Inequalities in Health Services Usage in a National Health System Scheme: The Case of a Southern Social European Region.

BACKGROUND: Health services can reduce inequalities caused by other determinants of health or increase them due to the effect of the inverse care law-the principle that the availability of good quality care tends to vary inversely with the need for it in the population served. OBJECTIVE: The purpose of the research was to describe inequalities in the use of nursing services, medical services in primary care, specialist care, and services not fully covered by the Basque public health system in Spain. METHODS: A cross-sectional study of adults aged at least 25 years who completed the 2013 Basque Health Survey (N = 10,454) was conducted. Age-standardized prevalence and prevalence ratios for use of services that are covered and noncovered in the health system were computed. The association of health services usage with socioeconomic variables was estimated using a Poisson regression model with robust variance. The relative index of inequality (RII) was used to measure the magnitude of socioeconomic status inequalities in health service use. All analyses were carried out separately for men and women. RESULTS: Individuals with lower socioeconomic status were more likely to use primary care (RII = 0.87, 95% CI [0.79, 0.97]) and less likely to use specialist services (RII = 0.82, 95% CI [0.75, 0.89]). Across noncovered health services, inequalities between the highest and lowest social groups were significant in all cases and especially marked in men's use of physiotherapists (RII = 0.46, 95% CI [0.35, 0.61]) and podiatrists (RII = 0.24, 95%CI [0.15, 0.38]). DISCUSSION: There are significant inequalities in primary and specialist health service use based on individual socioeconomic status, particularly for services that are not provided free of charge within the existing health system. This suggests that health service systems that are not explicitly designed to provide universal access may actually amplify preexisting social and health inequalities within their target populations.

The role of birthplace and educational attainment on induced abortion inequalities.

BACKGROUND: Induced abortion (IA) has shown social inequality related to birthplace and education with higher rates of IAs in immigrant and in less educated women relative to their native and highly educated counterparts. This study examined the independent and joint effects of birthplace and education on IA, repeated and IA performed during the 2nd trimester of pregnancy among women residing in the Basque Country, Spain. METHODS: We conducted a cross-sectional population-based study of IA among women aged 25-49 years residing in the Basque Country, Spain, between 2011 and 2013. Log-binomial regression was used to quantify the independent and joint effects of birthplace and education attainment on all outcomes. RESULTS: Immigrant women exhibited higher probability of having an IAs (PR: 5.31), a repeated (PR: 7.23) or a 2nd trimester IAs (PR: 4.07) than women born in Spain. We observed higher probabilities for all outcomes among women with a primary or less education relative to those with a graduate education (All IAs PR: 2.51; repeated PR: 6.00; 2nd trimester PR: 3.08). However, no significant heterogeneity was observed for the effect of education on the association of birthplace with IAs, repeated or 2nd trimester IAs. CONCLUSIONS: Birthplace and education are key factors to explain not only an IA decision but also having a repeated or a 2nd trimester IA. However, the effects of birthplace and education may be independent from each other on these outcomes. A better understanding of these factors on IAs is needed when designing programs for sexual and reproductive health aimed to reduce inequalities among women.

Parental Race/Ethnicity and Adverse Birth Outcomes in New York City: 2000-2010.

OBJECTIVES: To examine the association of maternal race/ethnicity only and parental race/ethnicity jointly with adverse birth outcomes (low birth weight, small for gestational age, preterm birth, and infant mortality) among New York City women. METHODS: We used Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene birth- and death-linked data from 2000 to 2010 (n = 984 807) to quantify the association of maternal race/ethnicity and parental race/ethnicity concordance or discordance with each outcome. RESULTS: By maternal race/ethnicity, infants of non-Hispanic Black, Hispanic, and Asian women had risks of adverse birth outcomes between 10% and 210% greater than infants of non-Hispanic White women. Infants of non-Hispanic Black, Asian, and Hispanic couples exhibited higher risk of adverse birth outcomes than infants of non-Hispanic White couples. Moreover, parental racial/ethnic discordance was associated with an increased risk of adverse birth outcomes, with highest risks for pairings of Asian men with non-Hispanic White, non-Hispanic Black, and Hispanic women, and of Asian women with non-Hispanic Black and Hispanic men. CONCLUSIONS: Parental race/ethnicity discordance may add stress to women during pregnancy, affecting birth outcomes. Thus, parental race/ethnicity should be considered when examining such outcomes.

