Poorer self-perceived health among migrants and ethnic minorities versus the majority population in Europe: a systematic review

Healthy ageing in a multi-ethnic population: A descriptive cross-sectional analysis from the HELIUS study

OBJECTIVE

We investigated ethnic health disparities in the Healthy Life in an Urban Setting multi-ethnic cohort using the multidimensional Healthy Ageing Score.

STUDY DESIGN

We conducted a cross-sectional analysis of the study baseline data (2011-2015) collected through questionnaires/physical examinations for 17,091 participants (54.8 % women, mean (SD) age = 44.5 (12.8) years) from South-Asian Surinamese (14.8 %), African Surinamese (20.5 %), Dutch (24.3 %), Moroccan (15.5 %), Turkish (14.9 %), and Ghanaian (10.1 %) origins, living in Amsterdam, the Netherlands.

MAIN OUTCOME MEASURES

We computed the Healthy Ageing Score developed in the Rotterdam Study, which has seven biopsychosocial domains: chronic diseases, mental health, cognitive function, physical function, pain, social support, and quality of life. That score was used to discern between healthy, moderate, and poor ageing. We explored differences in healthy ageing by ethnicity, sex, and age group using multinomial logistic regression.

RESULTS

The Healthy Ageing Score [overall: poor (69.0 %), moderate (24.8 %), and healthy (6.2 %)] differed between ethnicities and was poorer in women and after midlife (cut-off 45 years) across ethnicities (all p < 0.001). In the fully adjusted models in men and women, poor ageing (vs. healthy ageing) was highest in the South-Asian Surinamese [adjusted odds ratios (95 % confidence intervals)] [2.96 (2.24-3.90) and 6.88 (3.29-14.40), respectively] and Turkish [2.80 (2.11-3.73) and 7.10 (3.31-15.24), respectively] vs. Dutch, in the oldest [5.89 (3.62-9.60) and 13.17 (1.77-98.01), respectively] vs. youngest, and in the divorced [1.48 (1.10-2.01) and 2.83 (1.39-5.77), respectively] vs. married. Poor ageing was inversely associated with educational and occupational levels, mainly in men.

CONCLUSIONS

Compared with those of Dutch ethnic origin, ethnic minorities displayed less healthy ageing, which was more pronounced in women, before and after midlife, and was associated with sociodemographic factors.

A longitudinal perspective to migrant health: Unpacking the immigrant health paradox in Germany

Previous research finds that recent immigrants are healthier than the native-born, while more established immigrants exhibit worse health, suggesting a process of unhealthy assimilation. However, previous literature is mostly based on cross-sectional data or on longitudinal analyses similarly failing to disentangle individual-level variation from between-individual confounding. Moreover, previous longitudinal studies are often limited in their study of different health outcomes (few and mostly subjective health), populations (sometimes only elderly individuals), time periods (short panels) and geographical contexts (mostly Australia, Canada and USA). We address these limitations by comparing the health trajectories of adult immigrants and natives in Germany over extended periods, using data from years 2002-2021 of the German Socio-Economic Panel (SOEP), and investigating a wide range of health outcomes, including self-assessed physical and mental health measures, diagnosed illnesses, and health behaviors. We employ a longitudinal approach that stratifies immigrants by age at arrival, and compares them to natives of the same age. This allows us to estimate both Hierarchical Linear Models and more rigorous Fixed Effects models to further address confounding. Cross-sectionally, we confirm previous literature's findings: recent immigrants are healthier than natives and established immigrants. Longitudinally, we find support for the unhealthy assimilation hypothesis concerning subjective health and mental health, but not for the others health indicators or behaviors. We interpret these findings as possible evidence of immigrants' reduced access to timely health care and emphasize the need for greater longitudinal research investigating migrant gaps in various health outcomes.

A scoping review of academic and grey literature on migrant health research conducted in Scotland

BACKGROUND

Migration to Scotland has increased since 2002 with an increase in European residents and participation in the Asylum dispersal scheme. Scotland has become more ethnically diverse, and 10% of the current population were born abroad. Migration and ethnicity are determinants of health, and information on the health status of migrants to Scotland and their access to and barriers to care facilitates the planning and delivery of equitable health services. This study aimed to scope existing peer-reviewed research and grey literature to identify gaps in evidence regarding the health of migrants in Scotland.

METHODS

A scoping review on the health of migrants in Scotland was carried out for dates January 2002 to March 2023, inclusive of peer-reviewed journals and grey literature. CINAHL/ Web of Science/SocIndex and Medline databases were systematically searched along with government and third-sector websites. The searches identified 2166 journal articles and 170 grey literature documents for screening. Included articles were categorised according to the World Health Organisation's 2016 Strategy and Action Plan for Refugee and Migrant Health in the European region. This approach builds on a previously published literature review on Migrant Health in the Republic of Ireland.

RESULTS

Seventy-one peer reviewed journal articles and 29 grey literature documents were included in the review. 66% were carried out from 2013 onwards and the majority focused on asylum seekers or unspecified migrant groups. Most research identified was on the World Health Organisation's strategic areas of right to health of refugees, social determinants of health and public health planning and strengthening health systems. There were fewer studies on the strategic areas of frameworks for collaborative action, preventing communicable disease, preventing non-communicable disease, health screening and assessment and improving health information and communication.

CONCLUSION

While research on migrant health in Scotland has increased in recent years significant gaps remain. Future priorities should include studies of undocumented migrants, migrant workers, and additional research is required on the issue of improving health information and communication.

Can extended health communication improve newly settled refugees' health literacy? A quasi-experimental study from Sweden

Structural and contextual factors such as limited work and housing opportunities negatively affect the health and well-being of newly settled refugee migrants in receiving high-income countries. Health promotion initiatives aiming at strengthening health and integration have been tried out within the Swedish Introduction program for refugee migrants. However, longitudinal evaluations of these interventions are rare. The aim of the current study was to compare the effectiveness of a regular and an extended civic orientation course with added health communication and examine whether the latter would improve self-rated health and psychological well-being, health literacy and social capital among newly settled refugee migrants in Sweden. Pre- and post-assessment questionnaires were collected from the intervention group receiving the extended course (n = 143) and a control group receiving the regular course (n = 173). Linear mixed models and chi-square analyses showed a significant increase with a small effect size (0.21) in health literacy in the intervention group. However, there were no significant changes in emotional and practical support, general self-rated health or psychological well-being. The findings indicate that added health communication provided embedded in the civic orientation course can increase health literacy. However, further longitudinal studies are needed to confirm the sustainability of the observed effect and examine whether these short-term improvements in health literacy translate to long-term advances in health and integration.

Exploring the burden, prevalence and associated factors of chronic musculoskeletal pain in migrants from North Africa and Middle East living in Europe: a scoping review

BACKGROUND

Immigrants are exposed to numerous risk factors that may contribute to the development of chronic musculoskeletal pain. Recent political and environmental crises in North Africa and the Middle East have led to an increase in immigration to Europe that has challenged the healthcare system and especially the management of chronic conditions.

OBJECTIVE

The aims of this scoping review are to investigate the burden, prevalence, and associated factors of chronic musculoskeletal pain in immigrants from North Africa and the Middle East in Europe during the last decade. The intentions of the review are to inform healthcare policymakers, to identify gaps in the literature, and aid the planning of future research.

DESIGN

Online databases Medline, Embase, PubMed and Web of Science were used to identify epidemiological studies published from2012-2022 examining chronic pain in populations from North Africa and the Middle East with a migration background residing in Europe.

RESULTS

In total eleven studies were identified conducted in Norway (n = 3), Denmark (n = 3), Germany (n = 1), Austria (n = 1), Sweden (n = 1), and Switzerland (n = 1). Among the identified studies, eight studies were cross-sectional (n = 8), two were prospective cohort studies (n = 2) and one was a retrospective cohort study (n = 1). Data suggested that chronic pain is more prevalent, more widespread, and more severe in people with than without a migration background. Furthermore, immigrants who have resided in the destination country for a longer period experience a higher prevalence of chronic pain compared to those in the early phases of migration. The following factors were found to be associated with chronic pain in this population: female gender, lower education, financial hardship, being underweight or obese, time in transit during migration, experience of trauma, immigration status, anxiety, depression, and post-traumatic stress disorder.

CONCLUSION

Several gaps in the literature were identified. Research is limited in terms of quantity and quality, does not reflect actual immigration trends, and does not account for immigration factors. Prospective cohort studies with long follow-ups would aid in improving prevention and management of chronic pain in populations with a migration background. In particular, they should reflect actual immigration trajectories, account for immigration factors, and have valid comparison groups in the countries of origin, transit and destination.

