Cardiovascular Health and Related Health Care Use of Moluccan-Dutch Immigrants

Abstract

ObjectiveStudies regularly show a higher incidence, prevalence and mortality of cardiovascular disease among immigrant groups from low-income countries. Despite residing in the Netherlands for over 60 years, the Moluccan-Dutch cardiovascular disease profile and health care use are still unknown. We aimed to compare (a) the clinical prevalence of cardiovascular diseases and (b) the use of health care services by cardiovascular disease patients of 5,532 Moluccan-Dutch to an age-sex matched control group of 55,320 native Dutch.MethodsWe performed a cross-sectional analysis of data of the Achmea health insurance company for the period of 1 January 2009 to 31 December 2010. We collected information on health care use, including diagnostic information. Linear and logistic regression models were used for comparison.ResultsMoluccans had a higher clinical prevalence of ischemic heart diseases (odds ratio 1.26; 95% confidence interval 1.03–1.56), but tended to have a lower prevalence of cerebrovascular accidents (0.79; 0.56–1.11) and cardiac failure (0.67; 0.44–1.03). The clinical prevalence of cardiovascular diseases together tended to be lower among Moluccans (0.90; 0.80–1.00). Consultation of medical specialists did not differ. Angiotensin II inhibitors (1.42; 1.09–1.84), antiplatelet agents (1.27; 1.01–1.59) and statins (1.27; 1.00–1.60) were prescribed more frequently to Moluccans, as were cardiovascular agents in general (1.27; 0.94–1.71).ConclusionThe experience of Moluccans in the Netherlands suggests that, in the long run, cardiovascular risk and related health care use of ethnic minority groups may converge towards that of the majority population.

A systematic review of the use of health services by immigrants and native populations

“…Distribution of studies regarding publication year was as follows: 8 studies published in 2013 [ 17 , 22 – 24 , 27 , 28 , 41 , 42 ], 15 in 2014 [ 14 – 16 , 19 , 21 , 30 , 32 , 33 , 35 , 36 , 38 , 40 , 43 , 44 , 47 ], 10 in 2015 [ 13 , 18 , 25 , 26 , 29 , 31 , 34 , 45 , 46 , 48 ] and 3 in 2016 [ 20 , 37 , 39 ]. The majority of the publications analysed data from European countries (28; 78%), both North and Central (12) (Norway [ 13 – 15 , 19 , 20 ], Denmark [ 45 ], Sweden [ 35 ], the Netherlands [ 17 , 32 , 34 , 40 ] and Austria [ 41 ]) and South Europe (15) (France [ 22 , 36 ], Italy [ 18 , 24 , 29 , 37 , 43 ], Spain [ 23 , 27 , 28 , 31 , 38 , 39 , 46 ] and Portugal [ 33 ]) and 1 from the UK [ 26 ]. Seven papers (19%) explored this issue in North America (2 from USA [ 30 , 34 ] and 5 from Canada [ ...…”

“…The majority of the publications analysed data from European countries (28; 78%), both North and Central (12) (Norway [ 13 – 15 , 19 , 20 ], Denmark [ 45 ], Sweden [ 35 ], the Netherlands [ 17 , 32 , 34 , 40 ] and Austria [ 41 ]) and South Europe (15) (France [ 22 , 36 ], Italy [ 18 , 24 , 29 , 37 , 43 ], Spain [ 23 , 27 , 28 , 31 , 38 , 39 , 46 ] and Portugal [ 33 ]) and 1 from the UK [ 26 ]. Seven papers (19%) explored this issue in North America (2 from USA [ 30 , 34 ] and 5 from Canada [ 16 , 21 , 25 , 47 , 48 ]); and 1 (3%) in Asia (Singapore) [ 42 ] (see Fig. 2 ).…”

“…Geographical coverage of the studies has some variation: 21 performed at the national level [ 13 – 15 , 17 , 19 – 22 , 28 , 30 , 32 , 34 – 36 , 38 , 40 , 41 , 45 – 48 ], 10 at a regional level [ 16 , 18 , 23 , 25 – 27 , 29 , 31 , 37 , 44 ], 3 at a local level [ 28 , 33 , 42 ] and 1 multi-country study [ 39 ] with data from a regional level of 1 country and the national level of the other. There were only 4 longitudinal studies (2 prospective [ 18 , 42 ] and 2 retrospective [ 27 , 43 ]) and 1 case-control study [ 35 ].…”

“…The largest number of papers (18) used information from administrative [ 13 – 16 , 18 – 20 , 23 , 25 , 29 , 33 , 35 , 37 , 39 , 43 ] or insurance system databases [ 32 , 34 ] and specific hospital registries [ 28 ] as source of information. Among the 16 papers (44.4%) that analysed healthcare surveys, where people report their individual healthcare use, 14 studies used population-based surveys which were elaborated for other purposes [ 17 , 21 , 22 , 24 , 26 , 30 , 36 , 38 , 40 , 44 , 46 – 48 ] while 3 of the surveys were specifically designed to explore immigrants healthcare use [ 31 , 41 , 42 ].…”

Involving hard-to-reach ethnic minorities in low-budget health research: lessons from a health survey among Moluccans in the Netherlands

“…By the start of this study, there was very limited evidence regarding the health status of the Moluccan population. Recent studies demonstrate that Moluccans have high prevalence rates of hypertension and ischemic heart disease as compared to the native Dutch [ 30 , 32 ]. Given their lower socioeconomic position and persistent problems of integration [ 33 ] other types of health problems might as well be more prevalent among Moluccan residents.…”