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Capacity building in migration and health in higher education is key to better, sustainable, and equitable health care provision. However, developments so far have been patchy, non-structural, and often unsustainable. While training programs have been evaluated and competency standards developed, perspectives from individual teachers are hardly accessible. We present expert perspectives from five European countries to illustrate good examples in higher education and identify gaps to further the advancement of capacity building in migration and health. Based on these perspectives, we have identified thematic areas at four levels: conceptual evolution, policy and implementation, organization at the academic level and teaching materials and pedagogies. Finally, we propose creating spaces to share concrete educational practices and experiences for adaptation and replication. We summarize key recommendations for the advancement of capacity building in migration and health.
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BACKGROUND: Clinical outcomes among COVID-19 patients vary greatly with age and underlying comorbidities. We aimed to determine the demographic and clinical factors, particularly baseline chronic conditions, associated with an increased risk of severity in COVID-19 patients from a population-based perspective and using data from electronic health records (EHR). METHODS: Retrospective, observational study in an open cohort analyzing all 68,913 individuals (mean age 44.4 years, 53.2% women) with SARS-CoV-2 infection between 15 June and 19 December 2020 using exhaustive electronic health registries. Patients were followed for 30 days from inclusion or until the date of death within that period. We performed multivariate logistic regression to analyze the association between each chronic disease and severe infection, based on hospitalization and all-cause mortality. RESULTS: 5885 (8.5%) individuals showed severe infection and old age was the most influencing factor. Congestive heart failure (odds ratio -OR- men: 1.28, OR women: 1.39), diabetes (1.37, 1.24), chronic renal failure (1.31, 1.22) and obesity (1.21, 1.26) increased the likelihood of severe infection in both sexes. Chronic skin ulcers (1.32), acute cerebrovascular disease (1.34), chronic obstructive pulmonary disease (1.21), urinary incontinence (1.17) and neoplasms (1.26) in men, and infertility (1.87), obstructive sleep apnea (1.43), hepatic steatosis (1.43), rheumatoid arthritis (1.39) and menstrual disorders (1.18) in women were also associated with more severe outcomes. CONCLUSIONS: Age and specific cardiovascular and metabolic diseases increased the risk of severe SARS-CoV-2 infections in men and women, whereas the effects of certain comorbidities are sex specific. Future studies in different settings are encouraged to analyze which profiles of chronic patients are at higher risk of poor prognosis and should therefore be the targets of prevention and shielding strategies.
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COVID-19/epidemiología , Enfermedad Crónica/mortalidad , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , SARS-CoV-2/patogenicidad , Adulto , Anciano , COVID-19/complicaciones , COVID-19/patología , COVID-19/virología , Estudios de Cohortes , Comorbilidad , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/patología , Factores de Riesgo , España/epidemiologíaRESUMEN
Chronic obstructive airway diseases such as chronic obstructive pulmonary disease (COPD), asthma, rhinitis, and obstructive sleep apnea (OSA) are amongst the most common treatable and preventable chronic conditions with high morbidity burden and mortality risk. We aimed to explore the existence of multimorbidity clusters in patients with such diseases and to estimate their prevalence and impact on mortality. We conducted an observational retrospective study in the EpiChron Cohort (Aragon, Spain), selecting all patients with a diagnosis of allergic rhinitis, asthma, COPD, and/or OSA. The study population was stratified by age (i.e., 15-44, 45-64, and ≥ 65 years) and gender. We performed cluster analysis, including all chronic conditions recorded in primary care electronic health records and hospital discharge reports. More than 75% of the patients had multimorbidity (co-existence of two or more chronic conditions). We identified associations of dermatologic diseases with musculoskeletal disorders and anxiety, cardiometabolic diseases with mental health problems, and substance use disorders with neurologic diseases and neoplasms, amongst others. The number and complexity of the multimorbidity clusters increased with age in both genders. The cluster with the highest likelihood of mortality was identified in men aged 45 to 64 years and included associations between substance use disorder, neurologic conditions, and cancer. Large-scale epidemiological studies like ours could be useful when planning healthcare interventions targeting patients with chronic obstructive airway diseases and multimorbidity.
