The impact of economic recession on the health of migrant fathers over time: results from the Growing up in Ireland longitudinal study.

BACKGROUND: The relationship between economic conditions and health can depend on both the health outcome measured and the composition of the population. Analysis of outcomes by both ethnicity and country of birth has been recommended. The aim of our study is to explore the impact of recession on self-rated health and depression of migrant fathers in Ireland over time, considering both ethnicity and country of birth. METHODS: Longitudinal data from waves of a population-representative cohort study (Growing up in Ireland, 2008-2013) was used with Wave 1 collected before the recession and Wave 2 collecting information on how the recession affected families. Socio-demographic variables, self-rated health and depression were compared across three groups of fathers classified by self-identified ethnicity and country of birth: White Irish (n = 5628), Other White European (EU-10) (n = 431), and Black African (n = 192) using chi-square tests and logistic regression models. Rates of follow-up were compared across groups at Wave 3. RESULTS: Prior to the recession, the rate of employment was lowest for African fathers (51% vs 81% for EU-10 fathers and 92% for Irish fathers, p < 0.001). At Wave 2, African families were more likely to have experienced a very significant effect of the recession (40.1% compared to 22.4% for families from EU-10 and 21.3% for Irish families, p < 0.001). However, the impact of the recession on depression and self-rated health was only found in Irish fathers. By Wave 3, rates of follow-up were lower for migrant fathers, particularly for EU-10 fathers. CONCLUSIONS: Understanding the relationship between economic conditions and health is complex and may be related to multiple dimensions of socio-economic advantage and disadvantage. African families were already more likely to be disadvantaged prior to the recession and that pattern persisted during the recession. Further research on attrition rates of migrants in population cohort studies is needed and the development of effective strategies for recruitment, follow-up and analysis.

'If relevant, yes; if not, no': General practitioner (GP) users and GP perceptions about asking ethnicity questions in Irish general practice: A qualitative analysis using Normalization Process Theory.

CONTEXT: The use of ethnic identifiers in health systems is recommended in several European countries as a means to identify and address heath inequities. There are barriers to implementation that have not been researched. OBJECTIVE: This study examines whether and how ethnicity data can be collected in Irish general practices in a meaningful and acceptable way. METHODS: Qualitative case study data generation was informed by Normalization Process Theory (NPT) constructs about 'sense' making and 'engagement'. It consisted of individual interviews and focus group discussions based on visual participatory techniques. There were 70 informants, including 62 general practitioner (GP) users of diverse ethnic backgrounds recruited through community organisations and eight GPs identified through an inter-agency steering group. Data were analysed according to principles of thematic analysis using NPT. RESULTS: The link between ethnicity and health was often considered relevant because GP users grasped connections with genetic (skin colour, lactose intolerance), geographic (prevalence of disease, early years exposure), behavioural (culture/food) and social determinant (housing) factors. The link was less clear with religion. There was some scepticism and questions about how the collection of data would benefit GP consultations and concerns regarding confidentiality and the actual uses of these data (e.g. risk of discrimination, social control). For GPs, the main theme discussed was relevance: what added value would it bring to their consultations and was it was their role to collect these data? Their biggest concern was about data protection issues in light of the European Union (EU) General Data Protection Regulation (GDPR). The difficulty in explaining a complex concept such as 'ethnicity' in the limited time available in consultations was also worrying. CONCLUSIONS: Implementation of an ethnicity identifier in Irish general practices will require a strong rationale that makes sense to GP users, and specific measures to ensure that its benefits outweigh any potential harm. This is in line with both our participants' views and the EU GDPR.

Population perspective comparing COVID-19 to all and common causes of death during the first wave of the pandemic in seven European countries.

OBJECTIVES: Mortality statistics on the COVID-19 pandemic have led to widespread concern and fear. To contextualise these data, we compared mortality related to COVID-19 during the first wave of the pandemic across seven countries in Europe with all and common causes of death, stratifying by age and sex. We also calculated deaths as a proportion of the population by age and sex. STUDY DESIGN: Analysis of population mortality data. METHODS: COVID-19 related mortality and population statistics from seven European countries were extracted: England and Wales, Italy, Germany, Spain, France, Portugal and Netherlands. Available data spanned 14-16 weeks since the first recorded deaths in each country, except Spain, where only comparable stratified data over an 8-week time period was available. The Global Burden of Disease database provided data on all deaths and those from pneumonia, cardiovascular disease combining ischaemic heart disease and stroke, chronic obstructive pulmonary disease, cancer, road traffic accidents and dementia in 2017. RESULTS: Deaths related to COVID-19, while modest overall, varied considerably by age. Deaths as a percentage of all cause deaths during the time period under study ranged from <0.01% in children in Germany, Portugal and Netherlands, to as high as 41.65% for men aged over 80 years in England and Wales. The percentage of the population who died from COVID-19 was less than 0.2% in every age group under the age of 80. In each country, over the age of 80, these proportions were: England and Wales 1.27% males, 0.87% females; Italy 0.6% males, 0.38% females; Germany 0.13% males, 0.09% females; France 0.39% males, 0.2% females; Portugal 0.2% males, 0.15% females; and Netherlands 0.6% males, 0.4% females. CONCLUSIONS: Mortality rates from COVID-19 during the first wave of the pandemic were low including when compared to other common causes of death and are likely to decline further while control measures are maintained, treatments improve and vaccination is instituted. These data may help people to contextualise their risk and for decision-making by policymakers.