Self-rated health, time of residence and social determinants of health in immigrant populations: A complex relationship in groups of different origins in a Southern European region

Health of immigrant population changes with time of residence and under the effect of social determinants of health. This study analyses the health status of the immigrant population in the Basque Country according to groups of origin assessing the effect of time of residence on health in the different origin groups considering social and migration-related determinants of health. A cross-sectional study of the immigrant population in the Basque Country using the Foreign Origin Population Survey was conducted. A descriptive analysis is performed of each group of origin and Poisson models are applied. The main variable is self-rated health, and the independent variables are divided into three groups: demographic, socioeconomic and migration-related. For the study, immigrants are divided into six origin groups. Results show that the health and the effects of socioeconomic and migratory variables on health vary according to origin. Immigrants with greater economic difficulties present poorer health, though to different extents and the effects on health of educational level and perception of discrimination differ according to origin. Finally, the relation between time of residence and self-rated health varies according to origin: Colombian, Ecuadorian, Peruvian, Eastern EU and sub-Saharan immigrants living in Spain for 10 or more years report poorer health even when controlling for socioeconomic and migration-related variables, while people from the Maghreb and Asia do not. Therefore, the effects on health of time of residence, living conditions and the migratory experience differ according to migrant group, leading to the importance of analysing the health of immigrants as a heterogeneous group.

Ethnic disparities in the incidence of gynecologic malignancies among Israeli Women of Arab and Jewish Ethnicity: a 10-year study (2010-2019)

Background

Ethnic disparities in healthcare outcomes persist, even when populations share the same environmental factors and healthcare infrastructure. Gynecologic malignancies are a significant health concern, making it essential to explore how these disparities manifest in terms of their incidence among different ethnic groups.

Objective

To investigate ethnic disparities in the incidence of gynecologic malignancies incidence among Israeli women of Arab and Jewish ethnicity.

Design

Our research employs a longitudinal, population-based retrospective cohort design.

Method

Data on gynecologic cancer diagnoses among the Israeli population from 2010 to 2019 was obtained from a National Registry. Disease incidence rates and age standardization were calculated. A comparison between Arab and Jewish patients was performed, with Poisson regression models being used to analyze significant rate changes.

Results

Among Jewish women, the age-standardized ratio (ASR) for gynecologic malignancies decreased from 288 to 251 (p < 0.001) between 2014 and 2019. However, there was no significant change in the ASR among Arab women during the same period, with rates going from 192 to 186 (p = 0.802). During the study period, the incidence of ovarian cancer decreased significantly among Jewish women (p = 0.042), while the rate remained stable among Arab women (p = 0.102). A similar trend was observed for uterine cancer. The ASR of CIN III (Cervical Intraepithelial Neoplasia Grade 3) in Jewish women notably increased from 2017 to 2019, with an annual growth rate of 43.3% (p < 0.001). A similar substantial rise was observed among Arab women, with an annual growth rate of 40.5% (p < 0.001). In contrast, the incidence of invasive cervical cancer remained stable from 2010 to 2019 among women of both ethnic backgrounds.

Conclusion

Our findings indicate that Arab women in Israel have a lower incidence rate of gynecologic cancers, warranting further investigation into protective factors. Both ethnic groups demonstrate effective utilization of cervical screening.

Disparities in Coronavirus Disease 2019 Clinical Outcomes and Vaccination Coverage Among Migrants With Human Immunodeficiency Virus in the PISCIS Cohort: A Population-Based Propensity Score-Matched Analysis

Background

Coronavirus disease 2019 (COVID-19) disproportionately affects migrants and ethnic minorities, including those with human immunodeficiency virus (HIV). Comprehensive studies are needed to understand the impact and risk factors.

Methods

Using data from the PISCIS cohort of people with HIV (PWH) in Catalonia, Spain, we investigated COVID-19 outcomes and vaccination coverage. Among 10 640 PWH we compared migrants and non-migrants assessing rates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing, diagnosis, and associated clinical outcomes through propensity score matching and multivariable Cox regression.

Results

The cohort (mean age, 43 years; 83.5% male) included 57.4% (3053) Latin American migrants. Migrants with HIV (MWH) had fewer SARS-CoV-2 tests (67.8% vs 72.1%, P < .0001) but similar COVID-19 diagnoses (29.2% vs 29.4%, P = .847) compared to Spanish natives. Migrants had lower complete vaccination (78.9% vs 85.1%, P < .0001) and booster doses (63.0% vs 65.5%, P = .027). COVID-19 hospitalizations (8.1% vs 5.1%, P < .0001) and intensive care unit (ICU) admissions (2.9% vs 1.2%, P < .0001) were higher among migrants, with similar hospitalization duration (5.5 vs 4.0 days, P = .098) and mortality (3 [0.2%] vs 6 [0.4%], P = .510). Age ≥40 years, CD4 counts <200 cells/μL, ≥2 comorbidities, and incomplete/nonreception of the SARS-CoV-2 vaccine increased the risk of severe COVID-19 among migrants.

Conclusions

MWH had lower rates of SARS-CoV-2 testing and vaccination coverage, although the rates of COVID-19 diagnosis were similar between migrants and non-migrants. Rates of COVID-19-associated hospitalizations and ICU admissions were higher among migrants in comparison with non-migrants, with similar hospitalization duration and mortality. These findings can inform policies to address disparities in future pandemic responses for MWH.

Barriers and facilitators to refugees and asylum seekers accessing non hospital based care: A mixed methods systematic review protocol

Context

Social exclusion is characterised by and represents a form of disadvantage and marginalisation of vulnerable groups of people in society, who cannot fully participate in the normal activities of daily living. People who are socially excluded such as asylum seekers and refugees have complex healthcare needs and tend to present more to the acute hospital setting as emergency presentations. Little is known about barriers and facilitators experienced by this group to accessing nonhospital based care.

Objectives

This mixed methods systematic review, will critically examine the concept of barriers and facilitators for refugees and asylum seekers to accessing non hospital based care.

Methods

This methodological review will follow the Joanna Briggs Institute guidance for conducting mixed methods reviews. The following databases will be searched: Central Medline, PubMed, Embase, CINAHL, and the Cochrane Library. Relevant grey literature will be included. Title and abstract screening, followed by full-text screening will be undertaken independently by two reviewers. The Joanna Briggs Institute extraction tool will be adapted for data extraction.

Discussion

This mixed method review will comprehensively evaluate quantitative and qualitative data, synthesise both barriers and facilitators and follow a systematic approach through establishing use of mixed methods research across asylum seekers and refugees, and how they affect accessing non-hospital based care. It will explore conceptual models of access to healthcare and how they influence these factors.

Social patterning of childhood overweight in the French national ELFE cohort

An inverse social gradient in early childhood overweight has been consistently described in high-income countries; however, less is known about the role of migration status. We studied the social patterning of overweight in preschool children according to the mother's socio-economic and migration background. For 9250 children of the French ELFE birth cohort with body mass index collected at age 3.5 years, we used nested logistic regression to investigate the association of overweight status in children with maternal educational level, occupation, household income and migration status. Overall, 8.3% (95%CI [7.7-9.0]) of children were classified as overweight. The odds of overweight was increased for children from immigrant mothers (OR 2.22 [95% CI 1.75-2.78]) and descendants of immigrant mothers (OR 1.35 [1.04-2.78]) versus non-immigrant mothers. The highest odds of overweight was also observed in children whose mothers had low education, were unemployed or students, or were from households in the lowest income quintile. Our findings confirm that socio-economic disadvantage and migration status are risk factors for childhood overweight. However, the social patterning of overweight did not apply uniformly to all variables. These new and comprehensive insights should inform future public health interventions aimed at tackling social inequalities in childhood overweight.

Using self-reported health as a social determinants of health outcome: a scoping review of reviews

Reducing disease prevalence rather than promoting health has long been the objective of significant population health initiatives, such as the social determinants of health (SDH) framework. However, empirical evidence suggests that people with diagnosed diseases often answer the self-reported health (SRH) question positively. In pursuit of a better proxy to understand, measure and improve health, this scoping review of reviews examines the potential of SRH to be used as an outcome of interest in population health policies. Following PRISMA-ScR guidelines, it synthesizes findings from 77 review papers (published until 11 May 2022) and reports a robust association between SDH and SRH. It also investigates inconsistencies within and between reviews to reveal how variation in population health can be explained by studying the impact of contextual factors, such as cultural, social, economic and political elements, on structural determinants such as socioeconomic situation, gender and ethnicity. These insights provide informed hypotheses for deeper explorations of the role of SDH in improving SRH. The review detects several gaps in the literature. Notably, more evidence syntheses are required, in general, on the pathway from contextual elements to population SRH and, in particular, on the social determinants of adolescents' SRH. This study reports a disease-oriented mindset in collecting, analysing and reporting SRH across the included reviews. Future studies should utilize the capability of SRH in interconnecting social, psychological and biological dimensions of health to actualize its full potential as a central public health measure.

