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Enguita-Germán M, Tamayo I, Librero J, Ballesteros-Domínguez A, Oscoz-Villanueva I, Galbete A, Arnedo L, Cambra K, Gorricho J, Moreno-Iribas C, Millán-Ortuondo E, Ibáñez-Beroiz B. Sex-dependent effect of socioeconomic status on cardiovascular event risk in a population-based cohort of patients with type 2 diabetes. Eur J Public Health 2024; 34:441-448. [PMID: 38484146 PMCID: PMC11161156 DOI: 10.1093/eurpub/ckae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Socioeconomic status (SES) factors often result in profound health inequalities among populations, and their impact may differ between sexes. The aim of this study was to estimate and compare the effect of socioeconomic status indicators on incident cardiovascular disease (CVD)-related events among males and females with type 2 diabetes (T2D). METHODS A population-based cohort from a southern European region including 24,650 patients with T2D was followed for five years. The sex-specific associations between SES indicators and the first occurring CVD event were modeled using multivariate Fine-Gray competing risk models. Coronary Heart Disease (CHD) and stroke were considered secondary outcomes. RESULTS Patients without a formal education had a significantly higher risk of CVD than those with a high school or university education, with adjusted hazard ratios (HRs) equal to 1.24 (95%CI: 1.09-1.41) for males and 1.50 (95%CI: 1.09-2.06) for females. Patients with <18 000€ income had also higher CVD risk than those with ≥18 000€, with HRs equal to 1.44 (95%CI: 1.29-1.59) for males and 1.42 (95%CI: 1.26-1.60) for females. Being immigrant showed a HR equal to 0.81 (95%CI: 0.66-0.99) for males and 1.13 (95%CI: 0.68-1.87) for females. Similar results were observed for stroke, but differed for CHD when income is used, which had higher effect in females. CONCLUSION Socioeconomic inequalities in CVD outcomes are present among T2D patients, and their magnitude for educational attainment is sex-dependent, being higher in females, suggesting the need to consider them when designing tailored primary prevention and management strategies.
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Affiliation(s)
- Mónica Enguita-Germán
- Unidad de Metodología, Navarrabiomed-HUN-UPNA, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Pamplona, Spain
| | - Ibai Tamayo
- Unidad de Metodología, Navarrabiomed-HUN-UPNA, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Pamplona, Spain
| | - Julián Librero
- Unidad de Metodología, Navarrabiomed-HUN-UPNA, Pamplona, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Pamplona, Spain
| | - Asier Ballesteros-Domínguez
- Unidad de Metodología, Navarrabiomed-HUN-UPNA, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Pamplona, Spain
| | - Ignacio Oscoz-Villanueva
- Unidad de Metodología, Navarrabiomed-HUN-UPNA, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Pamplona, Spain
| | - Arkaitz Galbete
- Unidad de Metodología, Navarrabiomed-HUN-UPNA, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Pamplona, Spain
- Departamento de Estadística, UPNA, Pamplona, Spain
| | - Laura Arnedo
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Koldo Cambra
- Dirección de Salud Pública y Adicciones, Departamento de Sanidad del Gobierno Vasco, Vitoria-Gasteiz, Spain
| | - Javier Gorricho
- Servicio de Evaluación y Difusión de resultados en Salud, Servicio Navarro de Salud (SNS-O), Pamplona, Spain
| | - Conchi Moreno-Iribas
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. Instituto de Salud Pública, Pamplona, Spain
| | | | - Berta Ibáñez-Beroiz
- Unidad de Metodología, Navarrabiomed-HUN-UPNA, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Pamplona, Spain
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Féral Pierssens AL, Castan B, Cordel H, Vuillemin A, Chastang J, Papazian L, Linglart A, Pichard E, Boscal De Reals Q, Gonzalez J, Vignier N. The French medical community united against cuts to State Medical Aid. Health Policy 2024; 143:105037. [PMID: 38461617 DOI: 10.1016/j.healthpol.2024.105037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/29/2024] [Accepted: 03/03/2024] [Indexed: 03/12/2024]
Affiliation(s)
- Anne Laure Féral Pierssens
- Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Hôpital Jean Verdier, AP-HP, UFR SMBH, Université Sorbonne Paris Nord, Bobigny, France; LEPS, UR 3412, Université Sorbonne Paris Nord, Bobigny, France; LIEPP, SciencesPo Paris, France; Société française de médecine d'urgence (SFMU), France
| | - Bernard Castan
- Société de pathologie infectieuse de langue française (SPILF), France
| | - Hugues Cordel
- Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Hôpital Jean Verdier, AP-HP, UFR SMBH, Université Sorbonne Paris Nord, Bobigny, France; Société française de lutte contre le Sida (SFLS), France
| | | | | | | | | | - Eric Pichard
- Société francophone de médecine tropicale et santé internationale (SFMTSI), France
| | - Quiterie Boscal De Reals
- Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Hôpital Jean Verdier, AP-HP, UFR SMBH, Université Sorbonne Paris Nord, Bobigny, France
| | - Jésus Gonzalez
- Société de pneumologie de langue française (SPLF), France
| | - Nicolas Vignier
- Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Hôpital Jean Verdier, AP-HP, UFR SMBH, Université Sorbonne Paris Nord, Bobigny, France; Société de pathologie infectieuse de langue française (SPILF), France; Société française de lutte contre le Sida (SFLS), France; IAME, Inserm UMR 1137, Université Sorbonne Paris Nord, Université Paris Cité, Paris, France; French Collaborative Institute on Migration, Aubervilliers, France
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Moreno-Juste A, Poblador-Plou B, Ortega-Larrodé C, Laguna-Berna C, González-Rubio F, Aza-Pascual-Salcedo M, Bliek-Bueno K, Padilla M, de-la-Cámara C, Prados-Torres A, Gimeno-Feliú LA, Gimeno-Miguel A. Mental health and risk of death and hospitalization in COVID-19 patients. Results from a large-scale population-based study in Spain. PLoS One 2024; 19:e0298195. [PMID: 38346044 PMCID: PMC10861053 DOI: 10.1371/journal.pone.0298195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/19/2024] [Indexed: 02/15/2024] Open
Abstract
The COVID-19 pandemic has created unprecedented challenges for health care systems globally. This study aimed to explore the presence of mental illness in a Spanish cohort of COVID-19-infected population and to evaluate the association between the presence of specific mental health conditions and the risk of death and hospitalization. This is a retrospective cohort study including all individuals with confirmed infection by SARS-CoV-2 from the PRECOVID (Prediction in COVID-19) Study (Aragon, Spain). Mental health illness was defined as the presence of schizophrenia and other psychotic disorders, anxiety, cognitive disorders, depression and mood disorders, substance abuse, and personality and eating disorders. Multivariable logistic regression models were used to examine the likelihood of 30-day all-cause mortality and COVID-19 related hospitalization based on baseline demographic and clinical variables, including the presence of specific mental conditions, by gender. We included 144,957 individuals with confirmed COVID-19 from the PRECOVID Study (Aragon, Spain). The most frequent diagnosis in this cohort was anxiety. However, some differences were observed by sex: substance abuse, personality disorders and schizophrenia were more frequently diagnosed in men, while eating disorders, depression and mood, anxiety and cognitive disorders were more common among women. The presence of mental illness, specifically schizophrenia spectrum and cognitive disorders in men, and depression and mood disorders, substance abuse, anxiety and cognitive and personality disorders in women, increased the risk of mortality or hospitalization after COVID-19, in addition to other well-known risk factors such as age, morbidity and treatment burden. Identifying vulnerable patient profiles at risk of serious outcomes after COVID-19 based on their mental health status will be crucial to improve their access to the healthcare system and the establishment of public health prevention measures for future outbreaks.
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Affiliation(s)
- Aida Moreno-Juste
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragon, Miguel Servet University Hospital, Zaragoza, Spain
- San Pablo Primary Care Health Centre, Aragon Health Service (SALUD), Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Beatriz Poblador-Plou
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragon, Miguel Servet University Hospital, Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III (ISCIII), Madrid, Spain
| | | | - Clara Laguna-Berna
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragon, Miguel Servet University Hospital, Zaragoza, Spain
| | - Francisca González-Rubio
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragon, Miguel Servet University Hospital, Zaragoza, Spain
| | - Mercedes Aza-Pascual-Salcedo
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragon, Miguel Servet University Hospital, Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III (ISCIII), Madrid, Spain
- Primary Care Pharmacy Service Zaragoza III, Aragon Health Service (SALUD), Zaragoza, Spain
| | - Kevin Bliek-Bueno
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragon, Miguel Servet University Hospital, Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III (ISCIII), Madrid, Spain
- Department of Preventive Medicine, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - María Padilla
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III (ISCIII), Madrid, Spain
- Research Unit, Costa del Sol Hospital, Instituto de Investigación Biomédica de Málaga (IBIMA), Marbella, Spain
| | - Concepción de-la-Cámara
- Department of Psychiatry, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain
- Department of Medicine, Dermatology and Psychiatry, University of Zaragoza, Zaragoza, Spain
| | - Alexandra Prados-Torres
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragon, Miguel Servet University Hospital, Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Luis A. Gimeno-Feliú
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragon, Miguel Servet University Hospital, Zaragoza, Spain
- San Pablo Primary Care Health Centre, Aragon Health Service (SALUD), Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III (ISCIII), Madrid, Spain
- Department of Medicine, Dermatology and Psychiatry, University of Zaragoza, Zaragoza, Spain
| | - Antonio Gimeno-Miguel
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragon, Miguel Servet University Hospital, Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III (ISCIII), Madrid, Spain
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Domínguez-Rodríguez A, González-Rábago Y. 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. J Migr Health 2024; 9:100216. [PMID: 38356857 PMCID: PMC10865015 DOI: 10.1016/j.jmh.2024.100216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 02/16/2024] Open
Abstract
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.
