Stronks, K.

A cross-national comparative study of metabolic syndrome among non-diabetic Dutch and English ethnic groups (Article)

2013-01-01T00:00:00Z

Background: Evidence suggests a higher prevalence of type 2 diabetes (T2D) in The Netherlands than in England, although generalized obesity prevalence is substantially lower in The Netherlands. Metabolic syndrome (MS) is more strongly associated with the risk of progression to T2D than generalized obesity. Therefore examining MS may help to better understand the differences in T2D between the two countries. We assessed whether the Dutch and English differences in T2D prevalence reflect similar differences in MS in Whites, South-Asian Indians and African-Caribbeans living in these two countries. Methods: Secondary analyses of population-based studies of 3010 participants aged 35–60 years. Metabolic syndrome was defined according to the International Diabetes Federation criteria. Prevalence ratios (PRs) were estimated using regression models. Results: In general, the Dutch ethnic groups had a higher prevalence of MS than their English counterparts. Adjusted PRs were 1.37[95% confidence interval (CI)1.03–1.82] and 1.52 (1.06–2.19) in White-Dutch men and women compared to White-English men and women; 2.20 (1.14–4.26) and 1.46 (0.96–2.24) in Dutch-African-Caribbean men and women compared to English-African-Caribbean men and women and 0.97 (0.74–1.27) and 1.42 (1.00–2.03) in Dutch-Indian men and women compared with their English-Indian peers, respectively. Similar patterns were also observed for some MS components, e.g. raised fasting glucose in men and central obesity in women. Conclusion: The comparatively high prevalence of MS among Dutch ethnic groups may contribute to their high prevalence of T2D. The high levels of some MS components, e.g. raised fasting glucose in men and central obesity in women add to the high prevalence of MS in Dutch ethnic groups.

Perceived discrimination outside health care settings and health care utilization of Turkish and Moroccan GP patients in the Netherlands (Article)

2012-01-01T00:00:00Z

Background: Problematic interethnic relationships, expressed by feelings of discrimination, may contribute to ethnic variations in health and health care utilization. The impact of daily perceived discrimination on (mental) health has been shown. Less is known about the effect of everyday discrimination on the health care utilization. We examined the relationship between perceived discrimination of Turkish and Moroccan patients on GP health care utilization in the Netherlands and on health services use in the home country. Methods: Cohort study within the second Dutch National Survey of General Practice (2001). Interviews were conducted with 416 Turkish and 381 Moroccan respondents, and repeated in 2005 among respectively 118 and 102 participants. Linear, logistic and zero-inflated binomial regression models were used for the analyses. Results: Perceived discrimination was associated with non-attendance to the GP. Perceived quality of GP care was not a mediator in this relationship. No evidence was found for substitution of health care utilization in the home country to health care in the host country. GP attenders had higher odds of using health care in the home country than non-attenders. Over time, a lasting discrimination feeling was related to persistent non-attendance at the GP practice. Conclusion: Ethnic minority patients who feel discriminated may avoid GP health care. Further research is warranted on magnitude and health effects of such potential underutilization. Information on perceived discrimination within health care settings would increase insight into the profile of non-attenders, and on possible measures to better target interventions at a group at risk of underutilization.

The effect on mental health of a large scale psychosocial intervention for survivors of mass violence: A quasi-experimental study in Rwanda (Article)

2011-08-11T00:00:00Z

Background: War has serious and prolonged mental health consequences. It is argued that post-emergency mental health interventions should not only focus on psychological factors but also address the social environment. No controlled trials of such interventions exist. We studied the effect on mental health of a large scale psychosocial intervention primarily aimed at social bonding in post-genocide Rwanda. The programme is implemented at population level without diagnostic criteria for participation. It is open to any person older than 15 years, and enables participation of over 1500 individuals per year. We postulated that the mental health of programme participants would improve significantly relative to non-participants. Methods and Findings: We used a prospective quasi-experimental study design with measurement points pre and post intervention and at 8 months follow-up. 100 adults from both sexes in the experimental condition entered the study; follow-up measurements were taken from 81. We selected a control group of 100 respondents with similar age, sex and symptom score distribution from a random community sample in the same region; of these, 73 completed the study. Mental health was assessed by use of the Self Reporting Questionnaire (SRQ-20), a twenty item instrument to detect common mental disorders in primary health care settings. Mean SRQ-20 scores decreased by 2.3 points in the experimental group and 0.8 in the control group (p = 0.033). Women in the experimental group scoring above cut-off at baseline improved with 4.8 points to below cut-off (p<0.001). Men scoring above cut-off at baseline showed a similar trend which was statistically non-significant. No adverse events were observed. Conclusions: A large scale psychosocial intervention primarily aimed at social bonding caused a lasting improvement of mental health in survivors of mass violence in Rwanda. This approach may have a similar positive effect in other post-conflict settings. Trial Registration: Nederlands Trial Register 1120.

