title: Comparative analysis of premature mortality among urban immigrants in Bremen, Germany: a retrospective register-based linkage study.
abstract: OBJECTIVE
  The main objective of this study was to explore differences in mortality patterns among two large immigrant groups in Germany: one from Turkey and the other from the former Soviet Union (FSU). To this end, we investigated indicators of premature mortality.
  
  
  METHODS
  This study was conducted as a retrospective population-based study based on mortality register linkage. Using mortality data for the period 2004-2010, we calculated age-standardised death rates (SDR) and standardised mortality ratios (SMR) for premature deaths (<age 65 years). We computed years of potential life lost (YPLL) and analysed the underlying causes of death contributing to premature mortality.
  
  
  METHODS
  In this study, we made use of the unique possibilities of register-based research in relation to migration and health. Analyses were performed in three population groups in the federal state of Bremen, Germany: immigrants from Turkey, those from the FSU and the general population.
  
  
  RESULTS
  The SDRs for premature deaths of the two immigrant groups were lower compared to those of the general population. The SMRs remained under 1. Using the indicator of YPLL, we observed higher age-standardised YPLL rates among immigrant populations, particularly among males from the FSU compared to females and population groups 4238/100,000, 95% CI (4119 to 4358). Regarding main causes of premature death, we found larger contributions of infant mortality and diseases of the respiratory system among Turkish immigrants, and of injuries and poisonings, and mental and behavioural disorders among immigrants from the FSU.
  
  
  CONCLUSIONS
  While the overall trends favour the immigrant populations, the indicator of YPLL and cause-specific results indicate areas where the healthcare systems responsiveness may need to be improved, including preventive services. Further work with broader databases providing a similar level of differentiation is necessary to substantiate these findings.
authors.affiliation: Unit of Social Epidemiology, Department Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany Department of General and Interventional Cardiology, University Medical Center Hamburg-Eppendorf (UKE), University Heart Center (UHZ), Hamburg, Germany.
authors.forename: Nataliya
authors.initials: N
authors.lastname: Makarova
authors.affiliation: Unit of Social Epidemiology, Department Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany.
authors.forename: Tilman
authors.initials: T
authors.lastname: Brand
authors.affiliation: Unit of IT, Data Management and Medical Documentation, Department of Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Brünings-Kuppe
authors.affiliation: Unit of Statistical Modelling of Primary Data, Department of Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Pohlabeln
authors.affiliation: Unit of Translational Cancer Epidemiology, Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Luttmann
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002423:Cause of Death / Q000639:trends*; D002648:Child; D002675:Child, Preschool; D003644:Death Certificates; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D061213:Mortality, Premature / Q000208:ethnology*; D011159:Population Surveillance; D012189:Retrospective Studies; D017678:Sex Distribution; D014421:Turkey / Q000208:ethnology; D014586:USSR / Q000208:ethnology; D055815:Young Adult
keywords: Access and quality in healthcare; EPIDEMIOLOGY; Former Soviet Union; Migrant health; Premature mortality; Turkey