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Grande R, García-González JM, Stanek M. Differences in the risk of premature cancer mortality between natives and immigrants in Spain. Eur J Public Health 2023; 33:803-808. [PMID: 37390810 PMCID: PMC10567247 DOI: 10.1093/eurpub/ckad102] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND The healthy immigrant paradox has found wide support in the literature. To evaluate this hypothesis that immigrants have better health outcomes than the native population, this study aimed to compare the premature cancer mortality between the native and immigrant populations in Spain. METHODS We obtained the 2012-15 cause-specific mortality estimates from administrative records and participant characteristics data from the 2011 Spanish census. Using Cox proportional hazards regression models, we calculated the risks of mortality of the native and immigrant populations, and the latter populations' risk based on their regions of origin, and determined the effects of covariates of interest on the calculated risk. RESULTS Our results show that the risk of premature cancer mortality is lower among immigrants than among natives, and this gap is higher among men than among women. There is a lower mortality rate among Latin American immigrants (Latino men are 81% less likely to die prematurely from cancer than native-born men, and Latino women are 54% less). Moreover, despite social class disparities, immigrants' advantage in cancer mortality remained constant and decreased with increasing length of residence in the host country. CONCLUSIONS This study provided novel evidence on the 'healthy immigrant paradox', associated with the fact that migrants are favorably selected at origin, cultural patterns of the societies of origin and, in the case of men, there is some convergence or an 'unhealthy' integration that explains the fact that this advantage over natives is lost with more years of residence in Spain.
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Affiliation(s)
- Rafael Grande
- Department of Sociology, Universidad de Málaga, Málaga, Spain
| | | | - Mikolaj Stanek
- Department of Sociology, Universidad de Salamanca, Salamanca, Spain
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Moreno-Juste A, Gimeno-Miguel A, Poblador-Plou B, Calderón-Larrañaga A, Cano del Pozo M, Forjaz MJ, Prados-Torres A, Gimeno-Feliú LA. Multimorbidity, social determinants and intersectionality in chronic patients. Results from the EpiChron Cohort. J Glob Health 2023; 13:04014. [PMID: 36757132 PMCID: PMC9893716 DOI: 10.7189/13.04014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background Multimorbidity is influenced in an interconnected way, both in extent and nature, by the social determinants of health. We aimed at implementing an intersectional approach to analyse the association of multimorbidity with five important axes of social inequality (i.e. gender, age, ethnicity, residence area and socioeconomic class). Methods We conducted a cross-sectional observational study of all individuals who presented with at least one chronic disease in 2019 (n = 1 086 948) from the EpiChron Cohort (Aragon, Spain). Applying intersectional analysis, the age-adjusted likelihood of multimorbidity was investigated across 36 intersectional strata defined by gender, ethnicity, residence area and socioeconomic class. We calculated odds ratios (OR) 95% confidence interval (CI) using high-income urban non-migrant men as the reference category. The area under the receiver operator characteristics curve (AUC) was calculated to evaluate the discriminatory accuracy of multimorbidity. Results The prevalence of multimorbidity increased with age, female gender and low income. Young and middle-aged low-income individuals showed rates of multimorbidity equivalent to those of high-income people aged about 20 years older. The intersectional analysis showed that low-income migrant women living in urban areas for >15 years were particularly disadvantaged in terms of multimorbidity risk OR = 3.16 (95% CI = 2.79-3.57). Being a migrant was a protective factor for multimorbidity, and newly arrived migrants had lower multimorbidity rates than those with >15 years of stay in Aragon, and even non-migrants. Living in rural vs. urban areas was slightly protective against multimorbidity. All models had a large discriminatory accuracy (AUC = 0.7884-0.7895); the largest AUC was obtained for the model including all intersectional strata. Conclusions Our intersectional approach uncovered the large differences in the prevalence of multimorbidity that arise due to the synergies between the different socioeconomic and demographic exposures, beyond their expected additive effects.
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Affiliation(s)
- Aida Moreno-Juste
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain,San Pablo Primary Care Health Centre, Aragon Health Service (SALUD), Zaragoza, Spain,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Research Network on Health Services in Chronic Diseases (REDISSEC), Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Antonio Gimeno-Miguel
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Research Network on Health Services in Chronic Diseases (REDISSEC), Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Beatriz Poblador-Plou
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Research Network on Health Services in Chronic Diseases (REDISSEC), Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Amaia Calderón-Larrañaga
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Research Network on Health Services in Chronic Diseases (REDISSEC), Institute of Health Carlos III (ISCIII), Madrid, Spain,Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Mabel Cano del Pozo
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Research Network on Health Services in Chronic Diseases (REDISSEC), Institute of Health Carlos III (ISCIII), Madrid, Spain,General Directorate of Health Care, Department of Health, Government of Aragon, Zaragoza, Spain
| | - Maria João Forjaz
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Research Network on Health Services in Chronic Diseases (REDISSEC), Institute of Health Carlos III (ISCIII), Madrid, Spain,National Center of Epidemiology, Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Alexandra Prados-Torres
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Research Network on Health Services in Chronic Diseases (REDISSEC), Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Luis A Gimeno-Feliú
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain,San Pablo Primary Care Health Centre, Aragon Health Service (SALUD), Zaragoza, Spain,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Research Network on Health Services in Chronic Diseases (REDISSEC), Institute of Health Carlos III (ISCIII), Madrid, Spain,University of Zaragoza, Zaragoza, Spain
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Terragni L, Rossi A, Miscali M, Calogiuri G. Self-Rated Health Among Italian Immigrants Living in Norway: A Cross-Sectional Study. Front Public Health 2022; 10:837728. [PMID: 35719667 PMCID: PMC9198252 DOI: 10.3389/fpubh.2022.837728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 04/28/2022] [Indexed: 11/29/2022] Open
Abstract
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.
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Affiliation(s)
- Laura Terragni
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Alessio Rossi
- Department of Computer Science, University of Pisa, Pisa, Italy
| | - Monica Miscali
- Department of Historical and Classical Studies at the Norwegian University of Science and Technology, Trondheim, Norway
| | - Giovanna Calogiuri
- Department of Nursing and Health Sciences, Center for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
- Department of Public Health and Sport Sciences, Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
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Prevalence and associated risk factors for hepatitis B and C viruses among refugee populations living in Mahama, Rwanda: A cross-sectional study. PLoS One 2021; 16:e0257917. [PMID: 34634039 PMCID: PMC8504757 DOI: 10.1371/journal.pone.0257917] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/13/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION As part of the integration of refugees into Rwanda's national hepatitis C elimination agenda, a mass screening campaign for hepatitis B (HBV) and hepatitis C (HCV) was conducted among Burundian refugees living in Mahama Camp, Eastern Rwanda. This cross-sectional survey used data from the screening campaign to report on the epidemiology of viral hepatitis in this setting. METHODS Rapid diagnostic tests (RDTs) were used to screen for hepatitis B surface antigen (HBsAg) and hepatitis C antibody (anti-HCV) among people of ≥15years old. We calculated seroprevalence for HBsAg and anti-HCV by age and sex and also calculated age-and-sex adjusted risk ratios (ARR) for other possible risk factors. RESULTS Of the 26,498 screened refugees, 1,006 (3.8%) and 297 (1.1%) tested positive for HBsAg and Anti-HCV, respectively. HBsAg was more prevalent among men than women and most common among people 25-54 years old. Anti-HCV prevalence increased with age group with no difference between sexes. After adjusting for age and sex, having a household contact with HBsAg was associated with 1.59 times higher risk of having HBsAg (95% CI: 1.27, 1.99) and having a household contact with anti-HCV was associated with 3.66 times higher risk of Anti-HCV (95% CI: 2.26, 5.93). Self-reporting having HBV, HCV, liver disease, or previously screened for HBV and HCV were significantly associated with both HBsAg and anti-HCV, but RDT-confirmed HBsAg and anti-HCV statuses were not associated with each other. Other risk factors for HBsAg included diabetes (ARR = 1.97, 95% CI: 1.08, 3.59) and family history of hepatitis B (ARR = 1.32, 95% CI: 1.11, 1.56) and for anti-HCV included heart disease (ARR = 1.91, 95% CI: 1.30, 2.80) and history of surgery (ARR = 1.70, 95% CI: 1.24, 2.32). CONCLUSION Sero-prevalence and risks factors for hepatitis B and C among Burundian were comparable to that in the Rwandan general population. Contact tracing among household members of identified HBsAg and anti-HCV infected case may be an effective approach to targeted hepatitis screening given the high risk among self-reported cases. Expanded access to voluntary testing may be needed to improve access to hepatitis treatment and care in other refugee settings.
