Mediterranean diabetes morbidity and mortality in Belgium

Background: Despite their generally lower socio-economic status, migrant groups generally have a lower all-cause mortality rate than the host population. This phenomenon has also been observed in Belgium. However, migrant groups, 'privileged' with regard to mortality, often have a higher prevalence of type 2 diabetes. In Belgium e.g., diabetes prevalence is higher in the Turkish and Moroccan communities, especially among women. In addition, these women also show an excess diabetes mortality. In this paper, we address diabetes morbidity and mortality of Mediterranean migrants in Belgium. More specifically, we examine the hypothesis that excess diabetes mortality among Mediterranean migrant women is due to the fact that these women are less active on the labour market and/or less often occupy physically taxing jobs, at least compared to the male migrant population.

Methods: Logistic regression with diabetes as outcome variable was performed on the basis of the Health Interview Surveys 1997-2001-2004. To estimate diabetes mortality, Cox regression was used on data from the National Mortality Databank 1991-1996.

Results: In men, no significant ethnic differences in diabetes prevalence are found. In women on the other hand, a higher diabetes prevalence is observed in the Italian (OR = 1.93; 95%CI = 1.17-3.19), Turkish (OR = 7.40; 95%CI = 4.02-13.64) and Moroccan communities (OR = 5.03; 95%CI = 3.25-7.78). In line with these findings, excess diabetes mortality is found in Spanish and Moroccan women, but not in men. Results indicate that labour market participation plays an important part in this excess mortality. Whether or not the job is physically taxing, seems to bear little significance.

Conclusions: The higher diabetes morbidity and mortality among Mediterranean migrant women is associated with their being unemployed. An active screening of these women and improving their access to the labour market should be considered as important tracks for preventive policy.