Immigrant Status and Ethnic Inequities in Dental Caries in Children: Bilbao, Spain.

This study examined the migratory status/ethnic inequities in dental caries in school children aged 4-9 years (n = 1388) and the impact of the Children's Oral Health Program in the Municipality of Bilbao in the Basque Country Region, Spain. Using the 2017 Children's Oral Health Survey, log binomial regression was used to quantify the association of parental immigration status/ethnicity with tooth decay for (1) the primary and the permanent dentitions, separately, in children 4-9 years old; and (2) for the permanent dentition in children aged 7-9 years. Compared with Spanish children, Spanish Roma and immigrant children had a higher probability of tooth decay in primary and permanent teeth after adjustment. Similarly, Spanish Roma and immigrant children had a higher probability of caries experience in primary and permanent teeth. In children aged 7-9 years, Spanish Roma children had a greater probability of tooth decay and caries experience (DMFT index ≥ 1; PR: 6.20; 95% CI: 3.18, 12.12; and PR: 4.52; 95% CI: 2.46, 8.32; respectively) compared with Spanish Children. These associations were not observed in immigrant children. This study shows that parental immigration status and/or ethnicity affect caries outcomes in immigrant and Roma children in both primary and permanent dentition.

Adverse birth outcomes in New York City women: Revisiting the Hispanic Paradox.

In the United States, African American or non-Hispanic Black infants experienced worst birth outcomes whereas Hispanic and Asian infants have intermediate or similar outcomes compared with non-Hispanic white infants. The findings of better birth outcomes for Hispanic women have been coined the "Hispanic Paradox" given their low education, income, and access to care. New York City (NYC) has a great racial/ethnic diversity with implications for neighborhood racial/ethnic composition on birth outcomes by protecting women from psychosocial stress via social support that may buffer against racial/ethnic discrimination and/or racism. Data from 2012 to 2018 were used to examine the association of NYC women's race/ethnicity and neighborhood racial/ethnic minority composition with adverse birth outcomes (low birthweight [LBW], small for gestational age [SGA], preterm birth and infant mortality); and whether the association between mother's race/ethnicity and each birth outcome differed by neighborhood racial/ethnic composition. Multilevel logistic regression was used to control for the clustering of outcomes within neighborhoods. Black, Asian, and American Indian women have poorer birth outcomes than white women. Infants of Mexican American, Central American, and South American women were less likely to be of LBW whereas the opposite was true for infants of Cuban and other Hispanic women compared with infants of white women. When compared with white women, Mexican American, and South American women were less likely to have an SGA infant whereas Puerto Rican and other Hispanic women were more likely to have an SGA infant. All Hispanic women were more likely to have a preterm birth than white women whereas for infant mortality, greater odds of dying were observed for infants of Puerto Rican, Dominican, and other Hispanic women. Higher neighborhood racial/ethnic minority composition was associated with greater odds of having an adverse outcome. Finally, we observed heterogeneity of the associations between mother's race/ethnicity and birth outcomes by neighborhood racial/ethnic minority composition.

Interracial/ethnic marriage and adverse birth outcomes: The effect of neighborhood racial/ethnic composition.

Race/ethnicity is associated with adverse birth outcomes in the United States. However, mostly mother's race/ethnicity has been considered. We examined the associations of mother's and parents' race/ethnicity with low birth weight, small for gestational age, preterm birth and infant mortality among New York City women between 2012 and 2017. We also examined the independent and joint effects of neighborhood racial/ethnic composition. We found that mother's and parents' race/ethnicity are associated with adverse birth outcomes; these associations are outcome-specific; and neighborhood racial/ethnic composition is not only associated with such outcomes but also modifies the association of mother's and parents' race/ethnicity with these outcomes. Our findings underscore the need to consider the race/ethnicity of women's partners and their neighborhoods calling attention to the role of context where individuals reside, and their daily interactions take place. These findings may have implications beyond New York City as our society becomes more racial/ethnic diverse and interracial/ethnic marriage becomes more common in the United States.

Cardiovascular disease risk factors in Spain: A comparison of native and immigrant populations.