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Halley E, Giai J, Chappuis M, Tomasino A, Henaine R, Letrilliart L. Health Profile of Precarious Migrants Attending the Médecins Du Monde's Health and Social Care Centres in France: a Cross-Sectional Study. Int J Public Health 2021; 66:602394. [PMID: 34456664 PMCID: PMC8386651 DOI: 10.3389/ijph.2021.602394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 05/31/2021] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Emeraude Halley
- Collège universitaire de médecine générale, Université Claude Bernard Lyon 1, Univ. Lyon, Lyon, France
| | - Joris Giai
- Service de Biostatistique-Bioinformatique, Hospices Civils de Lyon, Pierre-Bénite, France
| | | | | | - Roland Henaine
- Unité d'enseignement Libre Médecine Humanitaire et SAMU Social, Université Claude Bernard Lyon 1, Lyon, France.,Service de chirurgie cardiaque C, Hôpital Cardiologique Louis Pradel, Bron, France
| | - Laurent Letrilliart
- Collège universitaire de médecine générale, Université Claude Bernard Lyon 1, Univ. Lyon, Lyon, France.,Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
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10
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Serre-Delcor N, Oliveira I, Moreno R, Treviño B, Hajdók E, Esteban E, Murias-Closas A, Denial A, Evangelidou S. A Cross-Sectional Survey on Professionals to Assess Health Needs of Newly Arrived Migrants in Spain. Front Public Health 2021; 9:667251. [PMID: 34409005 PMCID: PMC8365167 DOI: 10.3389/fpubh.2021.667251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/21/2021] [Indexed: 11/17/2022] Open
Abstract
Heightened conflicts and lack of safety due to reasons related to economic, social, ethnic, religious, sexual orientation, political, or nationality matters have increased migratory movements during the last, few decades. Unfortunately, when migrants arrive in new territories, they can face many barriers. For example, in Spain, some migrants have difficulties in accessing health services. The main objective of this study was to describe, from the perspective of social and healthcare professionals, health needs and barriers faced among migrants who recently arrived in Spain when accessing the health system. To accomplish this aim, we carried out a cross-sectional descriptive study using a newly created self-administered questionnaire. Statistical analysis was done using the SPSS 23.00® program. Survey collection was from April 2018 to October 2018, and the cohort comprised a total of 228 professionals. Most participants were females (76%), with an average age of 35 years [interquartile range (IQR) 29.8-43.0]. The most represented profession in the cohort was physician (48%), followed by social care professionals (32%), nursing (11%), and other (8%). Of these individuals, 61% stated having either little or limited knowledge of international migrant health rights, and 94% believed migrants must overcome barriers to receive health services. The four most reported barriers were as follows: language, cultural differences, administrative issues, and fear of being undocumented. Additionally, by order of importance, professionals viewed mental health disorders and infectious diseases as the most common contributors to disease burden in this group. The four most popular strategies implemented by professionals to improve healthcare access further for migrants included intercultural competency training for professionals; access to community health agents; access to translators; and development of health system navigation skills among those newly arrived. Study results suggest that governments should make greater efforts to provide social and healthcare professionals with more effective tools that overcome communication barriers and cultural competence training modules.
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Affiliation(s)
- Núria Serre-Delcor
- Tropical Medicine and International Health Unit Drassanes-Vall d'Hebron, PROSICS (International Health Program ot the Catalan Health Institute), Department of Infectious Diseases, Hospital Vall d'Hebron, Institut Català de la Salut, Barcelona, Spain
| | - Inés Oliveira
- Tropical Medicine and International Health Unit Drassanes-Vall d'Hebron, PROSICS (International Health Program ot the Catalan Health Institute), Department of Infectious Diseases, Hospital Vall d'Hebron, Institut Català de la Salut, Barcelona, Spain
| | - Ruben Moreno
- Vall d'Hebron Research Institute, Infectious Diseases Group, Barcelona, Spain
| | - Begoña Treviño
- Tropical Medicine and International Health Unit Drassanes-Vall d'Hebron, PROSICS (International Health Program ot the Catalan Health Institute), Department of Infectious Diseases, Hospital Vall d'Hebron, Institut Català de la Salut, Barcelona, Spain
| | - Eva Hajdók
- Vall d'Hebron Research Institute, Infectious Diseases Group, Barcelona, Spain
| | - Esperanza Esteban
- Vall d'Hebron Research Institute, Infectious Diseases Group, Barcelona, Spain
| | - Adrià Murias-Closas
- Vall d'Hebron Research Institute, Infectious Diseases Group, Barcelona, Spain
| | - Abdallah Denial
- Vall d'Hebron Research Institute, Infectious Diseases Group, Barcelona, Spain
| | - Stella Evangelidou
- Vall d'Hebron Research Institute, Infectious Diseases Group, Barcelona, Spain
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11
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Gullón P, Díez J, Cainzos-Achirica M, Franco M, Bilal U. Social inequities in cardiovascular risk factors in women and men by autonomous regions in Spain. GACETA SANITARIA 2021; 35:326-332. [PMID: 32674863 PMCID: PMC7985704 DOI: 10.1016/j.gaceta.2020.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To describe social inequities in cardiovascular risk factors in women and men by autonomous regions in Spain. METHOD We used data from 20,406 individuals aged 18 or older from the 2017 Spanish National Health Survey. We measured socioeconomic position using occupational social class and used data on self-reported cardiovascular risk factors: high cholesterol, diabetes, hypertension, obesity, and smoking. We estimated the relative risk of inequality using Poisson regression models. Analyses were stratified by men and women and by region (autonomous communities). RESULTS Overall, the relative risk of inequality was 1.02, 1.13, 1.06, 1.17 and 1.09 for high cholesterol, diabetes, hypertension, obesity, and current smoking, respectively. Ocuupational social class inequities in diabetes, hypertension, and obesity was stronger for women. Results showed a large regional heterogeneity in these inequities; some regions (e.g. Asturias and Balearic Islands) presented wider social inequities in cardiovascular risk factors than others (e.g. Galicia, Navarra or Murcia). CONCLUSION In Spain, we found marked social inequities in the prevalence of cardiovascular risk factors, with wide regional and women/men heterogeneity in these inequities. Education, social, economic and health policies at the regional level could reduce health inequities in cardiovascular risk factors and, thus, prevent cardiovascular disease.
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Affiliation(s)
- Pedro Gullón
- Public Health and Epidemiology Research Group, School of Medicine and Health Sciences, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA.
| | - Julia Díez
- Public Health and Epidemiology Research Group, School of Medicine and Health Sciences, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
| | - Miguel Cainzos-Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Manuel Franco
- Public Health and Epidemiology Research Group, School of Medicine and Health Sciences, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Usama Bilal
- Public Health and Epidemiology Research Group, School of Medicine and Health Sciences, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health Drexel University, Philadelphia, PA, USA
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12
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Gagliardi J, Brettschneider C, König HH. Health-related quality of life of refugees: a systematic review of studies using the WHOQOL-Bref instrument in general and clinical refugee populations in the community setting. Confl Health 2021; 15:44. [PMID: 34078413 PMCID: PMC8173726 DOI: 10.1186/s13031-021-00378-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/11/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose To systematically review studies on HRQOL, measured by the WHOQOL-Bref instrument, of refugees in general and clinical populations who are settled in the community of the hosting country, and outline the differences in scores among the two population groups and across the four domains of WHOQOL-Bref (physical, psychological, social relationships and environment domain) as well as factors impacting those outcomes. Methods Several databases were systematically searched by using a broad search strategy. Additionally, a hand search for grey literature was performed. Studies had to comply with the following inclusion criteria: (a) population of refugees; (b) living in the community of the country of destination; (c) assessing HRQOL through the WHOQOL-Bref instrument. Results 15 studies were identified and divided into two subgroups: (a) general population of refugees (b) clinical population of refugees, who were specifically selected for their mental status or because they had experienced relevant past traumas. Although we can outline common patterns among the two groups, in terms of domains scoring the highest and the lowest, heterogeneous values of HRQOL are observed across the studies included. Conclusions Individuals who were included in the clinical refugee group have a lower quality of life in respect to the general population of refugees. However, among the two groups different patterns can be outlined considering each domain of HRQOL: higher scores for the Physical and lower for the Environment domain when considering the general population of refugees and higher scores for the Environment and lower for the Psychological domain when referring to the clinical one. These lower scores are probably due to having a higher rate of mental distress and being more exposed to somatization, stigmatization and barriers to access the healthcare system of the hosting country. Supplementary Information The online version contains supplementary material available at 10.1186/s13031-021-00378-1.
