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Smith ML, Seegulam V, Szentkúti P, Horváth-Puhó E, Galea S, Lash TL, Rosellini AJ, Schnurr PP, Sørensen HT, Gradus JL. Risk of psychopathology following traumatic events among immigrants and native-born persons in Denmark. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1305-1316. [PMID: 36449069 DOI: 10.1007/s00127-022-02391-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 11/14/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE Immigrants may have increased risk of mental disorders compared with native-born persons. We aimed to expand the limited research on immigrants' posttraumatic psychopathology related to traumatic experiences in their country of resettlement. METHODS We obtained data from a cohort of Danish residents with ≥ 1 traumatic event recorded in health and administrative national registries during 1994-2016. We calculated risks of posttraumatic stress disorder (PTSD), depression, and substance use disorders (SUD) within 5 years post-trauma among native-born Danes and immigrants who had been in Denmark for ≥ 10 years at the time of their index trauma (including immigrants overall and immigrants from specific regions). Risks were compared via age- and sex-standardized risk ratios (SRR) with 95% confidence intervals (CI). We restricted to persons with no record of the disorder under investigation in the 10 years pre-trauma, and stratified by non-interpersonal (e.g., transport accidents) versus interpersonal trauma (e.g., assaults). RESULTS Following non-interpersonal trauma, immigrants were more likely than native-born Danes to be diagnosed with PTSD (SRR = 5.2, 95% CI 4.6, 5.9), about as likely to be diagnosed with depression (SRR = 0.98, 95% CI 0.92, 1.1), and less likely to be diagnosed with SUD (SRR = 0.89, 95% CI 0.82, 0.95). Results were similar following interpersonal trauma, except the SRR for PTSD was reduced in magnitude (SRR = 3.0, 95% CI 1.7, 5.4). There were differences by region of birth. CONCLUSION Immigrants to Denmark have higher risk of PTSD following traumatic experiences than do native-born Danes, possibly due to the combined influence of adverse pre-, peri-, and/or post-migration experiences.
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Affiliation(s)
- Meghan L Smith
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Vijaya Seegulam
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Péter Szentkúti
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Sandro Galea
- School of Public Health, Boston University, 715 Albany St., Boston, MA, 02118, USA
| | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Anthony J Rosellini
- Center for Anxiety and Related Disorders, Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Paula P Schnurr
- National Center for PTSD Executive Division, White River Junction, VT, USA
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jaimie L Gradus
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
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Vestgarden LA, Dahlborg E, Strunck J, Aasen EM. Nurses' discursive construction of older adult immigrant patients in hospitals. BMC Health Serv Res 2023; 23:586. [PMID: 37286985 DOI: 10.1186/s12913-023-09590-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/23/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND The immigrant population across Europe is ageing rapidly. Nurses will likely encounter an increasing number of patients who are older adult immigrants. Moreover, access to and equal provision of healthcare is a key issue for several European countries. The relationship between nurses and patients is asymmetrical with unequal power relations; however, the way nurses construct the patient through language and discourse can help maintain or change the balance of power. Unequal power relations can affect access and be a hindrance to equal healthcare delivery. Hence, the aim of this study is to explore how older adult immigrants are discursively constructed as patients by nurses. METHODS An exploratory qualitative design was used. Data were collected through in-depth interviews with a purposive sample of eight nurses from two hospitals. The nurses' narratives were analysed using critical discourse analysis (CDA) as described by Fairclough. RESULTS The analysis identified an overarching, stable, and dominant discursive practice; 'The discourse of the other', with three interdiscursive practices: (1) 'The discourse on the immigrant patient versus an ideal patient'; (2) 'The expert discourse'; and (3) 'The discourse of adaption'. Older immigrant adults were constructed as 'othered' patients, they were different, alienated, and 'they' were not like 'us'. CONCLUSION The way nurses construct older adult immigrants as patients can be an obstacle to equitable health care. The discursive practice indicates a social practice in which paternalism overrides the patient's autonomy and generalization is more prevalent than a person-centred approach. Furthermore, the discursive practice points to a social practice wherein the nurses' norms form the basis for normal; normality is presumed and desirable. Older adult immigrants do not conform to these norms; hence, they are constructed as 'othered', have limited agency, and may be considered rather powerless as patients. However, there are some examples of negotiated power relations where more power is transferred to the patient. The discourse of adaptation refers to a social practice in which nurses challenge their own existing norms to best adapt a caring relationship to the patient's wishes.