Diabetes prevalence in populations of South Asian Indian and African origins: A comparison of england and the Netherlands (Article)

2011-07-01T00:00:00Z

Background: We determined whether the overall lower prevalence of type II diabetes in England versus the Netherlands is observed in South-Asian-Indian and African-Caribbean populations. Additionally, we assessed the contribution of health behavior, body size, and socioeconomic position to observed differences between countries. Methods: Secondary analyses of population-based standardized individual-level data of 3386 participants were conducted. Results: Indian and African-Caribbean populations had higher prevalence rates of diabetes than whites in both countries. In crosscountry comparisons (and similar to whites), Indians residing in England had a lower prevalence of diabetes than those residing in the Netherlands; the prevalence ratio (PR) was 0.35 (95% confidence interval = 0.22 to 0.55) in women and 0.74 (0.50 to 1.10) in men after adjustment for other covariates. Among people of African descent as well, diabetes prevalence was lower in England than in the Netherlands; for women, PR = 0.43 (0.20 to 0.89) and for men, 0.57 (0.21 to 1.49). Conclusions: The increasing prevalence of diabetes after migration may be modified by the context in which ethnic minority groups live.

Dutch versus English advantage in the epidemic of central and generalised obesity is not shared by ethnic minority groups: comparative secondary analysis of cross-sectional data (Article)

2011-02-15T00:00:00Z

Background:Ethnic minority groups in Western European countries tend to have higher levels of overweight than the majority populations for reasons that are poorly understood. Investigating relative differences between countries could enable an investigation of the importance of national context in determining these inequalities. Objective:To explore: (1) whether Indian and African origin populations in England and the Netherlands are similarly disadvantaged compared with the White populations in terms of the prevalence of overweight and central obesity; (2) whether the previously known Dutch advantage of relatively low overweight prevalence is also observed in Dutch ethnic minority groups and (3) the contribution of health behaviour and socio-economic position to the differences observed. Methods:Secondary analyses of population-based studies of 16 406 participants from England and the Netherlands. Prevalence ratios were estimated using regression models. Results:Except for African men, ethnic minority groups in both countries had higher rates of overweight and central obesity than their White counterparts. However, the Dutch minority groups were relatively more disadvantaged than English minority groups as compared with the majority populations. The Dutch advantage of the low prevalence of obesity was only seen in White men and women and African men. In contrast, English-Indian (prevalence ratio=0.87, 95% confidence interval (CI): 0.81-0.93) and English-Caribbean (prevalence ratio=0.82, 95% CI: 0.76-0.89) women were less centrally obese than their Dutch equivalents. The Dutch-Indian men were very similar to the English-Indian men. The contribution of health behaviour and socio-economic position to the observed differences were small. Conclusion:Contrary to the patterns in White groups, the Dutch ethnic minority women were more obese than their English equivalents. More work is needed to identify factors that may contribute to these observed differences.International Journal of Obesity advance online publication, 15 February 2011; doi:10.1038/ijo.2010.281.

