Low overall mortality of Turkish residents in Germany persists and extends into a second generation: merely a healthy migrant effect?*

OBJECTIVE: To test the hypothesis that as a minority with lower socio-economic status, Turkish residents in Germany might experience a higher mortality than Germans. METHODS: All-cause mortality rates by age group and sex of Turkish and German adults for the time period 1980-94 were calculated from death registry data and mid-year population estimates. RESULTS: The age-adjusted mortality rate (per 100000) of Turkish males aged 25-65 years resident in Germany was 299 in 1980 and 247 in 1990, consistently half that of German males. The mortality of Turkish females in Germany was 140 in 1990, half that of German females. Mortality of Turkish males/females in Ankara was 835 and 426 in 1990. CONCLUSION: In view of the socio-economic status of Turkish residents in Germany the large mortality difference compared to Germans is unexpected. It cannot be fully explained by a selection at the time of hiring (healthy migrant effect) because it lasts over decades and extends into the second generation. A healthy worker effect is unlikely because Turkish residents have a lower employment rate than Germans. There is little evidence for movement of gravely ill persons back to Turkey. An 'unhealthy re-migration effect' in which socially successful migrants with a lower mortality risk stay in the host country while less successful ones return home even before becoming manifestly ill would partly explain our findings.