Risk factors for cardiovascular and cerebrovascular diseases among ethnic Germans from the former Soviet Union: results of a nested case-control study

BMC Public Health

Heiko Becher¹  Volker Winkler¹  Ema Kuhrs¹ 

[1] Institute of Public Health, University of Heidelberg, Im Neuenheimer Feld 324, Heidelberg 69120, Germany

关键词: Soviet Union;    Aussiedler;    Migrants;    CVD-Mortality;    Risk factors;    Nested case-control study;   

Others  :  1163785
DOI  :  10.1186/1471-2458-12-190

 received in 2011-11-02, accepted in 2012-03-13,  发布年份 2012

【 摘 要 】

Background

Diseases of the circulatory system (CVD) are the most common causes of death in developed countries. However, the prevalence of CVD varies between countries; for example, the mortality rate in Russia is about four times higher than in Western Europe. In a recent retrospective cohort study it was unexpectedly found that CVD mortality is lower among "Aussiedler" (ethnic Germans from the former Soviet Union) compared to the German population.

Methods

This is a case-control study, nested into a recent cohort study of migrants from the former Soviet Union. Relatives of cases and controls themselves were interviewed by telephone using a standardized questionnaire. To estimate relative risks via the odds ratio (OR), a conditional logistic regression procedure was performed.

Results

Commonly known risk factors for CVD were identified as relevant to Aussiedler. The best multivariate model for CVD includes five risk factors: consumption of alcohol, smoking, diabetes, cholesterol and consumption of sweets. For alcohol consumption and smoking, OR = 3.68 (95% CI, 1.58-8.58) and OR = 3.07 (95% CI, 1.42-6.62), respectively. For diabetes mellitus and high cholesterol values, OR = 3.29 (95% CI, 1.50-7.39) and OR = 2.32 (95% CI, 1.11-4.88), respectively. The almost complete abdication of sweets is associated with a protective effect, OR = 0.34 (95% CI, 0.18-0.64). The prevalence of risk factors is somewhat different to that of the autochthon German population and partly explains the differences in CVD mortality between both groups.

Conclusions

The reported lower prevalences of known risk factors of CVD such as alcohol consumption, high cholesterol, diabetes and smoking (in women) could contribute to a lower risk of CVD.

