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Is self-rated health lower in refugees in the Netherlands compared to other migrants?

Devillé, W., Groenewegen, P. Is self-rated health lower in refugees in the Netherlands compared to other migrants? European Journal of Public Health: 2004, 14(4 Suppl.) 97. Abstract. 12 th Annual EUPHA meeting: Urbanisation and health: new challenges in health promotion and prevention in Oslo, Norway, 7-9 october 2004.
Background: Self-rated health is a good predictor of morbidity, mortality and use of care. It can be measured by one simple question. As such it is included in many surveys in many countries, making general health measurements comparable between countries. Besides the four major migrant populations from Surinam, Netherlands Antilles, Turkey and Morocco, refugees from many countries are looking for a new life in the Netherlands. Differences in self-rated health may be partly due to personal characteristics as gender, age, education, socioeconomical status, ethnicity, period of stay in the host country and family size. Aim: The aim of this analysis is to look how self-rated health in refugees differs from the major migrant groups in the Netherlands. A second aim is to study to what extend possible differences between these groups may be explained by personal characteristics. Methods: The Second Dutch National Survey of General Practice collected during a one page mailed census in four languages personal information from 294.877 persons (response 76,5%) on the list of a representative sample of 104 GP practices. Among these people were 7430 adult migrants of the major migrant groups and 1434 adults from refugee countries, who arrived in the Netherlands during the last 15 years. The following personal characteristics were registered: country of birth, year of arrival in the Netherlands, age, gender, education, civil status, working situation, type of work, household and GP practice. Self-rated health of refugees is compared to the major migrant populations, adjusted for background variables. In a multilevel analysis households and GP practices will be taken into account. Results: Among refugees 8.9% rated their health as (very) poor, compared to 9.1% among migrants (p=0.2). This is not different for women or men. Self-rated health is associated
with age, but not differently between migrants and refugees. Controlled for age and gender, self-rated health is different between major migrants groups and refugees (p=0.046). Self-rated health is associated with education, civil status, working situation and type of work. All factors remain in a multivariate regression model (Adjusted R2 = 0.17), self-rated health being different between major migrants groups and refugees at p=0.002. But there is interaction with gender: only in men self-rated health remains significantly different (p=0.001) in the full model (Adjusted R2 = 0.18). Conclusions: Self-rated health is assessed worse in refugees when age and gender are taken into consideration. Differences in civil status, education, working situation and type of work explain partly these differences in male refugees. Further analysis should study which factors may explain these differences between male and female refugees: it might be caused e.g. by education or more refugee women being housewives and not working outside their households. Contextual factors may
play a role too. All municipalities in the Netherlands had up to now to take their share of refugees and make social housing available. Characteristics of social structure and population composition differ between municipalities and neighbourhoods.