Cardiovascular disease (CDV) risk factors are highly prevalent among adults with low social class in Spain. However, little is known on how these factors are distributed in the immigrant population, a socio-economic disadvantaged population. Thus, this study aims to examine inequalities in CVD risk factors among immigrant and native populations. We conducted a cross-sectional study using data from the Spanish National Health Survey 2017 and used log-binomial regression to quantify the association of immigrant status on CVD risk factors among adults aged 25-64 years. The probabilities of having at least three CVD risk factors were higher for immigrants from Eastern Europe (PR: 1.25; 95% CI: 1.15-1.35) and lower for immigrants from Africa (PR: 0.79; 95% CI: 0.69-0.89) when compared with natives. The association of immigrant status and CVD risk factors varies with educational attainment (p-interaction = 0.001). Immigrants from Eastern Europe with low educational attainment have a higher probability of having at least three CVD risk factors compared with their native counterparts. In contrast, immigrants from Africa and Latin America with low educational attainment had a protective effect against having at least three CVD risk relative to natives. Health prevention and promotion strategies to reduce the burden of CVD taking should account for educational attainment given its differential effect among the immigrant population in Spain.

Racial/ethnic inequities in the associations of allostatic load with all-cause and cardiovascular-specific mortality risk in U.S. adults.

Non-Hispanic blacks have higher mortality rates than non-Hispanic whites whereas Hispanics have similar or lower mortality rates than non-Hispanic blacks and whites despite Hispanics' lower education and access to health insurance coverage. This study examines whether allostatic load, a proxy for cumulative biological risk, is associated with all-cause and cardiovascular (CVD)-specific mortality risks in US adults; and whether these associations vary with race/ethnicity and further with age, sex and education across racial/ethnic groups. Data from the third National Health and Nutritional Examination Survey (NHANES III, 1988-1994) and the 2015 Linked Mortality File were used for adults 25 years or older (n = 13,673 with 6,026 deaths). Cox proportional hazards regression was used to estimate the associations of allostatic load scores (2 and ≥3 relative to ≤1) with a) all-cause and b) CVD-specific mortality risk among NHANES III participants before and after controlling for selected characteristics. Allostatic load scores are associated with higher all-cause and CVD-specific mortality rates among U.S. adults aged 25 years or older, with stronger rates observed for CVD-specific mortality. All-cause mortality rates for each racial/ethnic group differed with age and education whereas for CVD-specific mortality rates, this difference was observed for sex. Our findings of high allostatic load scores associated with all-cause and CVD-specific mortality among US adults call attention to monitor conditions associated with the allostatic load's biomarkers to identify high-risk groups to help monitor social inequities in mortality risk, especially premature mortality.

Place of Birth Inequalities in Dental Care Use before and after the Economic Crisis in Spain.

This study evaluates inequalities in the use of dental services according to place of birth before and after the economic crisis in Spain. A cross-sectional study was performed in adults aged 18 to 65 years in Spain. We used data from three Spanish National Health Surveys for the years 2006 (before the crisis), 2014, and 2017 (after the crisis). Log-binomial regression was used to quantify the association between place of birth and use of dental care services before and after controlling for the selected covariates. In 2006, we found a greater probability of not using dental care services in immigrants from Asia (PR: 1.36, 95% CI: 1.10-1.67) and Africa (PR: 1.16, 95% CI: 1.05-1.28) compared to the natives. For 2014, the probability of not using dental care services was greater for all immigrants relative to natives, with the greatest probability for those from Africa (PR: 1.71, 95% CI: 1.46-2.01) and Asia (PR: 1.3, 95% CI: 1.23-1.47). The associations for 2017 were weaker in magnitude than the ones observed for 2014, although stronger than for 2006. This study suggests that the economic recovery did not have the same impact for natives and immigrants regardless of regions of origin, given the observed inequalities in use of dental services.

Health Services Access Inequalities Between Native and Immigrant in a Southern European Region.

With the economic crisis in Spain, austerity measures were applied. However, it is unknown how these measures have affected the pattern of use of health services for the immigrant population. Thus, the objective of this study was to examine the inequalities in access to different levels of health care services according to place of birth. We used data from the 2014 Foreign Immigrant Population Survey (n = 1,908) and the Basque Health Survey 2013 for the native population (n = 4,232) for adults aged 16-59 years residing in the Basque Country, Spain. Log-binomial regression was used to quantify the association between country of origin and use of different levels of care in men and in women. We found a higher probability of using general practitioner (GP) services in immigrant women (PR: 1.19; 95% CI: 1.12-1.26) and men (PR: 1.11; 95% CI: 1.01-1.23) than in natives. This was also true for emergency services with immigrant women (PR: 1.97; 95% CI: 1.43-2.69) and men (PR: 1.50; 95% CI: 1.01-2.25). However, for specialized medicine services, there was no association. This study suggests the importance of guaranteeing access to health care to the entire population. Hence policies to eliminate barriers to health care are essential to ensure health for all.

