title: Ethnicity does not account for differences in the health-related quality of life of Turkish, Moroccan, and Moluccan elderly in the Netherlands.
abstract: BACKGROUND
  Data on how different groups of elderly immigrants perceive health-related quality of life (HRQOL) is scarce and research on the influence of ethnicity on HRQOL across ethnic groups is missing. Measuring HRQOL may help to detect cross-cultural differences and to decide whether ethnic-specific health and prevention programmes are required to improve HRQOL. We investigated differences in HRQOL among three elderly immigrant populations with a special focus on the contribution of ethnicity, in addition to other well-known determinants, to HRQOL.
  
  
  METHODS
  Data were collected between October 2011 and July 2012 as part of the project entitled "Stem van de oudere migrant", a quasi-experimental study in the Netherlands focussing on health of immigrant elderly. A survey was conducted among 201 elderly (aged 55 years and older) Moroccans (98), Turks (69), and Moluccans (34). HRQOL was assessed using the SF-12, measuring physical and mental health composite scores (PCS resp. MCS). Chi-square tests and ANOVAs were performed for group comparison. Hierarchical multiple linear regressions were conducted to examine whether ethnicity uniquely contributed to the observed variance in HRQOL when multimorbidity, loneliness, socio-demographics, and acculturation were taken into account.
  
  
  RESULTS
  Moroccans had the lowest scores on PCS (34.3 ± 31.4) and MCS (42.1 ± 27.0), followed by Turks (45.7 ± 27.0 for PCS and 54.7 ± 22.2 for MCS), and Moluccans (71.7 ± 21.2 for PCS and 74.4 ± 22.1 for MCS). Ethnicity was not independently associated with PCS and MCS scores, in contrast to loneliness (PCS β -0.461, p < 0.001 and MCS β -0.435, p < 0.001) and multimorbidity (PCS β -0.380, p < 0.001 and MCS β -0.398, p < 0.001). Gender was independently associated with PCS (β 0.148, p = 0.026) and attachment to Dutch culture with MCS (β 0.144, p = 0.029).
  
  
  CONCLUSIONS
  The lower level of HRQOL reported by elderly immigrant populations was affected by multimorbidity and loneliness but not ethnicity. Similar to native elders, interventions aiming at improving HRQOL for immigrant elderly should focus on loneliness and (mental and physical) disease. Finally, health literacy deserves attention to maintain health.
  
  
  BACKGROUND
  ISRCTN89447795.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, 3508 GA, the Netherlands. i.verhagen-3@umcutrecht.nl.
authors.forename: Ilona
authors.initials: I
authors.lastname: Verhagen
authors.forename: Wynand J G
authors.initials: WJ
authors.lastname: Ros
authors.forename: Bas
authors.initials: B
authors.lastname: Steunenberg
authors.forename: Niek J
authors.initials: NJ
authors.lastname: de Wit
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D054242:Emigrants and Immigrants / Q000523:psychology; D005006:Ethnicity / Q000523:psychology; D005260:Female; D054624:Health Status Disparities; D006305:Health Status Indicators; D006306:Health Surveys; D006801:Humans; D016014:Linear Models; D008132:Loneliness; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009018:Morocco / Q000208:ethnology; D009426:Netherlands; D011788:Quality of Life / Q000523:psychology; D011795:Surveys and Questionnaires; D014421:Turkey / Q000208:ethnology