Differences in survival and cause-specific mortality in a culturally diverse Greek population, 1999-2008.
BACKGROUND
Modern urban populations exhibit considerable internal heterogeneity. Several social groups, such as ethnic minorities or immigrants, constitute individual clusters with different demographic and epidemiological characteristics.


METHODS
Death records were collected from the Municipality Registry between 1999 and 2008. Kaplan-Meier survival analysis was conducted for (i) natively born Greeks, (ii) former USSR-repatriated Greeks and (iii) Roma. Further evaluation was conducted by log-rank (Mantel-Cox) test. Relative mortality rates were assessed by means of cross-tabulation (Pearson's χ(2)).


RESULTS
Statistically significant differences in median survival were observed among the three social groups (P < 0.001). The relative mortality from infectious diseases was higher in the Roma population compared with natively born Greeks, odds ratio (OR) = 8.31 [confidence interval (CI) 95% 3.19-21.61]. More than 70% of these deaths were attributed to respiratory tract infections and were associated with children under the age of 5. Excess mortality due to external causes, injuries and substance abuse was observed in repatriated males compared with their natively born counterparts, OR = 2.27 (CI 95% 1.35-3.81).


CONCLUSIONS
Specific public health interventions are required, to improve the survival of different cultural groups. For example, improvement of immunization status and increase in overall hygiene awareness can ameliorate high infant/childhood mortality in Roma population, while social integration can help reduce acculturation-related mortality among repatriated Greeks.
Laboratory of Hygiene and Environmental Protection, Medical Department, Democritus University of Thrace, Alexandroupolis 68100, Greece.
Christos
C
Nikolaidis
Laboratory of Hygiene and Environmental Protection, Medical Department, Democritus University of Thrace, Alexandroupolis 68100, Greece.
Evangelia
E
Nena
Laboratory of Demographic Analysis, Department of Planning and Regional Development, University of Thessaly, Volos 38334, Greece.
Michalis
M
Agorastakis
Laboratory of Hygiene and Environmental Protection, Medical Department, Democritus University of Thrace, Alexandroupolis 68100, Greece.
Theodore C
TC
Constantinidis
D000069:Acculturation; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009026:Mortality; D006178:Romani People / Q000706:statistics & numerical data; D012737:Sex Factors; D016019:Survival Analysis; D014586:USSR / Q000208:ethnology; D055815:Young Adult
acculturation; ethnicity; relative mortality; survival analysis