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Affiliation(s)
- Lisbeth Alnes Vestgarden
- Department of Health Sciences in Aalesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Box 1517, Aalesund, 6025, Norway.
| | - Elisabeth Dahlborg
- Department of Health Sciences, University West, Trollhättan, 46132, Sweden
| | - Jeanne Strunck
- Department of Culture and Learning, Faculty of Social Sciences and Humanities, Aalborg University, Kroghstraede 3, Aalborg, 9220, Denmark
| | - Elin Margrethe Aasen
- Department of Health Sciences in Aalesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Box 1517, Aalesund, 6025, Norway
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Differences in all-cause and cause-specific mortality due to external causes and suicide between young adult refugees, non-refugee immigrants and Swedish-born young adults: The role of education and migration-related factors. PLoS One 2022; 17:e0279096. [PMID: 36538535 PMCID: PMC9767339 DOI: 10.1371/journal.pone.0279096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND International migration has increased during the past years and little is known about the mortality of young adult immigrants and refugees that came to Sweden as children. This study aimed to investigate 1) the risk of all-cause and cause-specific mortality in young accompanied and unaccompanied refugees and non-refugee immigrants compared to Swedish born individuals; and 2) to determine the role of educational level and migrations-related factors in these associations. METHODS This register linkage study is based on 682,358 individuals (633,167 Swedish-born, 2,163 unaccompanied and 25,658 accompanied refugees and 21,370 non-refugee immigrants) 19-25 years old, who resided in Sweden 31.12.2004. Outcomes were all-cause mortality and mortality due to suicide and external causes. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated using Cox regression models with a maximum follow-up to 2016. RESULTS After adjusting for covariates, all-cause mortality was significantly lower in non-refugee immigrants (aHR 0.70, 95% CI 0.59-0.84) and refugees (aHR 0.76, 95% CI 0.65-0.88) compared to Swedish-born individuals. The same direction of association was observed for mortality due to suicide and external causes. No differences between accompanied and unaccompanied refugees were found. Risk estimates for all migrant groups varied with educational level, duration of residency, age at arrival and country of birth. Further, the mortality risk of migrants arriving in Sweden before the age of 6 years did not significantly differ from the risk of their Swedish-born peers. Low education was a considerable risk factor. CONCLUSION In general, young adult refugees and non-refugee immigrants have a lower risk of all-cause and cause-specific mortality than Swedish-born individuals. The identified migrant groups with higher mortality risk need specific attention.
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Syse A, Tønnessen M. Flere eldre innvandrere blant framtidens brukere av omsorgstjenester. TIDSSKRIFT FOR OMSORGSFORSKNING 2022. [DOI: 10.18261/tfo.8.2.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Loer AKM, Koschollek C, Hövener C. Investigating associated factors of primary and specialist health care utilization among people with selected nationalities: results of a multilingual survey in two German federal states. BMC Health Serv Res 2022; 22:1050. [PMID: 35978356 PMCID: PMC9382615 DOI: 10.1186/s12913-022-08419-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Approximately every fourth person in Germany has a migration background. Health research on the use of primary and specialist health care in this group is still scarce. Few studies have suggested a difference in the use of primary and specialist health care among people with a migration background. Potential resources and barriers to health care access should be investigated as they are critical to health equity. This study investigates associated sociodemographic, migration-sensitive, and health-related factors of primary and specialist health care utilization among people with a migration background as defined by nationality. METHODS Analyses are based on data from a feasibility study of the project "Improving Health Monitoring in Migrant Populations" (IMIRA), conducted by the Robert Koch Institute. The sample (n = 1055) included persons with Croatian, Polish, Romanian, Syrian, and Turkish nationalities living in the federal states of Berlin and Brandenburg, Germany. Descriptive and bivariate analyses as well as multiple binary logistic regression analyses were carried out to assess sociodemographic (sex, age, socioeconomic position), health-related (self-rated health), and migration-sensitive factors (duration of residence in Germany, residence status, German language proficiency) associated with the use of primary and specialist health care services in the past 12 months. RESULTS Of the total study population, 79.62% visited a general practitioner and 59.53% a specialized physician in the past 12 months. Participants who were female sex, aged 65 and older, and with moderate/poor/very poor self-rated health had higher odds of visiting a general practitioner and a specialized physician, with the strongest impact from self-rated health. After controlling for sociodemographic and health-related factors, duration of residence in Germany and residence status were associated with primary but not with specialist health care utilization. CONCLUSIONS Our results suggest that migration-sensitive characteristics, such as duration of residence, should be considered in a differentiated manner in health services research to gain detailed insights into health care utilization and its potential barriers among the heterogenous group of people with a migration background. Further research needs to be done to evaluate how to get people into contact with a general practitioner.