【 授权许可】

   
2012 Kuhrs et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Bundesministerium des Innern (BMI): Migration und Integration. Aufenthaltsrecht, Migrations- und Integrationspolitik in Deutschland. Aktuelle Eckdaten 2008, 26.
• [2]Zeeb H, Razum O: Epidemiologische Studien in der Migrationsforschung. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2006, 49:845-852.
• [3]Pfetsch B: In Russia we were Germans, and now we are Russians. - Dilemmas of identity formation and communication among German-Russian Aussiedler. [http://skylla.wzb.eu/pdf/1999/iii99-103.pdf] webciteFS III 99-103 Veröffentlichungsreihe der Abteilung Öffentlichkeit und soziale Bewegungen des Forschungsschwerpunktes Sozialer Wandel, Institutionen und Vermittlungsprozesse des Wissenschaftszentrums Berlin für Sozialforschung 1999.
• [4]Aparicio ML, Döring A, Mielck A, Holle R, und die KORA Studiengruppe: Unterschiede zwischen Aussiedlern und der übrigen deutschen Bevölkerung bezüglich Gesundheit, Gesundheitsversorgung und Gesundheitsverhalten: eine vergleichende Analyse anhand des KORA-Surveys 2000. Soz Praventivmed 2005, 50:107-118.
• [5]Becher H, Razum O, Kyobutungi C, Laki J, Ott JJ, Ronellenfitsch U, Winkler V: Mortalität von Aussiedlern aus der ehemaligen Sowjetunion. Ergebnisse einer Kohortenstudie. Dtsch Arztebl 2007, 104(23):A-1655-A-1661.
• [6]Razum O, Zeeb H, Akgun HS, Yilmaz S: Low overall mortality of Turkish residents in Germany persists and extends into a seond generation: merely a healthy migrant effect? Trop Med Int Health 1998, 3:297-303.
• [7]Razum O, Geiger I, Zeeb H, Ronellenfitsch U: Gesundheitsversorgung von Migranten. Dtsch Arztebl 2004, 101(43):A-2882-A-2887.
• [8]Junghanss T: Asylsuchende und Flüchtlinge: Gesundheitsversorgung einer komplexen Minderheit. Soz Praventivmed 1998, 43:11-17.
• [9]Tselmin S, Korneblum W, Reimann M, Bormstein SR, Schwarz PEH: The Health Status of Russian-speaking Immigrants in Germany. Horm Metab Res 2007, 39:858-861.
• [10]Bobak M, Marmot M: East-West mortality divide and its potential explanations: proposed research agenda. BMJ 1996, 312:421-425.
• [11]Ciment J: Life expectancy of Russian men falls to 58. BMJ 1999, 319:468.
• [12]Ginter E: Cardiovascular risk factors in the former communist countries Analysis of 40 European MONICA populations. Eur J Epidemiol 1995, 11:199-205.
• [13]Lancet T: Health in Russia is broke, but who is to fix it? Lancet 1999, 353(30):337.
• [14]Leon DA, Chenet L, Shkolnikov VM, Zakharov S, Shapiro J, Rakhmanova G, Vassin S, McKee M: Huge variation in Russian mortality rates 1984-94: artefact, alcohol, or what? Lancet 1997, 350:383-388.
• [15]Federal state statistics service. Death rates by main classes of causes of death (deaths per 100 000 population) [http://www.gks.ru/bgd/regl/b08_12/IssWWW.exe/stg/d01/05-07.htm] webcite
• [16]Adler NE, Ostrove JM: Socioeconomic status and health: what we know and what we don't. Ann N Y Acad Sci 1999, 896:3-15.
• [17]Tyroler HA: The influence of socioeconomic factors on cardiovascular disease risk factor development. Prev Med 1999, 29:36-40.
• [18]Marmot MG: Socio-economic Factors in Cardiovascular Disease. J Hypertens Suppl 1996, 14:204-205.
• [19]Ronellenfitsch U, Razum O: Deteriorating health satisfaction among immigrants from Eastern Europe to Germany. Int J Equity Health 2004., 3(4) doi:10.1186/1475-9276-3-4
• [20]Ronellenfitsch U: Cardiovascular Mortality among Ethnic German Immigrants from the Former Soviet Union to Germany: a retrospective cohort study. Inauguraldissertation der Medizinischen Fakultät Heidelberg der Ruprecht-KarlsUniversität 2005.
• [21]Kawabata H, Tran M, Hines P: Using SAS ® to Match Cases for Case Control Studies. In SUGI 29. Princeton, New Jersey; 2004:173-29.
• [22]Parsons LS, Ovation Research Group: Performing a 1:N Case-Control Match on Propensity Score. In SUGI 29. Seattle, Washington; 2004:165-29.
• [23]Parsons LS: Using SAS® Software to Perform a Case-Control Match on Propensity Score in an Observational Study. In SUGI 25. Cardiovascular Outcomes Research Center, Seattle, WA; 2000:225-25.
• [24]Rosenbaum PR, Rubin D: The central role of the propensity score in observational studies for causal effects. Biometrilca 1983, 70(1):41-55.