Healthy immigrants, unhealthy ageing? Analysis of health decline among older migrants and natives across European countries

The probability of having multiple chronic conditions simultaneously, or multimorbidity, tends to increase with age. Immigrants face a particularly high risk of unhealthy ageing. This study investigates the immigrant-native disparities in the speed of age-related chronic disease accumulation, focusing on the number of chronic health conditions; and considers the heterogeneity of this trajectory within immigrant populations by origin and receiving country. We use data from the Survey of Health, Ageing and Retirement in Europe from 2004 to 2020 on adults aged 50 to 79 from 28 European countries and employ both cross-sectional and longitudinal analyses. For longitudinal panel analyses, we use fixed-effects regression models to account for the unobserved heterogeneity related to individual characteristics including migration background. Our results indicate that immigrants report a higher number of chronic conditions at all ages relative to their native-born peers, but also that the immigrant-native differential in the number of chronic conditions decreases from age 65 onwards. When considering differences by origin country, we find that the speed of chronic disease accumulation is slower among immigrants from the Americas and the Asia and Oceania country groups than it is among natives. When looking at differences by receiving country group, we observe that the speed of accumulating chronic diseases is slower among immigrants in Eastern Europe than among natives, particularly at older ages. Our findings suggest that age-related trajectories of health vary substantially among immigrant populations by origin and destination country, which underscore that individual migration histories play a persistent role in shaping the health of ageing immigrant populations throughout the life course.

Does early-life migration experience determine health and health-risk behavior in later life? Evidence from elderly returns migrants in Kerala, India

Becoming elderly is an intrinsic part of life, and the burden of disease increases with age. However, the early life migration experience and occupational hazards at the destination can lead to serious health problems later in life. This study aims to understand the association between early life migration and the health and risky behavior of elderly return migrants using data from the Kerala Migration Survey in 2018. The results of bivariate and multivariate analyses show that the majority of migrants return due to retirement and ill health at the average age of 51 and suffer from poor health and multiple diseases. More than half (55%) of elderly returnees reported poor health, and among them, 70% have at least one chronic disease. The early life migration experience and injuries at the destination are the main determinants of poor self-rated health and chronic disease. Furthermore, elderly return migrants have high-risk health behaviours such as smoking and alcohol consumption, as well as less access to health schemes. Despite some shortcomings, this study identifies the most vulnerable groups among the elderly and their health characteristics. This will help to promote healthy aging in Kerala, India, or areas with increasing numbers of elderly and return migrants around the world.

The significance of green exercise for the health and wellbeing of Italian immigrants in Norway: a mixed-methods study

BACKGROUND

Green exercise (physical activity in presence of nature) has beneficial effects for health and wellbeing. Green exercise is a popular form of recreation in the Nordic countries, but participation is lower among the immigrant population from non-Western countries. However, no attention has been given to immigrants from the European Economic Area regarding this topic. Given the cultural and structural differences that surround green exercise in Italy and Norway, the case of the Italian immigrants in Norway is of interest to enrich our understanding of green exercise and its significance for health and wellbeing among immigrants in the Nordic countries.

METHODS

This convergent mixed methods study investigated the pathways that link green exercise to health and wellbeing among Italian immigrants in Norway. Quantitative data were collected through an online survey (n = 321), which was oversampled to better reflect the sociodemographic profile of the reference population. Logistic regression was used to model the association of green exercise with self-rated health (SRH) or satisfaction with life (SWL) before and after controlling for selected confounders (age, gender, educational level, language proficiency, social support, and childhood experiences with green exercise). Qualitative data were collected through semi-structured in-depth interviews (n = 14) and analysed thematically. Merging of the two strands was done using a simultaneous bidirectional approach.

RESULTS

The logistic regression found a significant bivariate association of green exercise with both SRH and SWL, though the association remained significant only for SWL after controlling for confounders. From the thematic analysis, three themes were identified: Green exercise opportunities contributing to overall satisfaction, Closeness to nature, and Embracing a new lifestyle. The integrated findings indicate that green exercise supported the immigrants' wellbeing, especially by providing stress relief, though socioeconomic status and acculturation may have a major impact on general health. Familiarity, appreciation of nature benefits, social support, and acculturation were identified as facilitating factors.

CONCLUSIONS

This study provides novel insights into how green exercise supports health, wellbeing, and inclusion among immigrants to the Nordic countries and emphasizes the importance of developing culturally adapted strategies to enhance this health-promoting activity among immigrant populations.

Design, Development, and Validation of the Self-Perceived Health Scale (SPHS)

Health is a multidimensional concept with notable psychological factors, such as self-perceived health (SPH). SPH is defined as the subjective assessment of individual health status, and it integrates information related to both physical and psychological aspects, such as lifestyle. This study describes the development of the Self-Perceived Health Scale (SPHS), and its validation in a Mexican sample (n = 600). Exploratory factor analysis (n = 303) and confirmatory factor analysis (n = 293) were carried out, and they supported the three-dimensionality of the SPH construct: physical health, psychological health, and healthy lifestyle. A final 12-item scale was obtained, and the scale showed adequate validity and reliability, as well as measurement invariance between sexes, indicating its robustness.

Migration status, physical limitations and associated self-rated health: a study of older Indian adults

BACKGROUND

Migrant status with mobility impairment becomes a double burden for health and wellbeing of older adults. This study examined the independent relationships and multitude effects between migrant status, functional and mobility impairments and poor self-rated health (SRH) among older Indian adults.

METHODS

This study utilised nationally representative Longitudinal Ageing Study in India wave-1 (LASI) data, including a sample of 30,736 individuals aged 60 years and above. The main explanatory variables were migrant status, difficulty in activities of daily living (ADL), difficulty in instrumental activities of daily living (IADL) and mobility impairments; and the outcome variable was poor-SRH. Multivariable logistic regression and stratified analyses were used to fulfil the study objectives.

RESULTS

Overall, about 23% of older adults reported poor-SRH. Reporting poor-SRH was more prevalent (28.03%) among recent migrants (less than ten years). The prevalence of reporting poor-SRH was significantly higher among older adults who had mobility impairment (28.65%), difficulty in ADL or IADL (40.82% & 32.57%). Migrant older adults (regardless of duration) who had mobility impairment had significantly greater odds of reporting poor-SRH compared with non-migrant older adults who did not have mobility impairment. Similarly, older respondents who had problems in ADL and IADL with migration status had higher odds of reporting poor-SRH than their non-migrant counterparts with no such problems.

CONCLUSIONS

The study revealed the vulnerability of migrant older adults with functional and mobility disability, as well as those with limited socioeconomic resources and suffering from multimorbidity on rating their perceived health. The findings can be utilised to target outreach programmes and provision of services for migrating older individuals with mobility impairments and enhance their perceived health and ensure active ageing.

Caregiving + Migrant Background = Double Jeopardy? Associations between Caregiving and Physical and Psychological Health According to Migrant Backgrounds in Norway

Informal caregiving can have detrimental consequences for physical and psychological health, but the impacts are highly heterogenous. A largely ignored question is whether these impacts differ with migrant backgrounds, and whether caregiving and a migrant background combine to create double jeopardy. We explored these questions using large-scale data that allows stratification by sex, regional background, and types (inside vs. outside of household) of caregivers. We used cross-sectional 2021 data collected from two Norwegian counties as part of the Norwegian Counties Public Health Survey (N = 133,705, RR = 43%, age 18+). The outcomes include subjective health, mental health, and subjective well-being. The findings show that both caregiving, especially in-household caregiving, and a migrant background relate to lower physical-psychological health. In bivariate analysis, non-Western caregivers, women particularly, reported poorer mental health and subjective well-being (but not physical health) than other caregiver groups. After controlling for background characteristics, however, no interaction exists between caregiver status and migrant background status. Although the evidence does not suggest double jeopardy for migrant caregivers, caution is warranted due to the likely underrepresentation of the most vulnerable caregivers of migrant backgrounds. Continued surveillance of caregiver burden and distress among people of migrant backgrounds is critical to develop successful preventive and supportive intervention strategies for this group, yet this aim hinges on a more inclusive representation of minorities in future surveys.

Differential Probability in Unmet Healthcare Needs Among Migrants in Four European Countries

Migrants and refugees try to reach Europe to seek protection and a better life. The responsiveness and stewardship of the European countries health system have an impact on the ability to access healthcare. This study aims to investigate the differential probability of healthcare unmet needs among migrants living in four European countries. We used a 2019 cross-sectional data from the European Union Income and Living Conditions survey. We performed a two-stage probit model with sample selection, first to identify the respondents with need for care, then those who need it but have not received it. We analysed reasons for unmet needs through accessibility, availability and acceptability. We then performed country studies assessing the national health systems, financing mechanisms and migration policies. Bringing together data on financial hardship and unmet needs reveals that migrants living in Europe have a higher risk of facing unmet healthcare needs compared to native citizens, and affordability of care remains a substantial barrier. Our results showed the country heterogeneity in the differential migrants’ unmet needs according to the place where they live, and this disparity seems attributed to the health system and policies applied. Given the diversity of socioeconomic conditions throughout the European countries, the health of migrants depends to a large degree on the integration and health policies in place. We believe that EU policies should apply further efforts to respect core health and protection ethics and to acknowledge, among others, principles of ‘do-no-harm’, equity and the right to health.