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Affiliation(s)
- Juliette Gagliardi
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.,Department of Economics, University of Bologna, Via Zamboni 33, Bologna, 40126, Italy
| | - Christian Brettschneider
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
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13
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Dalmau-Bueno A, García-Altés A, Vela E, Clèries M, Pérez CV, Argimon JM. Frequency of health-care service use and severity of illness in undocumented migrants in Catalonia, Spain: a population-based, cross-sectional study. Lancet Planet Health 2021; 5:e286-e296. [PMID: 33964238 DOI: 10.1016/s2542-5196(21)00036-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 02/08/2021] [Accepted: 02/24/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND In Spain, legislation was passed in 2012 excluding undocumented migrants from the public health-care system. Catalonia was one of the Spanish regions that did not implement this legislation, and continued to guarantee access to health care to the whole population. We aimed to analyse health-care use and health status among undocumented migrants in Catalonia, and compare health-care use and health status with legal residents classified according to their socioeconomic position (SEP). METHODS We did a population-based, cross-sectional study, with administrative individual data. The study included the resident population in Catalonia, Spain, in 2017, aged younger than 65 years and with a maximum annual income of less than €18 000 per year, and classified into three socioeconomic (SEP) groups-low SEP, very low SEP, and undocumented migrants. Indicators regarding health-care service use (primary care, emergency care, mental health care, acute care), drug prescriptions, and selected chronic and infectious diseases were analysed. FINDINGS Between Jan 1 and Dec 31, 2017, 4 071 988 residents of Catalonia were included in this study; undocumented migrants represented 2·8% (n=113 450) of this population. Of all undocumented migrants, 25 942 (61·0%) female participants aged 15-64 years and 19 819 (46·0%) male participants aged 15-64 years attended primary health-care centres: these rates were lower than in individuals with a very low SEP (84·8% in female participants and 72·1% in male participants). Hospital admission rates among male participants aged 15-64 years in the very low SEP group were more than three times as high as in undocumented migrants (111·6 vs 35·7). The highest tuberculosis rate was found in undocumented male migrants (incidence rate 4·35 [95% CI 3·55-5·16]). INTERPRETATION Undocumented migrants made less use of health-care services than those in the low and very low SEP groups, but for some infectious diseases, incidence was higher in undocumented migrants. These results constitute an additional argument to support the maintenance of universal health coverage for all citizens. FUNDING None.
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Affiliation(s)
| | - Anna García-Altés
- Agència de Qualitat i Avaluació Sanitàries de Catalunya, Barcelona, Spain; CIBER de Epidemiología y Salud Pública, Barcelona, Spain; Institut d'Investigació Biomèdica, Barcelona, Spain.
| | - Emili Vela
- Servei Català de la Salut, Barcelona, Spain
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14
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Healthy immigrant effect in non-European Union immigrants in Portugal: after a decade of (non-)integration! Public Health 2020; 186:95-100. [PMID: 32795770 DOI: 10.1016/j.puhe.2020.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 06/26/2020] [Accepted: 07/03/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The aim of the study was to characterise the existence of the healthy immigrant effect (HIE; better health initially, worsening with an increase in the length of residence) in a big city from a Western European country, particularly in a non-European Union immigrant population. STUDY DESIGN This is a cross-sectional study. METHODS We used data from the National Health Survey 2014 to compare the health status of the immigrant and Portuguese populations with different lengths of residence. After descriptive statistics, binary logistic regressions models, with adjusted levels and 95% confidence intervals, were used. RESULTS Immigrants were healthier than the Portuguese population (<10 years: odds ratio [OR] = 0.07; 95% confidence interval [CI] = [0.01; 0.51]; ≥10 years: OR = 0.62; 95% CI = [0.19; 2.03]), but had an increased likelihood of suffering from chronic diseases and risk behaviours with the increase in their length of stay in Portugal. After living in Portugal for more than 10 years, the immigrants showed no statistical difference in the main health indicators. CONCLUSIONS There was a tendency for the health status of immigrants to deteriorate over 10 years of residence in Portugal. To better understand the reasons behind the HIE, specific and tailored studies must be developed.
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15
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Ayub S, Marsh V, Reed S. An Exploration of Chronic Disease Perception, Management, and Barriers to Care in Liberian Refugees Resettled in Charlottesville, Virginia. J Natl Med Assoc 2020; 112:654-667. [PMID: 32693979 DOI: 10.1016/j.jnma.2020.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 05/29/2020] [Accepted: 06/22/2020] [Indexed: 10/23/2022]
Abstract
Charlottesville is a resettlement site for Liberian refugees. Many receive care at the International Family Medicine Clinic (IFMC). IFMC physicians note reduced adherence to chronic disease medications among refugee patients. This study aims to understand the Liberian refugee populations' model of chronic disease. In 2014, twelve one-on-one interviews were conducted. Topics included concept of disease, health care access, disease burden, acculturation, and socioeconomic factors. Transcripts were analyzed according to the explanatory model of disease and Krueger's framework analysis. This study can assist providers in tailoring their practices to meet the needs of refugee patients and inform future public health interventions.
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Affiliation(s)
- Suniah Ayub
- University of Florida, College of Medicine, Department of Surgery, Gainesville, FL, USA.
| | - Vickie Marsh
- University of Virginia, School of Medicine, Department of Family Medicine, Charlottesville, VA, USA
| | - Sean Reed
- University of Virginia, School of Medicine, Department of Family Medicine, Charlottesville, VA, USA
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16
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Gimeno-Feliu LA, Pastor-Sanz M, Poblador-Plou B, Calderón-Larrañaga A, Díaz E, Prados-Torres A. Multimorbidity and chronic diseases among undocumented migrants: evidence to contradict the myths. Int J Equity Health 2020; 19:113. [PMID: 32631325 PMCID: PMC7336489 DOI: 10.1186/s12939-020-01225-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/18/2020] [Indexed: 11/10/2022] Open
Abstract
Background There is little verified information on the global health status of undocumented migrants (UMs). Our aim is to compare the prevalence of the main chronic diseases and of multimorbidity in undocumented migrants, documented migrants, and Spanish nationals in a Spanish autonomous community. Methods Retrospective observational study of all users of the public health system of the region of Aragon over 1 year (2011): 930,131 Spanish nationals; 123,432 documented migrants (DMs); and 17,152 UMs. Binary logistic regression was performed to examine the association between migrant status (Spanish nationals versus DMs and UMs) and both multimorbidity and individual chronic diseases, adjusting for age and sex. Results The prevalence of individual chronic diseases in UMs was lower than in DMs and much lower than in Spanish nationals. Comparison with the corresponding group of Spanish nationals revealed odds ratios (OR) of 0.1–0.3 and 0.3–0.5 for male and female UMs, respectively (p < 0.05 in all cases). The risk of multimorbidity was lower for UMs than DMs, both for men (OR, 0.12; 95%CI 0.11–0.13 versus OR, 0.53; 95%CI 0.51–0.54) and women (OR, 0.18; 95%CI 0.16–0.20 versus OR, 0.74; 95%CI 0.72–0.75). Conclusions Analysis of data from a health system that offers universal coverage to all immigrants, irrespective of legal status, reveals that the prevalence of chronic disease and multimorbidity is lower in UMs as compared with both DMs and Spanish nationals. These findings refute previous claims that the morbidity burden in UM populations is higher than that of the native population of the host country.
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Affiliation(s)
- Luis Andrés Gimeno-Feliu
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain. .,Aragón Healthcare Service, San Pablo Health Centre, Zaragoza, Spain. .,Health Services Research on Chronic Patients Network (REDISSEC), Carlos III Health Institute, Madrid, Spain. .,Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain.
| | | | - Beatriz Poblador-Plou
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Carlos III Health Institute, Madrid, Spain
| | - Amaia Calderón-Larrañaga
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Carlos III Health Institute, Madrid, Spain.,Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Esperanza Díaz
- Department of Global Public Health and Primary Care, Research Group for General Practice, University of Bergen, Bergen, Norway.,Norwegian Centre for Minority Health Research, Oslo, Norway
| | - Alexandra Prados-Torres
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Carlos III Health Institute, Madrid, Spain
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17
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Kaitelidou D, Galanis P, Economou C, Mladovsky P, Siskou O, Sourtzi P. Inequalities Between Migrants and Non-Migrants in Accessing and Using Health Services in Greece During an Era of Economic Hardship. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2020; 50:444-457. [PMID: 32028832 DOI: 10.1177/0020731420902604] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A cross-sectional study was conducted from April 2013 until March 2014 to explore the existence of inequalities in access to and utilization of health services by migrants compared to non-migrants in Greece and to test the influence of various factors on these disparities. Also, we investigated the influence of several socioeconomic and demographic characteristics. Study population included 1,152 migrants and 702 non-migrants. Migrants, participants suffering from a chronic disease, those without health insurance, and patients who assessed their health status as not at all good/a little good/moderate were statistically more likely to report unmet needs in getting their medication. Uninsured participants, females, those unemployed or without a permanent occupational status, and those who assessed their health status as not at all good/a little good/moderate were statistically more likely to report unmet needs in access to health services during the last year. Regarding the use of health services, those with health coverage, non-migrants, and females were statistically more likely to go for a blood test as a hospital outpatient. Greece, despite administrative delays and barriers, provided full coverage to the uninsured, asylum seekers, and migrants, even many groups of undocumented migrants.