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Affiliation(s)
- Anne-Kathrin M Loer
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, 12101, Berlin, Germany.
| | - Carmen Koschollek
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, 12101, Berlin, Germany
| | - Claudia Hövener
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, 12101, Berlin, Germany
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Caputo J, Carollo A, Mussino E, Ahrenfeldt LJ, Lindahl-Jacobsen R, Drefahl S, Oksuzyan A. Spousal order of migration, gender, and hospitalization among immigrants in Denmark. Scand J Public Health 2022; 50:172-179. [PMID: 32862798 DOI: 10.1177/1403494820944724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Certain migration contexts that may help clarify immigrants' health needs are understudied, including the order in which married individuals migrate. Research shows that men, who are healthier than women across most populations, often migrate to a host country before women. Using Danish register data, we investigate descriptive patterns in the order that married men and women arrive in Denmark, as well as whether migration order is related to overnight hospitalizations. Methods: The study base includes married immigrants who lived in Denmark between January 1, 1980 and December 31, 2014 (N = 13,680). We use event history models to examine the influence of spousal migration order on hospitalizations. Results: The order that married individuals arrive in Denmark is indeed highly gendered, with men tending to arrive first, and varies by country of origin. Risk of hospitalization after age 50 does not depend on whether an individual migrated before, after, or at the same time as their spouse among either men or women. However, among those aged 18+, men migrating before their wives are more likely to experience hospitalizations within the first 5 years of arrival. Conclusions: These findings provide the first key insights about gendered migration patterns in Denmark. Although spousal order of migration is not related to overnight hospitalization among women, our findings provide preliminary evidence that men age 18+ who are first to arrive experience more hospitalization events in the following 5 years. Future research should explore additional outcomes and whether other gendered migration contexts are related to immigrants' health.