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Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Adolescente , Adulto , Anciano , Análisis por Conglomerados , Femenino , Humanos , Masculino , Persona de Mediana Edad , Multimorbilidad , Prevalencia , Enfermedad Pulmonar Obstructiva Crónica/mortalidad , Estudios Retrospectivos , España/epidemiología , Adulto JovenRESUMEN
BACKGROUND: There is little verified information on global healthcare utilization by irregular migrants. Understanding how immigrants use healthcare services based on their needs is crucial to establish effective health policy. We compared healthcare utilization between irregular migrants, documented migrants, and Spanish nationals in a Spanish autonomous community. METHODS: This retrospective, observational study included the total adult population of Aragon, Spain: 930,131 Spanish nationals; 123,432 documented migrants; and 17,152 irregular migrants. Healthcare utilization data were compared between irregular migrants, documented migrants and Spanish nationals for the year 2011. Multivariable standard or zero-inflated negative binomial regression models were generated, adjusting for age, sex, length of stay, and morbidity burden. RESULTS: The average annual use of healthcare services was lower for irregular migrants than for documented migrants and Spanish nationals at all levels of care analyzed: primary care (0.5 vs 4 vs 6.7 visits); specialized care (0.2 vs 1.8 vs 2.9 visits); planned hospital admissions (0.3 vs 2 vs 4.23 per 100 individuals), unplanned hospital admissions (0.5 vs 3.5 vs 5.2 per 100 individuals), and emergency room visits (0.4 vs 2.8 vs 2.8 per 10 individuals). The average annual prescription drug expenditure was also lower for irregular migrants (9) than for documented migrants (77) and Spanish nationals (367). These differences were only partially attenuated after adjusting for age, sex, and morbidity burden. CONCLUSIONS: Under conditions of equal access, healthcare utilization is much lower among irregular migrants than Spanish nationals (and lower than that of documented migrants), regardless of country of origin or length of stay in Spain.
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Utilización de Instalaciones y Servicios , Servicios de Salud , Migrantes , Adolescente , Adulto , Anciano , Utilización de Instalaciones y Servicios/estadística & datos numéricos , Femenino , Servicios de Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , España , Migrantes/estadística & datos numéricos , Adulto JovenRESUMEN
Type 2 diabetes mellitus (T2D) is often accompanied by chronic diseases, including mental health problems. We aimed at studying mental health comorbidity prevalence in T2D patients and its association with T2D outcomes through a retrospective, observational study of individuals of the EpiChron Cohort (Aragón, Spain) with prevalent T2D in 2011 (n = 63,365). Participants were categorized as having or not mental health comorbidity (i.e., depression, anxiety, schizophrenia, and/or substance use disorder). We performed logistic regression models, controlled for age, sex and comorbidities, to analyse the likelihood of 4-year mortality, 1-year all-cause hospitalization, T2D-hospitalization, and emergency room visit. Mental health comorbidity was observed in 19% of patients. Depression was the most frequent condition, especially in women (20.7% vs. 7.57%). Mortality risk was higher in patients with mental health comorbidity (odds ratio 1.24; 95% confidence interval 1.16-1.31), especially in those with substance use disorder (2.18; 1.84-2.57) and schizophrenia (1.82; 1.50-2.21). Mental health comorbidity also increased the likelihood of all-cause hospitalization (1.16; 1.10-1.23), T2D-hospitalization (1.51; 1.18-1.93) and emergency room visit (1.26; 1.21-1.32). These results suggest that T2D healthcare management should include specific strategies for the early detection and treatment of mental health problems to reduce its impact on health outcomes.
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Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/psicología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Comorbilidad , Depresión/epidemiología , Diabetes Mellitus Tipo 2/mortalidad , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Salud Mental/estadística & datos numéricos , Persona de Mediana Edad , Prevalencia , Esquizofrenia/epidemiología , España/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Adulto JovenRESUMEN
Multimorbidity (MM) is a widespread problem and it poses unsolved issues like the healthcare professionals' training. A training curriculum has been proposed, but it has not been sufficiently explored in a clinical context. The eMULTIPAP course is part of the MULTIPAP complex intervention, applied through a pragmatic controlled, cluster randomized clinical trial to general practitioners (GP) and his/her patients with MM with 12 months follow-up. The eMULTIPAP course is based on problem-based learning, constructivism and Ariadne principles. It has been assessed according to the Kirkpatrick model and has shown knowledge improvement and high applicability of learning with more motivation to consider MM in the clinical practice. It has also improved the Medication Appropriateness Index at 6-months and at 12- months. We conclude that the eMULTIPAP course generates significant changes in GP's learning, enhancing clinical practice in multimorbidity scenarios.