Raising ethnicity recording in NHS Lothian from 3% to 90% in 3 years: processes and analysis of data from Accidents and Emergencies.

BACKGROUND: The disproportionate burden of COVID-19 on ethnic minority populations has recently highlighted the necessity of maintaining accessible, routinely collected, ethnicity data within healthcare services. Despite 25 years of supportive legislation and policy in the UK, ethnicity data recording remains inconsistent, which has hindered needs assessment, evaluation and decision-making. We describe efforts to improve the completeness, quality and usage of ethnicity data within our regional health board, NHS Lothian. METHODS: The Ethnicity Coding Task Force was established with the aim of increasing ethnicity recording within NHS Lothian secondary care services from 3 to 90% over 3 years. We subsequently analysed these data specifically focusing on Accident and Emergency (A&E) use by ethnic group. RESULTS: We achieved 91%, 85% and 93% completeness of recording across inpatients, outpatients and A&E, respectively. Analysis of A&E data found a mixed pattern of attendance amongst ethnic minority populations and did not support the commonly perceived relationship between lower GP registration and higher A&E use within this population. CONCLUSIONS: We identified a successful approach to increase ethnicity recording within a regional health board, which could potentially be useful in other settings, and demonstrated the utility of these data in informing assessment of healthcare delivery and future planning.

Migrant health research in the Republic of Ireland: a scoping review.

BACKGROUND: Migration to European countries has increased in number and diversity in recent years. Factors such as access to healthcare, language barriers and legal status can impact the health outcomes of migrant groups. However, little is known about the evidence base on the health status of migrants in the Republic of Ireland. Our aim was to scope existing peer-reviewed research on the health of migrants in Ireland and identify any gaps in the evidence. METHODS: We conducted a scoping review of peer-reviewed research on the health of migrants in the Republic of Ireland. Eleven electronic databases were searched for peer-reviewed, empirical articles published between 2001 and 2017. Search terms were adapted from a World Health Organisation review. Findings were analysed using the 2016 World Health Organisation Strategy and Action Plan for Refugee and Migrant Health in the World Health Organisation European region, which outlines nine strategic areas that require collaborative action. RESULTS: Of 9396 articles retrieved, 80 met inclusion criteria, with the majority (81%) published since 2009. More than half of the studies had a quantitative design (65%). Migrants studied came from Eastern Europe, Asia and Africa and included labour migrants, refugees and asylum seekers. Most studies related to two World Health Organisation strategic areas; 4: "achieving public health preparedness and ensuring an effective response", and 5: "strengthening health systems and their resilience". CONCLUSION: There is growing attention to migrant health in Ireland with a balance of qualitative and quantitative research. While much of the identified research is relevant to three of the World Health Organisation strategic areas, there are significant gaps in the other six areas. The study design could be replicated in other countries to examine and inform migrant health research.

Heterogeneity/granularity in ethnicity classifications project: the need for refining assessment of health status.

BACKGROUND: Identifying ethnic inequalities in health requires data with sufficiently 'granular' (fine detailed) classifications of ethnicity to capture sub-group variation in healthcare use, risk factors and health behaviors. The Robert Wood Johnson Foundation (RWJF), in the USA, commissioned us to explore granular approaches to ethnicity data collection outside of the USA, commencing with the European Union. METHODS: We examined official data sources (population censuses/registers) within the EU-28 to determine the granularity of their approach to ethnicity. When ethnic information was not available, related variables were sought (e.g. country of birth). RESULTS: Within the EU-28, we found 55% of countries collected data on ethnicity. However, only 26% of these countries (England, Wales, Northern Ireland, Scotland, Republic of Ireland, Hungary, Poland and Slovakia) had a granular approach, with half of these being within the UK. Estonia, Lithuania, Croatia, Bulgaria, Republic of Cyprus and Slovenia collected one to six categories. A 'write-in' option only was found in Latvia, Romania and the Czech Republic. Forty-five percent of countries did not collect ethnicity data but collected other related variables. CONCLUSIONS: (i) Although there is reasonable attention to the diversity of ethnic groups in data collection, a granular approach does not predominate within EU-28 classifications. (ii) Where ethnicity is collected, it is conceptualized in different ways and diverse terminology is used. (iii) A write-in option provides the most granular approach. (iv) Almost half of the countries did not collect data on ethnicity, but did collect related variables that could be used as a proxy.