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Affiliation(s)
- Jennifer Caputo
- Center for Health and the Social Sciences, University of Chicago, Chicago, IL, USA.,Max Planck Institute for Demographic Research, Rostock, Germany
| | - Angela Carollo
- Max Planck Institute for Demographic Research, Rostock, Germany
| | - Eleonora Mussino
- Demography Unit, Department of Sociology, Stockholm University, Stockholm, Sweden
| | - Linda Juel Ahrenfeldt
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Rune Lindahl-Jacobsen
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Sven Drefahl
- Demography Unit, Department of Sociology, Stockholm University, Stockholm, Sweden
| | - Anna Oksuzyan
- Max Planck Institute for Demographic Research, Rostock, Germany
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Allik M, Brown D, Dundas R, Leyland AH. Differences in ill health and in socioeconomic inequalities in health by ethnic groups: a cross-sectional study using 2011 Scottish census. ETHNICITY & HEALTH 2022; 27:190-208. [PMID: 31313591 PMCID: PMC7614248 DOI: 10.1080/13557858.2019.1643009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 06/18/2019] [Indexed: 06/10/2023]
Abstract
Objectives: We compare rates of ill health and socioeconomic inequalities in health by ethnic groups in Scotland by age. We focus on ethnic differences in socioeconomic inequalities in health. There is little evidence of how socioeconomic inequalities in health vary by ethnicity, especially in Scotland, where health inequalities are high compared to other European countries.Design: A cross-sectional study using the 2011 Scottish Census (population 5.3 million) was conducted. Directly standardized rates were calculated for two self-rated health outcomes (poor general health and limiting long-term illness) separately by ethnicity, age and small-area deprivation. Slope and relative indices of inequality were calculated to measure socioeconomic inequalities in health.Results: The results show that the White Scottish population tend to have worse health and higher socioeconomic inequalities in health than many other ethnic groups, while White Polish and Chinese people tend to have better health and low socioeconomic inequalities in health. These results are more salient for ages 30-44. The Pakistani population has high rates of poor health similar to the White Scottish for ages 15-44, but at ages 45 and above Pakistani people have the highest rates of poor self-rated health. Compared to other ethnicities, Pakistani people are also more likely to experience poor health in the least deprived areas, particularly at ages 45 and above.Conclusions: There are statistically significant and substantial differences in poor self-rated health and in socioeconomic inequalities in health between ethnicities. Rates of ill health vary between ethnic groups at any age. The better health of the younger minority population should not be taken as evidence of better health outcomes in later life. Since socioeconomic gradients in health vary by ethnicity, policy interventions for health improvement in Scotland that focus only on deprived areas may inadvertently exclude minority populations.
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Affiliation(s)
- Mirjam Allik
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Denise Brown
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Ruth Dundas
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Alastair H Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Amin R, Rahman S, Tinghög P, Helgesson M, Runeson B, Björkenstam E, Qin P, Mehlum L, Holmes EA, Mittendorfer-Rutz E. Healthcare use before and after suicide attempt in refugees and Swedish-born individuals. Soc Psychiatry Psychiatr Epidemiol 2021; 56:325-338. [PMID: 32556379 PMCID: PMC7870606 DOI: 10.1007/s00127-020-01902-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 06/09/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE There is a lack of research on whether healthcare use before and after a suicide attempt differs between refugees and the host population. We aimed to investigate if the patterns of specialised (inpatient and specialised outpatient) psychiatric and somatic healthcare use, 3 years before and after a suicide attempt, differ between refugees and the Swedish-born individuals in Sweden. Additionally, we aimed to explore if specialised healthcare use differed among refugee suicide attempters according to their sex, age, education or receipt of disability pension. METHODS All refugees and Swedish-born individuals, 20-64 years of age, treated for suicide attempt in specialised healthcare during 2004-2013 (n = 85,771 suicide attempters, of which 4.5% refugees) were followed 3 years before and after (Y - 3 to Y + 3) the index suicide attempt (t0) regarding their specialised healthcare use. Annual adjusted prevalence with 95% confidence intervals (CIs) of specialised healthcare use were assessed by generalized estimating equations (GEE). Additionally, in analyses among the refugees, GEE models were stratified by sex, age, educational level and disability pension. RESULTS Compared to Swedish-born, refugees had lower prevalence rates of psychiatric and somatic healthcare use during the observation period. During Y + 1, 25% (95% CI 23-28%) refugees and 30% (95% CI 29-30%) Swedish-born used inpatient psychiatric healthcare. Among refugees, a higher specialised healthcare use was observed in disability pension recipients than non-recipients. CONCLUSION Refugees used less specialised healthcare, before and after a suicide attempt, relative to the Swedish-born. Strengthened cultural competence among healthcare professionals and better health literacy among the refugees may improve healthcare access in refugees.