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Educación Médica Continua/métodos , Multimorbilidad , Médicos de Atención Primaria/educación , Polifarmacología , Atención Primaria de Salud/normas , Aprendizaje Basado en Problemas/métodos , Anciano , Quimioterapia Combinada/métodos , Quimioterapia Combinada/normas , Evaluación Educacional , Femenino , Humanos , Prescripción Inadecuada/prevención & control , Masculino , Polifarmacia , Atención Primaria de Salud/métodos , Mejoramiento de la Calidad , Desarrollo de Personal/métodosRESUMEN
We aimed to analyze baseline socio-demographic and clinical factors associated with an increased likelihood of mortality in men and women with coronavirus disease (COVID-19). We conducted a retrospective cohort study (PRECOVID Study) on all 4412 individuals with laboratory-confirmed COVID-19 in Aragon, Spain, and followed them for at least 30 days from cohort entry. We described the socio-demographic and clinical characteristics of all patients of the cohort. Age-adjusted logistic regressions models were performed to analyze the likelihood of mortality based on demographic and clinical variables. All analyses were stratified by sex. Old age, specific diseases such as diabetes, acute myocardial infarction, or congestive heart failure, and dispensation of drugs like vasodilators, antipsychotics, and potassium-sparing agents were associated with an increased likelihood of mortality. Our findings suggest that specific comorbidities, mainly of cardiovascular nature, and medications at the time of infection could explain around one quarter of the mortality in COVID-19 disease, and that women and men probably share similar but not identical risk factors. Nonetheless, the great part of mortality seems to be explained by other patient- and/or health-system-related factors. More research is needed in this field to provide the necessary evidence for the development of early identification strategies for patients at higher risk of adverse outcomes.
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Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/mortalidad , Neumonía Viral/complicaciones , Neumonía Viral/mortalidad , Anciano , COVID-19 , Enfermedad Crónica , Estudios de Cohortes , Comorbilidad , Infecciones por Coronavirus/virología , Femenino , Humanos , Laboratorios , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/virología , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , SARS-CoV-2 , EspañaRESUMEN
BACKGROUND: There is little verified information on the global health status of undocumented migrants (UMs). Our aim is to compare the prevalence of the main chronic diseases and of multimorbidity in undocumented migrants, documented migrants, and Spanish nationals in a Spanish autonomous community. METHODS: Retrospective observational study of all users of the public health system of the region of Aragon over 1 year (2011): 930,131 Spanish nationals; 123,432 documented migrants (DMs); and 17,152 UMs. Binary logistic regression was performed to examine the association between migrant status (Spanish nationals versus DMs and UMs) and both multimorbidity and individual chronic diseases, adjusting for age and sex. RESULTS: The prevalence of individual chronic diseases in UMs was lower than in DMs and much lower than in Spanish nationals. Comparison with the corresponding group of Spanish nationals revealed odds ratios (OR) of 0.1-0.3 and 0.3-0.5 for male and female UMs, respectively (p < 0.05 in all cases). The risk of multimorbidity was lower for UMs than DMs, both for men (OR, 0.12; 95%CI 0.11-0.13 versus OR, 0.53; 95%CI 0.51-0.54) and women (OR, 0.18; 95%CI 0.16-0.20 versus OR, 0.74; 95%CI 0.72-0.75). CONCLUSIONS: Analysis of data from a health system that offers universal coverage to all immigrants, irrespective of legal status, reveals that the prevalence of chronic disease and multimorbidity is lower in UMs as compared with both DMs and Spanish nationals. These findings refute previous claims that the morbidity burden in UM populations is higher than that of the native population of the host country.
