Noémi Mózes ¹ Johanna Takács ² Zoltan Ungvari ^3,4 Helga Judit Feith ^2*

• ¹ Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
• ² Department of Social Sciences, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
• ³ Vascular Cognitive Impairment, Neurodegeneration, and Healthy Brain Aging Program, Department of Neurosurgery, Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
• ⁴ International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Károly Rácz School of Ph.D. Studies, Semmelweis University, Budapest, Hungary

Background: The Roma minority, Europe's largest ethnic minority, experiences significant disparities in living conditions and health outcomes compared to the non-Roma populations across the continent. Despite extensive documentation of the socio-economic challenges faced by the Roma, there is a notable lack of comparative research. Methods: This study aims to fill this gap by examining the differences in socio-economic characteristics, living conditions, and self-reported health status between Roma (R) and non-Roma (nR) women in Hungary, Romania, and Slovakia, providing a cross-country comparative analysis. Utilizing simple and multiple binary logistic models, our research analysed data collected from September 2020 to March 2022, involving 322 Roma and 294 non-Roma women in Hungary, 258 Roma and 183 non-Roma women in Romania, and 146 Roma and 163 non-Roma women in Slovakia. Results: Findings indicate significant associations between increased age (R:OR = 1.04[1.02,1.06], p<0,001), (nR:OR = 1.04[1.02,1.05], p<0,001) lower financial situation (R:OR = 2.05[1.01,4.18], p=0,048) (nR:OR = 1.67[1.01,2.77], p=0,047), and basic education level (R:OR = 3.60[1.29,10.08], p=0,015) (nR:OR = 3.64[1.77,7.51], p<0,001) with the likelihood of poor health status across both groups in Hungary. In Romania, increased age (OR = 1.04[1.02,1.06], p<0,001) and basic education level (OR = 5.24[2.29,11.99], p<0,001) were particularly predictive of poor health among non-Roma, while in Slovakia, age (OR = 1.05[1.02,1.07], p<0,001) was a significant factor for Roma, and intermediate education level (OR = 2.68[1.16,6.20],p=0,021) was for non-Roma. The study also found that a higher number of children (HU:OR = 1.35[1.12,1.63], p=0,002), (SK:OR = 1.57[1.25,1.96], p<0,001) and problems with housing comfort (SK:OR = 4.83[2,19,10.62], (p=0,015) and wall conditions (SK:OR = 2.81[1.22,6.46], p<0,001) significantly impacted the health status of non-Roma women in Hungary and Romania. Conversely, an increase in household size was associated with a better health status among Roma women in Hungary (OR = 1.04[1.02,1.06]) and Slovakia (OR = 1.78[1.61,1.99]). Conclusion: By offering a novel comparative analysis, this study highlights the critical need for focused attention on the health disparities faced by Roma women, particularly those in a multiply disadvantaged situation due to their ethnic and socio-economic status.