Pediatric Hospitalizations from Immigration Detention in Texas, 2015-2018.

Although there are concerns regarding children's health in immigration detention, there are little data regarding hospitalizations in this population. Using 2015-2018 Texas inpatient data, we identified 95 hospitalizations of children in detention and found that most (60%) were driven by infectious causes, and that 37% of these children were admitted to an intensive care unit (ICU) or intermediate ICU.

Trends in Sexual Assault Against Detainees in US Immigration Detention Centers, 2018-2022.

This study examines sexual assault allegations perpetrated against individuals detained across US Immigration and Customs Enforcement (ICE) detention facilities from 2018 to 2022.

Giving Back: A mixed methods study of the contributions of US-Based Nigerian physicians to home country health systems.

BACKGROUND: There is increased interest in the capacity of US immigrants to contribute to their homelands via entrepreneurship and philanthropy. However, there has been little research examining how immigrant physicians may support health systems and what factors facilitate or raise barriers to increased support. METHODS: This study used an observational design with paper questionnaire and interview components. Our sample was drawn from attendees of a 2011 conference for US Based Nigerian physicians; respondents who were not US residents, physicians, and of Nigerian birth or parentage were excluded from further analysis. Respondents were randomly selected to complete a follow-up interview with separate scripts for those having made past financial contributions or medical service trips to support Nigerian healthcare (Group A) and those who had done neither (Group B). Survey results were analyzed using Fischer exact tests and interviews were coded in pairs using thematic content analysis. RESULTS: Seventy-five of 156 (48 %) individuals who attended the conference met inclusion criteria and completed the survey, and 13 follow-up interviews were completed. In surveys, 65 % percent of respondents indicated a donation to an agency providing healthcare in Nigeria the previous year, 57 % indicated having gone on medical service trips in the prior 10 years and 45 % indicated it was "very likely" or "likely" that they would return to Nigeria to practice medicine. In interviews, respondents tended to favor gifts in kind and financial gifts as modes of contribution, with medical education facilities as the most popular target. Personal connections, often forged in medical school, tended to facilitate contributions. Individuals desiring to return permanently focused on their potential impact and worried about health system under-preparedness; those not desiring permanent return centered on how safety, financial security and health systems issues presented barriers. CONCLUSIONS: This study demonstrates several mechanisms by which health systems may benefit from expatriate engagement. Greater identification of reliable local partners for diaspora, deeper collaboration with those partners and a focus on sustainable interventions might improve the quantity and impact of contributions. Ethnic medical associations have a unique role in organizing and facilitating diaspora response. Public-private partnerships may help diaspora negotiate the challenges of repatriation.

A call for increased transparency and accountability of health care outcomes in US Immigration and Customs Enforcement detention centers.

Concerns over health care in US Immigration and Customs Enforcement (ICE) facilities have grown over the past decade, including reports of medical mismanagement, inadequate mental health care, and inappropriate use of solitary confinement. Despite being a federally funded agency, reporting and accountability of health outcomes in ICE facilities is limited. This manuscript outlines current standards for health in ICE detention, how compliance is evaluated, why this process fails, and how current processes can be improved to achieve transparency and accountability. Ultimately, health metrics must be: 1) frequent; 2) timely; 3) granular; 4) collected by an independent body; and 5) publicly reported. Financial compensation for health service providers must be contingent on meeting these required metrics, with contract termination for persistent violations. Transparent and accountable monitoring systems, as are required in other federally funded healthcare facilities, are essential to accurately measure health outcomes and harms of individuals held in detention.

Deaths in Immigration and Customs Enforcement (ICE) detention: A Fiscal Year (FY) 2021-2023 update.

Background: This study describes the deaths of individuals in Immigration and Customs Enforcement (ICE) detention between FY2021-2023, updating a report from FY2018-2020, which identified an increased death rate amidst the COVID-19 pandemic. Methods: Data was extracted from death reports published online by ICE. Causes of deaths were recorded, and death rates per 100,000 admissions were calculated using population statistics reported by ICE. Reports of individuals released from ICE custody just prior to death were also identified and described. Results: There were 12 deaths reported from FY2021-2023, compared to 38 deaths from FY2018-2020. The death rate per 100,000 admissions in ICE detention was 3.251 in FY2021, 0.939 in FY2022, and 1.457 in FY2023, compared with a pandemic-era high of 10.833 in FY2020. Suicide caused 1 of 12 (8.3%) deaths in FY2021-2023 compared with 9 of 38 (23.7%) deaths in FY2018-2020. COVID-19 was contributory in 3 of 11 (25%) medical deaths in FY2021-2023, compared with 8 of 11 (72.7%) in the COVID-era months of FY2020 (p = 0.030). Overall, 4 of 11 (36.3%) medical deaths in FY2021-2023 resulted from cardiac arrest in detention facilities, compared with 6 of 29 (20.3%) in FY2018-2020. Three deaths of hospitalized individuals released from ICE custody with grave prognoses were identified. Conclusions: The death rate among individuals in ICE custody decreased in FY2021-2023, which may be explained in part by the release of vulnerable individuals following recent federal legal determinations (e.g., Fraihat v. ICE). Identification of medically complex individuals released from ICE custody just prior to death and not reported by ICE indicates that reported deaths underestimate total deaths associated with ICE detention. Attentive monitoring of mortality outcomes following release from ICE custody is warranted.

