title: Stomach cancer mortality in two large cohorts of migrants from the Former Soviet Union to Israel and Germany: are there implications for prevention?
abstract: OBJECTIVE
  Prevention and early detection are key elements for the reduction of stomach cancer mortality. To apply pertinent measures effectively, high-risk groups need to be identified. With this aim, we assessed stomach cancer mortality among migrants from the Former Soviet Union (FSU), a high-risk area, to Germany and Israel.
  
  
  METHODS
  We calculated standardized mortality ratios (SMRs) comparing stomach cancer mortality in two retrospective migrant cohorts from the FSU to Germany (n=34,393) and Israel (n=589,388) to that in the FSU and the host country. The study period ranges from 1990 to 2005 in Germany and from 1990 to 2003 in Israel. Vital status and cause of death were retrieved from municipal and state registries. To assess secular mortality trends, we calculated annual age-standardized mortality rates in the cohorts, the FSU, and the two host countries and conducted Poisson regression modeling.
  
  
  RESULTS
  SMRs (95% confidence intervals) for men in the German migrant cohort were 0.51 (0.36-0.70) compared with the FSU population and 1.44 (1.04-1.99) compared with the German population, respectively. For women, SMRs were 0.73 (0.49-1.03) compared with the FSU population and 1.40 (0.98-1.99) compared with the German population. SMRs for men in the Israeli migrant cohort were 0.49 (0.45-0.53) compared with the FSU population and 1.79 (1.65-1.94) compared with the Israeli population. SMRs for women in the Israeli cohort were 0.65 (0.59-0.72) compared with the FSU population and 1.82 (1.66-1.99) compared with the Israeli population. Poisson modeling showed a secular decrease in all populations with a time lag of 4-5 years between migrants and 'natives' in Germany and converging rates between migrants and the general population in Israel.
  
  
  CONCLUSIONS
  Stomach cancer mortality in migrants from the FSU remains elevated after migration to Germany and Israel but is much lower than in the FSU. Due to a secular decline, it can be expected that mortality among migrants from the FSU reaches within a few years levels similar to those of the host countries today. Therefore, migrant-specific prevention and early detection measures cannot be recommended. Detailed risk factor profiles, however, need to be obtained through further studies.
authors.affiliation: Department of Surgery, University Medicine Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany. ulrich.ronellenfitsch@chir.ma.uni-heidelberg.de
authors.forename: Ulrich
authors.initials: U
authors.lastname: Ronellenfitsch
authors.forename: Catherine
authors.initials: C
authors.lastname: Kyobutungi
authors.forename: Jördis Jennifer
authors.initials: JJ
authors.lastname: Ott
authors.forename: Ari
authors.initials: A
authors.lastname: Paltiel
authors.forename: Oliver
authors.initials: O
authors.lastname: Razum
authors.forename: Matthias
authors.initials: M
authors.lastname: Schwarzbach
authors.forename: Volker
authors.initials: V
authors.lastname: Winkler
authors.forename: Heiko
authors.initials: H
authors.lastname: Becher
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004812:Epidemiologic Methods; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D017678:Sex Distribution; D013274:Stomach Neoplasms / Q000208:ethnology / Q000401:mortality* / Q000517:prevention & control; D014171:Transients and Migrants / Q000706:statistics & numerical data; D014586:USSR / Q000208:ethnology; D055815:Young Adult