gms | German Medical Science

Introduction and study question

Diaspora migration flows from the former Soviet Union (FSU) to Western Europe and Israel have increased since the late 1980s [Ref. 1]. Ethnic Germans, so-called Aussiedler have contributed to these flows and about 2 million have resettled in Germany since the late 1980s. Mortality from external causes, like suicide, among immigrants is influenced by factors in the country of origin [Ref. 2], factors in the migration process and post-migration factors in the host country [Ref. 3], [Ref. 4]. Risk factors responsible for the East-West mortality gap [Ref. 5], selection effects and difficulties in integration and acculturation [Ref. 6], should lead to higher mortality from external causes of death like suicide amongst the Aussiedler. We investigated whether ethnic German immigrants from the FSU had increased mortality from external causes compared to native Germans.

Materials and Methods

We established a cohort of 34,393 out of 218,356 eligible Aussiedler who settled in North Rhine Westphalia (NRW) from the FSU between 1990 and 2001. Other methodological details of how the cohort was selected have been described elsewhere [Ref. 7]. Vital status and causes of death were ascertained through the local registries. We calculated Standardized Mortality Ratios (SMR), using the mortality rates of the native German population in NRW as comparison, for three main outcomes i.e. all external causes, suicide and self-inflicted harm, and accidents and adverse effects. Poisson regression models were used to assess the effect of covariates (age, sex, calendar period, family size on arrival, length of stay in Germany, and the size of the city of residence) on the SMR.

Results

The cohort accumulated 242,000 person years, and vital status was established in 91% of participants. Overall, 1657 deaths were observed with 2738 expected, yielding an SMR of 0.61 (95% CI: 0.57, 0.63). Thus the overall mortality was significantly lower than expected. Out of these deaths, 88 were from external causes, 21 females and 67 males, with 19.8 and 48.2 expected deaths respectively. Males had 39% increase in mortality from all external causes and accidents, and a 30% excess mortality from suicide. Females had comparable mortality to native Germans for all external causes but a slightly increased mortality from accidents. There were large age-specific variations in the SMR with the most mortality disadvantage among Aussiedler < 65 years. Results for the Poisson regression analysis are shown in Table 1 [Tab. 1]. SMR for all external causes and suicide decreased with the length of stay. Age and sex had variable effects on the SMR depending on the outcome while the calendar period had no clear effect.

Discussion

Ethnic German immigrants have a mortality disadvantage from external causes compared to native Germans. This disadvantage is however not as large as would be expected if the Aussiedler were representative of the general population in FSU countries. Throughout the 1990s, mortality from suicide and all external causes among males in the Russian federation aged below 65 years, was two to four times, and four to nine times higher respectively, compared to the German population [Ref. 8]. Our findings imply that the Aussiedler had an unexpected pre-migration mortality advantage. It also suggests that the excess mortality from external causes in FSU countries, is (was) not uniformly distributed among all ethnicities – a finding that warrants further research.