Late-life mortality in older Jews exposed to the Nazi regime

OBJECTIVES: To evaluate the mortality risk associated with exposure to the Nazi regime 6 decades after the war. DESIGN: A national representative survey with 7-year follow-up data. SETTING: A national representative survey of Israeli Jews aged 60 and older conducted in 1997 and 1998. PARTICIPANTS: Four thousand one hundred seventy-nine Israeli Jews participated in the study. To evaluate the mortality risk associated with exposure to the Nazi regime, Cox proportional-hazards models were used, controlling for age, sex, education, religiousness, mental health, sleep disturbance, and baseline health. MEASUREMENTS: A 7-year follow-up of all-cause mortality. RESULTS: Of the 4,179 Israeli Jews who participated in the study, 1,472 (35%) self-identified as being exposed to the Nazi regime, defined as having lived in a country that was under the Nazi occupation or directly ruled by the Nazi regime. There was no statistically significant difference in mortality rate between those exposed to the Nazi regime (29.8%) and those who were not (27.5%) (adjusted hazard ratio=1.01, 95% confidence interval=0.88-1.15). CONCLUSION: Israeli Jews who survived exposure to the Nazi regime are not at greater risk for death than the general population of Israeli Jews in later life. It is unclear whether these individuals represent a particularly resilient group or whether the risks of psychological trauma on mortality are mitigated over time.