Barriers and facilitators experienced by migrants and refugees when accessing pharmaceutical care: A scoping review

BACKGROUND

Pharmacists in the community are often among the first health professionals encountered by new arrivals. Their accessibility and the longevity of the relationship gives pharmacy staff unique opportunities to work with migrants and refugees to meet their health needs. While the language, cultural and health literacy barriers that cause poorer health outcomes are well documented in medical literature, there is a need to validate the barriers to accessing pharmaceutical care and to identify facilitators for efficient care in the migrant/refugee patient-pharmacy staff interaction.

OBJECTIVE

The purpose of this scoping review was to investigate the barriers and facilitators that migrant and refugee populations experience when accessing pharmaceutical care in host countries.

METHODS

A comprehensive search of Medline, Emcare on Ovid, CINAHL and SCOPUS databases, guided by the PRISMA-ScR statement, was undertaken to identify the original research published in English between 1990 and December 2021. The studies were screened based on inclusion and exclusion criteria.

RESULTS

A total of 52 articles from around the world were included in this review. The studies revealed that the barriers to migrants and refugees accessing pharmaceutical care are well documented and include language, health literacy, unfamiliarity with health systems, and cultural beliefs and practises. Empirical evidence was less robust for facilitators, but suggested strategies included improvement of communication, medication review, community education and relationship building.

CONCLUSIONS

While barriers experienced are known, there is a lack of evidence for facilitators for provision of pharmaceutical care to refugees and migrants and poor uptake of available tools and resources. There is a need for further research to identify facilitators that are effective in improving access to pharmaceutical care and practical for implementation by pharmacies..

Barriers and facilitators to refugees, asylum seekers and people experiencing homelessness accessing non hospital based care: A mixed methods systematic review protocol

Context: Social exclusion is characterised by and represents a form of disadvantage and marginalisation of vulnerable groups of people in society, who cannot fully participate in the normal activities of daily living.  Socially excluded groups consist of, but are not limited to the following groups: people experiencing homelessness, asylum seekers and refugees.  People from socially excluded groups have complex healthcare needs including infectious and non-communicable diseases. People from socially excluded groups tend to present more to the acute hospital setting as emergency presentations.  Little is known about barriers and facilitators experienced by these groups to accessing non hospital based care. Objectives: This mixed methods systematic review, will critically examine the concept of barriers and facilitators for refugees, asylum seekers and people experiencing homelessness, to accessing non hospital based care. Methods:  This methodological review will follow the Joanna Briggs Institute guidance for conducting mixed methods reviews.  The following databases will be searched: Central Medline, PubMed, Embase, CINAHL, and the Cochrane Library. Relevant grey literature will be included. Title and abstract screening, followed by full-text screening will be undertaken independently by two reviewers. The Joanna Briggs Institute extraction tool will be adapted for data extraction.   Discussion: This mixed method review will comprehensively evaluate quantitative and qualitative data, synthesise both barriers and facilitators and follow a systematic approach through establishing use of mixed methods research across a number of marginalised groups, and how they affect accessing non hospital based care.   It will explore conceptual models of access to healthcare and how they influence these factors.

Social relations and health in an ethnically diverse social housing area selected for large structural changes compared to municipal levels: a Danish survey study

BACKGROUND

This study aims to describe demographics, social relations and health in an ethnically diverse social housing area selected to undergo large structural changes and compare it to the surrounding municipality. Furthermore, to explore the association between social relations and self-rated health (SRH) and the interaction with country of origin in both populations.

METHODS

Data sources include a multilingual interviewer-driven survey study in a social housing area (N = 209) and a municipal health survey (N = 1,638) among residents aged 45 + years. Information on social relations include contact frequency with and support from family, friends, and neighbors. Descriptive and multivariate logistic regression analyses adjusted for age, sex, and country of origin are presented, as well as joint effect analyses of social relations and country of origin on SRH.

RESULTS

In the social housing area, 38.8% of the respondents reported poor SRH compared to 19.5% in the municipality. In both study populations low contact frequency was associated with poor SRH, however insignificantly in the social housing area compared to the municipality sample, OR = 1.50 (0.65-3.46) vs. OR = 2.42 (1.70-3.45). Joint exposure to having non-Western background and low contact frequency was strongly associated with poor SRH in the social housing area, OR = 6.28 (1.80-21.89) but less so in the municipality, OR = 3.67 (1.55-8.69). The same tendency was seen regarding low support from social relations.

CONCLUSIONS

This study provides insight to a population that is generally underrepresented in survey studies. In the social housing area, approximately twice as many reported poor SRH compared to the municipality data. In both populations, low contact frequency and low support were associated with poor SRH. Residents with weak social relations and non-Western origin simultaneously were more likely to report poor SRH in the social housing area specifically but less so in the municipality, indicating a higher vulnerability among the residents in the social housing area.

Development of a complex intervention (safe and secure) to support non-western migrant patients with palliative care needs and their families

PURPOSE

International evidence supports the benefits of early use of palliative care, although the best use of services is often under-utilised among Danish migrants. The study aims to develop a theoretically informed, evidence-based intervention to increase support in palliative care service provision among non-western migrant patients with a life-threatening disease and their families in Denmark.

METHODS

The overall approach was guided by the United Kingdom Medical Research Council framework for developing and evaluating complex interventions by involving stakeholders for example patients, family caregivers, and healthcare professionals. The intervention was developed iteratively by incorporating theory and evidence. Evidence was synthesized from a systematic review, semi-structured interviews, and group discussions with patients (n = 8), family caregivers (n = 11), healthcare professionals (n = 10); and three workshops with migrants (n = 5), social and healthcare professionals (n = 6). The study took place in six different settings in two regions across Denmark.

RESULTS

The safe and secure complex intervention is a healthcare professional (e.g. nurse, physiotherapist, or occupational therapist) led patient-centred palliative care intervention at the basic level. The final intervention consists of three components 1. Education and training sessions, 2. Consultations with the healthcare professional, and 3. Coordination of care.

CONCLUSION

This study describes the development of a supportive palliative care intervention for non-western migrant patients with palliative care needs and their families, followed by a transparent and systematic reporting process. A palliative care intervention combining multiple components targeting different stakeholders, is expected that safe and secure is more suitable and well customized in increasing access and use of palliative care services for non-western migrant families in Denmark.

A scoping review of refugees' employment integration experience and outcomes in Canada

BACKGROUND

Refugees involuntarily arrive to Canada to escape unfavourable conditions in their home country. Employment is an important marker of integration and a foundational determinant of health yet; little is known about the employment integration experiences of refugees as a distinct group of workers in Canada.

OBJECTIVE

This scoping review was completed to explore the employment experience and outcomes of refugees in Canada and to identify gaps in the literature.

METHODS

Three databases were searched for peer-reviewed articles published in English over a 25-year period, 1993 to 2018, for research on refugees and employment in the Canadian context. The research team reviewed all articles, including abstract screening, full text review and data extraction; consensus on inclusion was reached for all articles. Relevant articles were synthesized for overarching themes.

RESULTS

The search strategy identified 2,723 unique articles of which 16 were included in the final sample. There was a mix of quantitative, qualitative and mixed-methods studies which reported on employment rates of refugees, the quality of jobs secured, gendered differences in employment experience and differential impacts of under/unemployment on health and well-being.

CONCLUSION

The findings suggest that refugees in Canada do not secure jobs that are in line with their previous skills and experience leading to downward occupational mobility and poorer health with refugee women experiencing these outcomes more acutely. Research in this area with long-term outcomes and contextualized experiences is needed, as well as studies that include equity considerations such as racialization and gender.