Ethnicity recording in health and social care data collections in Ireland: where and how is it measured and what is it used for?

BACKGROUND: In the European Union (EU), discrimination based on racial and ethnic origin is prohibited under the Racial Equality Directive. Ireland is one of only three EU countries where a legal duty of equality data collection is placed on public bodies. It provides an important context in which to study ethnic equality monitoring; however no systematic mapping of where it occurs in health information systems has been carried out. The aim of this study is to identify all existing national health and social care data collections with information on ethnicity and to explore how this data has been collected and used. METHODS: An electronic search of a national catalogue of health and social care data collections (N = 97) was carried out to identify any collections which contained information on ethnicity. Data dictionaries were searched and key informants contacted. For each of the data collections that collected information on ethnicity, data was extracted on the ethnic categories used and how this data is collected; the completeness of ethnicity recording; and other measures related to ethnicity in the data collection. Relevant outputs for these data collections, related to ethnicity, were identified through key informants and electronic searches. RESULTS: Of the 97 data collections, 14 (14%) collected information on ethnic or cultural background. Country of birth was collected by 10 of these 14 data collections. Most used the ethnic categories in the Census and recommended that ethnicity should be self-identified and not assigned. Reported rates of identification were generally high (≥90%). Data collections which recorded ethnicity tended to be focused on potentially high-risk populations with no routine recording in primary care. There were some examples of where ethnic equality monitoring had informed targeted interventions e.g. vaccination awareness initiatives or cultural training for healthcare staff. CONCLUSIONS: Despite strong policy and legal imperatives, there is limited data collection of ethnicity in health and social care data collections in Ireland. While there are some examples of where differences by ethnicity have been identified and acted upon, a more coordinated and comprehensive approach to the collection, quality and utilization of ethnicity data is needed to promote health equity.

Ethnic Minority Health in Ireland-Co-creating knowledge (EMH-IC): a participatory health research protocol.

INTRODUCTION: International policy recommends continuous, cost-effective monitoring of health data to enable health services to identify and respond to health inequities as experienced by different ethnic groups. However, there is a lack of routinely collected ethnicity data, particularly in primary care, and very little implementation research internationally to understand how ethnic identifiers are introduced, embedded and used in healthcare settings. This paper describes a protocol for a novel participatory health research project with the objective of building the evidence base on ethnic minority health in Ireland. Findings on the participatory appraisal of ethnic identifiers as an intervention to generate useful data about minority and majority ethnic groups will have relevance in other settings and countries. METHODS AND ANALYSIS: This multidisciplinary project is designed as a participatory health research study where all stakeholders, including ethnic minority communities, participate in co-design of the research protocol, project governance, collaborative data interpretation and disseminating findings. A national catalogue of all routinely collected health data repositories will be electronically searched for any repositories that contain information on ethnicity. A secondary quantitative analysis of a population-representative cohort study, Growing Up in Ireland, will be carried out to compare the health of ethnic minority and majority groups. A qualitative case study informed by normalisation process theory will be carried out at three primary care sites to monitor the implementation of an ethnic identifier and identify barriers and levers to implementation. ETHICS AND DISSEMINATION: Ethical approval for the qualitative case study has been granted by the Irish Council for General Practitioners (06/09/17). Permission to access data from Growing Up in Ireland has been granted by the Director General of the Central Statistics Office. Dissemination will be carried out at community events and academic conferences, in peer-reviewed journal publications, and through academic and healthcare provider networks.

Immigration and Sleep Problems in a Southern European Country: Do Immigrants Get the Best Sleep?