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Enfermedad Crónica/epidemiología , Emigrantes e Inmigrantes , Estado de Salud , Multimorbilidad , Migrantes , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Atención a la Salud , Documentación , Femenino , Humanos , Jurisprudencia , Modelos Logísticos , Masculino , Persona de Mediana Edad , Programas Nacionales de Salud , Oportunidad Relativa , Prevalencia , Estudios Retrospectivos , España/epidemiología , Adulto JovenRESUMEN
The correct management of patients with multimorbidity remains one of the main challenges for healthcare systems worldwide. In this study, we analyze the existence of multimorbidity patterns in the general population based on gender and age. We conducted a cross-sectional study of individuals of all ages from the EpiChron Cohort, Spain (1,253,292 subjects), and analyzed the presence of systematic associations among chronic disease diagnoses using exploratory factor analysis. We identified and clinically described a total of 14 different multimorbidity patterns (12 in women and 12 in men), with some relevant differences in the functions of age and gender. The number and complexity of the patterns was shown to increase with age in both genders. We identified associations of circulatory diseases with respiratory disorders, chronic musculoskeletal diseases with depression and anxiety, and a very consistent pattern of conditions whose co-occurrence is known as metabolic syndrome (hypertension, diabetes, obesity, and dyslipidaemia), among others. Our results demonstrate the potential of using real-world data to conduct large-scale epidemiological studies to assess the complex interactions among chronic conditions. This could be useful in designing clinical interventions for patients with multimorbidity, as well as recommendations for healthcare professionals on how to handle these types of patients in clinical practice.
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Multimorbilidad , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Enfermedad Crónica , Estudios de Cohortes , Comorbilidad , Estudios Transversales , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Prevalencia , España , Adulto JovenRESUMEN
BackgroundChagas disease has spread beyond its original borders on the American continent with migration. It can be transmitted from mother to child, through organ transplantation and transfusion of blood and blood products. It is necessary to determine when to screen for this infection.AimOur objective was to evaluate the appropriateness of screening for Trypanosoma cruzi infection in Latin American migrants and their descendants.MethodsWe reviewed the literature using rigorous criteria. The quality of evidence was ranked according to the GRADE classification. An evidence to decision framework was adopted to provide information on the most relevant aspects necessary to formulate recommendations.ResultsThe 33 studies evaluated revealed a prevalence of T. cruzi infection among Latin American migrants in Europe of 6.08% (95% confidence interval (CI): 3.24-9.69; 28 studies). Vertical transmission occurred in three of 100 live births (95% CI: 1-6; 13 studies). The prevalence of cardiovascular disease was 19% (95% CI: 13-27; nine studies), including only 1% severe cardiac events (95% CI: 0-2; 11 studies). The overall quality of evidence was low because of risk of bias in the studies and considerable heterogeneity of the evaluated populations. The recommendations took into account economic studies on the value of screening strategies and studies on acceptability of screening and knowledge of the disease in the affected population.ConclusionsWe identified five situations in which screening for T. cruzi infection is indicated. We recommend screening persons from endemic areas and children of mothers from these areas.
