title: Does poorer self-rated health mediate the effect of Roma ethnicity on mortality in patients with coronary artery disease after coronaro-angiography?
abstract: OBJECTIVE
  The aim of this prospective cohort study was to assess the effect of Roma ethnicity and self-rated health (SRH) on 9-year all-cause mortality in patients with coronary artery disease (CAD) after coronaro-angiography (CAG), and whether SRH mediates the effect of ethnicity.
  
  
  METHODS
  623 patients (103 Roma) were included. We obtained data from medical records and patients interviews. A Cox regression model adjusted for age, gender and education was used to analyze the effect of Roma ethnicity on mortality, as well as potential mediation by SRH.
  
  
  RESULTS
  Roma ethnicity and poor SRH were predictors of increased mortality in patients with CAD, with hazard rates (95 % confidence intervals) 2.34 (1.24; 4.42) and 1.81 (1.02; 3.21). Adding education decreased the size of ethnic differences in mortality. The mediating effect of SRH on the association of ethnicity with mortality was not statistically significant; neither modified ethnicity the effect of SRH.
  
  
  CONCLUSIONS
  Poor SRH does not mediate the higher mortality among Roma patients after CAG even though it indicates an increased risk of mortality. Roma patients with CAD have to be referred for special cardiological care earlier.
authors.affiliation: Cardiology Clinic, East Slovakian Institute for Cardiac and Vascular Diseases, Ondavska 8, 040 01, Kosice, Slovak Republic. asudzinova@vusch.sk.|Graduate School Kosice Institute for Society and Health, Safarik University, Kosice, Slovak Republic. asudzinova@vusch.sk.
authors.forename: Adriana
authors.initials: A
authors.lastname: Sudzinova
authors.affiliation: Graduate School Kosice Institute for Society and Health, Safarik University, Kosice, Slovak Republic.
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Rosenberger
authors.affiliation: Department of Community and Occupational Health, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Roy E
authors.initials: RE
authors.lastname: Stewart
authors.affiliation: Graduate School Kosice Institute for Society and Health, Safarik University, Kosice, Slovak Republic.|Department of Community and Occupational Health, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Jitse P
authors.initials: JP
authors.lastname: van Dijk
authors.affiliation: Department of Community and Occupational Health, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Sijmen A
authors.initials: SA
authors.lastname: Reijneveld
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000428:Alcohol Drinking / Q000208:ethnology; D000792:Angiography; D015992:Body Mass Index; D003324:Coronary Artery Disease / Q000208:ethnology* / Q000401:mortality* / Q000601:surgery; D005260:Female; D015438:Health Behavior; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006178:Romani People; D057566:Self Report; D012737:Sex Factors; D012907:Smoking / Q000208:ethnology; D012959:Socioeconomic Factors
keywords: Coronary angiography; Coronary artery disease; Mortality; Roma ethnicity; Self-rated health