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contrast, cancer and cardiac disease showed no higher
numbers in the non-Western polio group, compared
with the general immigrant population (data not
shown) (20). Both the non-Western and the Western
immigrant group reported unsatisfactory physical
health to a higher degree than the native Norwegian
polio group (Table IV), but all polio groups were 4
times more dissatisfied with their physical health than
the general population of Norway (19).
There are no reliable biomarkers for post-polio deve-
lopment, including neurophysiology. Patient-reported
new muscular weakness can also reflect pain, neuropa-
thy, depression and deconditioning. The non-Western
immigrant group had normal body weight, with a mean
BMI of 25 kg/m 2 , although nearly 70% claimed that
they seldom or never exercised. Immigrant men and
women, in general, exercise less frequently than the
general Norwegian population, and they report having
poorer health, especially in women and those aged
40–54 years (19, 20).
A study from Denmark showed that infectious
diseases, mental disorders, diseases of the nervous
system and diseases of the circulatory and respiratory
systems were more common among polio survivors
(25). Similarly, a study from Taiwan showed that polio
patients have a higher risk of hypertension, ischaemic
heart disease, stroke, rheumatoid arthritis and chronic
pulmonary diseases (26). The current study supports
these findings, except for heart disease.
The non-Western immigrant group reported severe
fatigue, with a mean FSS score of 5.5. This is in line
with a mean score of 5.7 in a study of a Norwegian
polio group in 1997, the time of debut of post-polio
in many polio survivors (27). The Western immigrant
group and the native Norwegian polio group reported
only moderate fatigue, in accordance with normative
Norwegian data for the general population above 60
years (23). The high score among the non-Western im-
migrant group indicates that they are in the midst of a
period of demanding daily life conditions, with possible
post-polio syndrome, resulting in more fatigue. Fatigue
tends to be more severe among younger polio patients,
who also have more pain and lower quality of life (28).
The non-Western polio group reported more intense
pain than the 2 other groups according to the visual
analogue scale (VAS). Chronic pain and depression are
reported differently across ethnic and socio-economic
groups (29, 30). These findings might reflect an under-
lying psychological cause, or also lack of competence
in the healthcare system to meet and treat persons with
a different cultural background.
Psychological problems and loneliness were repor-
ted more frequently in the 2 immigrant polio groups.
These findings are in accordance with the general
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population of non-Western immigrants to Norway,
where more than one-third reported anxiety and depres-
sion, most frequently among women (20). In contrast,
males in our non-Western polio group reported more
psychological problems than females. Several of the
problems in the immigrant polio groups probably att-
ribute to feeling marginalized as an immigrant, rather
than to being disabled.
The non-Western immigrant polio group had a higher
level of education than the Western immigrant and the
native Norwegian polio groups, with nearly half being
educated at bachelor or higher university level. Howe-
ver, only one-third of the non-Western immigrant polio
group was working full-time or part-time, and more
than 40% received disability pension. This probably
reflects difficulties in entering the labour market when
both immigrant and disabled, and may also explain why
the median income in the non-Western immigrant polio
group was much lower than in the Western immigrant
and native Norwegian polio groups.
Polio survivors who are active and employed have
better quality of life, feel less lonely, and have better
mental health than those who are not employed (13,
32, 33). A study of Norwegian polio patients in 2001
showed that 65% were employed until 60 years of
age, and there was no significant association between
severity of weakness and education, employment and
profession (34). Annual income did not differ between
polio patients and controls (35). A study from Denmark
showed that Western polio patients had a higher risk
of receiving disability pension, even if they were well
educated, whereas their income was similar to cohort
controls (36). Emphasis should be on enabling immi-
grants with polio to gain employment.
In the non-Western immigrant group, 72% reported
using a powered wheelchair, and one in four were full-
time wheelchair users. This contradicts previous findings
that use of technical aids was especially problematic for
immigrant men with polio, since they were visible signs
of disability and thereby symbolized a lack of ability to
take care of and protect the family (12). Earlier onset of
polio, combined with lack of rehabilitation, orthopaedic
devices, corrective surgery and orthopaedic equipment,
would consequently lead to more severe deformities
of joints, contractures and discrepancies in leg length,
and thereby prevent functional gait. More than 80% of
the non-Western group reported weakness of the lower
limbs in the acute phase, and the residual chronic leg
weakness was twice as high as in the Western and the
Norwegian groups, indicating a more severe polio se-
quelae. This explains the increased use of wheelchairs.
The non-Western immigrant polio group reported
that the public health system did not cover their needs.
A possible explanation might be that lack of care in the