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Enfermedad de Chagas/diagnóstico , Emigrantes e Inmigrantes/estadística & datos numéricos , Tamizaje Masivo/métodos , Guías de Práctica Clínica como Asunto , Refugiados/estadística & datos numéricos , Trypanosoma cruzi/aislamiento & purificación , Enfermedad de Chagas/epidemiología , Enfermedad de Chagas/prevención & control , Europa (Continente)/epidemiología , Femenino , Humanos , Masculino , Enfermedades Desatendidas/diagnóstico , Enfermedades Desatendidas/epidemiología , Prevalencia , Sociedades MédicasRESUMEN
BACKGROUND: Mortality is a robust indicator of health and offers valuable insight into the health of immigrants. However, mortality estimates can vary significantly depending on the manner in which immigrant status is defined. Here, we assess the impact of nationality, country of origin, and length of stay in the host country on mortality estimates in an immigrant population in Aragón, Spain. METHODS: Cross-sectional retrospective study of all adult subjects from the EpiChron Cohort in 2011 (n = 1,102,544), of whom 146,100 were foreign-born (i.e., according to place of birth) and 127,213 were non-nationals (i.e., according to nationality). Directly standardized death proportions between years 2012-2015 were calculated, taking into account the age distribution of the European population in 2013. Binary logistic regression was used to compare the four-year probability of death. RESULTS: The age- and sex-standardized number of deaths per 1000 subjects were 45.1 (95%CI 44.7-45.2) for the Spanish-born population, 29.3 (95%CI 26.7-32.1) for the foreign-born population, and 18.4 (95%CI 15.6-21.6) for non-Spanish nationals. Compared with the Spanish-born population, the age- and sex-adjusted likelihood of dying was equally reduced in the foreign-born and non-national populations (OR 0.6; 95%CI 0.5-0.7) when the length of stay was less than 10 years. No significant differences in mortality estimates were detected when the length of stay was over 10 years. CONCLUSIONS: Mortality estimates in immigrant populations were lower than those of the native Spanish population, regardless of the criteria applied. However, the proportion of deaths was lower when immigrant status was defined using nationality instead of country of birth. Age- and sex-standardized death proportions tended to increase with increased length of stay in the host country.
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Emigrantes e Inmigrantes/estadística & datos numéricos , Etnicidad/estadística & datos numéricos , Equidad en Salud/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Mortalidad , Adolescente , Adulto , África , Anciano , Anciano de 80 o más Años , Asia , Estudios de Cohortes , Estudios Transversales , Europa Oriental , Femenino , Humanos , América Latina , Modelos Logísticos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , España , Adulto JovenRESUMEN
Aim: Multimorbidity is a growing phenomenon in primary care, and knowledge of the influence of social determinants on its evolution is vital. The aim of this study was to understand the relationship between multimorbidity and immigration, taking into account length of residence in the host country and area of origin of the immigrant population. Methods: Cross-sectional retrospective study of all adult patients registered within the public health service of Aragon, Spain (N = 1092279; 144238 were foreign-born), based on data from the EpiChron Cohort. Age-standardized prevalence rates of multimorbidity were calculated. Different models of binary logistic regressions were conducted to study the association between multimorbidity, immigrant status and length of residence in the host country. Results: The risk of multimorbidity in foreign-borns was lower than that of native-borns [odds ratio (OR): 0.54, 95% confidence interval (CI): 0.53-0.55]. The probability of experiencing multimorbidity was lowest for Asians (OR: 0.34, 95% CI: 0.31-0.37) and Eastern Europeans (OR: 0.42, 95% CI: 0.40-0.43), and highest for Latin Americans (OR: 0.70, 95% CI: 0.68-0.72). Foreign-born immigrants residing in Aragon for ≥5 years had a higher multimorbidity risk than those residing for <5 years (OR: 2.3, 95% CI: 2.2-2.4). Conclusion: Prevalence of multimorbidity is lower among foreign-borns as compared with native-borns, but increases rapidly with length of residence in the host country. However, the progressive development of multimorbidity among immigrants varies widely depending on area of origin. These findings provide important insight into the health care needs of specific population groups and may help minimize the negative impact of multimorbidity among the most vulnerable groups.