Advancing Research To Address The Health Impacts Of Structural Racism In US Immigration Prisons.

The US is the world leader in imprisoning immigrants. Its mass immigration detention system emerged as an extension of mass incarceration, rooted in a legacy of racist US immigration and criminal laws. Immigration policy is a structural determinant of health that negatively affects the health of imprisoned immigrants, their families, and their communities. The systemic harms of "detention facilities," which we refer to as "immigration prisons," have been extensively documented, yet incrementalist reforms have failed to result in improved outcomes for immigrants. We argue that ending the practice of immigrant imprisonment is the most effective solution to mitigating its harms. Community-based programs are safer and less expensive than imprisonment, while also being effective at ensuring compliance with government requirements. We identify several priorities for researchers and policy makers to tackle the health inequities resulting from this structurally racist system. These include applying a critical, intersectional lens to studying the policies and practices that drive imprisonment, engaging affected communities in research and policy development, and creating an accountable and transparent system of data collection and release to inform health interventions. The reliance of the US on immigrant imprisonment is a policy choice with immense social and economic costs; dismantling it is critical to advancing health equity.

Little To No Correlation Found Between Immigrant Entry And COVID-19 Infection Rates In The United States.

The relationship between immigrant entry and COVID-19 spread in the United States has driven much political discussion and policy, including the implementation of Title 42 by the Centers for Disease Control and Prevention. To examine the relationship between COVID-19 spread and immigrant entry, we compared 2020-21 immigrant flows with local COVID-19 rates, using estimates of border crossings from the Border Patrol and visas issued through the Department of Labor's seasonal guest worker program. Our analysis capturing seasonal guest worker entry at the national level showed no statistically significant relationship with COVID-19 rates. Our analyses of Southwest border crossings showed a small, statistically significant relationship between immigrant flows and COVID-19 rates in border counties (0.14 percent increase in local cases per 100,000 residents for each additional 100 immigrants). However, this estimate is modest compared with the fact that half of all month-to-month changes in case rates were greater than 59 percent. Furthermore, the modest increase became nonsignificant with increasing local vaccination rates. Estimates also did not maintain their statistical significance when analyzed with some alternative approaches. Our findings support existing evidence that the short-term impacts of immigrant flow on local COVID-19 rates were minimal.

Reported Visa Acceptance or Sponsorship for Non-US Citizen Applicants to US Internal Medicine Residency Programs.

Background: Non-US citizen international medical graduates (IMGs) make up a significant proportion of the physician workforce, especially in physician shortage areas and specialties. IMGs face barriers matriculating in US residency programs. Whether a program reports accepting J-1 visas and sponsoring H-1B visas influences their decision to apply, it remains unclear which institutional factors shape programs' likelihood to consider visa-seeking applicants. Objective: We investigated factors associated with programs reporting accepting J-1 visas or sponsoring H-1B visas for non-citizen applicants in internal medicine, the specialty most sought after by IMGs. Methods: We performed multivariable regression analyses using publicly available data to identify characteristics associated with reported visa acceptance (J-1 and or H-1B). Covariates included university affiliation, program size, program type (academic, university-affiliated community, or community), and Doximity reputation ranking. Results: We identified 419 programs: 267 (63.7%) reported accepting J-1 visas. Among programs that accepted J-1 visas, 65.6% (n=175) accepted only J-1 visas while 34.5% (n=92) sponsored H-1B and accepted J-1 visas. Ranking in the third quartile (vs first quartile) was associated with lower odds of accepting J-1 (aOR 0.12; 95% CI 0.02-0.87; P=.04) and sponsoring H-1B visas (aOR 0.19; 95% CI 0.05-0.76; P=.02). Community status (vs academic) was associated with lower odds of accepting J-1 visas (aOR 0.2; 95% CI 0.06-0.64; P=.007), as was county hospital affiliation vs non-county hospitals (aOR 0.22; 95% CI 0.11-0.42; P<.001). Conclusions: While prior evidence shows that most internal medicine programs that substantially enroll IMGs are low ranking, high-ranking internal medicine programs are paradoxically more likely to report that they consider and sponsor visa-seeking applicants.

