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Does socioeconomic status fully mediate the effect of ethnicity on the health of Roma people in Hungary?
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  1. Z Vokó1,
  2. P Csépe2,
  3. R Németh3,
  4. K Kósa1,
  5. Z Kósa4,
  6. G Széles1,
  7. R Ádány1,5
  1. 1
    Department of Preventive Medicine, Faculty of Public Health, Medical and Health Science Centre, University of Debrecen, Hungary
  2. 2
    Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
  3. 3
    National Centre for Healthcare Audit and Inspection, Budapest, Hungary
  4. 4
    Department of Health Visitor Methodology and Public Health, Faculty of Health, Medical and Health Science Centre, University of Debrecen, Hungary
  5. 5
    Public Health Research Group of the Hungarian Academy of Sciences, at the Medical & Health Science Center, University of Debrecen, Debrecen, Hungary
  1. Z Vokó, Division of Biostatistics & Epidemiology, Department of Preventive Medicine, Faculty of Public Health, Medical and Health Sciences Centre, University of Debrecen, H-4028 Debrecen, Kassai út 26/b, Hungary; z.voko{at}sph.dote.hu

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusion: 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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Footnotes

  • Competing interests: None.

  • Funding: The National Health Interview Survey, 2003, was funded by the Hungarian Ministry of Health in the framework of the National Public Health Programme. The Roma Health Survey was funded from Hungarian research grants from the National Research and Development Program (NKFP-1B/0013/2002) and the Ministry of Environment (KvH-96/167/2000). This project was funded by the National Scientific Council on Health (ETT: 331/2006).

  • Ethics approval: Ethical Committee of the Hungarian National Scientific Council on Health.

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