This study analyzes the differences in the prevalence of insomnia symptoms and nonrestorative sleep (NRS) between people born in Spain and immigrants from 7 countries with most immigrants in Spain. Data come from the 2006 Spanish National Health Survey. The sample was composed of all individuals aged 16 to 64 years from Spain and the 7 countries with most immigrants in Spain (N = 22,224). In both sexes, people from Bolivia had a higher prevalence of insomnia symptoms and NRS. Conversely, people from Ecuador, Morocco, and Romania had less insomnia symptoms and NRS than Spanish-born participants. No differences were found between Spanish-born participants and Colombian, Peruvian, and Argentinian women. Poor living conditions in the country of origin and in the host country, discrimination, and culturally related lifestyles could be related to poorer sleep health among Bolivian men. Acculturation may explain the similar sleep health patterns noted between Spanish-born participants and long-term immigrants.

Different Patterns in Health Care Use Among Immigrants in Spain.

This study aims to analyze the differences in the use of primary care (PC), hospital, and emergency services between people born in Spain and immigrants. Data were obtained from the 2006 Spanish National Health Survey. The sample was composed of individuals aged 16-64 years from Spain and the seven countries with most immigrants in Spain (n = 22,224). Hierarchical multiple logistic regression models were fitted. Romanian men were less likely to use health care at all levels compared to men from other countries. Women from Argentina, Bolivia and Ecuador reported a lower use of PC. Among women, there were no differences in emergency visits or hospitalizations between countries. Bolivian men reported more hospitalizations than Spanish men, whereas Argentinean men reported more emergency visits than their Spanish counterparts. In Spain, most immigrants made less than, or about the same use of health care services as the native Spanish population.

Health inequality between immigrants and natives in Spain: the loss of the healthy immigrant effect in times of economic crisis.

BACKGROUND: The immigrant population living in Spain grew exponentially in the early 2000s but has been particularly affected by the economic crisis. This study aims to analyse health inequalities between immigrants born in middle- or low-income countries and natives in Spain, in 2006 and 2012, taking into account gender, year of arrival and socioeconomic exposures. METHODS: Study of trends using two cross-sections, the 2006 and 2012 editions of the Spanish National Health Survey, including residents in Spain aged 15-64 years (20 810 natives and 2950 immigrants in 2006, 14 291 natives and 2448 immigrants in 2012). Fair/poor self-rated health, poor mental health (GHQ-12 > 2), chronic activity limitation and use of psychotropic drugs were compared between natives and immigrants who arrived in Spain before 2006, adjusting robust Poisson regression models for age and socioeconomic variables to obtain prevalence ratios (PR) and 95% confidence interval (CI). RESULTS: Inequalities in poor self-rated health between immigrants and natives tend to increase among women (age-adjusted PR2006 = 1.39; 95% CI: 1.24-1.56, PR2012 = 1.56; 95% CI: 1.33-1.82). Among men, there is a new onset of inequalities in poor mental health (PR2006 = 1.10; 95% CI: 0.86-1.40, PR2012 = 1.34; 95% CI: 1.06-1.69) and an equalization of the previously lower use of psychotropic drugs (PR2006 = 0.22; 95% CI: 0.11-0.43, PR2012 = 1.20; 95% CI: 0.73-2.01). CONCLUSIONS: Between 2006 and 2012, immigrants who arrived in Spain before 2006 appeared to worsen their health status when compared with natives. The loss of the healthy immigrant effect in the context of a worse impact of the economic crisis on immigrants appears as potential explanation. Employment, social protection and re-universalization of healthcare would prevent further deterioration of immigrants' health status.

Heterogeneous patterns of health status among immigrants in Spain.

OBJECTIVES: (1) To analyse differences in the self-perceived health and mental health status between the Spanish population and immigrants from the seven leading countries in terms of number of immigrants; (2) to examine whether differences are accounted for by socio-economic characteristics, and (3) to determine whether the patterns of associations differ by gender. METHODS: Data come from the 2006 Spanish National Health Survey. The sample was composed of all 20-64 year old Spaniards and immigrants from the seven countries with most immigrants in Spain (Argentina, Bolivia, Colombia, Ecuador, Peru, Romania and Morocco) [n=20,731]. RESULTS: In both sexes, people from Bolivia had poorer health outcomes, above all Bolivian males. Conversely, people from Argentina and Colombia had the best health outcomes. For the rest of the countries varied results depending on gender, country and health indicator were found. CONCLUSIONS: Differences in health status between people born in Spain and foreign-born people depend on relationships between country of birth, characteristics of the migration process, gender, ethnicity and the health outcome analyzed.

