Does socioeconomic status fully mediate the effect of ethnicity on the health of Roma people in Hungary?
BACKGROUND
Several models have been proposed to explain the association between ethnicity and health. It was investigated whether the association between Roma ethnicity and health is fully mediated by socioeconomic status in Hungary.


METHODS
Comparative health interview surveys were performed in 2003-04 on representative samples of the Hungarian population and inhabitants of Roma settlements. Logistic regression models were applied to study whether the relationship between Roma ethnicity and health is fully mediated by socioeconomic status, and whether Roma ethnicity modifies the association between socioeconomic status and health.


RESULTS
The health status of people living in Roma settlements was poorer than that of the general population (odds ratio of severe functional limitation after adjustment for age and gender 1.8 (95% confidence interval 1.4 to 2.3)). The difference in self-reported health and in functionality was fully explained by the socioeconomic status. The less healthy behaviours of people living in Roma settlements was also related very strongly to their socioeconomic status, but remained significantly different from the general population when differences in the socioeconomic status were taken into account, (eg odds ratio of daily smoking 1.6 (95% confidence interval 1.3 to 2.0) after adjustment for age, gender, education, income and employment).


CONCLUSIONS
Socioeconomic status is a strong determinant of health of people living in Roma settlements in Hungary. It fully explains their worse health status but only partially determines their less healthy behaviours. Efforts to improve the health of Roma people should include a focus on socioeconomic status, but it is important to note that cultural differences must be taken into account in developing public health interventions.
Vokó
Z
Z
Department of Preventive Medicine, Medical and Health Sciences Centre, University of Debrecen, Kassai, Hungary. z.voko@sph.dote.hu
Csépe
P
P
Németh
R
R
Kósa
K
K
Kósa
Z
Z
Széles
G
G
Adány
R
R
D000293:Adolescent; D000328:Adult; D004032:Diet / Q000208:ethnology; D004522:Educational Status; D005260:Female; D015438:Health Behavior; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D006178:Romani People / Q000706:statistics & numerical data*; D012907:Smoking / Q000208:ethnology; D012923:Social Class; D055815:Young Adult