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Burns R, Wyke S, Eyre MT, Boukari Y, Sørensen TB, Tsang C, Campbell CNJ, Beale S, Zenner D, Hargreaves S, Campos-Matos I, Harron K, Aldridge RW. COVID-19 vaccination coverage for half a million non-EU migrants and refugees in England. Nat Hum Behav 2024; 8:288-299. [PMID: 38049560 PMCID: PMC10896718 DOI: 10.1038/s41562-023-01768-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 10/23/2023] [Indexed: 12/06/2023]
Abstract
Despite evidence suggesting that some migrants are at risk of under-immunization and have experienced severe health inequities during the pandemic, data are limited on migrants' COVID-19 vaccine coverage globally. Here we linked data from non-European Union migrants and resettled refugees to the national COVID-19 vaccination dataset in England. We estimated patterns in second and third dose delays and overdue doses between 12 December 2020 and 20 April 2022 by age, visa type and ethnicity. Of the 465,470 linked records, 91.8% (427,073/465,470) of migrants received a second dose and 51.3% (238,721/465,470) received a third. Refugees had the highest risk of delayed second (adjusted odds ratio 1.66; 95% confidence interval 1.55-1.79) and third dose (1.55; 1.43-1.69). Black migrants were twice as likely to have a second dose delayed (2.37; 2.23-2.54) than white migrants, but this trend reversed for the third dose. Older migrants (>65 years) were four times less likely to have received their second or third dose compared with the general population in England aged >65 or older. Policymakers, researchers and practitioners should work to understand and address personal and structural barriers to vaccination for diverse migrant populations.
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Affiliation(s)
- Rachel Burns
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK.
| | - Sacha Wyke
- Department of Health and Social Care, Office for Health Improvement and Disparities, London, UK
| | - Max T Eyre
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Yamina Boukari
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
| | - Tina B Sørensen
- Immunisation and Vaccine Preventable Diseases, UK Health Security Agency, London, UK
| | - Camille Tsang
- Immunisation and Vaccine Preventable Diseases, UK Health Security Agency, London, UK
| | - Colin N J Campbell
- Immunisation and Vaccine Preventable Diseases, UK Health Security Agency, London, UK
| | - Sarah Beale
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Dominik Zenner
- Global Public Health Unit, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Infection and Population Health Department, Institute of Global Health, University College London, London, UK
| | - Sally Hargreaves
- Institute for Infection and Immunity, St George's University of London, Cranmer Terrace London, London, UK
| | - Ines Campos-Matos
- Department of Health and Social Care, Office for Health Improvement and Disparities, London, UK
- UK Health Security Agency, London, UK
| | - Katie Harron
- UCL Great Ormond Street, Institute of Child Health, University College London, London, UK
| | - Robert W Aldridge
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK
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Zhang CX, Lewer D, Aldridge RW, Hayward AC, Cornaglia C, Trussell P, Lillford-Wildman C, Castle J, Gommon J, Campos-Matos I. Small numbers, big impact: making a utilitarian case for the contribution of inclusion health to population health in England. J Epidemiol Community Health 2023; 77:816-820. [PMID: 37734936 DOI: 10.1136/jech-2023-220849] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/28/2023] [Indexed: 09/23/2023]
Abstract
Inclusion health groups make up a small proportion of the general population, so despite the extreme social exclusion and poor health outcomes that these groups experience, they are often overlooked in public health investment and policy development. In this paper, we demonstrate that a utilitarian argument can be made for investment in better support for inclusion health groups despite their small size. That is, by preventing social exclusion, there is the potential for large aggregate health benefits to the whole population. We illustrate this by reframing existing published mortality estimates into population attributable fractions to show that 12% of all-cause premature deaths (95% CI 10.03% to 14.29%) are attributable to the circumstances of people who experience homelessness, use drugs and/or have been in prison. We also show that a large proportion of cause-specific premature deaths in the general population can be attributed to specific inclusion health groups, such as 43% of deaths due to viral hepatitis (95% CI 30.35% to 56.61%) and nearly 4000 deaths due to cancer (3844, 95% CI 3438 to 4285) between 2013 and 2021 attributed to individuals who use illicit opioids. Considering the complexity of the inclusion health policy context and the sparseness of evidence, we discuss how a shift in policy framing from 'inclusion health vs the rest of the population' to 'the impact of social exclusion on broader population health' makes a better case for increased policy attention and investment in inclusion health. We discuss the strengths and limitations of this approach and how it can be applied to public health policy, resource prioritisation and future research.