Exposición al humo ambiental de tabaco en locales de hostelería de Barcelona: medición de partículas respirables / Second-hand smoke exposure in hospitality venues in Barcelona: measurement of respirable particles

Objetivo: Medir la concentración de partículas respirables de tamaño igual o menor que 2,5 m (PM2,5)como marcador del humo ambiental de tabaco (HAT) en locales de hostelería de Barcelona 2 años después de la entrada en vigor de la Ley 28/2005.Métodos: Se trata de un estudio descriptivo transversal. La población de estudio fueron 40 locales de laciudad de Barcelona seleccionados por muestreo de ruta aleatoria con representación de los distintos tipos de regulación existentes tras la aplicación de la Ley (permitido fumar, prohibido fumar y localescon zonas para fumadores y no fumadores). El trabajo de campo se realizó entre octubre y diciembre de2007. El HAT se cuantificó determinando las PM2,5 con un monitor con fotómetro láser (Side Pack AM510 Personal Aerosol Monitor). Se realizaron mediciones iniciales de 5 minutos en el exterior del local y de 30 minutos en el interior. Además, se recogieron variables de tipo observacional relacionadas con las características del local y los signos de consumo tabaco.Resultados: La concentración dePM2,5 en los locales donde se permite fumar es cinco veces más alta que enlos que se ha prohibido (182 g/m3 y 34 g/m3, respectivamente), y supera la concentración establecida como perjudicial por la Environmental Protection Agency de Estados Unidos (35 g/m3). En aquellos locales en que se ha prohibido fumar, la concentración de PM2,5 no supera este estándar ni muestra diferencias significativas con la concentración en el exterior del local.Conclusiones: Dos años después de la entrada en vigor de la Ley de medidas sanitarias frente al tabaquismo,la exposición al HAT en los locales de hostelería donde se permitía fumar seguía siendo muy alta. Estosuponía un importante riesgo para la salud de los trabajadores de este sector (AU)

Objectives: To quantify the concentration of respirable particles equal to or smaller than 2.5 m (PM2.5)as a marker of second-hand smoke (SHS) exposure in a sample of hospitality venues in Barcelona 2 years after the Spanish smoking law came into effect.Methods: We performed a cross-sectional descriptive study from October to December 2007. The studypopulation consisted of 40 hospitality venues in Barcelona selected by a random route sampling, with representation of the different types of smoking regulation included in the law (smoking allowed, smokingban and venues with smoking areas). SHS levels were quantified by measuring PM2.5 concentrations,which were measured using a laser photometer (Side PackAM510 Personal Aerosol Monitor). The measurements were carried out for 5 minutes outside the venue and for 30 minutes inside the venue. In addition,observational variables related to the characteristics of the venue and signs of tobacco consumption were recorded.Results: The concentration of PM2.5 in venues where smoking was still allowed was five times higherthan that in venues where smoking was banned (182 g/m3 and 34 g/m3, respectively) and exceeded the concentration established by the US Environmental Protection Agency (EPA) as harmful (35 g/m3).However, in venues where smoking was banned, the concentration was lower than the EPA standard and there were no significant differences with the outdoor PM2.5 concentration. Conclusions: Two years after the introduction of the Spanish smoking law, SHS exposure in venues wheresmoking was allowed was q still very high, representing a significant health risk for hospitality workers (AU)

[Second-hand smoke exposure in hospitality venues in Barcelona: measurement of respirable particles]. / Exposición al humo ambiental de tabaco en locales de hostelería de Barcelona: medición de partículas respirables.

OBJECTIVES: To quantify the concentration of respirable particles equal to or smaller than 2.5µm (PM(2.5)) as a marker of second-hand smoke (SHS) exposure in a sample of hospitality venues in Barcelona 2 years after the Spanish smoking law came into effect. METHODS: We performed a cross-sectional descriptive study from October to December 2007. The study population consisted of 40 hospitality venues in Barcelona selected by a random route sampling, with representation of the different types of smoking regulation included in the law (smoking allowed, smoking ban and venues with smoking areas). SHS levels were quantified by measuring PM(2.5) concentrations, which were measured using a laser photometer (Side Pack AM 510 Personal Aerosol Monitor). The measurements were carried out for 5 minutes outside the venue and for 30 minutes inside the venue. In addition, observational variables related to the characteristics of the venue and signs of tobacco consumption were recorded. RESULTS: The concentration of PM(2.5) in venues where smoking was still allowed was five times higher than that in venues where smoking was banned (182µg/m(3) and 34µg/m(3), respectively) and exceeded the concentration established by the US Environmental Protection Agency (EPA) as harmful (35µg/m(3)). However, in venues where smoking was banned, the concentration was lower than the EPA standard and there were no significant differences with the outdoor PM(2.5) concentration. CONCLUSIONS: Two years after the introduction of the Spanish smoking law, SHS exposure in venues where smoking was allowed was q still very high, representing a significant health risk for hospitality workers.