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Affiliation(s)
- Daphne Kaitelidou
- Department of Nursing, Center for Health Services Management and Evaluation, National and Kapodistrian University of Athens, Athens, Greece
| | - Petros Galanis
- Department of Nursing, Center for Health Services Management and Evaluation, National and Kapodistrian University of Athens, Athens, Greece
| | - Charalambos Economou
- Department of Sociology, Panteion University of Social and Political Sciences, Athens, Greece
| | - Philipa Mladovsky
- Department of International Development, London School of Economics and Political Science, London, UK
| | - Olga Siskou
- Department of Nursing, Center for Health Services Management and Evaluation, National and Kapodistrian University of Athens, Athens, Greece
| | - Panayota Sourtzi
- Department of Nursing, Sector of Public Health, Occupational Health Nursing, National and Kapodistrian University of Athens, Athens, Greece
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18
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Staniforth R, Such E. Public health practitioners' perspectives of migrant health in an English region. Public Health 2019; 175:79-86. [PMID: 31442610 DOI: 10.1016/j.puhe.2019.06.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 06/10/2019] [Accepted: 06/30/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Migration is a complex and contested topic of public debate. Professionals working in public health must negotiate this politicised complexity, yet few studies examine the perspectives and practices of public health professionals in relation to migrant health. This study seeks to redress this by exploring how migrant health is conceptualised and addressed by public health professionals after a key transitional point in the reorganisation of public health in England and the public vote for the UK to leave the EU. STUDY DESIGN This is a qualitative in-depth exploratory study. METHODS Ten interviews and one focus group were conducted with 14 public health professionals working at Public Health England or local authorities in an English region. Recordings were transcribed, and thematic analysis was conducted. RESULTS Professionals viewed migrant health mainly through a health inequalities lens; migrants were considered vulnerable, and their health was often determined by wider social issues. This influenced public health professionals' perceived ability to affect change. Public health professionals were greatly influenced by the societal, policy and institutional, post-Brexit vote context in England, describing nervousness around addressing migrant health. At an institutional level, public health professionals described a sense that migrant health was not prioritised. It was considered 'too hard' and complex, especially with shrinking resources and highly politicised social narratives. Consequently, migrant health was often not directly addressed in current practice. The gaps identified by public health professionals were as follows: lack of knowledge of health needs and cultural difference; lack of access to appropriate training; lack of cultural diversity within the public health workforce; and concerns about meaningful community engagement. CONCLUSIONS These findings raise concerns about public health professionals' ability to address the health needs of migrants living in England. The gaps highlighted require further and deeper examination across relevant organisations including the broader public health infrastructure in the UK.
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Affiliation(s)
- R Staniforth
- Public Health, School of Health and Related Research, Regent Street, Sheffield, S1 4DP, UK.
| | - E Such
- Public Health, School of Health and Related Research, Regent Street, Sheffield, S1 4DP, UK
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19
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Wikman-Jorgensen P, López-Velez R, Llenas-García J, Treviño B, Pascual R, Molina I, Domínguez Á, Torrús D, Ruiz Giardín JM, Monge-Maillo B, Norman FF, Romero M, Perez-Molina JA. Latent and active tuberculosis infections in migrants and travellers: A retrospective analysis from the Spanish +REDIVI collaborative network. Travel Med Infect Dis 2019; 36:101460. [PMID: 31369899 DOI: 10.1016/j.tmaid.2019.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 07/16/2019] [Accepted: 07/22/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Tuberculosis (TB) is the leading cause of infectious disease mortality worldwide. We analysed active and latent TB infections (LTBI) from the Spanish Network for the Study of Imported Infectious Diseases by Travellers and Immigrants (+REDIVI). METHODS Observational, retrospective, multicentre study of TB and LTBI registered in the +REDIVI network from October 2009 to December 2016. RESULTS Of 1008 cases of LTBI, 884 (87.7%) were immigrants; 93 (4.5%), immigrants visiting friends and relatives (VFR); 2 (0.9%), VFR-travellers; and 29 (1.1%), travellers. Absolute (N = 157 vs. N = 75) and relative (12.5% vs. 5.9%) frequency decreased over the study period (p = 0.003). Median time to diagnosis was 24.6 months (females 50.3 vs males 11.9; p < 0.001). Of 448 TB cases, 405 (90.4%) were in immigrants; 30 (6.7%), VFR-immigrants; 6 (1.3%), VFR-travellers; and 7 (1.6%), travellers. Median time to diagnosis was 62.5 months (females 86.6 vs males 70.1; p = 0.0075). There were 8 multidrug resistant TB cases and 1 extensively drug resistant case of TB, all in immigrants. CONCLUSION TB was frequently diagnosed more than 5 years after arrival in Spain. Screening programmes for TB and LTBI in immigrants should be considered beyond this time point. Women showed a higher diagnostic delay for both latent and active TB.
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Affiliation(s)
| | - Rogelio López-Velez
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramon y Cajal Hospital, IRYCIS, Madrid, Spain
| | | | - Begoña Treviño
- Unitat Medicina Tropical i Salut Internacional Vall d'Hebron-Drassanes, PROSICS, Barcelona, Spain
| | - Reyes Pascual
- Hospital General Universitario de Elda, Alicante, Spain; Departamento de Medicina Clinica, Universidad Miguel Hernández, San Juan de Alicante, Spain
| | - Israel Molina
- Department of Infectious Diseases, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, PROSICS Barcelona, Barcelona, Spain
| | - Ángel Domínguez
- Hospital Universitario Virgen de la Macarena de Sevilla, Sevilla, Spain
| | - Diego Torrús
- Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Begoña Monge-Maillo
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramon y Cajal Hospital, IRYCIS, Madrid, Spain
| | - Francesca F Norman
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramon y Cajal Hospital, IRYCIS, Madrid, Spain
| | - Mónica Romero
- Hospital General Universitario de Elda, Alicante, Spain
| | - José A Perez-Molina
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramon y Cajal Hospital, IRYCIS, Madrid, Spain
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Prados-Torres A, Poblador-Plou B, Gimeno-Miguel A, Calderón-Larrañaga A, Poncel-Falcó A, Gimeno-Feliú LA, González-Rubio F, Laguna-Berna C, Marta-Moreno J, Clerencia-Sierra M, Aza-Pascual-Salcedo M, Bandrés-Liso AC, Coscollar-Santaliestra C, Pico-Soler V, Abad-Díez JM. Cohort Profile: The Epidemiology of Chronic Diseases and Multimorbidity. The EpiChron Cohort Study. Int J Epidemiol 2019; 47:382-384f. [PMID: 29346556 PMCID: PMC5913592 DOI: 10.1093/ije/dyx259] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2017] [Indexed: 12/21/2022] Open
Affiliation(s)
- A Prados-Torres
- EpiChron Research Group on Chronic Diseases: Aragon Health Sciences Institute (IACS), IIS Aragon, Miguel Servet University Hospital, Zaragoza, University of Zaragoza, Health Services Research on Chronic Patients Network (REDISSEC), Spain, JA-CHRODIS+, EU
| | - B Poblador-Plou
- IACS, IIS Aragon, Miguel Servet University Hospital, Zaragoza, REDISSEC, Spain
| | - A Gimeno-Miguel
- IACS, IIS Aragon, Miguel Servet University Hospital, Zaragoza, REDISSEC, Spain
| | - A Calderón-Larrañaga
- Aging Research Center, Karolinska Institutet, Stockholm, Sweden, REDISSEC, Spain
| | | | - L A Gimeno-Feliú
- Primary Care Health Centre (PCHC) San Pablo, Zaragoza, SALUD, University of Zaragoza, REDISSEC, Spain
| | | | - C Laguna-Berna
- IACS, IIS Aragon, Miguel Servet University Hospital, Zaragoza, REDISSEC, Spain
| | - J Marta-Moreno
- Miguel Servet University Hospital, Zaragoza, SALUD, REDISSEC, Spain
| | | | | | | | - C Coscollar-Santaliestra
- Primary Care Health Centre (PCHC) San Pablo, Zaragoza, SALUD, University of Zaragoza, REDISSEC, Spain
| | - V Pico-Soler
- PCHC Torrero-La Paz, Zaragoza, SALUD, REDISSEC, Spain
| | - J M Abad-Díez
- Aragon Health Service (SALUD), Department of Health, GRISSA Research Group, Spain
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Dattoli VCC, Lucio DDS, Chaves ITDS. A utilização da atenção primária à saúde por imigrantes em Florianópolis. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2019. [DOI: 10.5712/rbmfc14(41)1786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objetivo: Conhecer o perfil do imigrante que utiliza a atenção primária de Florianópolis. Métodos: Estudo transversal de base populacional com dados cadastrais de estrangeiros moradores de Florianópolis, que utilizaram a Atenção Primária à Saúde entre os anos de 2014 e 2016. As variáveis utilizadas foram: nacionalidade, sexo, idade, nível de escolaridade, raça, endereço de moradia e tipos de serviços utilizados. Resultados: Um total de 10.108 estrangeiros utilizaram a atenção básica em Florianópolis no período do estudo, com predomínio de adultos, brancos, com ensino médio ou superior, predominância de argentinos, uruguaios e haitianos, utilizando predominantemente serviços da farmácia e consultas médicas, distribuídos em todas unidades de saúde da capital. Houve maior nível de escolaridade e maior proporção de crianças e idosos na população provinda de países desenvolvidos, além de uma menor utilização dos serviços. Discussão: Estudo pioneiro no Brasil. O perfil dos imigrantes estudados é comparável à população de estudos europeus, com predomínio de latino-americanos e caribenhos, com faixa etária prevalecendo população economicamente ativa, utilizando consultas médicas e com alta escolaridade entre imigrantes de países desenvolvidos.
