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      Prevalence of Chronic Diseases and Activity-Limiting Disability among Roma and Non-Roma People: A Cross-Sectional, Census-Based Investigation

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          Abstract

          The lack of recommended design for Roma health-monitoring hinders the interventions to improve the health status of this ethnic minority. We aim to describe the riskiness of Roma ethnicity using census-derived data and to demonstrate the value of census for monitoring the Roma to non-Roma gap. This study investigated the self-declared occurrence of at least one chronic disease and the existence of activity limitations among subjects with chronic disease by the database of the 2011 Hungarian Census. Risks were assessed by odds ratios (OR) and 95% confidence intervals (95% CI) from logistic regression analyses controlled for sociodemographic factors. Roma ethnicity is a risk factor for chronic diseases (OR = 1.17; 95% CI: 1.16–1.18) and for activity limitation in everyday life activities (OR = 1.20; 95% CI: 1.17–1.23), learning-working (OR = 1.24; 95% CI: 1.21–1.27), family life (OR = 1.22; 95% CI: 1.16–1.28), and transport (OR = 1.03; 95% CI: 1.01–1.06). The population-level impact of Roma ethnicity was 0.39% (95% CI: 0.37–0.41) for chronic diseases and varied between 0 and 1.19% for activity limitations. Our investigations demonstrated that (1) the Roma ethnicity is a distinct risk factor with significant population level impact for chronic disease occurrence accompanied with prognosis worsening influence, and that (2) the census can improve the Roma health-monitoring system, primarily by assessing the population level impact.

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          Most cited references38

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          Does it matter who answers the race question? Racial classification and income inequality in Brazil.

          Previous studies of racial inequality have relied on official statistics that presumably use self-classification of race. Using novel data from a 1995 national survey in Brazil, we find that the estimates of racial income inequality based on self-classification are lower than those based on interviewer classification. After human capital and labor market controls, whites earn 26% more than browns with interviewer classification but earn only 17% more than browns with self-classification. Black-brown differences hardly change: Blacks earn 13% and 12% less than browns with interviewer classification and self-classification, respectively. We contend that interviewer classification of race is more appropriate because analysts of racial inequality are interested in the effects of racial discrimination, which depends on how others classify one's race.
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            The health of the Roma people: a review of the published literature.

            The Roma people originated in northern India and have been known in Europe for nearly a thousand years. For much of that time they have been the subjects of discrimination and oppression, culminating in the extermination of half a million Roma in the Nazi death camps. While it is widely believed that the health of Roma people is often poorer than the majority population, these inequalities remain largely unresearched. Published literature on the health of the Roma people was identified using Medline. Opinion pieces were excluded, as were papers relating to anthropometry and to genetic markers. The resultant papers were analysed by country of study and by disease type or care group. Some 70% of papers identified related to just three countries; Spain and the Czech and Slovak Republics. Much literature concentrates upon communicable disease or reproductive health. The limited evidence suggests increased morbidity from non-communicable disease, but there is little published on this topic. Evidence on health care, though fragmentary, suggests poorer access to health services and uptake of preventative care. Published research on the health needs of the Roma population is sparse. The topics that have received attention suggest a focus on concepts of contagion or social Darwinism, indicating a greater concern with the health needs of the majority populations with which they live. There is a need for both further research into the health of Roma people; with particular emphasis on non-communicable disease; and also for interventions that improve Roma health. Such research must, however, be handled with sensitivity, recognising the social and political context of the society concerned.
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              Does socioeconomic status fully mediate the effect of ethnicity on the health of Roma people in Hungary?

              Several models have been proposed to explain the association between ethnicity and health. It was investigated whether the association between Roma ethnicity and health is fully mediated by socioeconomic status in Hungary. Comparative health interview surveys were performed in 2003-04 on representative samples of the Hungarian population and inhabitants of Roma settlements. Logistic regression models were applied to study whether the relationship between Roma ethnicity and health is fully mediated by socioeconomic status, and whether Roma ethnicity modifies the association between socioeconomic status and health. The health status of people living in Roma settlements was poorer than that of the general population (odds ratio of severe functional limitation after adjustment for age and gender 1.8 (95% confidence interval 1.4 to 2.3)). The difference in self-reported health and in functionality was fully explained by the socioeconomic status. The less healthy behaviours of people living in Roma settlements was also related very strongly to their socioeconomic status, but remained significantly different from the general population when differences in the socioeconomic status were taken into account, (eg odds ratio of daily smoking 1.6 (95% confidence interval 1.3 to 2.0) after adjustment for age, gender, education, income and employment). Socioeconomic status is a strong determinant of health of people living in Roma settlements in Hungary. It fully explains their worse health status but only partially determines their less healthy behaviours. Efforts to improve the health of Roma people should include a focus on socioeconomic status, but it is important to note that cultural differences must be taken into account in developing public health interventions.
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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                26 September 2019
                October 2019
                : 16
                : 19
                : 3620
                Affiliations
                [1 ]Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Kassai St 26/B, H-4028 Debrecen, Hungary; vincze.ferenc@ 123456sph.unideb.hu (F.V.); anettefoldvari@ 123456gmail.com (A.F.); palinkas.anita@ 123456sph.unideb.hu (A.P.); sipos.valeria@ 123456sph.unideb.hu (V.S.)
                [2 ]Doctoral School of Health Sciences, University of Debrecen, Kassai St 26/B, H-4028 Debrecen, Hungary
                [3 ]Department of Dermatology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary; janka.eszter.a@ 123456gmail.com
                [4 ]WHO Collaborating Centre on Vulnerability and Health, Public Health Research Institute, University of Debrecen, Kassai St 26/B, H-4028 Debrecen, Hungary; adany.roza@ 123456sph.unideb.hu
                [5 ]Public Health Research Institute, University of Debrecen, Kassai St 26/B, H-4028 Debrecen, Hungary
                [6 ]MTA-DE-Public Health Research Group, Public Health Research Institute, University of Debrecen, Kassai St 26/B, H-4028 Debrecen, Hungary
                Author notes
                [* ]Correspondence: sandor.janos@ 123456sph.unideb.hu ; Tel.: +3620-932-3140
                Author information
                https://orcid.org/0000-0003-3595-7737
                Article
                ijerph-16-03620
                10.3390/ijerph16193620
                6801756
                31561641
                8c06e188-1e4c-4cce-9441-7e0f18dc81bd
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 31 August 2019
                : 25 September 2019
                Categories
                Article

                Public health
                roma minority,health status,census,risk assessment,impact assessment,monitoring
                Public health
                roma minority, health status, census, risk assessment, impact assessment, monitoring

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