Aruban (RR = 1.25, 95% CI: 1.15, 1.36) males, and lower among Moroccan males (RR = 0.85, 95% CI: 0.81, 0.90). Among females, inequalities in mortality were small. In general, mortality differences were influenced by socio-economic and marital status. Most minority groups had a high mortality at young ages and low mortality at older ages, a high mortality from ill-defined conditions (which is related to mortality abroad) and external causes, and a low mortality from neoplasms. Cardiovascular disease mortality was low among Moroccan males (RR = 0.51, 95% CI: 0.44, 0.59) and high among Surinamese males (RR = 1.13, 95% CI: 1.05, 1.21) and females (RR = 1.14, 95% CI: 1.06, 1.23). Homicide mortality was elevated in all groups. CONCLUSION: Socio-economic factors and marital status were important determinants of ethnic inequalities in mortality in The Netherlands. Mortality from cardiovascular diseases, homicide, and mortality abroad were of particular importance for shifting the balance from high towards low all-cause mortality.