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Emigrantes e Inmigrantes/estadística & datos numéricos , Multimorbilidad/tendencias , Adulto , África/etnología , Estudios Transversales , Europa Oriental/etnología , Femenino , Médicos Generales/estadística & datos numéricos , Humanos , América Latina/etnología , Masculino , Persona de Mediana Edad , Prevalencia , Atención Primaria de Salud , Estudios Retrospectivos , España , Factores de TiempoRESUMEN
BACKGROUND: Although equity in health care is theoretically a cornerstone in Western societies, several studies show that services do not always provide equitable care for immigrants. Differences in pharmaceutical consumption between immigrants and natives are explained by variances in predisposing factors, enabling factors and needs across populations, and can be used as a proxy of disparities in health care use. By comparing the relative differences in pharmacological use between natives and immigrants from the same four countries of origin living in Spain and Norway respectively, this article presents a new approach to the study of inequity in health care. METHODS: All purchased drug prescriptions classified according to the Anatomical Therapeutic Chemical (ATC) system in Aragon (Spain) and Norway for a total of 5 million natives and nearly 100,000 immigrants for one calendar year were included in this cross-sectional study. Age and gender adjusted relative purchase rates for immigrants from Poland, China, Colombia and Morocco compared to native populations in each of the host countries were calculated. Direct standardisation was performed based on the 2009 population structure of the OECD countries. RESULTS: Overall, a significantly lower proportion of immigrants in Aragon (Spain) and Norway purchased pharmacological drugs compared to natives. Patterns of use across the different immigrant groups were consistent in both host countries, despite potential disparities between the Spanish and Norwegian health care systems. Immigrants from Morocco showed the highest drug use rates in relation to natives, especially for antidepressants, "pain killers" and drugs for peptic ulcer. Immigrants from China and Poland showed the lowest use rates, while Colombians where more similar to host countries. CONCLUSIONS: The similarities found between the two European countries in relation to immigrants' pharmaceutical use disregarding their host country emphasises the need to consider specific immigrant-related features when planning and providing healthcare services to this part of the population. These results somehow remove the focus on inequity as the main reason to explain differences in purchase between immigrants and natives.
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Prescripciones de Medicamentos/estadística & datos numéricos , Emigrantes e Inmigrantes/estadística & datos numéricos , Disparidades en Atención de Salud , Atención Primaria de Salud/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Noruega/etnología , Atención Primaria de Salud/métodos , Factores Socioeconómicos , España/etnologíaRESUMEN
BACKGROUND: Multiple parameters influence adherence to drug treatment, including socio-economic, healthcare, condition, therapy, and patient-related factors. However, studies of the impact of patient-related factors, particularly regarding comorbid conditions, have produced conflicting results. OBJECTIVES: To analyse the association between mental and physical comorbidity and non-adherence to antihypertensive medication in patients attending primary care, after including a comprehensive range of chronic comorbidities and potential confounders. METHODS: Cross-sectional study of 113,397 adults with a diagnosis of hypertension in 2010 assigned to the public health service of a region in northeastern Spain. Pharmacy billing records were linked to data from electronic health records at individual level. Non-adherence was defined as an antihypertensive medication possession ratio (MPR) <80%. Multivariable logistic regression models were used to estimate the odds ratio for non-adherence. Potential predictors included mental and physical comorbidity, age, sex, blood pressure level, nationality, rurality, polypharmacy, and number of visits to the GP and to different specialties. RESULTS: One fifth of the study population showed poor adherence levels. Female sex, younger age, foreign nationality, living in a rural area, low blood pressure levels, polypharmacy, and mental comorbidity were positively and significantly associated with non-adherence. Conversely, non-adherence was negatively and significantly associated with the presence of cardiovascular risk factors and higher annual rates of GP visits. CONCLUSION: The majority of patient-related determinants identified here (e.g., the presence of mental comorbidity, polypharmacy, foreign nationality) underscores the need for a patient- rather than a disease-centred care approach, as well as adequate physician-patient communication.
