Ethnicity and childhood mortality in the Netherlands

Background: This paper describes the rates and the causes of differences in childhood mortality between Turkish, Moroccan and native Dutch children in The Netherlands. Methods: Retrospective analysis of all routinely collected death certificates of 0-15 year old children who died between 1979 and 1993. In total 20,211 death certificates of which 1,764 of Turkish and Moroccan children were analysed. Childhood mortality was divided into four age periods, analysed according to ICD-9 codes and measured over three five-year periods. Results: Compared to native Dutch children, the relative mortality risk (RR) for Turkish and Moroccan infants and children is twice as high. It did diminish from 3.2 in the first five-year period (1979-1983) to 2.2 in the second (1984-1988). After 1988 no further decline in relative mortality risk was noticed (RR: 2.1). Minor differences were found between the Turkish and Moroccan groups in the four different age categories. The relative risk for Turkish and Moroccan children to die from different diagnostic categories is as follows: infectious diseases: RR 2.2 (95% CI: 1.83-2.68), hereditary (metabolic) disorders: RR 2.0 (CI: 1.78-2.20), accidents en drowning RR 1.9 (CI: 1.64-2.21). There was a decline in all cause specific mortality ratios over time except for hereditary disorders and (traffic) accidents and drowning. One quarter of the Turkish and Moroccan children died while on holiday in their country of origin. The only significant difference between the Turkish and Moroccan group was found in Sudden Infant Death Syndrome. While the actual number of SIDS cases declined drastically over the last five year period, the SIDS rate for Turkish infants remained twice as high as for Dutch infants and four times higher than for Moroccan infants. Conclusion: Differences in mortality between Turkish, Moroccan and Dutch children are significant and have hardly changed during the last 10 years. Apart from apparent socio-economic differences, socio-cultural and life-style factors may play an important role as well. Preventive measures such as health and safety education concerning the (yearly) holiday trip to the country of origin, genetic counselling in consanguinity, better knowledge of early warning symptoms of serious infectious diseases, road safety education and early swimming-lessons are possible. The high SIDS differences have to be investigated further.