Health inequalities between male and female immigrants in Spain after the beginning of the economic crisis

Exploring differences in the utilization of the emergency department between migrant and non-migrant populations: a systematic review

BACKGROUND

Migrants face several barriers when accessing care and tend to rely on emergency services to a greater extent than primary care. Comparing emergency department (ED) utilization by migrants and non-migrants can unveil inequalities affecting the migrant population and pave the way for public health strategies aimed at improving health outcomes. This systematic review aims to investigate differences in ED utilization between migrant and non-migrant populations to ultimately advance research on migrants' access to care and inform health policies addressing health inequalities.

METHODS

A systematic literature search was conducted in March 2023 on the Pubmed, Scopus, and Web of Science databases. The included studies were limited to those relying on data collected from 2012 and written in English or Italian. Data extracted included information on the migrant population and the ED visit, the differences in ED utilization between migrants and non-migrants, and the challenges faced by migrants prior to, during, and after the ED visit. The findings of this systematic review are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines.

RESULTS

After full-text review, 23 articles met the inclusion criteria. All but one adopted a quantitative methodology. Some studies reported a higher frequency of ED visits among migrants, while others a higher frequency among non-migrants. Migrants tend to leave the hospital against medical advice more frequently than the native population and present at the ED without consulting a general practitioner (GP). They are also less likely to access the ED via ambulance. Admissions for ambulatory care-sensitive conditions, namely health conditions for which adequate, timely, and effective outpatient care can prevent hospitalization, were higher for migrants, while still being significant for the non-migrant population.

CONCLUSIONS

The comparison between migrants' and non-migrants' utilization of the ED did not suggest a clear pattern. There is no consensus on whether migrants access EDs more or less than non-migrants and on whether migrants are hospitalized at a higher or lower extent. However, migrants tend to access EDs for less urgent conditions, lack a referral from a GP and access the ED as walk-ins more frequently. Migrants are also discharged against medical advice more often compared to non-migrants. Findings of this systematic review suggest that migrants' access to care is hindered by language barriers, poor insurance coverage, lack of entitlement to a GP, and lack of knowledge of the local healthcare system.

Inequities in hospitalisation in a South European country: Lessons learned from the last European recession

In Spain, regional health systems (universal access) depend on each Autonomous Communities (ACs). The management of the 2008 economic crisis has been different in the ACs, which may have led to an increase in inequities in the use of health services. The objective of this study was to analyse the impact of individual and regional characteristics on public hospitalisation inequities in Spain for the period 2003-2017. We developed a repeated cross-sectional study through Spanish National Health Surveys (2003, 2006, 2011 and 2017) and the Spanish European Health Survey (2014; n = 118,499 subjects). Multilevel and Oaxaca decomposition analyses were conducted to analyse the effect of individual and regional factors in hospitalisation inequities. The results showed that the prevalence of hospitalisation was higher for women (2003: 11.2%; 2017: 9.0%) than for men (2003: 10.7%; 2017: 8.8%) and it decreased with time. Multilevel analyses showed that, after adjustment for variables related to healthcare demand, there were inequities in the probability of hospitalisation, mainly in women. The decomposition analyses showed a higher effect of the number of hospital beds available on hospitalisation in men than in women. There is a direct relationship between the number of hospital beds and the probability of hospitalisation in both sexes. In conclusion, a progressive decrease in hospitalisation use was observed in Spain in the context of the economic recession. Individual-level and regional-level factors were associated with hospitalisation inequities. It is necessary to guarantee equitable access to health services according to the need even in recession times.

Understanding the Healthy Immigrant Effect in the Context of Mental Health Challenges: A Systematic Critical Review

The "Healthy Immigrant Effect" (HIE) suggests that immigrants have a health advantage over the domestic-born which vanishes with increased length of residency. Most HIE research focuses on physical health, with less attention given to mental health (MH). This systematic review of 58 MH studies examines whether there is a MH advantage among immigrants and explores changes in immigrants' MH, besides critically assessing the use of HIE theory. Inconsistent evidence was detected regarding the presence of MH advantage, whereas consistent, convincing evidence was revealed for a decline in immigrants' MH over years. Although the HIE theory can help reveal MH disparities, this theory alone does not explain the reasons for these disparities nor inform about potential avenues to improve immigrants' MH. A paradigm shift is needed to incorporate other potential theoretical concepts/frameworks, including the "Health Inequalities Action" framework, for a broader understanding of MH issues and to inform effective, culturally-sensitive interventions.

[Mental health in Spain and differences by sex, and by autonomous communities]

OBJECTIVE

To describe the evolution of psychological distress in the adult Spanish population in 2006, 2011 and 2017. To study the mental health status of the population in 2017 analyzing the prevalence of psychological distress, prescription of psychiatric drugs, diagnosis and self-perceived health, in Spain and in the autonomous regions, and differentiating between men and women.

METHOD

Cross-sectional study, using data from the 2006, 2011 and 2017 National Health Surveys in Spain.

VARIABLES

psychological distress (GHQ-12), self-perceived health, mental disorder diagnosis, prescription of psychiatric drugs, sex and autonomous community. The frequencies, percentages and confidence intervals at 95% were calculated. The statistical significance level for the chi-square test was p <0.05.

RESULTS

The prevalence of psychological distress in Spain was 22.2% in 2006, 22.1% in 2011 and 19.1% in 2017. With the exception of Cantabria in 2011, in all cases the prevalence of psychological distress was higher in women than men. In 2017, most of the autonomous communities showed prevalence of diagnosis and poor self-perceived health near the Spanish average (15.4% and 33.6%, respectively). The Spanish average of tranquilizer prescription was 9.2%. The highest prevalence was found in Galicia while the lowest was found in Cantabria (overall population and men) and Ceuta and Melilla (women). The Spanish average of antidepressant prescription was 3.6%. The highest prevalence was found in Asturias (overall population and women) and in Galicia (men), while the lowest was found in Ceuta and Melilla.

CONCLUSIONS

Psychological distress is a prevalent phenomenon although its prevalence in Spain has decreased slightly. There are big differences in the prescription of psychiatric drugs between each autonomous community. Women showed poorer outcomes on each mental health indicator analyzed.