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Affiliation(s)
- Claire X Zhang
- Addictions & Inclusion Directorate, Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
- Institute of Health Informatics, University College London, London, UK
| | - Dan Lewer
- Institute of Epidemiology & Health Care, University College London, London, UK
- UCL Collaborative Centre for Inclusion Health, University College London, London, UK
- Bradford Institute for Health Research, Bradford, UK
| | - Robert W Aldridge
- Institute of Health Informatics, University College London, London, UK
| | - Andrew C Hayward
- Institute of Epidemiology & Health Care, University College London, London, UK
- UCL Collaborative Centre for Inclusion Health, University College London, London, UK
| | - Carlotta Cornaglia
- Addictions & Inclusion Directorate, Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
| | - Peta Trussell
- Addictions & Inclusion Directorate, Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
| | - Charlotte Lillford-Wildman
- Addictions & Inclusion Directorate, Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
| | - Joanna Castle
- Addictions & Inclusion Directorate, Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
| | - Jake Gommon
- Addictions & Inclusion Directorate, Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
| | - Ines Campos-Matos
- Addictions & Inclusion Directorate, Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
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Bozorgmehr K, McKee M, Azzopardi-Muscat N, Bartovic J, Campos-Matos I, Gerganova TI, Hannigan A, Janković J, Kállayová D, Kaplan J, Kayi I, Kondilis E, Lundberg L, Mata IDL, Medarević A, Suvada J, Wickramage K, Puthoopparambil SJ. Integration of migrant and refugee data in health information systems in Europe: advancing evidence, policy and practice. THE LANCET REGIONAL HEALTH. EUROPE 2023; 34:100744. [PMID: 37927430 PMCID: PMC10625017 DOI: 10.1016/j.lanepe.2023.100744] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/29/2023] [Accepted: 09/19/2023] [Indexed: 11/07/2023]
Abstract
Coverage of migrant and refugee data is incomplete and of insufficient quality in European health information systems. This is not because we lack the knowledge or technology. Rather, it is due to various political factors at local, national and European levels, which hinder the implementation of existing knowledge and guidelines. This reflects the low political priority given to the topic, and also complex governance challenges associated with migration and displacement. We review recent evidence, guidelines, and policies to propose four approaches that will advance science, policy, and practice. First, we call for strategies that ensure that data is collected, analyzed and disseminated systematically. Second, we propose methods to safeguard privacy while combining data from multiple sources. Third, we set out how to enable survey methods that take account of the groups' diversity. Fourth, we emphasize the need to engage migrants and refugees in decisions about their own health data. Based on these approaches, we propose a change management approach that narrows the gap between knowledge and action to create healthcare policies and practices that are truly inclusive of migrants and refugees. We thereby offer an agenda that will better serve public health needs, including those of migrants and refugees and advance equity in European health systems. Funding No specific funding received.