Pilot study evaluating the effects of an intervention to enhance culturally appropriate hypertension education among healthcare providers in a primary care setting (Article)

2010-05-14T00:00:00Z

Background: To improve hypertension care for ethnic minority patients of African descent in the Netherlands, we developed a provider intervention to facilitate the delivery of culturally appropriate hypertension education. This pilot study evaluates how the intervention affected the attitudes and perceived competence of hypertension care providers with regard to culturally appropriate care.Methods: Pre- and post-intervention questionnaires were used to measure the attitudes, experienced barriers, and self-reported behaviour of healthcare providers with regard to culturally appropriate cardiovascular and general care at three intervention sites (N = 47) and three control sites (N = 35).Results: Forty-nine participants (60%) completed questionnaires at baseline (T0) and nine months later (T1). At T1, healthcare providers who received the intervention found it more important to consider the patient's culture when delivering care than healthcare providers who did not receive the intervention (p = 0.030). The intervention did not influence experienced barriers and self-reported behaviour with regard to culturally appropriate care delivery.Conclusion: There is preliminary evidence that the intervention can increase the acceptance of a culturally appropriate approach to hypertension care among hypertension educators in routine primary care.

The effect of neighbourhood income and deprivation on pregnancy outcomes in Amsterdam, The Netherlands (Article)

2009-09-01T00:00:00Z

Background: Studies suggest that the neighbourhoods in which people live influence their health. The main objective of this study was to investigate the associations of neighbourhood-level income and unemployment/social security benefit on pregnancy outcomes: preterm delivery, small for gestational age (SGA), pregnancy-induced hypertension (PIH) and miscarriage/perinatal death in Amsterdam. Methods: A random sample of 7883 from 82 neighbourhoods in Amsterdam. Individual-level data from the Amsterdam Born Children and their Development (ABCD) study were linked to data on neighbourhood-level factors. Multilevel logistic regression was used to estimate odds ratios and neighbourhood-level variance. Results: After adjustment for individual-level factors, women living in low-income neighbourhoods (third, second and first quartiles) were more likely than women living in high-income neighbourhoods (fourth quartile) to have SGA births: OR 1.32 (95% CI 1.04 to 1.68), 1.42 (1.11 to 1.82) and 1.62 (1.25 to 2.08) respectively. Women living in the quartile of neighbourhoods with the highest unemployment/social security benefit were more likely than those living in the quartile with the lowest unemployment/social security benefit to have SGA births 1.36 (1.08 to 1.72). The neighbourhood-level variance was significant only for SGA births. No significant associations were found between neighbourhood-level factors and other pregnancy outcomes. Conclusion: The findings suggest that neighbourhood income and deprivation are related to SGA births. More research is needed to explore possible mechanisms underlying poor neighbourhood environment and pregnancy outcomes, in particular through stress mechanisms. Such information might be necessary to help improve maternal and fetal health.

Design and evaluation of a regional perinatal audit (Article)

2008-04-01T00:00:00Z

Objective: To describe the experiences of a regional audit of perinatal deaths, including the experiences of the audit members, to discuss similarities and differences with other, existing perinatal audits and to summarize the implications for future implementation. Study design: Perinatal audit with blinded regional auditors. Consecutive cases of perinatal death were analysed for the presence of substandard care. A random selection of cases was reviewed by an external audit panel. The prevalence of substandard care in the Amsterdam audit was compared with other, existing audits. A survey among audit members was executed. Results: Care providers from all Amsterdam hospitals, as well as general practitioners and independent midwives cooperated. One hundred thirty-seven perinatal deaths were reviewed. In 25% of all perinatal death cases, substandard care factors were present. After 23 completed weeks substandard care factors were present in 35% of cases, and in 52% of intrapartum deaths. These figures are comparable with other, non-regional oriented audits. The review of the external panel was also comparable to the review of the regional audit committee. All audit members felt secure to discuss freely the presence of substandard care. Conclusion: First systematic experiences with a regional perinatal audit are described. We conclude that a regional perinatal audit is executable. Cooperation of regional care providers is good. Review of substandard care factors is comparable to other, non-regional oriented perinatal audits.