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Antihipertensivos/uso terapéutico , Barreras de Comunicación , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Cumplimiento de la Medicación , Trastornos Mentales/epidemiología , Anciano , Anciano de 80 o más Años , Comorbilidad , Estudios Transversales , Femenino , Humanos , Hipertensión/diagnóstico , Masculino , Trastornos Mentales/diagnóstico , Persona de Mediana Edad , PolifarmaciaRESUMEN
BACKGROUND: Changes in migration patterns that have occurred in recent decades, both quantitative, with an increase in the number of immigrants, and qualitative, due to different causes of migration (work, family reunification, asylum seekers and refugees) require constant u pdating of the analysis of how immigrants access health services. Understanding of the existence of changes in use patterns is necessary to adapt health services to the new socio-demographic reality. The aim of this study is to describe the scientific evidence that assess the differences in the use of health services between immigrant and native populations. METHODS: A systematic review of the electronic database MEDLINE (PubMed) was conducted with a search of studies published between June 2013 and February 2016 that addressed the use of health services and compared immigrants with native populations. MeSH terms and key words comprised Health Services Needs and Demands/Accessibility/Disparities/Emigrants and Immigrants/Native/Ethnic Groups. The electronic search was supplemented by a manual search of grey literature. The following information was extracted from each publication: context of the study (place and year), characteristics of the included population (definition of immigrants and their sub-groups), methodological domains (design of the study, source of information, statistical analysis, variables of health care use assessed, measures of need, socio-economic indicators) and main results. RESULTS: Thirty-six publications were included, 28 from Europe and 8 from other countries. Twenty-four papers analysed the use of primary care, 17 the use of specialist services (including hospitalizations or emergency care), 18 considered several levels of care and 11 assessed mental health services. The characteristics of immigrants included country of origin, legal status, reasons for migration, length of stay, different generations and socio-demographic variables and need. In general, use of health services by the immigrants was less than or equal to the native population, although some differences between immigrants were also identified. CONCLUSIONS: This review has identified that immigrants show a general tendency towards a lower use of health services than native populations and that there are significant differences within immigrant sub-groups in terms of their patterns of utilization. Further studies should include information categorizing and evaluating the diversity within the immigrant population.
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INTRODUCTION: As the flows of immigrant populations increase worldwide, their heterogeneity becomes apparent with respect to the differences in the prevalence of chronic physical and mental disease. Multimorbidity provides a new framework in understanding chronic diseases holistically as the consequence of environmental, social, and personal risks that contribute to increased vulnerability to a wide variety of illnesses. There is a lack of studies on multimorbidity among immigrants compared to native-born populations. METHODOLOGY: This nationwide multi-register study in Norway enabled us i) to study the associations between multimorbidity and immigrant origin, accounting for other known risk factors for multimorbidity such as gender, age and socioeconomic levels using logistic regression analyses, and ii) to identify patterns of multimorbidity in Norway for immigrants and Norwegian-born by means of exploratory factor analysis technique. RESULTS: Multimorbidity rates were lower for immigrants compared to Norwegian-born individuals, with unadjusted odds ratios (OR) and 95% confidence intervals 0.38 (0.37-0.39) for Eastern Europe, 0.58 (0.57-0.59) for Asia, Africa and Latin America, and 0.67 (0.66-0.68) for Western Europe and North America. Results remained significant after adjusting for socioeconomic factors. Similar multimorbidity disease patterns were observed among Norwegian-born and immigrants, in particular between Norwegian-born and those from Western European and North American countries. However, the complexity of patterns that emerged for the other immigrant groups was greater. Despite differences observed in the development of patterns with age, such as ischemic heart disease among immigrant women, we were unable to detect the systematic development of the multimorbidity patterns among immigrants at younger ages. CONCLUSIONS: Our study confirms that migrants have lower multimorbidity levels compared to Norwegian-born. The greater complexity of multimorbidity patterns for some immigrant groups requires further investigation. Health care policies and practice will require a holistic approach for specific population groups in order to meet their health needs and to curb and prevent diseases.
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Ansiedad/epidemiología , Depresión/epidemiología , Emigrantes e Inmigrantes , Adolescente , Adulto , Anciano , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Noruega/epidemiología , Adulto JovenRESUMEN
OBJECTIVES: International migration is rapidly increasing worldwide. However, the health status of migrants differs across groups. Information regarding health at arrival and subsequent periodic follow-up in the host country is necessary to develop equitable health care to immigrants. The objective of this study was to determine the impact of the length of stay in Norway and other sociodemographic variables on the prevalence of multimorbidity across immigrant groups (refugees, labour immigrants, family reunification immigrants and education immigrants). METHODS: This is a register-based study merging data from the National Population Register and the Norwegian Health Economics Administration database. Sociodemographic variables and multimorbidity across the immigrant groups were compared using Persons' chi-square test and anova as appropriate. Several binary logistic regression models were conducted. RESULTS: Multimorbidity was significantly lower among labour immigrants (OR (95% CI) 0.23 (0.21-0.26) and 0.45 (0.40-0.50) for men and women, respectively) and education immigrants (OR (95% CI) 0.40 (0.32-0.50) and 0.38 (0.33-0.43)) and higher among refugees (OR (95% CI) 1.67 (1.57-1.78) and 1.83 (1.75-1.92)), compared to family reunification immigrants. For all groups, multimorbidity doubled after a five-year stay in Norway. Effect modifications between multimorbidity and sociodemographic characteristics across the different reasons for migration were observed. CONCLUSIONS: Multimorbidity was highest among refugees at arrival but increased rapidly among labour immigrants, especially females. Health providers need to ensure tailor-made preventive and management strategies that take into account pre-migration and post-migration experiences for immigrants in order to address their needs.