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Hernando Rovirola C, Gaillardin F, Ferrer Serret L, Cayuela Mateo A, Ronda Pérez E, Casabona Barbarà J. Facilitadores de la participación e implementación de la subcohorte PELFI de familias inmigrantes. GACETA SANITARIA 2019; 33:45-52. [DOI: 10.1016/j.gaceta.2017.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 07/09/2017] [Accepted: 07/13/2017] [Indexed: 11/28/2022]
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23
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Immigration factors and potentially avoidable hospitalizations in Canada. SSM Popul Health 2018; 7:100336. [PMID: 30581968 PMCID: PMC6299159 DOI: 10.1016/j.ssmph.2018.100336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 12/03/2018] [Accepted: 12/06/2018] [Indexed: 11/22/2022] Open
Abstract
Objective Estimate the effect of immigration characteristics on the risk of a hospitalization for an ambulatory care sensitive condition (ACSC). Research design We analyzed data on the Canadian resident adult population aged 18 to 74 years who responded to the 2006 long form Census. The Census data were linked to the Canadian Institute for Health Information (CIHI)’s Discharge Abstract Database (DAD) for fiscal years 2006–2007, 2007–2008, and 2008–2009. We conducted a logistic regression on the binary variable we created for an ACSC admission. Measures The CIHI definition of ACSC hospitalizations was used to identify potentially avoidable hospitalizations in the DAD. Immigration factors analyzed included years in Canada, ethnic origin, and ability to speak one of the official languages. Results There were 3,342,450 respondents aged between 18 and 74. Using the Canadian at birth as our reference population, recent immigrants (up to five years in Canada) had lower odds of an ACSC hospitalization, regardless of their ethnic origins, with the exception of immigrants from Oceania and from other North American countries for whom the effect was not significant. The protective effect was still present in children of immigrants (AOR=0.89). Immigrants from the Caribbean, from Southern, Eastern, and Western Europe, as well as those from East Asia had lower odds across categories of time spent in Canada. The protective effect was stronger in immigrants from East Asia and lower in those of Oceanic and other North American countries. Conclusions Our results suggest that the healthy immigrant effect dissipates with time in Canada but remains even in children of immigrants. The protective effect differs depending on the ethnic origin of the immigrant. Immigrants generally arrive in a country with a higher health status than that of the local population. Immigrants and children of immigrants have lower odds of having an ACSC hospitalization are lower than Canadians at birth. Odds of an ACSC hospitalization vary depending on immigration characteristics such as the ethnic origin and the time lived in Canada.
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Ruiz-Azarola A, Escudero Carretero M, López-Fernández LA, Gil García E, March Cerdà JC, López Jaramillo D. [The perspective of migrants on access to health care in the context of austerity policies in Andalusia (Spain)]. GACETA SANITARIA 2018; 34:261-267. [PMID: 30554737 DOI: 10.1016/j.gaceta.2018.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 09/13/2018] [Accepted: 09/18/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To conduct an assessment of migrant people regarding their access to the health system following entry into force of Royal Decree-Law 16/2012 along with the impact of economic cuts on such access. METHOD Qualitative phenomenological study with semi-structured interviews, conducted in Andalusia (Spain), in two phases (2009-2010 and 2012-2013), with 36 participants. The sample was segmented by length of stay, nationality and area of residence. The nationalities of origin are Bolivia, Morocco and Romania. RESULTS Elements facilitating access in both periods: regular administrative situation, possession of Individual Health Card, knowledge of the language, social networks and information. The results show differences in access to health care for migrants before and after the enforcement of the RDL 16/2012, within austerity policies. In the second period, access barriers such as waiting times or incompatibility of schedules are aggravated and the socio-economic and administrative conditions of participants worsen. CONCLUSIONS The design of policies, economic and regulatory health care, should take into account barriers and facilitators of access as fundamental main points of health protection for migrants and, therefore, for the general population.
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Affiliation(s)
- Ainhoa Ruiz-Azarola
- Escuela Andaluza de Salud Pública, Granada, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España.
| | - María Escudero Carretero
- Escuela Andaluza de Salud Pública, Granada, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Instituto de Investigación Biosanitaria de Granada, Granada, España
| | - Luis Andrés López-Fernández
- Escuela Andaluza de Salud Pública, Granada, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España
| | | | - Joan Carles March Cerdà
- Escuela Andaluza de Salud Pública, Granada, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Instituto de Investigación Biosanitaria de Granada, Granada, España
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Diaz E, Ortiz-Barreda G, Ben-Shlomo Y, Holdsworth M, Salami B, Rammohan A, Chung RYN, Padmadas SS, Krafft T. Interventions to improve immigrant health. A scoping review. Eur J Public Health 2018; 27:433-439. [PMID: 28339883 PMCID: PMC5445720 DOI: 10.1093/eurpub/ckx001] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Disparities in health between immigrants and their host populations have been described across countries and continents. Hence, interventions for improving health targeting general populations are not necessarily effective for immigrants. Aims: To conduct a systematic search of the literature evaluating health interventions for immigrants; to map the characteristics of identified studies including range of interventions, immigrant populations and their host countries, clinical areas targeted and reported evaluations, challenges and limitations of the interventions identified. Following the results, to develop recommendations for research in the field. Methods: A scoping review approach was chosen to provide an overview of the type, extent and quantity of research available. Studies were included if they empirically evaluated health interventions targeting immigrants and/or their descendants, included a control group, and were published in English (PubMed and Embase from 1990 to 2015). Results: Most of the 83 studies included were conducted in the USA, encompassed few immigrant groups and used a randomized controlled trial (RCT) or cluster RCT design. Most interventions addressed chronic and non-communicable diseases and attendance at cancer screening services, used individual targeted approaches, targeted adult women and recruited participants from health centres. Outcome measures were often subjective, with the exception of interventions for cardiovascular risk and diabetes. Generally, authors claimed that interventions were beneficial, despite a number of reported limitations. Conclusions: Recommendations for enhancing interventions to improve immigrant health are provided to help researchers, funders and health care commissioners when deciding upon the scope, nature and design of future research in this area.
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Affiliation(s)
- Esperanza Diaz
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Norwegian Centre for Minority Health Research, Oslo, Norway
| | - Gaby Ortiz-Barreda
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Michelle Holdsworth
- School of Health and Related Research- ScHARR, University of Sheffield, Sheffield, UK
| | - Bukola Salami
- Faculty of Nursing, University of Alberta, Alberta, Canada
| | - Anu Rammohan
- Discipline of Economics, University of Western Australia, Perth, Australia
| | - Roger Yat-Nork Chung
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | | | - Thomas Krafft
- Faculty of Health, Medicine and Life Sciences, CAPHRI School for Public Health and Primary Care, Maastricht University, The Netherlands
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Butler S. A glimpse into a neglected population – Emerging adults. Scand J Pain 2017; 17:230-232. [DOI: 10.1016/j.sjpain.2017.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Stephen Butler
- Department of Public Health and Caring Sciences , Uppsala University , Uppsala , Sweden
- Multidisciplinary Pain Center, Academic Hospital of Uppsala , Uppsala , Sweden
- National Center for Complex Disorders , St. Olav’s Hospital , Trondheim , Norway
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Petrelli A, Di Napoli A, Rossi A, Costanzo G, Mirisola C, Gargiulo L. The variation in the health status of immigrants and Italians during the global crisis and the role of socioeconomic factors. Int J Equity Health 2017; 16:98. [PMID: 28606147 PMCID: PMC5468957 DOI: 10.1186/s12939-017-0596-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 06/06/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The effects of the recent global economic and financial crisis especially affected the most vulnerable social groups. Objective of the study was to investigate variation of self-perceived health status in Italians and immigrants during the economic global crisis, focusing on demographic and socioeconomic factors. METHODS Through a cross-sectional design we analyzed the national sample of multipurpose surveys "Health conditions and use of health services" (2005 and 2013) conducted by the Italian National Institute of Statistics (ISTAT). Physical Component Summary (PCS) and Mental Component Summary (MCS) scores, derived from SF-12 questionnaire, were assumed as study outcome, dichotomizing variables distribution at 1st quartile. Prevalence rate ratios (PRR) were estimated through log-binomial regression models, stratified by citizenship and gender, evaluating the association between PCS and MCS with surveys' year, adjusting for age, educational level, employment status, self-perceived economic resources, smoking habits, body mass index. RESULTS From 2005 to 2013 the proportion of people not employed or reporting scarce/insufficient economic resources increased, especially among men, in particular immigrants. Compared with 2005 we observed in 2013 among Italians a significant lower probability of worse PCS (PRR = 0.96 both for males and females), while no differences were observed among immigrants; a higher probability of worse MCS was observed, particularly among men (Italians: PRR = 1.26;95%CI:1.22-1.29; immigrants: PRR = 1.19;95%CI:1.03-1.38). Self-perceived scarce/insufficient economic resources were strongly and significantly associated with worse PCS and MCS for all subgroups. Lower educational level was strongly associated with worse PCS in Italians and slightly associated with worse MCS for all subgroups. Being not employed was associated with worse health status, especially mental health among men. CONCLUSIONS Our findings support the hypothesis that economic global crisis could have negatively affected health status, particularly mental health, of Italians and immigrants. Furthermore, results suggest socioeconomic inequalities increase, in economic resources availability dimension. In a context of public health resources' limitation due to financial crisis, policy decision makers and health service managers must face the challenge of equity in health.