[Sociodemographic variables and lifestyle as predictors of self-perceived health in immigrants in the Basque Country [Spain]]. / Variables sociodemográficas y estilos de vida como predictores de la autovaloración de la salud de los inmigrantes en el País Vasco.

OBJECTIVE: To explore the importance of socio-demographic factors as well as life-style and their influence in self-rated health of Maghribian, Sub-Saharian, Latin-American and non-Communitarian European immigrant groups living in the Basque Country (Spain). METHODS: Descriptive cross-study with a convenience sample of 689 persons, consisting of 219 Maghribians (31.8%), 152 Sub-Saharians (22.1%), 167 Latino(a)s (24.2%) and 151 non-Communitarian Europeans (21.9%). Data base have been completed with data collected using the 2002 Regional Basque Health Interview Survey (ESCAV 2002). The multivariate analysis was performed by using the dicotomic logistic regression (software SPSS 13). RESULTS: We found that 64.2% of Maghribian, 78.7% of Sub-Saharian, 66.1% of Latin-American and 67.1% of non-Communitarian European assessed their health as very good or good. The significantly associated variables (p<0.05 and p<0.01) with self-rated health were collective membership, sex and age. Persons belonging to the Sub-Saharian collective showed a stronger advantage of positively self-assessed health (OR=2.08; 95%CI: 1.29-3.36). This advantage was also found among men of all four collectives (OR=2.16, 95%CI: 1.54-3.02) and in persons in the age of 33-38 years (OR=3.13, 95%CI: 1.71-5.73). Those variables remained significant in the multivariate analysis. CONCLUSIONS: Our results demonstrated the importance of considering differences in the health status and in self-rated health among immigrant groups, as well as the variables associated with those differences, when developing community-based health strategies.

[Impact in the utilisation of the health services of socio-demographic variables, life-style and self-rated health by immigrant groups living in the Basque Country, Spain]. / Impacto en la utilización de los servicios sanitarios de las variables sociodemográficas, estilos de vida y autovaloración de la salud por parte de los colectivos de inmigrantes del País Vasco, 2005.

BACKGROUND: The progressive incorporation of foreign population in our country requires the knowledge of the impact of these groups in our health system. The aim of this work is to identify the factors associated to the utilisation of the public health services of immigrant groups in the Basque Country. METHODS: Descriptive cross-study with a convenience sample of 689 persons, consisting of 219 Maghribians (31.8%), 152 Sub-Saharan (22.1%), 167 Latino(a)s (24.2%) and 151 non-Communitarian Europeans (21.9%). Data base have been completed with data collected using the 2002 Regional Basque Health Interview Survey (ESCAV2002). The multivariate analysis was performed by using the dicotomic logistic regression (software SPSS 13). RESULTS: The utilisation of the health services by the immigrants was associated to the fact of be a woman (OR=3.37, IC=1.77-6.43), Maghribian (OR=3.35, IC=1.51-7.45) and to have a bad self-rated health (OR=2.22, IC=1.00-4.90). A major utilisation of the hospital urgency during the first two years of stage was found in Sub-Saharan (OR=4.12, IC=1.23-13.81) and non-Communitarian European (OR=3.56, IC=1.08-11.80) immigrants. CONCLUSIONS: Results from this study allows to identify differences in the utilisation of public health services by immigrants in the CAPV, taking into account the sex, self-rated health, immigrant group and time of residence in the host country.

Obesity Inequalities According to Place of Birth: The Role of Education.