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Comorbilidad , Emigrantes e Inmigrantes , Emigración e Inmigración , Estado de Salud , Refugiados , Migrantes , Adolescente , Adulto , Anciano , Etnicidad , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Motivación , Noruega , Oportunidad Relativa , Atención Primaria de Salud , Sistema de Registros , Factores Sexuales , Factores Socioeconómicos , Adulto JovenRESUMEN
BACKGROUND: Immigrant's use of primary health care (PHC) services differs from that of native's, but studies are non-consistent, and the importance of individual explaining variables like socio-economic status, morbidity burden and length of stay in the host country is uncertain. METHODS: Registry-based study using merged data from the National Population Register and the Norwegian Health Economics Administration Database for all immigrants and natives ≥ 15 years registered in Norway in 2008 (3 739 244 persons), applying the Johns Hopkins ACG® Case-Mix System. Using multivariate binary logistic and negative binomial regression analyses, respectively, we compared overall use of PHC and number of visits to PHC between immigrants and natives, and investigated the significance of socio-economic, immigration and morbidity variables. RESULTS: A significantly lower percentage of immigrants used the general practitioner (GP) compared with natives. Among GP users, however, most immigrants used the GP at a 2-15% significantly higher rate compared with natives. Older immigrants used their GP less and at lower rates than younger immigrants. A significantly lower percentage of immigrants from high-income countries, but a higher percentage of all other immigrants used emergency services compared with natives, with no differences in use rates. Morbidity burden and length of stay were essential explaining variables. CONCLUSION: Lower use of PHC among immigrants could be due to better health or to access barriers, and should be further studied, especially for the oldest immigrants. Adjusted high frequency of use may be appropriate, but it might also be a signal of non-effective contacts.
Asunto(s)
Emigrantes e Inmigrantes/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Sistema de Registros/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Anciano , Femenino , Médicos Generales/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Noruega , Factores Socioeconómicos , Factores de Tiempo , Adulto JovenRESUMEN
OBJECTIVE: To compare the likelihood of being a frequent attender (FA) to general practice among native Norwegians and immigrants, and to study socioeconomic and morbidity factors associated with being a FA for natives and immigrants. DESIGN, SETTING AND SUBJECTS: Linked register data for all inhabitants in Norway with at least one visit to the general practitioner (GP) in 2008 (2 967 933 persons). Immigrants were grouped according to their country of origin into low- (LIC), middle- (MIC), and high-income countries (HIC). FAs were defined as patients whose attendance rate ranked in the top 10% (cut-off point > 7 visits). MAIN OUTCOME MEASURES: FAs were compared with other GP users by means of multivariate binary logistic analyses adjusting for socioeconomic and morbidity factors. RESULTS: Among GP users during the daytime, immigrants had a higher likelihood of being a FA compared with natives (OR (95% CI): 1.13 (1.09-1.17) and 1.15 (1.12-1.18) for HIC, 1.84 (1.78-1.89) and 1.66 (1.63-1.70) for MIC, and 1.77 (1.67-1.89) and 1.65 (1.57-1.74) for LIC for men and women respectively). Pregnancy, middle income earned in Norway, and having cardiologic and psychiatric problems were the main factors associated with being a FA. Among immigrants, labour immigrants and the elderly used GPs less often, while refugees were overrepresented among FAs. Psychiatric, gastroenterological, endocrine, and non-specific drug morbidity were relatively more prevalent among immigrant FA compared with natives. CONCLUSION: Although immigrants account for a small percentage of all FAs, GPs and policy-makers should be aware of differences in socioeconomic and morbidity profiles to provide equality of health care.