Avoiding Medicaid enrollment after the reversal of the changes in the public charge rule among Latino and Asian immigrants.

OBJECTIVE: To estimate the avoidance of Medicaid enrollment among Latino and Asian immigrants due to fears about immigration status. In 2019, changes to the "public charge" rule made it difficult for immigrants to receive a green card or permanent residence visa, particularly for those who used health and nutrition benefits. Despite the Biden administration's reversal of these changes, fear and misinformation persist among immigrants. DATA SOURCES: Pooled data from the 2017 to 2020 California Health Interview Survey. STUDY DESIGN: We used adjusted predicted probability models to estimate differences in access to and use of health care and health insurance coverage among Latino and Asian immigrant adults with and without green cards, using US citizens as the reference. We estimated the avoidance of Medicaid enrollment among immigrants without a green card, the immigrant population subject to the public charge rule. DATA COLLECTION/EXTRACTION METHODS: Population stratified by race/ethnicity and green card status. PRINCIPAL FINDINGS: Latino immigrants without a green card were -23.1% (CI: -27.8, -18.4) less likely to be insured, -9.2% (CI: -12.8, -5.5) less likely to have Medicaid coverage, -9.3% (CI: -14.5, -4.1) less likely to have a usual source of care, and -8.4% (CI: -13.2, -0.3) less likely to have a physician visit relative to citizens. Asian immigrants without a green card were -11.7% (CI: -19.7, -3.72) less likely to be insured, -8.8% (CI: -11.6, -6.1) less likely to have Medicaid coverage, -11.6% (CI: -19.3, -3.9) less likely to have a usual source of care, and -11.0% (CI: -19.2, -2.3) less likely to have a physician visit. Between 107,956 and 192,905 Latino immigrants and 1294 and 4702 Asian immigrants in California likely avoided Medicaid enrollment due to fears about their immigration status. CONCLUSION: While our estimates are lower than those of previous studies, our findings highlight barriers to health care for immigrants despite the reversal of the changes in the public charge rule. Since the public charge rule was not abolished, immigrants with low incomes might choose not to seek health care, despite recent efforts in California to expand Medicaid coverage to all eligible immigrants regardless of documentation statuses.

Adult hospitalizations from immigration detention in Louisiana and Texas, 2015-2018.

Poor health conditions within immigration detention facilities have attracted significant concerns from policymakers and activists alike. There is no systematic data on the causes of hospitalizations from immigration detention facilities or their relative morbidity. The objective of this study, therefore, was to analyze the causes of hospitalizations from immigration detention facilities, as well as the percentage of hospitalizations necessitating ICU or intermediate-ICU (i.e, "step-down") admission and the types of surgical and interventional procedures conducted during these hospitalizations. We conducted a cross-sectional study of statewide adult (age 18 and greater) hospitalization data, with hospitalizations attributed to immigration facilities via payor designations (from Immigration and Customs Enforcement) and geospatial data in Texas and Louisiana from 2015-2018. Our analysis identified 5,215 hospitalizations of which 887 met inclusion criteria for analysis. Average age was 36 (standard deviation, 13.7), and 23.6% were female. The most common causes of hospitalization were related to infectious diseases (207, 23.3%) and psychiatric illness (147, 16.6%). 340 (38.3%) hospitalizations required a surgical or interventional procedure. Seventy-two (8.1%) hospitalizations required ICU admission and 175 (19.5%) required intermediate ICU. In this relatively young cohort, hospitalizations from immigration detention were accompanied with significant morbidity. Policymakers should mitigate the medical risks of immigration detention by improving access to medical and psychiatric care in facilities.

South African physician emigration and return migration, 1991-2017: a trend analysis.