• [25]Holle R, Happich M, Löwel H, Wichmann HE, MONICA/KORA Study Group: KORA - A Research Platform for Population Based Health Research KORA - Eine Forschungsplattform für bevölkerungsbezogene Gesundheitsforschung. Gesundheitswesen 2005, 67(1):19-S25.
• [26]Kleinbaum GD, Klein M, Logistic Regression: A Self-Learning Text. In Introduction to Logistic Regressio, Volume Kapitel 1. 2nd edition. Berlin Heidelberg: Springer-Verlag New York; 2002:13-50.
• [27]Robert Koch-Institut (RKI): Bundes-Gesundheitssurvey: Alkohol Konsumverhalten in Deutschland Beiträge zur Gesundheitsberichterstattung des Bundes. 2003, 6.
• [28]Spratt M, Carpenter J, Sterne JAC, Carlin JB, Heron J, Henderson J, Tilling K: Strategies for Multiple Imputation in Longitudinal Studies. Am J Epidemiol 2010, 172:478-487.
• [29]Statistisches Bundesamt: Mikrozensus - Fragen zur Gesundheit - Körpermaße der Bevölkerung 2009. Wiesbaden 2011, 15.
• [30]Robert Koch-Institut (RKI): Diabetes mellitus. Gesundheitsberichterstattung des Bundes. Heft 24. Berlin 2005, 11.
• [31]Robert Koch-Institut (RKI): Gesundheitsberichterstattung des Bundes. Gesundheit in Deutschland. Berlin 2006, 116.
• [32]Robert Koch-Institut (RKI): Alkoholkonsum und alkoholbezogene Störungen. Heft 40. Berlin 2008, 12.
• [33]Robert Koch-Institut (RKI): Hypertonie. Heft 43. Berlin 2008, 11.
• [34]Robert Koch-Institut (RKI): Beiträge zur Gesundheitsberichterstattung des Bundes Daten und Fakten: Ergebnisse der Studie „Gesundheit in Deutschland aktuell 2009". Berlin 2011, 106:109-112. 128
• [35]DKFZ - Deutsches Krebsforschungszentrum: Tabakatlas Deutschland 2009. Heidelberg 2009, 28.
• [36]Thefeld W: Verbreitung der Herz-Kreislauf-Risikofaktoren Hypercholesterinämie, Übergewicht, Hypertonie und Rauchen in der Bevölkerung. Robert Koch-Institut, Berlin. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2000, 43:415-423.
• [37]Grundy SM, Pasternak R, Greenland P, Smith S, Fuster V: Assessment of Cardiovascular Risk by Use of Multiple-Risk-Factor Assessment Equations. A Statement for Healthcare Professionals from the American Heart Association and the American College of Cardiology. [http://www.circulationaha.org] webciteCirculation 1999, 100:1481-1492.
• [38]Strobl R, Kühnel W: Dazugehörig und ausgegrenzt. Analysen zu Integrationschancen junger Aussiedler. Weinheim/München 2000.
• [39]Hammar N, Kaprio J, Hagstrom U, Alfredsson L, Koskenvuo M, Hammar T: Migration and mortality: a 20 year follow up of Finnish twin pairs with migrant co-twins in Sweden. J Epidemiol Community Health 2002, 56:362-366.
• [40]Nair C, Nargundkar M, Johansen H, Strachan J: Canadian cardiovascular disease mortality: first generation immigrants versus Canadian born. Health Rep 1990, 2:203-228.
• [41]Singh GK, Siahpush M: Ethnic-immigrant differentials in health behaviors, morbidity, and cause-specific mortality in the United States: an analysis of two national data bases. Hum Biol 2002, 74:83-109.
• [42]Shkolnikov VM, Andreev EM, Anson J, Mesle F: The peculiar pattern of mortality of Jews in Moscow, 1993-95. Popul Stud (Camb) 2004, 58:311-329.
• [43]Weick S: Zuwanderer in Deutschland optimistisch. Untersuchung zu Lebensbedingungen, Integration und Zufriedenheit bei Migranten. In ZUMA Publikation. ISI: Informationsdienst soziale Indikatoren Sozialberichterstattung, gesellschaftliche Trends, aktuelle Informationen; 1996::1-4.
• [44]Wilson M, Daly M: Life expectancy, economic inequality, homicide, and reproductive timing in Chicago neighbourhoods. BMJ 1997, 314:1271-1274.
• [45]Ronellenfitsch U, Kyobutungi C, Becher H, Razum O: All-cause and Cardiovascular mortality among ethnic German immigrants from the Former Soviet Union: a cohort study. BMC Public Health 2006, 6:16. BioMed Central Full Text
• [46]Nelson LM, Longstreth WT, Koepsell TD, Checkoway H, van Belle G: Completeness and Accuracy of Interview Data from Proxy Respondents: Demographic, Medical, and Life-style Factors. Epidemiology 1994, 5(2):204-217.
• [47]Ronksley PE, Brien SE, Turner BJ, Mukamal KJ, Ghali WA: Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis. BMJ 2011, 342:d671.