Effects of Immigrants, Health, and Ageing on Economic Growth in the European Union

Population ageing and low birth rates are two problems of the EU that have an impact on employment, production, and economic growth. Against this background, immigration, health expenditure, and the health of migrants must become a key element of European policy. For this reason, this paper focused on identifying the effect of immigration, health, and ageing on economic growth in order to highlight their importance from an economic perspective. We constructed different econometric models with Eurostat data for 27 countries and 13 years (2008-2020), whose dependent variable was gross domestic product. Independent variables were the number of immigrants by gender and age, health expenditure per capita (total and by function), immigrants' perception of their health as very good, and the proportion of the population aged 65 years and over. The model selected to analyze the results was Prais-Winsten regression heteroskedastic panels corrected standard errors modeled by applying the option (ar1) to correct for autocorrelation, using Stata software (version 16). The results show that health expenditure has a significant positive effect on economic growth, higher in hospital services, followed by medical products; immigrants' perception as very good is only significant in some models. The number of immigrants has a (positive) effect, although less significant than public expenditure on health. Its effect is larger when the immigrant is aged between 15 and 64 years and smaller for male immigrants than for female immigrants. Without the ageing variable, immigration is not significant. Moreover, there are significant differences between European countries in relation to the variables analyses (immigration, immigrants' perception of their health, ageing and public expenditure on health, and public expenditure on health according to function). This may be due to the different regulations on both immigration and public health in the countries that make up the European Union.

A cross-sectional study of health and well-being among newly settled refugee migrants in Sweden-The role of health literacy, social support and self-efficacy

Structural barriers such as inadequate housing, lack of employment opportunities, and discrimination are known to adversely affect the health of newly settled refugee migrants. However, these barriers remain largely unresolved and unaddressed. Thus, there is a need to better understand how other factors, such as individual-level health resources, may influence health and mitigate ill health in the early post-migration phase. In this study, we aimed to explore the relationship between health outcomes and individual health resources including health literacy, social support, and self-efficacy in newly settled refugee migrants. Survey data was collected from 787 refugee migrants in Sweden. Logistical regression analysis showed that limited health literacy, lack of emotional support, and low self-efficacy were consistently associated with poor health outcomes. Demographic variables such as gender, education, and type of residence permit were not as imperative. Individual-level health resources may play an important role in the general and psychological well-being of newly settled migrants. Promoting health literacy and facilitating the attainment of social support may buffer for structural challenges in the establishment phase and enhance the prospects of later health and social integration.

Comparison of Beliefs about Health in Migrants and Swedish-Born Persons with Type 2 Diabetes

BACKGROUND

Based on findings from previous qualitative studies comparing migrants and Swedish-born persons with diabetes mellitus type 2, it was hypothesized that dissimilarities exist in beliefs about health, including factors of importance for health between groups.

METHODS

A survey in a diabetes clinic in a migrant-dense area in Sweden.

RESULTS

Migrants generally perceived their health as poorer than Swedes, although it was not significantly different. Health mainly meant feeling well, being alert, and healthy and learning to live with disease despite of person's origin. Studying factors of importance for health, migrants perceived knowledge about the body and treatment to influence health to a lower extent (p 0.009) and use of nature cure remedies to a higher extent (p 0.029) than Swedish-born persons.

CONCLUSIONS

The findings partly supported the hypothesis that dissimilarities in factors of importance for health exist between migrants and Swedish-born persons, and need to be assessed.

Health and health-related behaviours in refugees and migrants who self-identify as sexual or gender minority - A National population-based study in Sweden

BACKGROUND

To examine health and health-related behaviors in migrant and refugee individuals who identify as sexual or gender minority, and in comparison to their heterosexual peers.

METHODS

The study included 168,952 individuals (aged 16-84 years, males: 45·9%, sexual or gender minorities: 3·1%) who answered the Swedish National Public Health Survey in 2018 and 2020. Participants were grouped into Swedish-and Western-born (White) heterosexual, White sexual- or gender minority, migrant heterosexual, migrant sexual- or gender minority, refugee heterosexual, and refugee sexual- or gender minority. Outcomes included mental health (for example suicidal ideation, wellbeing), general health, risky behaviors (risk alcohol use, risk gambling, and substance use), and experiences of violence. Associations between 1) sexual- or gender -ethnic identities and 2) gender-ethnic identities and all outcomes were analyzed using logistic and linear regression adjusting for sex, age, and educational level.

FINDINGS

Being a sexual- or gender minority, regardless of ethnic minority status, was associated with worse general health and mental ill-health compared to heterosexual peers including suicidal ideation in refugee sexual- or gender minority individuals (OR 2·42, 95 % CI 1·44-4·08). Ethnic minorities (heterosexual and sexual- or gender minority migrants and refugees) had lower odds of drug and risk alcohol use compared to White heterosexual peers but higher odds of risk gambling (1·88, 1·49-2·37 for refugee heterosexuals). Transgender refugees had high odds for risk gambling (8·62, 1·94-38·40) and exposure to physical violence (7·46, 2·97-18·70).

INTERPRETATION

In this national population-based study, sexual and gender minority individuals have worse mental and general health regardless of ethnic minority status. We did not find evidence for worse health in sexual- or gender minority refugees in comparison to migrant, and White sexual- or gender minorities and their heterosexual peers. Transgender individuals (White and ethnic minority) experienced significantly higher levels of physical violence. Public health policy should emphasize preventive measures to reduce exposure to violence and discrimination in sexual- and gender minority individuals, increase access and use of mental healthcare services and sensitise healthcare professionals about higher rates of health and related issues faced by sexual- and gender minority individuals including those with multiple minority identities.

FUNDING

We received no external funding for this study and hence the funder had no role in the study design, data collection, data analysis, data interpretation, writing of the manuscript and the decision to submit.

Cognitive Disability Among Arab Americans by Nativity Status and Arrival Year: Lack of Evidence for the Healthy Migrant Effect

Limited research exists on cognitive disabilities among Arab Americans, especially as it relates to arrival year among the foreign-born. The objectives of this study were to estimate the age- and sex-adjusted prevalence and associations of cognitive disability by (1) nativity status and (2) arrival year (pre-1991, 1991-2000, 2001-2013, and 2014-2018). We analyzed 11 years (2008-2018) of data from the American Community Survey (ACS) Public Use Microdata Samples (weighted n = 264,086; ages ≥ 45 years). Weighted means, percentages, age- and sex-adjusted prevalence estimates, and logistic regression results (crude and adjusted) were calculated. Among all Arab Americans, the age- and sex-adjusted prevalence of cognitive disability was 6.5%. The prevalence was lower for US-born (4.0%) compared to foreign-born (6.0%) (p-value < 0.0001). In logistic regression results, foreign-born Arab Americans were more likely to have a cognitive disability compared to US-born Arab Americans after adjusting for age and sex (OR = 1.41; 95% CI = 1.24, 1.61). Among foreign-born, Arab Americans arriving in 2014 or later had a lower prevalence of cognitive disability (3.4%) compared to all other arrival years at approximately 4.7%. With those arriving prior to 1991 as the reference category, those arriving between 1991 and 2000 were more likely to report a cognitive disability (OR = 1.05; 95% CI = 1.00, 1.08). However, those arriving between 2014 and 2018 were less likely to report a cognitive disability (OR = 0.81; 95% CI = 0.73, 0.88). These findings challenge the universality of the "healthy migrant effect" and highlight the relevance of socioeconomic disparities for Arab American cognitive health.

Language-supported labor ward visits for pregnant migrant women: Staff experiences in a Swedish hospital

INTRODUCTION

METHODS

RESULTS

CONCLUSIONS

Self-Rated Health Among Italian Immigrants Living in Norway: A Cross-Sectional Study

Background

Most studies on immigrant health focus on immigrant groups coming from extra-European and/or low-income countries. Little attention is given to self-rated health (SRH) in the context EU/EEA migration. To know more about health among European immigrants can provide new insights related to social determinants of health in the migration context. Using the case of Italian immigrants in Norway, the aim of this study was to (i) examine the levels of SRH among Italian immigrants in Norway as compared with the Norwegian and the Italian population, (ii) examine the extent to which the Italian immigrant perceived that moving to Norway had a positive or negative impact on their SRH; and (iii) identify the most important factors predicting SRH among Italian immigrants in Norway.

Methods

A cross-sectional survey was conducted among adult Italian immigrants in Norway (n = 321). To enhance the sample's representativeness, the original dataset was oversampled to match the proportion of key sociodemographic characteristics of the reference population using the ADASYN method (oversampled n = 531). A one-sample Chi-squared was performed to compare the Italian immigrants' SRH with figures on the Norwegian and Italian populations according to Eurostat statistics. A machine-learning approach was used to identify the most important predictors of SRH among Italian immigrants.

Results

Most of the respondents (69%) rated their SRH as "good" or "very good". This figure was not significantly different with the Norwegian population, nor to the Italians living in Italy. A slight majority (55%) perceived that their health would have been the same if they continued living in Italy, while 23% perceived a negative impact. The machine-learning model selected 17 variables as relevant in predicting SRH. Among these, Age, Food habits, and Years of permanence in Norway were the variables with the highest level of importance, followed by Trust in people, Educational level, and Health literacy.

Conclusions

Italian immigrants in Norway can be considered as part of a "new mobility" of high educated people. SHR is shaped by several interconnected factors. Although this study relates specifically to Italian immigrants, the findings may be extended to other immigrant populations in similar contexts.