The development of a strategy for tackling health inequalities in the Netherlands. (Article)

2004-10-23T00:00:00Z

Over the past decade, the Dutch government has pursued a research-based approach to tackle socioeconomic inequalities in health. We report on the most recent phase in this approach: the development of a strategy to reduce health inequalities in the Netherlands by an independent committee. In addition, we will reflect on the way the report of this committee has influenced health policy and practice.A 6-year research and development program was conducted which covered a number of different policy options and consisted of 12 intervention studies. The study results were discussed with experts and policy makers. A government advisory committee developed a comprehensive strategy that intends to reduce socioeconomic inequalities in disability-free life expectancy by 25% in 2020. The strategy covers 4 different entry-points for reducing socioeconomic inequalities in health, contains 26 specific recommendations, and includes 11 quantitative policy targets. Further research and development efforts are also recommended.Although the Dutch approach has been influenced by similar efforts in other European countries, particularly the United Kingdom and Sweden, it is unique in terms of its emphasis on building a systematic evidence-base for interventions and policies to reduce health inequalities. Both researchers and policy-makers were involved in the process, and there are clear indications that some of the recommendations are being adopted by health policy-makers and health care practice, although more so at the local than at the national level.

A strategy for tackling health inequalities in the Netherlands (Article)

2002-01-01T00:00:00Z

Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 1738, 3000 DR Rotterdam, Netherlands. mackenbach@mgz.fgg.eur.nl

Explaining educational differences in mortality: the role of behavioral and material factors (Article)

1999-01-01T00:00:00Z

OBJECTIVES: This study examined the role of behavioral and material factors in explaining educational differences in all-cause mortality, taking into account the overlap between both types of factors. METHODS: Prospective data were used on 15,451 participants in a Dutch longitudinal study. Relative hazards of all-cause mortality by educational level were calculated before and after adjustment for behavioral factors (alcohol intake, smoking, body mass index, physical activity, dietary habits) and material factors (financial problems, neighborhood conditions, housing conditions, crowding, employment status, a proxy of income). RESULTS: Mortality was higher in lower educational groups. Four behavioral factors (alcohol, smoking, body mass index, physical activity) and 3 material factors (financial problems, employment status, income proxy) explained part of the educational differences in mortality. With the overlap between both types of factors accounted for, material factors were more important than behavioral factors in explaining mortality differences by educational level. CONCLUSIONS: The association between educational level and mortality can be largely explained by material factors. Thus, improving the material situation of people might substantially reduce educational differences in mortality.

Role of childhood health in the explanation of socioeconomic inequalities in early adult health (Article)

1998-01-01T00:00:00Z

STUDY OBJECTIVE: To examine the contribution of childhood health to the explanation of socioeconomic inequalities in health in early adult life. DESIGN: Retrospective data were used, which were obtained from a postal survey in the baseline of a prospective cohort study (the Longitudinal Study on Socio-Economic Health Differences in the Netherlands). Adult socioeconomic status was indicated by educational level, while health was indicated by perceived general health. Childhood health was measured by self reported periods of severe disease in childhood. Relations were analysed using logistic regression models. The reduction in odds ratios of "less than good" perceived general health for different educational groups after adjustment for childhood health was used to estimate the contribution of childhood health. SETTING: The population of the city of Eindhoven and surroundings in the south east of the Netherlands in 1991. PARTICIPANTS: 2511 respondents, aged 25-34 years, men and women, of Dutch nationality, were included in the analysis. MAIN RESULTS: There was a clear association between childhood health and adult health, as well as an association between childhood health and adult socioeconomic status. Approximately 5% to 10% of the increased risk of the lower socioeconomic groups of having a "less than good" perceived general health can be explained by childhood health. CONCLUSIONS: Childhood health contributes to the explanation of socioeconomic inequalities in early adult health. Although this contribution is not very large, it cannot be ignored and has to be interpreted largely in terms of selection on health.

Does childhood socioeconomic status influence adult health through behavioural factors? (Article)

1998-01-01T00:00:00Z

BACKGROUND: The purpose of this study is to assess to what extent the effect of childhood socioeconomic status on adult health could be explained by a higher prevalence of unhealthy behaviour among those with lower childhood socioeconomic status. METHODS: Data were obtained from the baseline of a prospective cohort study in the Netherlands (13 854 respondents, aged between 25 and 74). Childhood socioeconomic group was indicated by occupation of the father, and adult health was indicated by perceived general health, health complaints and mortality. Adult socioeconomic status was measured by current occupation. Behavioural factors were smoking, alcohol consumption, Body Mass Index and physical activity. Relations were analysed using logistic regression models. RESULTS: A clear association between childhood socioeconomic circumstances and adult health was shown, as well as an association between childhood socioeconomic circumstances and health-related behaviour, even after adjustment for current socioeconomic status. Physical activity shows the strongest relation with childhood socioeconomic circumstances. Behavioural factors explain the relation between childhood socioeconomic status and adult health for approximately 10%. CONCLUSIONS: Childhood socioeconomic circumstances have an independent effect on adult health and health-related behaviour: the risk of health problems and health damaging behaviour is higher in lower childhood socioeconomic groups. The independent effect of childhood circumstances on adult health operates for a small part through unhealthy behaviour.