This study examined obesity inequalities according to place of birth and educational attainment in men and in women in Spain. A cross-sectional study was conducted using data from the Spanish National Health Survey 2011⁻2012 and from the European Health Survey in Spain 2014. We used data for 27,720 adults aged 18⁻64 years of whom 2431 were immigrants. We used log-binomial regression to quantify the association of place of birth with obesity before and after adjusting for the selected characteristics in women and in men. We found a greater probability of obesity in immigrant women (PR: 1.42; 95% CI: 1.22⁻1.64) and a lower probability of obesity in immigrant men (PR: 0.73; 95% CI: 0.59⁻0.89) relative to natives after adjustment. Significant heterogeneity was observed for the association of place of birth and obesity according to education in men (p-interactions = 0.002): Men with lower educational levels (PR: 0.47; 95% CI: 0.26⁻0.83) have a protective effect against obesity compared with their native counterparts. This study suggests that place of birth may affect obesity in women and in men. However, this effect may be compounded with education differently for women and men.

Perceived discrimination and self-rated health in the immigrant population of the Basque Country, Spain.

OBJECTIVE: To examine the effect of perceived discrimination and self-rated health among the immigrant population in the Basque Country, Spain, and determine whether this effect varies according to region of origin, age, sex and education. METHODS: Descriptive cross-sectional study. The study population included immigrants aged 18 and older residing in the Basque Country. Data from the 2014 Foreign Immigrant Population Survey (n=3,456) were used. Log-binomial regression was used to quantify the association between perceived discrimination and self-rated health before and after checking for the selected characteristics. RESULTS: Almost 1 in 10 immigrant adults reports perceiving discrimination. In adjusted analyses, the immigrants perceiving discrimination were almost were 1.92 more likely to rate their health as poor (prevalence ratio: 1.92; 95% CI: 1.44-2.56) than those who did not report discrimination. This association did not vary according to region of origin, age, sex or educational level. CONCLUSIONS: Perceived discrimination shows a consistent relationship with perceived health. Moreover, this association did not depend on the region of origin, age, sex or educational level of immigrants. These results show the need for implementing inclusive policies to eliminate individual and institutional discrimination and reduce health inequalities between the immigrant and native populations.

Induced abortion in a Southern European region: examining inequalities between native and immigrant women.

OBJECTIVES: To examine induced abortion (IA) inequalities between native and immigrant women in a Southern European region and whether these inequalities depend on a 2010 Law facilitating IA. METHODS: We conducted two analyses: (1) prevalence of total IAs, repeat and second trimester IA, in native and immigrant women aged 12-49 years for years 2009-2013 according to country of origin; and (2) log-binomial regression was used to quantify the association of place of origin with repeat and second trimester IAs among women with IAs. RESULTS: Immigrants were more likely to have an IA than Spanish women, with the highest probability in Sub-Saharan Africa (PR 8.32 95 % CI 3.66-18.92). Immigrant women with an IA from countries other than Maghreb and Asia have higher probabilities of a repeat IA than women from Spain. Women from Europe non-EU/Romania were 50 % (95 % CI 0.30-0.79) less likely to have a second trimester IA, while women from Central America/Caribbean were 45 % (95 % CI 1.11-1.89) more likely than Spanish women. The 2010 Law did not affect these associations. CONCLUSIONS: There is a need for parenthood planning programs and more information and access to contraception methods especially in immigrant women to help decrease IAs.

[Immigration and health: Social inequalities between native and immigrant populations in the Basque Country (Spain)]. / Inmigración y salud: desigualdades entre la población autóctona e inmigrante en el País Vasco.

OBJECTIVE: To analyze health inequalities between native and immigrant populations in the Basque Country (Spain) and the role of several mediating determinants in explaining these differences. METHODS: A cross-sectional study was performed in the population aged 18 to 64 years in the Basque Country. We used data from the Basque Health Survey 2007 (n=4,270) and the Basque Health Survey for Immigrants 2009 (n=745). We calculated differences in health inequalities in poor perceived health between the native population and immigrant populations from distinct regions (China, Latin America, the Maghreb and Senegal). To measure the association between poor perceived health and place of origin, and to adjust this association by several mediating variables, odds ratios (OR) were calculated through logistic regression models. RESULTS: Immigrants had poorer perceived health than natives in the Basque Country, regardless of age. These differences could be explained by the lower educational level, worse employment status, lower social support, and perceived discrimination among immigrants, both in men and women. After adjustment was performed for all the variables, health status was better among men from China (OR: 0.18; 95% confidence interval [CI95%]: 0.04-0.91) and Maghreb (OR: 0.26; 95% CI: 0.08-0.91) and among Latin American women (OR: 0.36; 95% CI: 0.14-0.92) than in the native population. CONCLUSIONS: These results show the need to continue to monitor social and health inequalities between the native and immigrant populations, as well as to support the policies that improve the socioeconomic conditions of immigrants.