Barriers to Accessing Primary Care and Appropriateness of Healthcare Among Immigrants in Italy

INTRODUCTION

The health status and health care needs of immigrant populations must be assessed. The aim of this study was to evaluate barriers to accessing primary care and the appropriateness of health care among resident immigrants in Italy, using indicators regarding maternal health, avoidable hospitalization, and emergency care.

METHODS

Cross-sectional study using some indicators of the National Monitoring System of Health Status and Healthcare of the Immigrant Population (MSHIP), coordinated by the National Institute for Health, Migration and Poverty (INMP), calculated on perinatal care, hospital discharge, and emergency department databases for the years 2016-2017 in nine Italian regions (Piedmont, Trento, Bolzano, Emilia-Romagna, Tuscany, Umbria, Latium, Basilicata, Sicily). The analyses were conducted comparing immigrant and Italian residents.

RESULTS

Compared to Italian women, immigrant women had fewer than five gynecological examinations (8.5 vs. 16.3%), fewer first examinations after the 12th week of gestational age (3.8 vs. 12.5%), and fewer than two ultrasounds (1.0 vs. 3.8%). Compared to Italians, immigrants had higher standardized rates (× 1,000 residents) of avoidable hospitalizations (males: 2.1 vs. 1.4; females: 0.9 vs. 0.7) and of access to emergency departments for non-urgent conditions (males: 62.0 vs. 32.7; females: 52.9 vs. 31.4).

CONCLUSIONS

In Italy, there appear to be major issues regarding accessing services and care for the immigrant population. Policies aimed at improving socioeconomic conditions and promoting integration can promote healthy lifestyles and appropriate access to health care, counteracting the emergence of health inequities in the immigrant population.

Development and Effectiveness of a Mobile Health Intervention in Improving Health Literacy and Self-management of Patients With Multimorbidity and Heart Failure: Protocol for a Randomized Controlled Trial

Background

Patients with multimorbidity and complex health needs are defined as a priority by the World Health Organization (WHO) and the European Union. There is a need to develop appropriate strategies with effective measures to meet the challenge of chronicity, reorienting national health systems. The increasing expansion of mobile health (mHealth) interventions in patient communication, the reduction of health inequalities, improved access to health care resources, adherence to treatment, and self-care of chronic diseases all point to an optimistic outlook. However, only few mobile apps demonstrate their effectiveness in these patients, which is diminished when they are not based on evidence, or when they are not designed by and for users with different levels of health literacy (HL).

Objective

This study aims to evaluate the efficacy of an mHealth intervention relative to routine clinical practice in improving HL and self-management in patients with multimorbidity with heart failure (HF) and complex health needs.

Methods

This is a randomized, multicenter, blinded clinical trial evaluating 2 groups, namely, a control group (standard clinical practice) and an intervention group (standard clinical practice and an ad hoc designed mHealth intervention previously developed), for 12 months.

Results

The contents of the mHealth intervention will address user-perceived needs based on the development of user stories regarding diet, physical exercise, cardiac rehabilitation, therapeutic adherence, warning signs and symptoms, and emotional management. These contents have been validated by expert consensus. The creation and development of the contents of the mHealth intervention (app) took 18 months and was completed during 2021. The mobile app is expected to be developed by the end of 2022, after which it will be applied to the experimental group as an adjunct to standard clinical care during 12 months.

Conclusions

The trial will demonstrate whether the mobile app improves HL and self-management in patients with HF and complex health needs, improves therapeutic adherence, and reduces hospital admissions. This study can serve as a starting point for developing other mHealth tools in other pathologies and for their generalization to other contexts.

Trial Registration

ClinicalTrials.gov NCT04725526; https://tinyurl.com/bd8va27w

International Registered Report Identifier (IRRID)

DERR1-10.2196/35945

Sarcopenia and its relation to protein intake across older ethnic populations in the Netherlands: the HELIUS study

Objective: To examine the prevalence of sarcopenia and its association with protein intake in men and women in a multi-ethnic population.Design: We used cross-sectional data from the HELIUS (Healthy Life in an Urban Setting) study, which includes nearly 25,000 participants (aged 18-70 years) of Dutch, South-Asian Surinamese, African Surinamese, Turkish, Moroccan, and Ghanaian ethnic origin. For the current study, we included 5161 individuals aged 55 years and older. Sarcopenia was defined according to the EWGSOP2. In a subsample (N = 1371), protein intake was measured using ethnic-specific Food Frequency Questionnaires. Descriptive analyses were performed to study sarcopenia prevalence across ethnic groups in men and women, and logistic regression analyses were used to study associations between protein intake and sarcopenia.Results: Sarcopenia prevalence was found to be sex- and ethnic-specific, varying from 29.8% in Turkish to 61.3% in South-Asian Surinamese men and ranging from 2.4% in Turkish up to 30.5% in South-Asian Surinamese women. Higher protein intake was associated with a 4% lower odds of sarcopenia in the subsample (OR = 0.96, 95%-CI: 0.92-0.99) and across ethnic groups, being only significant in the South-Asian Surinamese group.Conclusion: Ethnic differences in the prevalence of sarcopenia and its association with protein intake suggest the need to target specific ethnic groups for prevention or treatment of sarcopenia.

Healthcare system resilience in Bangladesh and Haiti in times of global changes (climate-related events, migration and Covid-19): an interdisciplinary mixed method research protocol

Background

Since climate change, pandemics and population mobility are challenging healthcare systems, an empirical and integrative research to studying and help improving the health systems resilience is needed. We present an interdisciplinary and mixed-methods research protocol, ClimHB, focusing on vulnerable localities in Bangladesh and Haiti, two countries highly sensitive to global changes. We develop a protocol studying the resilience of the healthcare system at multiple levels in the context of climate change and variability, population mobility and the Covid-19 pandemic, both from an institutional and community perspective.

Methods

The conceptual framework designed is based on a combination of Levesque’s Health Access Framework and the Foreign, Commonwealth and Development Office’s Resilience Framework to address both outputs and the processes of resilience of healthcare systems. It uses a mixed-method sequential exploratory research design combining multi-sites and longitudinal approaches. Forty clusters spread over four sites will be studied to understand the importance of context, involving more than 40 healthcare service providers and 2000 households to be surveyed. We will collect primary data through questionnaires, in-depth and semi-structured interviews, focus groups and participatory filming. We will also use secondary data on environmental events sensitive to climate change and potential health risks, healthcare providers’ functioning and organisation. Statistical analyses will include event-history analyses, development of composite indices, multilevel modelling and spatial analyses.

Discussion

This research will generate inter-disciplinary evidence and thus, through knowledge transfer activities, contribute to research on low and middle-income countries (LMIC) health systems and global changes and will better inform decision-makers and populations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07294-3.

Perceived health, adversity, and posttraumatic stress disorder in Syrian and Iraqi refugees

BACKGROUND

Exposure to armed conflict and fleeing country of origin for refugees has been associated with poorer psychological health.

METHODS

Within the first month following their arrival in the United States, 152 Syrian and Iraqi refugees were screened in a primary care setting for posttraumatic stress disorder (PTSD), anxiety, and depression and rated their perceived health, and perceived level of adversity of violence, armed conflict/flight. The moderating effects of psychiatric symptoms on the relation between perceived adversity and perceived health were assessed.

RESULTS

Three models based on diagnosis (PTSD, anxiety, and depression) were tested. While significant effects were found on perceived adversity negatively influencing perceived health across diagnoses, slightly different patterns emerged based on diagnosis.

DISCUSSION

Findings suggest that refugees' perception regarding adversity of violence, armed conflict, and flight may contribute to perceived health, with a moderating role of clinically significant symptoms of PTSD, anxiety, and depression.

Racial and Ethnic Differences in the Perceptions of Health, Work Environment and Experiences of Work-Related Symptoms Among Cleaning Workers

This study explored racial and ethnic differences in perception of work environment, safe work practices, general health status, experience of work-related injury or illness and subsequent symptom reporting and health care seeking behaviors among cleaning workers. This study analyzed cross-sectional data obtained from 183 cleaning workers employed in a university hospital or a health sciences campus in Northern California. The sample included 120 Asians (65.6%), 37 Hispanics (20.2%), and 27 other ethnicities (14.2%); 85.7% were foreign-born. Asian workers perceived lower job control and supervisor support and higher job strain than other workers. The odds of perceiving general health as excellent or very good were lower among Asians compared to Hispanics and Others. Asians who experienced chemical-related symptoms were less likely than Hispanics and others to report the symptoms to their supervisor or seek healthcare. Our study findings indicated racial/ethnic differences in perceptions of work and general health, seeking healthcare, and reporting behaviors among cleaning workers. Asian workers, specifically, may need special attention to improve their experiences of work environments and health in the workplace.