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Affiliation(s)
- Kayvan Bozorgmehr
- Department of Population Medicine & Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
- Section Health Equity Studies & Migration, University Hospital Heidelberg, Heidelberg, Germany
- Lancet Migration European Hub
| | - Martin McKee
- European Observatory on Health Systems and Policies, London, UK
- London School of Medicine & Tropical Hygiene, London, UK
| | | | | | - Ines Campos-Matos
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
| | | | - Ailish Hannigan
- WHO Collaborating Centre for Migrant’s Involvement in Health Research, School of Medicine, University of Limerick, Limerick, Ireland
| | | | - Daniela Kállayová
- Lancet Migration European Hub
- Department of Public Health, Screening and Prevention, Ministry of Health, Slovak Republic
- Trnava University, Trnava, Slovak Republic
| | - Josiah Kaplan
- UNICEF Global Office of Research and Foresight, Florence, Italy
| | - Ilker Kayi
- Department of Public Health, School of Medicine, Koç University, Istanbul, Türkiye
| | - Elias Kondilis
- Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lene Lundberg
- Lancet Migration European Hub
- Norwegian Centre for E-health Research, Tromsø, Norway
| | | | - Aleksandar Medarević
- Institute of Public Health of Serbia 'Dr Milan Jovanovic Batut', Belgrade, Serbia
| | - Jozef Suvada
- St. Elizabeth University of Public Health and Social Work, Slovak Republic
- WHO Collaborating Centre for Infectious Diseases, Research Methods and Recommendations, and McMaster GRADE Centre, Department of Health Research Methods, Evidence and Impact, McMaster University, Canada
| | - Kolitha Wickramage
- UN Migration Agency Global Data Institute, Migration Health Division, International Organization for Migration, Berlin, Germany
| | - Soorej Jose Puthoopparambil
- WHO Collaborating Centre on Migration and Health Data and Evidence, Global Health and Migration Unit, Department of Women’s and Children’s Health, Uppsala University, Sweden
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Hiam L, Zhang CX, Burns R, Darlington-Pollock F, Wallace M, McKee M. What can the UK learn from the impact of migrant populations on national life expectancy? J Public Health (Oxf) 2022; 44:e499-e505. [PMID: 35313344 PMCID: PMC9383602 DOI: 10.1093/pubmed/fdac013] [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: 10/13/2021] [Revised: 01/11/2022] [Accepted: 01/17/2022] [Indexed: 01/19/2023] Open
Abstract
Improvements in life expectancy at birth in the UK had stalled prior to 2020 and have fallen during the COVID-19 pandemic. The stagnation took place at a time of relatively high net migration, yet we know that migrants to Australia, the USA and some Nordic countries have positively impacted national life expectancy trends, outperforming native-born populations in terms of life expectancy. It is important to ascertain whether migrants have contributed positively to life expectancy in the UK, concealing worsening trends in the UK-born population, or whether relying on national life expectancy calculations alone may have masked excess mortality in migrant populations. We need a better understanding of the role and contribution of migrant populations to national life expectancy trends in the UK.
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Affiliation(s)
| | - Claire X Zhang
- Institute of Health Informatics, University College London, NW1 2DA, UK
| | - Rachel Burns
- Institute of Health Informatics, University College London, NW1 2DA, UK
| | | | - Matthew Wallace
- Demography Unit, Sociology Department, Stockholm University, 106 91 Stockholm, UK
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, WC1H 9SH, UK
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Pathak N, Zhang CX, Boukari Y, Burns R, Mathur R, Gonzalez-Izquierdo A, Denaxas S, Sonnenberg P, Hayward A, Aldridge RW. Development and Validation of a Primary Care Electronic Health Record Phenotype to Study Migration and Health in the UK. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:13304. [PMID: 34948912 PMCID: PMC8707886 DOI: 10.3390/ijerph182413304] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/07/2021] [Accepted: 12/10/2021] [Indexed: 11/16/2022]
Abstract
International migrants comprised 14% of the UK's population in 2020; however, their health is rarely studied at a population level using primary care electronic health records due to difficulties in their identification. We developed a migration phenotype using country of birth, visa status, non-English main/first language and non-UK-origin codes and applied it to the Clinical Practice Research Datalink (CPRD) GOLD database of 16,071,111 primary care patients between 1997 and 2018. We compared the completeness and representativeness of the identified migrant population to Office for National Statistics (ONS) country-of-birth and 2011 census data by year, age, sex, geographic region of birth and ethnicity. Between 1997 to 2018, 403,768 migrants (2.51% of the CPRD GOLD population) were identified: 178,749 (1.11%) had foreign-country-of-birth or visa -status codes, 216,731 (1.35%) non-English-main/first-language codes, and 8288 (0.05%) non-UK-origin codes. The cohort was similarly distributed versus ONS data by sex and region of birth. Migration recording improved over time and younger migrants were better represented than those aged ≥50. The validated phenotype identified a large migrant cohort for use in migration health research in CPRD GOLD to inform healthcare policy and practice. The under-recording of migration status in earlier years and older ages necessitates cautious interpretation of future studies in these groups.