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Affiliation(s)
- Ridwanul Amin
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 17177, Stockholm, Sweden.
| | - Syed Rahman
- Department of Global Public Health, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Petter Tinghög
- Swedish Red Cross University College, 14157 Huddinge, Sweden
| | - Magnus Helgesson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Bo Runeson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, S.t Göran’s Hospital, Karolinska Institutet, Stockholm County Council, 11281 Stockholm, Sweden
| | - Emma Björkenstam
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Ping Qin
- National Centre for Suicide Research and Prevention, University of Oslo, 0374 Oslo, Norway
| | - Lars Mehlum
- National Centre for Suicide Research and Prevention, University of Oslo, 0374 Oslo, Norway
| | - Emily A. Holmes
- Department of Clinical Neuroscience (CNS), K8, Psychology, Karolinska Institutet, 17177 Stockholm, Sweden ,Department of Psychology, Uppsala University, 75237 Uppsala, Sweden
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 17177 Stockholm, Sweden
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Ohm E, Holvik K, Kjøllesdal MKR, Madsen C. Health care utilisation for treatment of injuries among immigrants in Norway: a nationwide register linkage study. Inj Epidemiol 2020; 7:60. [PMID: 33190634 PMCID: PMC7667780 DOI: 10.1186/s40621-020-00286-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/01/2020] [Indexed: 11/25/2022] Open
Abstract
Background Previous research has generally found lower rates of injury incidence in immigrant populations than in native-born populations. Most of this literature relies on mortality statistics or hospital data, and we know less about injuries treated in primary health care. The aim of the present study was to assess use of primary and secondary care for treatment of injuries among immigrants in Norway according to geographic origin and type of injury. Methods We conducted a nationwide register-based cohort study of all individuals aged 25–64 years who resided in Norway as of January 1st 2008. This cohort was followed through 2014 by linking sociodemographic information and injury data from primary and secondary care. We grouped immigrants into six world regions of origin and identified immigrants from the ten most frequently represented countries of origin. Six categories of injury were defined: fractures, superficial injuries, open wounds, dislocations/sprains/strains, burns and poisoning. Poisson regression models were fitted to estimate incidence rate ratios separately for injuries treated in primary and secondary care according to immigrant status, geographic origin and type of injury, with adjustment for sex, age, county of residence, marital status and socioeconomic status. Results Immigrants had a 16% lower incidence of injury in primary care than non-immigrants (adjusted IRR = 0.84, 95% CI 0.83–0.84), and a 10% lower incidence of injury in secondary care (adjusted IRR = 0.90, 95% CI 0.90–0.91). Immigrants from Asia, Africa and European countries outside EU/EEA had lower rates than non-immigrants for injuries treated in both primary and secondary care. Rates were lower in immigrants for most injury types, and in particular for fractures and poisoning. For a subset of injuries treated in secondary care, we found that immigrants had lower rates than non-immigrants for treatment of self-harm, falls, sports injuries and home injuries, but higher rates for treatment of assault, traffic injuries and occupational injuries. Conclusions Health care utilisation for treatment of injuries in primary and secondary care in Norway was lower for immigrants compared to non-immigrants. Incidence rates were especially low for immigrants originating from Asia, Africa and European countries outside EU/EEA, and for treatment of fractures, poisoning, self-harm and sports injuries.
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Affiliation(s)
- Eyvind Ohm
- Norwegian Institute of Public Health, PO Box 222, Skøyen, 0213, Oslo, Norway.
| | - Kristin Holvik
- Norwegian Institute of Public Health, PO Box 222, Skøyen, 0213, Oslo, Norway
| | | | - Christian Madsen
- Norwegian Institute of Public Health, PO Box 222, Skøyen, 0213, Oslo, Norway
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Del Puente F, Riccardi N, Taramasso L, Sarteschi G, Pincino R, Di Biagio A. Migrants and imported disease: Trends of admission in an Italian infectious disease ward during the migration crisis of 2015-2017. BMC Public Health 2020; 20:738. [PMID: 32434483 PMCID: PMC7238611 DOI: 10.1186/s12889-020-08886-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 05/10/2020] [Indexed: 11/29/2022] Open
Abstract
Background Since 2014, the migrant population residing in Europe has dramatically increased. Migrants’ unmet health needs represent a barrier to integration and should be promptly addressed, without stigma, in order to favour resettlement. Methods All-cause of admissions in the migrant population at the Infectious Disease Clinic of Policlinico San Martino Hospital in Genoa between 2015 and 2017 were analysed. Patients were classified by duration of residence in Italy according to the Recommendation on Statistics of International Migration, cause of hospitalization, and region of origin. All data were evaluated with SPSS Statistics. Results Two hundred thirty-five people were admitted, 86 (36.5%) of them residing in Italy for less than 1 year. Except for a significant increase in migrants from Africa, there was no change considering the area of origin, hospitalization reason or by comparing residency in Italy for more or less than 1 year. A considerable number of hospitalizations were related to non-communicable pathologies and latent tuberculosis infection. Residents in Italy for less than 1 year or with active tuberculosis had prolonged hospitalizations, while HIV-infected had shorter hospital stays. Conclusions No difference in terms of diagnosis were found between migrants with longer or shorter period of residence in Italy. Adequate outpatient services for the management of communicable diseases could significantly reduce the length of hospitalizations in the migrant population.