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Affiliation(s)
- Alessio Petrelli
- National Institute for Health, Migration and Poverty (INMP), Via San Gallicano, 25 a, 00153, Rome, Italy.
| | - Anteo Di Napoli
- National Institute for Health, Migration and Poverty (INMP), Via San Gallicano, 25 a, 00153, Rome, Italy
| | - Alessandra Rossi
- National Institute for Health, Migration and Poverty (INMP), Via San Gallicano, 25 a, 00153, Rome, Italy
| | - Gianfranco Costanzo
- National Institute for Health, Migration and Poverty (INMP), Via San Gallicano, 25 a, 00153, Rome, Italy
| | - Concetta Mirisola
- National Institute for Health, Migration and Poverty (INMP), Via San Gallicano, 25 a, 00153, Rome, Italy
| | - Lidia Gargiulo
- National Institute of Statistics (ISTAT), Viale Liegi, 13, 00198, Rome, Italy
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Fadnes LT, Diaz E. Primary healthcare usage and use of medications among immigrant children according to age of arrival to Norway: a population-based study. BMJ Open 2017; 7:e014641. [PMID: 28148537 PMCID: PMC5294001 DOI: 10.1136/bmjopen-2016-014641] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Morbidity, use of healthcare and medication use have been reported to vary across groups of migrants and according to the different phases of migration, but little is known about children with immigrant background. In this study, we investigate whether the immigrant children's age of arrival predicts differences in usage of primary healthcare (PHC) and in use of prescribed medication. METHODS This nationwide, population-based study used information for children under 18 years of age in 2008 from three linked registers in Norway. Use of medication was assessed with logistic regression analyses presented with ORs with 95% CIs. RESULTS Of 1 168 365 children, 119 251 had immigrant background. The mean number of PHC visits among children aged 10-18 years, was 1.19 for non-immigrants, 1.17 among second generation immigrants, 1.12, 1.05 and 0.83 among first immigrant children who were <5, 5-9 and ≥10 years at arrival in Norway, respectively. Patterns were similar for younger immigrants, and were confirmed with regression models adjusting for age and sex. First generation immigrant children used less of nearly all groups of prescribed medication compared to non-immigrants when adjusting for age and sex (overall OR 0.48 (0.47 to 0.49)), and medication was also generally less used among second generation immigrant children (overall OR 0.92 (0.91 to 0.94)). CONCLUSIONS Age of arrival predicted PHC usage among children among first-generation children. First-generation immigrant children, particularly those arriving later in adolescence, used PHC less than age corresponding non-immigrant children. Immigrant children used less prescribed medication compared to non-immigrants after adjustment for age and sex.
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Affiliation(s)
- Lars T Fadnes
- Department of Clinical Dentistry,
University of Bergen, Bergen,
Norway
- Department of Global Public Health and Primary Care,
University of Bergen, Bergen,
Norway
| | - Esperanza Diaz
- Department of Global Public Health and Primary Care,
University of Bergen, Bergen,
Norway
- Norwegian Centre for Minority Health Research,
Norway
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Fadnes LT, Møen KA, Diaz E. Primary healthcare usage and morbidity among immigrant children compared with non-immigrant children: a population-based study in Norway. BMJ Open 2016; 6:e012101. [PMID: 27737883 PMCID: PMC5073609 DOI: 10.1136/bmjopen-2016-012101] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Health status, disease spectrum and use of healthcare have been reported to vary across groups of migrants and according to the different phases of migration. However, most studies are conducted among adults. This study assesses usage of primary healthcare (PHC) by children with immigrant background compared with non-immigrant children in Norway and describes their relative morbidity burden. DESIGN Population-based retrospective cohort study. SETTING This study used 3 linked population-based registers in Norway for children under 18 years of age in 2008. MAIN EXPOSURE AND OUTCOME MEASURES Immigrants were defined as children with both parents born abroad, and further classified into first and second generation, and according to the World Bank income categories of their parents' country of origin. Usage and morbidity were assessed with negative binomial regression and logistic regression analyses, respectively. Further, population-attributable fraction analyses on PHC visits were conducted to estimate the impact on the primary health system. PARTICIPANTS 1 168 365 children including 119 251 with immigrant background. RESULTS The mean number of visits to PHC for non-immigrant children was 1.40 compared with 1.19 for immigrants from high-income countries (HIC) and 1.76 for immigrants from low-income countries (LIC). Compared with non-immigrants, first generation immigrants used PHC significantly less after adjusting for age and sex (incidence risk ratio (IRR) 0.70 (HIC) to 0.93 (LIC)) while second generation immigrant children generally used PHC more (IRR 1.03 (HIC) to 1.43 (LIC)); however, the median number of visits were similar between all groups. The morbidity spectrum also varied between the groups. CONCLUSIONS Compared with non-immigrants, the excess number of consultations attributable to immigrant groups corresponds to around 1.3% of PHC visits among children.
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Affiliation(s)
- Lars T Fadnes
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Kathy Ainul Møen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Esperanza Diaz
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Norwegian Centre for Minority Health Research, Norway
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Gimeno-Feliu LA, Calderón-Larrañaga A, Diaz E, Poblador-Plou B, Macipe-Costa R, Prados-Torres A. Global healthcare use by immigrants in Spain according to morbidity burden, area of origin, and length of stay. BMC Public Health 2016; 16:450. [PMID: 27230885 PMCID: PMC4882823 DOI: 10.1186/s12889-016-3127-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 05/10/2016] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The healthcare of immigrants is an important aspect of equity of care provision. Understanding how immigrants use the healthcare services based on their needs is crucial to establish effective health policy. METHODS This retrospective, observational study included the total population of Aragon, Spain (1,251,540 individuals, of whom 11.9 % were immigrants). Patient-level data on the use of primary, specialised, hospital, and emergency care as well as prescription drug use in 2011 were extracted from the EpiChron Cohort and compared between immigrants and nationals. Multivariable standard or zero-inflated negative binomial regression models were generated, adjusting for age, sex, length of stay, and morbidity burden. RESULTS The annual visit rates of immigrants were lower than those of nationals for primary care (3.3 vs 6.4), specialised care (1.3 vs 2.7), planned hospital admissions/100 individuals (1.6 vs 3.8), unplanned hospital admissions/100 individuals (2.7 vs 4.7), and emergency room visits/10 individuals (2.3 vs 2.8). Annual prescription drug costs were also lower for immigrants (€47 vs €318). These differences were only partially attenuated after adjusting for age, sex and morbidity burden. CONCLUSION In a universal coverage health system offering broad legal access to immigrants, the global use of healthcare services was lower for immigrants than for nationals. These differences may be explained in part by the healthy migration effect, but also reveal possible inequalities in healthcare provision that warrant further investigation.
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Affiliation(s)
- Luis A Gimeno-Feliu
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain. .,San Pablo Health Centre, C/ Aguadores 7, 50003, Zaragoza, Spain. .,Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain.
| | - Amaia Calderón-Larrañaga
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, Madrid, Spain
| | - Esperanza Diaz
- Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway.,Norwegian Centre for Minority Health Research (NAKMI), Oslo University Hospital, Bergen, Norway
| | - Beatriz Poblador-Plou
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, Madrid, Spain
| | | | - Alexandra Prados-Torres
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, Madrid, Spain.,Department of Microbiology, Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain
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Gele AA, Pettersen KS, Kumar B, Torheim LE. Diabetes Risk by Length of Residence among Somali Women in Oslo Area. J Diabetes Res 2016; 2016:5423405. [PMID: 27314048 PMCID: PMC4897676 DOI: 10.1155/2016/5423405] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 04/08/2016] [Accepted: 04/19/2016] [Indexed: 11/18/2022] Open
Abstract
Type 2 diabetes represents a major health problem worldwide, with immigrants strongly contributing to the increase in diabetes in many countries. Norway is not immune to the process, and immigrants in the country are experiencing an increase in the prevalence of diabetes after arrival. However, the dynamics of these transitions in relation to the duration of residence in the new environment in Norway are not clearly understood. From this background, a cross-sectional quantitative study using a respondent-driven sampling method was conducted among 302 Somali women living in Oslo area. The results show that 41% of the study participants will be at risk for developing diabetes in the coming 10 years, which coincides with 85% of the study participants being abdominally obese. Significant associations were found between years of stay in Norway and the risk for diabetes with those who lived in Norway >10 years, having twofold higher odds of being at risk for developing diabetes compared to those who lived in Norway ≤5 years (OR: 2.16, CI: 1.08-4.32). Understanding the mechanisms through which exposure to the Norwegian environment leads to higher obesity and diabetes risk may aid in prevention efforts for the rapidly growing African immigrant population.