The Health Status and Healthcare Utilization of Ethnic Germans in Russia

Ethnic German resettlers from the former Soviet Union are one of the largest migrant groups in Germany. In comparison with the majority of the German population, resettlers exhibit worse subjective health and utilize fewer preventive measures. However, there is little evidence on health among ethnic Germans who remained in Russia. Hence, the objective of this study was to determine the differences in subjective health, diabetes, smoking, and utilization of health check-ups between ethnic Germans and the majority population in Russia. We used data from the Russian Longitudinal Monitoring Survey II from 1994 to 2018 (general population of Russia n = 41,675, ethnic Germans n = 158). Multilevel logistic regression was used to calculate odds ratios (ORs) adjusted for age, sex, period, and place of residence. Analyses were furthermore stratified by the periods 1994-2005 and 2006-2018. Ethnic Germans in Russia rated their health less often as good compared with the Russian majority population (OR = 0.67, CI = 0.48-0.92). Furthermore, ethnic Germans were more likely to smoke after 2006 (OR = 1.91, CI = 1.09-3.37). Lower subjective health among ethnic Germans in Russia is in line with findings among minority populations in Europe. Increased odds of smoking after 2006 may indicate the deteriorating risk behavior of ethnic Germans in Russia.

COVID-19 vaccine hesitancy in people with migratory backgrounds: a cross-sectional study among Turkish- and German-speaking citizens in Munich

Background

This study aimed to investigate the knowledge, attitudes, behaviors, and COVID-19 vaccine hesitancy of people with migratory backgrounds among Turkish- and German-speaking patients in Munich.

Methods

Primary outcomes were the intention to get vaccinated for COVID-19 and COVID-19 knowledge levels (25 true/false items). Other variables included demographics, attitudes to COVID-19 and vaccination (7 items), and behaviors regarding COVID-19 (7 items). The attitude and behavior questions had 5-point Likert scales. Of the 10 Turkish-speaking family physicians in Munich, six agreed to administer Turkish or German questionnaires to consecutive patients in February 2021. Furthermore, participants with either citizenship, country of origin, native language, or place of birth being non-German were categorized as “Having a migratory background.” Data from 420 respondents were analyzed.

Results

Women constituted 41.4% (n = 174), the mean age was 42.2 ± 15.5 years, 245 (58.3%) preferred the Turkish questionnaire, 348 (82.9%) had a migratory background, and 197 (47.9%) intended to be vaccinated. The mean knowledge, attitude, and behavioral scores were 21.5 ± 3.2 (max = 25), 3.7 ± 0.8 (max = 5), and 4.0 ± 0.5 (max = 5). While 42.3% (n = 145) of the participants with a migratory background considered getting vaccinated, this proportion was 76.5% (n = 52) for non-immigrant Germans (Chi-square = 26.818, p < 0.001). Non-migratory background (odds ratio (OR): 3.082), high attitude scores (OR: 2.877), male sex (OR: 2.185), years of schooling (OR: 1.064), and age (OR: 1.022) were positively associated with vaccination intention.

Conclusions

We suggest initiating or supporting projects run by persons or groups with immigrant backgrounds to attempt to elaborate and change their vaccination attitudes.

Health literacy and e-health literacy among Arabic-speaking migrants in Sweden: a cross-sectional study

Background

Health inequities arise when the public cannot access and understand health information in an easy, accessible, and understandable way. Evidence supports that health literacy (HL) is a determinant for health outcomes, and when HL is limited this may have a major impact on morbidity as well as mortality. Migrants are known to have limited HL. Therefore, this study aimed to explore comprehensive health literacy (CHL) and electronic health literacy (eHL) among Arabic-speaking migrants in Sweden.

Methods

This was a cross-sectional observational study conducted in Sweden. A total of 703 persons were invited to participate between February and September 2019. Two questionnaires – the Health Literacy Survey European Questionnaire (HLS-EU-Q16) and the eHealth Literacy Scale (eHEALS) – and questions about self-perceived health and Internet use were distributed in Swedish and Arabic. Various statistical analyses were performed to determine the associations for limited CHL and eHL.

Results

A total of 681 respondents were included in the analysis. Of these, 334 (49%) were native Arabic-speaking migrants and 347 (51%) were native Swedish-speaking residents. CHL and eHL differed between the groups. The Arabic speakers had significantly lower mean sum scores in eHL 28.1 (SD 6.1) vs 29.3 (6.2), p = 0.012 and lower proportion of sufficient CHL 125 (38.9%) vs 239 (71.3%), p < 0.001 compared to Swedish speakers. Multiple regression analysis showed on associations between limited CHL and eHL and being Arabic speaking, less Internet use, and not finding the Internet to be important or useful. Furthermore, longer time spent in Sweden was associated with higher levels of CHL among the Arabic speakers, (OR 0.94, 95% CI 0.91–0.98, p < 0.01).

Conclusions

CHL and eHL differ between Arabic-speaking migrants and native Swedish speakers, but also between Arabic speakers who have lived different lengths of time in Sweden. Though it seems that the eHealth literacy is less affected by language spoken, the Internet is suggested to be an appropriate channel for disseminating health information to Arabic-speaking migrants.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12187-5.

Ethnic differences in functional limitations: a comparison of older migrants and native Dutch older population

Background

Although the older migrants population in Europe is expected to grow substantially in the coming years, there is little information about their health status and particularly functional limitations. This study examined the association of ethnicity and mobility, hearing and visual limitations in comparison to the general population in the Netherlands, and whether relevant characteristics explained the potential differences between older migrants and non-migrants.

Methods

Secondary data analysis of 12 652 subjects 55 years and older who participated in the health survey in the four largest Dutch cities. To establish limitations in vision, hearing and mobility, the Organization for Economic Co-operation and Development (OECD) questionnaire was used. Logistic regression analysis was used to examine the association between limitations and ethnic background, subsequently adjusting for demographic and socio-economic characteristics and relevant health- and lifestyle-related factors.

Results

Older migrants had higher prevalences of functional limitations. The age- and- gender adjusted ORs were 2 to 8-fold compared with older non-migrants. After adjusting for socioeconomic status and health-and lifestyle indicators, Moroccan, Turkish and Surinamese migrants still had increased ORs for visual limitations [ORs (95% CI), respectively: 2.48 (1.49–4.14), 3.08 (1.75–5.41) and 1.97 (1.33–2.91)] compared with the Dutch. For mobility limitations, only the Turkish migrants had an OR twice as high (2.19; 1.08–4.44) as the non-migrants. No significant differences were found between Antillean/Aruban migrants and non-migrants.

Conclusions

Important ethnic inequalities exist in various functional limitations, particularly in vision. These results underline the importance of tailored preventive interventions in older migrants to detect and prevent these limitations at an early stage.

Recommendations for ethnic equity in health: A Delphi study from Denmark

AIMS

A key issue in public health is how to approach ethnic inequities. Despite an increased focus on the health of people from ethnic minorities in the last 15 years, significant ethnic health inequities still exist in Denmark. These arise during pregnancy and are exacerbated by higher rates of exposure to health risks during the life course. This study aimed to formulate recommendations on both structural and organisational levels to reduce ethnic health inequities.

METHODS

Nine decision-makers - representing municipalities, regions, the private sector and voluntary organisations in Denmark - participated in the formulation of recommendations inspired by the Delphi method. The consensus process was conducted in three rounds during spring 2020, resulting in eight overall recommendations, including suggestions for action.

RESULTS

The recommendations address both structural and organisational levels. They aim to strengthen: 1) health policies and strategies related to the needs of people from ethnic minorities, including health literacy, linguistic, cultural and social differences; 2) health-promoting local initiatives developed in co-creation with people from ethnic minorities; 3) health promotion and prevention from a life course perspective with a focus on early intervention; 4) cross-sectoral and interdisciplinary collaborations that facilitate transitions and coordination; 5) competencies of professionals in terms of cultural knowledge, awareness, reflexivity and skills; 6) access to healthcare services by increasing information and resources; 7) interpreting assistance for, and linguistic accessibility to, healthcare services; 8) documentation and intervention research.

CONCLUSIONS

To reduce ethnic health inequities, it is crucial that Danish welfare institutions, including their strategies, approaches and skills of employees, are adapted to serve an increasingly heterogeneous population.

Adverse working conditions and immigrants' physical health and depression outcomes: a longitudinal study in Greece

PURPOSE

Τhe study examines whether adverse working conditions for immigrants in Greece bear an association with deteriorated physical health and increased levels of depression during 2018 and 2019.

METHODS

A panel dataset resulted from the collaboration with centers providing free Greek language courses to immigrant population groups. Random Effects models assess the determinants of physical health and depression.

