RESUMEN
AIMS OF THE STUDY: Approximately 3 million Turkish immigrants are living in Germany, in North Rhine-Westfalia their share amounts to 4.7%. They use the same rehabilitation services as Germans, but their treatment usually shows less positive results - as other studies have shown. The aims of the research project "Immigration and Health Inequalities in Rehabilitation" were (a) to quantify the use of medical rehabilitation by Turkish immigrants in different diagnosis groups, (b) to compare outcomes in different diagnosis groups and (c) to find out whether the results will be explained by immigrant status, or by socio-economic factors accompanying immigrant status. METHODS AND RESULTS: An analysis of routine data from Deutsche Rentenversicherung Rheinland and Deutsche Rentenversicherung Westfalen (Rhineland and Westfalia Pension Insurances) was carried out, pertaining to 363 855 persons who had participated in at least one rehabilitation procedure between 2000 and 2006. 4.8% of all rehabilitees were identified as being of Turkish origin. A modified name-based algorithm was used to help to identify Turkish rehabilitees. The outcome of rehabilitation was measured by comparing the medical discharge assessments. Turkish people were in need of rehabilitation more often because of mental disorders/behavioural disturbances (Turkish men=22.0% vs. non-Turkish men=18.4% [p<0.001]; Turkish women=30.8% vs. non-Turkish women=21.6% [p<0.001]) and less often because of neoplasms (Turkish men=4.7% vs. non-Turkish men =7.8% [p<0.001]; Turkish women=6.4% vs. non-Turkish women=13.9% [p<0.001]). Concerning treatment results in several diagnosis groups Turkish rehabilitees benefitted less from treatment than non-Turkish rehabilitees did (musculoskeletal disorders: OR=2.08 [95%-CI=1.97-2.20]; mental disorders/behavioural disturbances: OR=1.70 [95%-CI=1.57-1.84]; respiratory diseases: OR=1.41 [95%-CI=1.14-1.75]; digestive disorders/metabolic diseases: OR=1.36 [95%-CI=1.11-1.66]). Non-Turkish rehabilitees had higher chances of success, even adjusted by social and performance-related factors. The differences were non-significant only in cardio-vascular disease and neoplasm treatment. CONCLUSIONS: Rehabilitation outcomes are significantly less favourable for Turkish people. The differences found can partially be traced to factors related to their migration background and not only to other social differences or performance-related factors of the health services. Immigrant status, hence, affects rehabilitation outcome and must receive attention in both rehabilitation plans and rehabilitation facilities.