Although critical for understanding health labour market trends in low- and middle-income countries (LMICs), longitudinal LMIC health worker emigration and return migration trends are not routinely documented. This article seeks to better understand SA's trends in physician emigration and return migration and whether economic growth and related policies affect migration patterns. This study used physician registry data to analyse patterns of emigration and return migration only among SA-trained physicians registered to practice in top destination countries such as Australia, Canada, New Zealand, the USA or the UK between 1991 and 2017, which represent the top five emigration destinations for this group. A linear regression model analysed the relationship between migration trends (as dependent variables) and SA's economic growth, health financing and HIV prevalence (as independent variables). There has been a 6-fold decline in emigration rates from SA between 1991 and 2017 (from 1.8% to 0.3%/year), with declines in emigration to all five destination countries. About one in three (31.8% or 5095) SA physicians returned from destination countries as of 2017. Annual physician emigration fell by 0.16% for every $100 rise in SA GDP per capita (2011 international dollars) (95% confidence interval -0.60% to -0.086%). As of 2017, 21.6% (11 224) of all SA physicians had active registration in destination nations, down from a peak of 33.5% (16 366) in 2005, a decline largely due to return migration. Changes to the UK's licensing regulations likely affected migration patterns while the Global Code of Practice on International Recruitment contributed little to changes. A country's economic growth might influence physician emigration, with significant contribution from health workforce policy interventions. Return migration monitoring should be incorporated into health workforce planning.

Changes in Health Care Use Among Undocumented Patients, 2014-2018.

Importance: The 2016 presidential campaign was marked by intensified rhetoric around the deportation of undocumented immigrants. The association of such rhetoric with primary, emergency, and inpatient care among undocumented immigrants is unclear. Objective: To examine the association of increased anti-immigrant rhetoric during the 2016 presidential campaign with health care use among a group of Medicaid-ineligible patients largely composed of undocumented immigrants. Design, Setting, and Participants: Using a difference-in-differences (DID) approach, this cohort study analyzed health care use between January 1, 2014, and May 31, 2018, in a retrospective cohort of Medicaid and Medicaid-ineligible (>90% undocumented) adult and pediatric patients. The inflection point of interest was June 16, 2015, the date of Donald Trump's announcement of candidacy, which represented a documented increase in anti-immigration rhetoric during the presidential campaign. Analyses were controlled for age, self-reported sex, and baseline comorbidities. Data analysis was conducted from August 28, 2018, to September 1, 2020. Main Outcomes and Measures: The DID of the number of completed primary care encounters before and after June 16, 2015, in Medicaid compared with Medicaid-ineligible patients. Secondary outcomes included the DID of emergency department (ED) visits and inpatient discharges over the same period. Results: There were 20 211 patients included in the analysis: 1501 (7.4%) in the sample of predominantly undocumented Medicaid-ineligible patients (861 [57.4%] female) and 18 710 (92.6%) in the Medicaid control group (10 443 [55.8%] female). The mean (SD) age as of 2018 in the Medicaid-ineligible group was 38.2 (15.4) years compared with 22.2 (16.5) years in the control group. There was a differential decrease in completed visits among Medicaid-ineligible children compared with Medicaid children (DID estimate, 0.8; 95% CI, 0.7-0.9) and Medicaid-ineligible adults (DID estimate, 0.8; 95% CI, 0.8-0.9). There was also a significant differential increase in ED visits among Medicaid-ineligible children (DID estimate, 2.3; 95% CI, 1.1-5.0). In addition, there was a differential decrease in inpatient discharges among Medicaid-ineligible adults (DID estimate, 0.5; 95% CI, 0.4-0.7), with no significant change in ED visits or ED admission rates in this group. Conclusions and Relevance: In this cohort study, there was a significant decrease in primary care use among undocumented patients during a period of increased anti-immigrant rhetoric associated with the 2016 presidential campaign, coincident with an increase in ED visits among children and a decrease in inpatient discharges among adults, with the latter possibly attributed to a decrease in elective admissions during this period.

Towards diaspora-driven research capacity strengthening in low- and middle-income countries: results from India and Nepal.

BACKGROUND: Biomedical research from high-income countries often informs practice and policy in low- and middle-income countries (LMICs) with vastly different socioeconomic and health systems. Engagement of LMIC-based researchers is integral to setting research priorities in the local context. METHODS: A program, comprising a research seminar and workshop, and utilizing diaspora health professionals to understand research needs and build research capacity in LMICs, was created and pilot-tested at two institutions in India (65 participants) and Nepal (30 participants). Pre- and post-program surveys were instituted to assess participants' attitudes towards research. RESULTS: In the pre-program survey, most participants (India: 76%, Nepal: 100%) perceived research as 'very/extremely important' in their careers. However, a majority felt that finding time (India: 75%, Nepal: 81%) and funding (India: 82%, Nepal: 100%) for research was 'difficult/very difficult'. After the program, 86-91% and 86-100% of participants from India and Nepal, respectively, felt that the various courses were very useful/useful for their research careers. CONCLUSIONS: Research is seen as an integral part of educational training and career advancement in LMICs. However, inadequate training, funding and mentorship remain a challenge. Engagement of diaspora health workers may serve as an important avenue for collaborative biomedical research capacity strengthening in LMICs.