Social factors associated with the knowledge about HIV of the immigrants from China, Latin America, the Maghreb and Senegal in the Basque Country (Spain).

The objective of this study was to identify the social factors that explain the differences in knowledge with regards to HIV/AIDS among immigrants in the Basque Country (Spain). We conducted a cross-sectional study based on information obtained in the Basque Health Survey for 754 immigrants from: 86 China, 368 Latin America, 237 the Maghreb and 74 Senegal. Odds ratios (95% CI) were calculated from logistic regression models to measure the degree of association between inadequate knowledge regarding transmission, prevention and places where HIV testing is offered, and the independent variables. We found that this inadequate knowledge is associated with place of birth, sex, a lower level of education, immigration status, difficulties in understanding Spanish, and not receiving advice about AIDS in primary care. These findings indicate that initiatives must be developed to promote equity in the provision of healthcare through clinical guidelines, including details of the specific needs of different groups of immigrants and considering gender issues.

Perceived discrimination and self-rated health in the immigrant population of the Basque Country, Spain / Discriminación y salud percibida en la población inmigrante del País Vasco (España)

Objective: To examine the effect of perceived discrimination and self-rated health among the immigrant population in the Basque Country, Spain, and determine whether this effect varies according to region of origin, age, sex and education. Methods: Descriptive cross-sectional study. The study population included immigrants aged 18 and older residing in the Basque Country. Data from the 2014 Foreign Immigrant Population Survey (n=3,456) were used. Log-binomial regression was used to quantify the association between perceived discrimination and self-rated health before and after checking for the selected characteristics. Results:Almost 1 in 10 immigrant adults reports perceiving discrimination. In adjusted analyses, the immigrants perceiving discrimination were almost were 1.92 more likely to rate their health as poor (prevalence ratio: 1.92; 95% CI: 1.44-2.56) than those who did not report discrimination. This association did not vary according to region of origin, age, sex or educational level. Conclusions: Perceived discrimination shows a consistent relationship with perceived health. Moreover, this association did not depend on the region of origin, age, sex or educational level of immigrants. These results show the need for implementing inclusive policies to eliminate individual and institutional discrimination and reduce health inequalities between the immigrant and native populations (AU)

Objetivo: Examinar el efecto de la discriminación en la salud percibida en la población inmigrante en el País Vasco y si este efecto es explicado por las diferencias en la región de origen, la edad, el sexo y la educación. Métodos: Estudio descriptivo transversal cuya población de estudio fue la población inmigrante de 18 años y más de edad, en el País Vasco. Los datos proceden de la Encuesta de Población Inmigrante Extranjera 2014 (n=3456). Se utilizó la regresión log binomial para medir la asociación entre la discriminación y la salud percibida antes y después de controlar por las características seleccionadas. Resultados: La discriminación fue referida por casi uno de cada 10 inmigrantes. En los análisis ajustados, los inmigrantes que refirieron discriminación tuvieron 1,92 de probabilidad de tener mala salud (razón de prevalencia: 1,92; intervalo de confianza del 95%: 1,44-2,56) en comparación con quienes no la refirieron. Esta asociación no cambió según la región de origen, el sexo ni el nivel de estudios. Conclusiones: La percepción de discriminación muestra una consistente relación con la salud percibida. Además, esta relación no depende del lugar de origen, la edad, el sexo ni el nivel de estudios de los inmigrantes. Estos resultados muestran la necesidad de implementar políticas inclusivas que eliminen la discriminación, tanto individual como institucional, para reducir las desigualdades en salud entre la población inmigrante y la autóctona (AU)

Inmigración y salud: desigualdades entre la población autóctona e inmigrante en el País Vasco / Immigration and health: Social inequalities between native and immigrant populations in the Basque Country (Spain)