Socioeconomic inequalities in health in the working population: the contribution of working conditions (Article)

1998-01-01T00:00:00Z

BACKGROUND: The aim was to study the impact of different categories of working conditions on the association between occupational class and self-reported health in the working population. METHODS: Data were collected through a postal survey conducted in 1991 among inhabitants of 18 municipalities in the southeastern Netherlands. Data concerned 4521 working men and 2411 working women and included current occupational class (seven classes), working conditions (physical working conditions, job control, job demands, social support at work), perceived general health (very good or good versus less than good) and demographic confounders. Data were analysed with logistic regression techniques. RESULTS: For both men and women we observed a higher odds ratio for a less than good perceived general health in the lower occupational classes (adjusted for confounders). The odds of a less than good perceived general health was larger among people reporting more hazardous physical working conditions, lower job control, lower social support at work and among those in the highest category of job demands. Results were similar for men and women. Men and women in the lower occupational classes reported more hazardous physical working conditions and lower job control as compared to those in higher occupational classes. High job demands were more often reported in the higher occupational classes, while social support at work was not clearly related to occupational class. When physical working conditions and job control were added simultaneously to a model with occupational class and confounders, the odds ratios for occupational classes were reduced substantially. For men, the per cent change in the odds ratios for the occupational classes ranged between 35% and 83%, and for women between 35% and 46%. CONCLUSIONS: A substantial part of the association between occupational class and a less than good perceived general health in the working population could be attributed to a differential distribution of hazardous physical working conditions and a low job control across occupational classes. This suggests that interventions aimed at improving these working conditions might result in a reduction of socioeconomic inequalities in health in the working population.

Socio-economic inequalities in health : individual choice or social circumstances? (Doctoral Thesis)

1997-04-16T00:00:00Z

Being in good health is seen as one of the most valuable goods in life. Therefore it is viewed as unfair that certain groups within society, for example unmanied people or some ethnic groups, do not appeal' to enjoy an equal share of good health compared to other sections of the population. The perceived injustice is even more emphatic if differences in health correspond with the distribution of other goods (see Schuyt 1987). This is the case with inequalities in health between socio-economic groups which are the focus of this thesis. Empirical studies in many countries show that people who are worst off as far as their socio-economic position is concerned are also worst off when it comes to health. This thesis addresses the background of these socio-economic inequalities in health as well as the consequences for health policy. This chapter contains a brief introduction to the concept of social stratification and specifies roughly the objectives of this thesis.

The interrelationship between income, health and employment status (Article)

1997-01-01T00:00:00Z

BACKGROUND: The aim of the study was to test the hypothesis that the relatively strong association between income and health compared to that between education/occupation and health, can partly be interpreted in terms of an association between employment status and health. METHODS: Health indicators used were the prevalence of one or more chronic conditions, and perceived general health. Data were generated from a postal survey, part of the baseline data collection of a Dutch prospective cohort study on socioeconomic inequalities in health. RESULTS: After controlling for differences in other socioeconomic indicators, the association between income and health was found to be stronger than that between occupation or education and health. Most of the difference in strength was found to be due to employment status, especially among men. Controlling for employment status, and controlling for the distribution of those with a long-term work disability in particular, reduced the risks of lower income groups, whereas the risks of lower educational and occupational groups hardly changed. CONCLUSIONS: These results suggest that the relatively strong association between income and health can for a large part be interpreted in terms of an interrelationship between employment status, income and health. More specifically, it is largely due to the concentration of the long-term disabled in lower income groups. This indicates the importance of the selection mechanism, as these groups are excluded from paid employment because of their health status, leading to a lowering of income. However, income was still found to be related to perceived general health after controlling for employment status especially among women. This suggests that an explanation in terms of an effect of material factors on health may also be important.