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Affiliation(s)
- Filippo Del Puente
- Department of Health Sciences (DiSSal), Infectious Diseases Clinic, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Niccolò Riccardi
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Verona, Italy.,StopTB Italia Onlus, Milan, Italy
| | - Lucia Taramasso
- Department of Internal Medicine, Infectious Diseases Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Giovanni Sarteschi
- Department of Health Sciences (DiSSal), Infectious Diseases Clinic, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Rachele Pincino
- Department of Health Sciences (DiSSal), Infectious Diseases Clinic, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Antonio Di Biagio
- Department of Health Sciences (DiSSal), Infectious Diseases Clinic, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy.
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Ponce-Blandón JA, Mérida-Martín T, Jiménez-Lasserrotte MDM, Jiménez-Picón N, Macías-Seda J, Lomas-Campos MDLM. Analysis of Prehospital Care of Migrants Who Arrive Intermittently at the Coasts of Southern Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17061964. [PMID: 32192156 PMCID: PMC7143934 DOI: 10.3390/ijerph17061964] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 03/15/2020] [Indexed: 01/02/2023]
Abstract
Background: The aim of this study is to identify the sociodemographic characteristics and the most frequent diseases and nursing interventions carried out on migrants arriving by sea at southern Spain. Method: Cross-sectional, descriptive, and retrospective study based on the database of the Spanish Red Cross Intervention Activation System. All migrants who arrived on the coasts of a southern province during 2016 and were assisted by the Red Cross were included. Results: A total of 2027 people were registered, mostly males, aged between 18 and 40 years. Of these, 4.9% required healthcare, and 2.9% were referred to hospital. Highlighted diagnoses were headaches (15.6%), pregnancy (12.8%), and lower-limb wounds (6.4%), and outstanding nursing interventions were “care of wounds” (24.7%), “pain management” (21.9%), and “prenatal care” (15.2%). Statistically significant relationships were found between the diagnosed diseases and gender, geographic area of origin, and seasonal time of the year, as well as between nursing interventions performed and those three variables. Conclusions: Although in general, a good health condition was observed in most of the migrants treated, the most frequent health situations attended were related to dermatological, gynecological, and headache problems. The most performed nursing interventions were related to skin/wound care and promotion of physical comfort, requiring a low need for hospital transfers. Female gender, origin from sub-Saharan Africa and arrival in the summer period carry a greater risk of suffering health problems when migrants reach Spanish coasts.
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Affiliation(s)
- José Antonio Ponce-Blandón
- Centro Universitario de Enfermería de la Cruz Roja, Universidad de Sevilla, 41009 Sevilla, Spain;
- Correspondence: ; Tel.: +34615585859
| | | | | | - Nerea Jiménez-Picón
- Centro Universitario de Enfermería de la Cruz Roja, Universidad de Sevilla, 41009 Sevilla, Spain;
| | - Juana Macías-Seda
- Facultad de Enfermería, Fisioterapia y Podología. Universidad de Sevilla, 41009 Sevilla, Spain; (J.M.-S.); (M.d.l.M.L.-C.)