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Affiliation(s)
- Abdi A. Gele
- Oslo and Akershus University College of Applied Sciences, P.O. Box 4, Street Olavs Plass, 0130 Oslo, Norway
- Norwegian Center for Minority Health Research, P.O. Box 4956, Nydalen, 0424 Oslo, Norway
| | - Kjell Sverre Pettersen
- Oslo and Akershus University College of Applied Sciences, P.O. Box 4, Street Olavs Plass, 0130 Oslo, Norway
| | - Bernadette Kumar
- Norwegian Center for Minority Health Research, P.O. Box 4956, Nydalen, 0424 Oslo, Norway
| | - Liv Elin Torheim
- Oslo and Akershus University College of Applied Sciences, P.O. Box 4, Street Olavs Plass, 0130 Oslo, Norway
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Gimeno-Feliu LA, Calderón-Larrañaga A, Prados-Torres A, Revilla-López C, Diaz E. Patterns of pharmaceutical use for immigrants to Spain and Norway: a comparative study of prescription databases in two European countries. Int J Equity Health 2016; 15:32. [PMID: 26912255 PMCID: PMC4765128 DOI: 10.1186/s12939-016-0317-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 02/11/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although equity in health care is theoretically a cornerstone in Western societies, several studies show that services do not always provide equitable care for immigrants. Differences in pharmaceutical consumption between immigrants and natives are explained by variances in predisposing factors, enabling factors and needs across populations, and can be used as a proxy of disparities in health care use. By comparing the relative differences in pharmacological use between natives and immigrants from the same four countries of origin living in Spain and Norway respectively, this article presents a new approach to the study of inequity in health care. METHODS All purchased drug prescriptions classified according to the Anatomical Therapeutic Chemical (ATC) system in Aragon (Spain) and Norway for a total of 5 million natives and nearly 100,000 immigrants for one calendar year were included in this cross-sectional study. Age and gender adjusted relative purchase rates for immigrants from Poland, China, Colombia and Morocco compared to native populations in each of the host countries were calculated. Direct standardisation was performed based on the 2009 population structure of the OECD countries. RESULTS Overall, a significantly lower proportion of immigrants in Aragon (Spain) and Norway purchased pharmacological drugs compared to natives. Patterns of use across the different immigrant groups were consistent in both host countries, despite potential disparities between the Spanish and Norwegian health care systems. Immigrants from Morocco showed the highest drug use rates in relation to natives, especially for antidepressants, "pain killers" and drugs for peptic ulcer. Immigrants from China and Poland showed the lowest use rates, while Colombians where more similar to host countries. CONCLUSIONS The similarities found between the two European countries in relation to immigrants' pharmaceutical use disregarding their host country emphasises the need to consider specific immigrant-related features when planning and providing healthcare services to this part of the population. These results somehow remove the focus on inequity as the main reason to explain differences in purchase between immigrants and natives.
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Affiliation(s)
- Luis Andres Gimeno-Feliu
- EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), IIS Aragon, Miguel Servet University Hospital, Paseo Isabel La Católica 1-3, 50009, Zaragoza, Spain. .,San Pablo Health Centre, C/Aguadores 7, 50003, Zaragoza, Spain. .,Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, C/Domingo Miral s/n, 50009, Zaragoza, Spain. .,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, C/Sinesio Delgado 4, 28029, Madrid, Spain.
| | - Amaia Calderón-Larrañaga
- EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), IIS Aragon, Miguel Servet University Hospital, Paseo Isabel La Católica 1-3, 50009, Zaragoza, Spain. .,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, C/Sinesio Delgado 4, 28029, Madrid, Spain.
| | - Alexandra Prados-Torres
- EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), IIS Aragon, Miguel Servet University Hospital, Paseo Isabel La Católica 1-3, 50009, Zaragoza, Spain. .,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, C/Sinesio Delgado 4, 28029, Madrid, Spain. .,Department of Microbiology, Preventive Medicine and Public Health, University of Zaragoza, C/Domingo Miral s/n, 50009, Zaragoza, Spain.
| | - Concha Revilla-López
- Teaching Unit of Preventive Medicine and Public Health, Aragon Health Sciences Institute (IACS), Avda. San Juan Bosco 13, 50009, Zaragoza, Spain.
| | - Esperanza Diaz
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, 5018, Bergen, Norway. .,Norwegian Centre for Minority Health Research, Gullhaugveien 1-3, 0484, Oslo, Norway.
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Diaz E, Kumar BN, Gimeno-Feliu LA, Calderón-Larrañaga A, Poblador-Pou B, Prados-Torres A. Multimorbidity among registered immigrants in Norway: the role of reason for migration and length of stay. Trop Med Int Health 2015; 20:1805-14. [PMID: 26426974 DOI: 10.1111/tmi.12615] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES International migration is rapidly increasing worldwide. However, the health status of migrants differs across groups. Information regarding health at arrival and subsequent periodic follow-up in the host country is necessary to develop equitable health care to immigrants. The objective of this study was to determine the impact of the length of stay in Norway and other sociodemographic variables on the prevalence of multimorbidity across immigrant groups (refugees, labour immigrants, family reunification immigrants and education immigrants). METHODS This is a register-based study merging data from the National Population Register and the Norwegian Health Economics Administration database. Sociodemographic variables and multimorbidity across the immigrant groups were compared using Persons' chi-square test and anova as appropriate. Several binary logistic regression models were conducted. RESULTS Multimorbidity was significantly lower among labour immigrants (OR (95% CI) 0.23 (0.21-0.26) and 0.45 (0.40-0.50) for men and women, respectively) and education immigrants (OR (95% CI) 0.40 (0.32-0.50) and 0.38 (0.33-0.43)) and higher among refugees (OR (95% CI) 1.67 (1.57-1.78) and 1.83 (1.75-1.92)), compared to family reunification immigrants. For all groups, multimorbidity doubled after a five-year stay in Norway. Effect modifications between multimorbidity and sociodemographic characteristics across the different reasons for migration were observed. CONCLUSIONS Multimorbidity was highest among refugees at arrival but increased rapidly among labour immigrants, especially females. Health providers need to ensure tailor-made preventive and management strategies that take into account pre-migration and post-migration experiences for immigrants in order to address their needs.
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Affiliation(s)
- Esperanza Diaz
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Norwegian Centre for Minority Health Research, Oslo, Norway
| | - Bernadette N Kumar
- Norwegian Centre for Minority Health Research, Oslo, Norway
- Institute for Health and Society, University of Oslo, Oslo, Norway
| | - Luis-Andrés Gimeno-Feliu
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- University of Zaragoza, Zaragoza, Spain
- San Pablo Health Centre, Zaragoza, Spain
| | - Amaia Calderón-Larrañaga
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas, Carlos III Health Institute, Madrid, Spain
| | - Beatriz Poblador-Pou
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas, Carlos III Health Institute, Madrid, Spain
| | - Alexandra Prados-Torres
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- University of Zaragoza, Zaragoza, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas, Carlos III Health Institute, Madrid, Spain
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Santosa A, Rocklöv J, Högberg U, Byass P. Achieving a 25% reduction in premature non-communicable disease mortality: the Swedish population as a cohort study. BMC Med 2015; 13:65. [PMID: 25889300 PMCID: PMC4393602 DOI: 10.1186/s12916-015-0313-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 03/06/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The 2012 World Health Assembly set a target for Member States to reduce premature non-communicable disease (NCD) mortality by 25% over the period 2010 to 2025. This reflected concerns about increasing NCD mortality burdens among productive adults globally. This article first considers whether the WHO target of a 25% reduction in the unconditional probability of dying between ages of 30 and 70 from NCDs (cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases) has already taken place in Sweden during an equivalent 15-year period. Secondly, it assesses which population sub-groups have been more or less successful in contributing to overall changes in premature NCD mortality in Sweden. METHODS A retrospective dynamic cohort database was constructed from Swedish population registers in the Linnaeus database, covering the entire population in the age range 30 to 69 years for the period 1991 to 2006, which was used directly to measure reductions in premature NCD mortality using a life table method as specified by the WHO. Multivariate Poisson regression models were used to assess the contributions of individual background factors to decreases in premature NCD mortality. RESULTS A total of 292,320 deaths occurred in the 30 to 69 year age group during the period 1991 to 2006, against 70,768,848 person-years registered. The crude all-cause mortality rate declined from 5.03 to 3.72 per 1,000 person-years, a 26% reduction. Within this, the unconditional probability of dying between the ages of 30 and 70 from NCD causes as defined by the WHO fell by 30.0%. Age was consistently the strongest determinant of NCD mortality. Background determinants of NCD mortality changed significantly over the four time periods 1991-1994, 1995-1998, 1999-2002, and 2003-2006. CONCLUSIONS Sweden, now at a late stage of epidemiological transition, has already exceeded the 25% premature NCD mortality reduction target during an earlier 15-year period. This should be encouraging news for countries currently implementing premature NCD mortality reduction programmes. Our findings suggest, however, that it may be difficult for Sweden and other late-transition countries to reach the current 25 × 25 target, particularly where substantial premature mortality reductions have already been achieved.
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Affiliation(s)
- Ailiana Santosa
- Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Umeå University, Umeå, 90187, Sweden.
| | - Joacim Rocklöv
- Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Umeå University, Umeå, 90187, Sweden.
| | - Ulf Högberg
- Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Umeå University, Umeå, 90187, Sweden. .,Department of Women's and Children's Health, Uppsala University, Akademiska Sjukhuset, 75185, Uppsala, Sweden.
| | - Peter Byass
- Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Umeå University, Umeå, 90187, Sweden. .,MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Parktown, Johannesburg, 2193, South Africa.
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