Objetivo: Analizar las desigualdades en el estado de salud percibido de la población autóctona e inmigrante residente en la comunidad autónoma del País Vasco y el papel de diferentes determinantes sociales en la explicación de tales desigualdades. Métodos: Estudio descriptivo transversal referido a la población de 18 a 64 años de edad residente en el País Vasco. Se utilizaron datos de la Encuesta de Salud de Euskadi 2007 (n = 4734) y de la Encuesta de Salud de la Población Inmigrante del País Vasco 2009 (n = 765). Se analizaron las desigualdades en la mala salud percibida entre personas autóctonas y cuatro grupos de inmigrantes (China, Latinoamérica, Magreb y Senegal). Para medir la asociación entre la mala salud y el lugar de nacimiento, y poder ajustarla por diferentes variables, se calcularonodds ratio (OR) mediante modelos de regresión logística. Resultados: La población inmigrante en el País Vasco mostró un peor estado de salud percibido que la autóctona, con independencia de la edad. El menor nivel de estudios, la peor situación laboral, el menor apoyo social y la discriminación percibida en la población inmigrante explicaron estas diferencias, en hombres y mujeres. En los hombres de China (OR: 0,18; intervalo de confianza del 95% [IC95%]: 0,04-0,91) y Magreb (OR: 0,26; IC95%: 0,08-0,91), y en las mujeres latinoamericanas (OR: 0,36; IC95%: 0,14-0,92), fue mejor que la de la población autóctona tras ajustar por todas las variables. Conclusiones: Los resultados muestran la necesidad de seguir monitorizando las desigualdades sociales y en salud entre la población autóctona e inmigrante en España, así como de apoyar aquellas políticas sociales que mejoren las condiciones de vida de la población inmigrante (AU)

Objective: To analyze health inequalities between native and immigrant populations in the Basque Country (Spain) and the role of several mediating determinants in explaining these differences. Methods: A cross-sectional study was performed in the population aged 18 to 64 years in the Basque Country. We used data from the Basque Health Survey 2007 (n = 4,270) and the Basque Health Survey for Immigrants 2009 (n = 745). We calculated differences in health inequalities in poor perceived health between the native population and immigrant populations from distinct regions (China, Latin America, the Maghreb and Senegal). To measure the association between poor perceived health and place of origin, and to adjust this association by several mediating variables, odds ratios (OR) were calculated through logistic regression models. Results: Immigrants had poorer perceived health than natives in the Basque Country, regardless of age. These differences could be explained by the lower educational level, worse employment status, lower social support, and perceived discrimination among immigrants, both in men and women. After adjustment was performed for all the variables, health status was better among men from China (OR: 0.18; 95% confidence interval [CI95%]: 0.04-0.91) and Maghreb (OR: 0.26; 95% CI: 0.08-0.91) and among Latin American women (OR: 0.36; 95% CI: 0.14-0.92) than in the native population. Conclusions: These results show the need to continue to monitor social and health inequalities between the native and immigrant populations, as well as to support the policies that improve the socioeconomic conditions of immigrants (AU)

[Relationship between migrant status and social support and quality of life in Moroccans in the Basque Country (Spain)]. / Relación del estatus migratorio y del apoyo social con la calidad de vida de los marroquíes en el País Vasco.

OBJECTIVE: To analyze the effect of birth place, migrant status and the modulatory role of social support on health-related quality of life (HRQoL) and the presence of anxiety/depression symptoms. METHODS: We performed a cross-sectional study of three samples composed of 2,776 persons: 1,239 Moroccans in Morocco, 149 Moroccans in the Basque Country (Spain) and 1,388 autochthonous individuals. HRQoL and the presence of anxiety/depression symptoms were evaluated using the Short-Form-36 (SF-36) and the Mental Health Inventory-5 (MHI-5). Social support was evaluated with the Duke scale. Multivariate analyses were performed with dichotomic logistic regression (SPSS 16). RESULTS: Immigrant status, compared with living in Morocco, was a protective factor in practically all SF-36 dimensions but was also a risk factor for the development of anxiety/depression symptoms. Differences in HRQoL between Moroccans and the autochthonous population in the Basque Country were attenuated when variables of social support were included in the multivariate models. Low social support and dissatisfaction with social life increased the risk of low HRQoL scores and the presence of anxiety/depression symptoms among Moroccans in the Basque Country. CONCLUSIONS: Some health indicators are more favorable in Moroccans in the Basque Country than in those living in Morocco, but the frequency of anxiety/depression is higher in Moroccan immigrants. The key factor to understanding social inequalities in health among Moroccan immigrants is social support. Strategies to maintain optimal health in these immigrant collectives should include public policies of social inclusion.