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Finnvold JE. How social and geographical backgrounds affect hospital admission with a serious condition: a comparison of 11 immigrant groups with native-born Norwegians. BMC Health Serv Res 2018; 18:843. [PMID: 30409144 PMCID: PMC6225619 DOI: 10.1186/s12913-018-3670-0] [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: 09/22/2017] [Accepted: 10/31/2018] [Indexed: 11/17/2022] Open
Abstract
Background The foreign-born population in Norway displays considerable diversity in terms of source country, socioeconomic status and settlement experience. This study assessed the consequences of this diversity for the risk of being admitted to hospital with a serious condition. To what extent could variations between immigrant and native-born hospitalisation patterns be accounted for by variations in income, education and residential area characteristics? Methods The study linked information on socioeconomic and geographical level-of-living factors involving 2,820,283 individuals between 20 and 69 years old to hospital admissions recorded in Norway’s National Patient Registry. Immigrants from 11 of the most frequently represented countries were included. The outcome variable consisted of a selection of relatively serious diagnoses (neoplasms and endocrine, circulatory and respiratory diseases), totalling 548,140 admissions from 2008 to 2011. Age- and gender-adjusted admission rates were analysed using a Poisson regression. Results The adjustments for income and education reduced the hospitalisation rates of almost all immigrant groups. The groups whose previous rates were above native-born rates moved towards the Norwegian reference, whereas groups that initially had lower age- and gender-adjusted rates compared with the Norwegian-born population increased the distance to the Norwegian reference. The risk of hospitalisation among most immigrant groups decreased compared with the Norwegian-born population when their income and educational levels were accounted for. Particularly, immigrants with lower levels of income or education tended to have relatively low hospitalisation rates, indicating the possibility of a healthy immigrant effect. While many immigrant groups used less somatic healthcare than the native-born population did, higher educational or income levels did not prevent hospitalisation to the same extent as they did for the native-born population. Conclusions Although adjustments for socioeconomic factors tended towards lower hospitalisation rates for most immigrant groups, the adjustments did not reduce the considerable variations among individual countries.
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Affiliation(s)
- Jon Erik Finnvold
- Norwegian Social Research (NOVA), Oslo Metropolitan University, Postboks 4. St. Olavs plass, 0130, Oslo, Norway.
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Syse A, Dzamarija MT, Kumar BN, Diaz E. An observational study of immigrant mortality differences in Norway by reason for migration, length of stay and characteristics of sending countries. BMC Public Health 2018; 18:508. [PMID: 29665802 PMCID: PMC5905163 DOI: 10.1186/s12889-018-5435-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 04/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Knowledge of mortality differentials in immigrant groups depending on their reason for migration, length of stay in host countries and characteristics of sending countries may be beneficial for policy interventions aimed to improve various immigrant groups' health and welfare. METHODS We employed discrete-time hazard regression models with time-varying covariates to compare the death risk of immigrants to those of Norwegian-born natives using linked register data on the Norwegian population aged 25-79 during 1990-2015. More than 492,000 deaths occurred in around 4.6 million individuals. All analyses were adjusted for sex, age, calendar time and sociodemographic characteristics. RESULTS Immigrants had an 11% survival advantage overall. Those immigrating due to work or education had the lowest death risk, whereas refugees had the highest death risk (albeit lower than that of natives). Death risks increased markedly with length of stay, and were most pronounced for those having spent more than 40% of their lives in Norway. Net of reason for migration, only minor differences were observed depending on Human Development Index characteristics of sending countries. CONCLUSION Independent of reason for migration and characteristics of sending countries, those who immigrate to Norway in adulthood appear to be particularly healthy. The higher death risk associated with prolonged lengths of stay suggests that disadvantageous 'acculturation' or stress factors related to the post-migration period may play a role in the long run. The health and welfare of long-term immigrants thus warrants further research.
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Affiliation(s)
| | | | - Bernadette N Kumar
- The Norwegian Centre for Minority Health Research, Norwegian Institute of Public Health, Oslo, Norway
| | - Esperanza Diaz
- The Norwegian Centre for Minority Health Research, Norwegian Institute of Public Health, Oslo, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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