title: [High mortality due to infectious diseases and unnatural causes of death among asylum seekers in the Netherlands, 1998-1999].
abstract: OBJECTIVE
  Description of causes of death among asylum seekers in the Netherlands compared to the Dutch standard population and identification of preventive measures to avoid preventable death.
  
  
  METHODS
  An analysis of the causes of death of asylum seekers accommodated in housing facilities of the Central Organ Asylum seekers (COA) for the period 1998-1999 was performed. The primary cause of death was attributed using the International Classification of Diseases (ICD-10) and grouped according to the most important causes of death list issued by Statistics Netherlands. After stratification for gender and age standardised mortality ratios (SMR) were computed.
  
  
  RESULTS
  In 82% of the observed deaths amongst asylum seekers a description of the cause and circumstances of death could be obtained. During the 2-year study period 156 asylum seekers died (of which 49 due to an unnatural cause of death and 15 due to infectious diseases). Fourteen stillbirths were registered in an index population of 37,688 in 1998 and 54,110 in 1999. The crude mortality rate was 1.95 per 1000 for male asylum seekers and 1.25 per 1000 for female asylum seekers. Compared to the Dutch standard population, the SMR was 1.23 (95%-CI: 1.01-1.42) for male asylum seekers and 0.85 (0.59-1.11) for female asylum seekers. The elevated mortality in male asylum seekers was due to the high mortality for infectious diseases with an SMR of 4.1 (1.3-6.9) and unnatural death with an SMR of 2.5 (1.7-3.2). More specifically, drowning had an SMR of 11.1 (2.3-20.7), murder and manslaughter 7.3 (2.5-12.0) and suicide 2.8 (1.5-4.1). AIDS accounted for half of the mortality due to infectious diseases.
  
  
  CONCLUSIONS
  In 1998-1999, drowning, murder, manslaughter and suicide contributed significantly to an elevated mortality rate amongst male asylum seekers in the Netherlands. Some of these unnatural deaths could be avoided by implementing preventive measures.
authors.affiliation: Medische Opvang Asielzoekers Oost, Vermeerstraat 11, 7731 SM Ommen. hkoppenaal@freeler.nl
authors.forename: H
authors.initials: H
authors.lastname: Koppenaal
authors.forename: C A
authors.initials: CA
authors.lastname: Bos
authors.forename: J
authors.initials: J
authors.lastname: Broer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003141:Communicable Diseases / Q000401:mortality*; D003710:Demography; D004332:Drowning / Q000401:mortality; D004641:Emigration and Immigration; D005260:Female; D006708:Homicide / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011157:Population Dynamics; D012036:Refugees / Q000706:statistics & numerical data*; D017678:Sex Distribution; D013223:Statistics as Topic; D013405:Suicide / Q000706:statistics & numerical data