Relación del estatus migratorio y del apoyo social con la calidad de vida de los marroquíes en el País Vasco / Immigration in Spain and the health system: A fiscal policy perspective

La población española ha crecido en los últimos 10 años en más de 6 millones de personas, de las cuales más de las tres cuartas partes son inmigrantes. Aunque en buena medida se trata de un fenómeno de inmigración económica ligado al intenso ritmo de crecimiento de la economía española, los determinantes sociológicos del proceso confieren al colectivo inmigrante un perfil cuya consideración es relevante para la valoración del impacto de la inmigración en el gasto público y en el sistema de protección social. El crecimiento de la población inmigrante, con menor edad media y tasas de natalidad más altas, permite compensar transitoriamente los desequilibrios demográficos del sistema de pensiones. Por otra parte, las características sociológicas y económicas del colectivo determinan demandas específicas al sistema de protección social. La integración de los inmigrantes se ve facilitada por el acceso a los servicios básicos, educación y salud, lo que, por otra parte, pudiera influir positivamente en el flujo migratorio. El rápido crecimiento de la población ha supuesto en el corto plazo una congestión de los servicios sanitarios, especialmente de la atención primaria, como consecuencia de la desigual distribución de los inmigrantes en el territorio. El gasto imputable a los inmigrantes es menos que proporcional a su peso en la población y se concentra en cuatro comunidades autónomas (AU)

The Spanish population has grown by over 6 million people in the last 10 years and immigrants account for 4.5 million of this increase. Although this influx has largely been motivated by economic reasons, stimulated by the sharp growth of the Spanish economy, sociological factors must also be considered to assess the impact of immigration shock on public expenditure and the social welfare system. On the one hand, the demographic growth caused by immigration temporarily balances the pension system, as immigrants have a lower average age and a higher fertility rate. On the other hand, the demographic and economic features of the immigrant community make additional demands on the social welfare system. Universal access to basic public services such as the education and health systems is a crucial asset in the integration policy aimed at the immigrant collective, and compensates for its possible effect as an incentive to immigrate. In the short term, the huge population growth has led to health services’ congestion, especially in primary health care, because of the unequal geographic distribution of immigrants. The health expenditure imputable to immigrants is lower than their share in the total population and is highly concentrated in four autonomous regions (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.

[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.

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

Objetivo: Investigar la importancia de los factores sociodemográficosy de los estilos de vida en la autovaloración de lasalud en los inmigrantes de origen magrebí, subsahariano, latinoamericanoy europeo no comunitario del País Vasco.Métodos: Estudio descriptivo transversal con una muestraformada por 219 magrebíes (31,8%), 152 subsaharianos(22,1%), 167 latinoamericanos (24,2%) y 151 europeos no comunitarios(21,9%). La herramienta para la recopilación dedatos fue la Encuesta de Salud de la Comunidad Autónomadel País Vasco (ESCAV’2002). El análisis multivariante se realizócon regresión logística dicotómica (soporte SPSS 13).Resultados: Para la autovaloración de la salud, el 64,2% delos magrebíes, el 78,7% de los subsaharianos, el 66,1% de loslatinoamericanos y el 67,1% de los europeos declararon teneruna salud muy buena o buena. Las variables asociadas significativamente(p < 0,05 y p < 0,01) a la autovaloración de lasalud fueron la procedencia, el sexo y la edad. Ser subsaharianomostró mayor ventaja para una mejor valoración de la salud(odds ratio [OR] = 2,08; intervalo de confianza del 95% (IC95%):1,29-3,36). La ventaja también se observó para los hombres(OR = 2,16; IC95%: 1,54-3,02) y la edad, especialmente en losde 33-38 años (OR = 3,13; IC95%: 1,71-5,73). En el análisismultivariante, dichas variables mantuvieron su significación.Conclusiones: Los resultados muestran la importancia de considerarel estado de salud percibida en los diferentes colectivosde inmigrantes e identificar las diferencias, así como lasvariables asociadas, para poder desarrollar actuacionesorientadas a mejorar la salud en estos grupos(AU)

Objective: To explore the importance of socio-demographicfactors as well as life-style and their influence in self-rated healthof Maghribian, Sub-Saharian, Latin-American and non-Communitarian European immigrant groups living in the BasqueCountry (Spain).Methods: Descriptive cross-study with a convenience sampleof 689 persons, consisting of 219 Maghribians (31.8%),152 Sub-Saharians (22.1%), 167 Latino(a)s (24.2%) and 151non-Communitarian Europeans (21.9%). Data base have beencompleted with data collected using the 2002 Regional BasqueHealth Interview Survey (ESCAV 2002). The multivariateanalysis 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-CommunitarianEuropean assessed their health as very good orgood. The significantly associated variables (p < 0.05 and p< 0.01) with self-rated health were collective membership, sexand age. Persons belonging to the Sub-Saharian collective showeda stronger advantage of positively self-assessed health(OR = 2.08; 95%CI: 1.29-3.36). This advantage was also foundamong 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 themultivariate analysis.Conclusions: Our results demonstrated the importance of consideringdifferences in the health status and in self-rated healthamong immigrant groups, as well as the variables associatedwith those differences, when developing community-basedhealth strategies(AU)

[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.

Impacto en la utilizacion 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 / Impact in the utilisation of the health services of socio-demographic variables, life-style and self-rated health by inmigrant groups living in the Basque Country, Spain

Fundamento. La progresiva incorporación de población extranjera en nuestro país requiere de conocimientos sobre el impacto de estos grupos en el sistema sanitario. El objetivo de este trabajo es identificar los factores asociados a la utilización de los servicios públicos de salud en los grupos de población inmigrante del País Vasco. Métodos. Estudio descriptivo transversal con una muestra de conveniencia formada por 689 personas:219 magrebíes (31,8%), 152 subsaharianas (22,1%), 167 latinoamericanas (24,2%) y 151 europeas no comunitarias (21,9%). La herramienta utilizada fue la Encuesta de Salud de la Comunidad Autónoma del País Vasco (ESCAV’2002). El análisis multivariante se realizó utilizando regresión logística dicotómica (soporte SPSS 14). Resultados. La mayor utilización de los servicios sanitarios se asoció al hecho de ser mujer (OR=3,37, IC=1,77-6,43), magrebí (OR=3,35, IC=1,51-7,45) y tener una mala autovaloración de la salud (OR=2,22, IC=1,00-4,90). La mayor utilización de la urgencia hospitalaria durante los dos primeros años de estancia se encontró en personas subsaharianas (OR=4,12, IC=1,23-13,81) y europeas no comunitarias (OR=3,56, IC=1,08-11,80). Conclusiones. Los resultados de este estudio permiten identificar las diferencias en la utilización de los servicios públicos de salud en los grupos de inmigrantes de la CAPV en función del sexo, autovaloración de la salud, grupo inmigrante de pertenencia y tiempo de estancia en el país de acogida (AU)

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-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: 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-Saharian (OR=4,12, IC=1,23-13,81) and non-Communitarian European (OR=3,56, IC=1,08-11,80) inmigrants. 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 (AU)