RESULTS

Findings indicate that workers with no written contract of employment, receiving hourly wages lower than the national hourly minimum wages, and experiencing insults and/or threats in their present job experience worse physical health and increased levels of depression. Moreover, the study found that the inexistence of workplace contracts, underpayment, and verbal abuse in the workplace may coexist. An increased risk of underpayment and verbal abuse reveals itself when workers do not have a contract of employment and vice versa.

CONCLUSION

Immigrant workers without a job contract might experience a high degree of workplace precariousness and exclusion from health benefits and insurance. Immigrant workers receiving a wage lower than the corresponding minimum potentially do not secure a living income, resulting in unmet needs and low investments in health. Workplace abuse might correspond with vulnerability related to humiliating treatment. These conditions can negatively impact workers' physical health and foster depression. Policies should promote written employment contracts and ensure a mechanism for workers to register violations of fair practices.

Health Profile of Precarious Migrants Attending the Médecins Du Monde's Health and Social Care Centres in France: a Cross-Sectional Study

Objective: The present study aimed to compare the precarious migrants' health problems managed in Médecins du Monde's health and social care centres (CASO) with those of patients attending general practice in France. Methods: We compared the most frequent health problems managed in the 19 CASO in metropolitan France with those of a national sample of usual general practice consultations, after standardisation for age and sex. Results: Precarious migrants had fewer health problems managed per consultation than other patients (mean: 1.31 vs. 2.16), and these corresponded less frequently to chronic conditions (21.3% vs. 46.8%). The overrepresented health problems among CASO consultations were mainly headache (1.11% vs. 0.45%), viral hepatitis (1.05% vs. 0.20%), type 1 diabetes (1.01% vs. 0.50%) and teeth/gum disease (1.01% vs. 0.23%). Their underrepresented health problems were mainly lipid disorder (0.39% vs. 8.20%), depressive disorder (1.36% vs. 5.28%) and hypothyroidism (0.50% vs. 3.08%). Prevention issues were nominal in precarious migrants (0.16%). Conclusion: Both chronic somatic and mental conditions of precarious migrants are presumably underdiagnosed. Their screening should be improved in primary care.

Factors Associated with Return Migration of First-Generation Immigrants in Belgium (2001-2011)

Belgium is a country with a long and diverse history of migration. Given the diverse context of immigration to Belgium, reasons for return migration will most likely vary as well. With this study, we want to quantify the return migration of Belgium's immigrants and assess whether socio-economic, sociodemographic and health factors are related to return migration. Individually linked census and register data comprising the total Belgian first-generation immigrant population aged 25+ were used. Age-standardized emigration rates (ASER) by migrant origin and gender were calculated for the period 2001-2011. Additionally, relative return migration differences were calculated by country of origin and gender, adjusted for age group, length of stay, household composition, socio-economic indicators (education, home ownership and employment status) and self-rated health in 2001. Return migration was most common among immigrants from Spanish descent and from the neighbouring countries and higher among men than among women. Return migration was highly selective in terms of older age, lower length of stay in Belgium, not living with a partner or children, being high-educated, unemployed and in good health. Key issues for future research include examining the reasons for return migration, identifying the country of destination and accounting for household characteristics.

The isolation paradox: A comparative study of social support and health across migrant generations in the U.S

Social isolation and international migration have potentially adverse effects on physical and mental health, and may compound each other when migrants have limited access to supportive social networks. This problem may be particularly serious in older age groups, who are more vulnerable to illness and isolation. We analyze population representative data from a detailed survey of social networks and health in the San Francisco Bay Area, U.S., to compare access to different types of social support and health outcomes among first-generation migrants, second-generation migrants, and nonmigrants between 50 and 70 years old (N = 674). We find that first-generation migrants report systematically lower levels of social support and poorer self-rated health compared to nonmigrants, even after controlling for sociodemographic characteristics. While social support is strongly and positively associated with health in the general population, this relationship is null or, in some cases, reversed among migrants in the first and second generations. These results provide further evidence that migration operates as an adverse social determinant of health, and suggest an isolation paradox: migrants are healthier than nonmigrants only at very low levels of social support, and they do not experience the same beneficial health effects of social support as nonmigrants.

Identifying people at risk for influenza with low vaccine uptake based on deprivation status: a systematic review

BACKGROUND

Influenza vaccination is an important public health intervention for controlling disease burden, but coverage rates are still low also in risk groups. In order to identify non-vaccinating subgroups, deprivation and socio-economic indices, i.e. measures used to synthetically describe people's socio-economic status while taking into account several dimensions, may be used. We aimed to synthetize evidence from studies investigating association between deprivation/socio-economic indices and influenza vaccination coverage in population at risk-persons ≥65 years of age, individuals with comorbidities, pregnant women and health-care workers.

METHODS

We searched PubMed, ISI WoS, CINAHL and Scopus to identify observational studies published up to October 10th 2017 in English or Italian. Studies reporting quantitative estimates of the association between deprivation/socio-economic indices and influenza vaccination coverage in populations at risk were included.

RESULTS

A total of 1474 articles were identified and 12 were eventually included in the final review. Studies were mostly cross-sectional, performed in European countries, from 2004 to 2017. Seven studies focussed on deprivation and five on socio-economic indices. Studies on deprivation indices and vaccination coverage showed that people from the most deprived areas had lower coverage. Regarding socio-economic condition, results were contrasting, even though it may also be concluded that people from lower groups have lower vaccination coverage.

CONCLUSIONS

Our work supports the possibility to identify people likely to have lower influenza vaccination coverage based on deprivation/socio-economic indices. Efforts should be performed in order to further strengthen robustness, transferability and suitability of these indices in addressing public health problems.

[Health status among immigrant in Catalonia from a gender perspective: PELFI project]

OBJECTIVE

The objective of the study is to assess the health status of immigrant men and women from non-EU countries living in the Metropolitan Area of Barcelona (Catalonia, Spain) and to identify the social determinants of health from a gender perspective.

METHOD

Cross-sectional analysis from a cohort of immigrant families recruited in Badalona and Santa Coloma de Gramenet, in Spain (PELFI cohort). In 2015-2016, 167 immigrants answered the baseline epidemiological questionnaire and the 5-level EuroQol instrument (EQ-5D) which measures health status. To identify health determinants, Tobit models were constructed to the EQ-5D index.

RESULTS

Women rated poorer self-perceived health (p=0.005). To be diagnosed with and illness was only associated with poor self-perceived health among men (p<0.05). Length of residence, domestic work, and especially double workload deteriorated women's health. After adjusting models by demographics and social determinants, permanent administrative status (-0.136; p=0.015) and social support (0.182; p=0.02) were associated with health status in both sexes. To have a job was associated with better health only in men.

CONCLUSIONS

Non-EU immigrants living in the Metropolitan Area of Barcelona are a socially vulnerable group of population and present inequalities in health by sex. Social support and occupation are key factors of their health status. Interventions to reduce immigrant vulnerabilities and inequalities in health should promote their social inclusion and cohesion from a gender perspective.

Arabic Version of the Electronic Health Literacy Scale in Arabic-Speaking Individuals in Sweden: Prospective Psychometric Evaluation Study

Background

Health information is often communicated through the internet. It is vital for the end user to have a range of digital skills as well as understand the information to promote their health. There is a valid and reliable 8-item instrument, the Electronic Health Literacy Scale (eHEALS), that evaluates these skills. The number of Arabic-speaking people migrating to Sweden and to other parts of the world is increasing due to unstable military and political situations in their countries of origin. Poor health and limited health literacy have been described in this population in Sweden. Still, to our knowledge, an Arabic version of eHEALS has not been tested for validity or reliability. Thus, Arabic-speaking populations in Sweden cannot be included in studies measuring eHealth literacy, which does not support equal treatment in health care.

Objective

The aim of this study was to translate and adapt the original English eHEALS version into Arabic and to evaluate its psychometric properties.

Methods

The eHEALS was rigorously translated, adapted, and evaluated for content validity. We conducted prospective psychometric evaluation with natively Arabic-speaking participants living in Sweden. Construct validity, factor structure, internal consistency, and test-retest reliability were evaluated using Spearman correlation, principal component analysis, Cronbach α, and weighted quadratic Cohen κ, respectively.

Results

The study population consisted of Arabic-speaking participants (n=298; age: mean 41.8 years, SD 10.5). Construct validity was supported with weak and moderate correlations. Principal component factor analysis revealed a one-factor structure. Internal consistency was high (Cronbach α=0.92); test-retest reliability was acceptable (weighted quadratic Cohen κ=0.76). Evaluation indicated that eHealth literacy threshold values should be dichotomized (limited and sufficient) rather than trichotomized (inadequate, problematic, and sufficient).

Conclusions

The Arabic version of eHEALS, a unidimensional scale that is valid and reliable for measuring eHealth literacy among natively Arabic-speaking people in Sweden, was found to be acceptable and feasible in a general population.