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Affiliation(s)
- Neha Pathak
- Institute of Health Informatics, University College London, 222 Euston Rd., London NW1 2DA, UK; (N.P.); (C.X.Z.); (Y.B.); (R.B.); (A.G.-I.); (S.D.)
- Guy’s & St. Thomas’ NHS Foundation Trust, London SE1 9RT, UK
| | - Claire X. Zhang
- Institute of Health Informatics, University College London, 222 Euston Rd., London NW1 2DA, UK; (N.P.); (C.X.Z.); (Y.B.); (R.B.); (A.G.-I.); (S.D.)
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London SW1H 0EU, UK
| | - Yamina Boukari
- Institute of Health Informatics, University College London, 222 Euston Rd., London NW1 2DA, UK; (N.P.); (C.X.Z.); (Y.B.); (R.B.); (A.G.-I.); (S.D.)
- Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London SW1H 0EU, UK
| | - Rachel Burns
- Institute of Health Informatics, University College London, 222 Euston Rd., London NW1 2DA, UK; (N.P.); (C.X.Z.); (Y.B.); (R.B.); (A.G.-I.); (S.D.)
| | - Rohini Mathur
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK;
| | - Arturo Gonzalez-Izquierdo
- Institute of Health Informatics, University College London, 222 Euston Rd., London NW1 2DA, UK; (N.P.); (C.X.Z.); (Y.B.); (R.B.); (A.G.-I.); (S.D.)
- Health Data Research UK, London NW1 2BF, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, 222 Euston Rd., London NW1 2DA, UK; (N.P.); (C.X.Z.); (Y.B.); (R.B.); (A.G.-I.); (S.D.)
- Health Data Research UK, London NW1 2BF, UK
| | - Pam Sonnenberg
- Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, UK;
| | - Andrew Hayward
- Institute of Epidemiology & Health Care, University College London, 1-19 Torrington Place, London WC1E 7HB, UK;
| | - Robert W. Aldridge
- Institute of Health Informatics, University College London, 222 Euston Rd., London NW1 2DA, UK; (N.P.); (C.X.Z.); (Y.B.); (R.B.); (A.G.-I.); (S.D.)
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Feufack-Donfack LB, Sarah-Matio EM, Abate LM, Bouopda Tuedom AG, Ngano Bayibéki A, Maffo Ngou C, Toto JC, Sandeu MM, Eboumbou Moukoko CE, Ayong L, Awono-Ambene P, Morlais I, Nsango SE. Epidemiological and entomological studies of malaria transmission in Tibati, Adamawa region of Cameroon 6 years following the introduction of long-lasting insecticide nets. Parasit Vectors 2021; 14:247. [PMID: 33964974 PMCID: PMC8106832 DOI: 10.1186/s13071-021-04745-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/23/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Malaria remains a serious public health problem in Cameroon. Implementation of control interventions requires prior knowledge of the local epidemiological situation. Here we report the results of epidemiological and entomological surveys carried out in Tibati, Adamawa Region, Cameroon, an area where malaria transmission is seasonal, 6 years after the introduction of long-lasting insecticidal bed nets. METHODS Cross-sectional studies were carried out in July 2015 and 2017 in Tibati. Thick blood smears and dried blood spots were collected from asymptomatic and symptomatic individuals in the community and at health centers, respectively, and used for the molecular diagnosis of Plasmodium species. Adult mosquitoes were collected by indoor residual spraying and identified morphologically and molecularly. The infection status of Plasmodium spp. was determined by quantitative PCR, and positivity of PCR-positive samples was confirmed by Sanger sequencing. RESULTS Overall malaria prevalence in our study population was 55.0% (752/1367) and Plasmodium falciparum was the most prevalent parasite species (94.3%), followed by P. malariae (17.7%) and P. ovale (0.8%); 92 (12.7%) infections were mixed infections. Infection parameters varied according to clinical status (symptomatic/asymptomatic) and age of the sampled population and the collection sites. Infection prevalence was higher in asymptomatic carriers (60.8%), but asexual and sexual parasite densities were lower. Prevalence and intensity of infection decreased with age in both the symptomatic and asymptomatic groups. Heterogeneity in infections was observed at the neighborhood level, revealing hotspots of transmission. Among the 592 Anopheles mosquitoes collected, 212 (35.8%) were An. gambiae, 172 (29.1%) were An. coluzzii and 208 (35.1%) were An. funestus (s.s.). A total of 26 (4.39%) mosquito specimens were infected by Plasmodium sp. and the three Anopheles mosquitoes transmitted Plasmodium at equal efficiency. Surprisingly, we found an An. coluzzii specimen infected by Plasmodium vivax, which confirms circulation of this species in Cameroon. The positivity of all 26 PCR-positive Plasmodium-infected mosquitoes was successively confirmed by sequencing analysis. CONCLUSION Our study presents the baseline malaria parasite burden in Tibati, Adamawa Region, Cameroon. Our results highlight the high malaria endemicity in the area, and hotspots of disease transmission are identified. Parasitological indices suggest low bednet usage and that implementation of control interventions in the area is needed to reduce malaria burden. We also report for the first time a mosquito vector with naturally acquired P. vivax infection in Cameroon.
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Affiliation(s)
- Lionel Brice Feufack-Donfack
- Service de Paludisme du Centre Pasteur Cameroun, BP 1274, Yaounde, Cameroon
- CNRS UPR 9022, Inserm U 963, Université de Strasbourg, 2, allée Konrad Roentgen, 67084 Strasbourg Cedex, France
| | - Elangwe Milo Sarah-Matio
- Service de Paludisme du Centre Pasteur Cameroun, BP 1274, Yaounde, Cameroon
- UMR MIVEGEC, IRD, CNRS, Université de Montpellier, Institut de Recherche pour le Développement, 911 avenue Agropolis, 34394 Montpellier, France
| | - Luc Marcel Abate
- UMR MIVEGEC, IRD, CNRS, Université de Montpellier, Institut de Recherche pour le Développement, 911 avenue Agropolis, 34394 Montpellier, France
| | - Aline Gaelle Bouopda Tuedom
- Service de Paludisme du Centre Pasteur Cameroun, BP 1274, Yaounde, Cameroon
- Faculté de Médecine et des Sciences Pharmaceutiques de l’Université de Douala (FMSP–UD), BP 2701 Douala, Cameroon
| | - Albert Ngano Bayibéki
- Université Catholique d’Afrique Centrale, Yaoundé-Campus Messa, BP 1110, Yaounde, Cameroon
| | - Christelle Maffo Ngou
- Service de Paludisme du Centre Pasteur Cameroun, BP 1274, Yaounde, Cameroon
- UMR MIVEGEC, IRD, CNRS, Université de Montpellier, Institut de Recherche pour le Développement, 911 avenue Agropolis, 34394 Montpellier, France
| | - Jean-Claude Toto
- Laboratoire de Recherche sur le Paludisme, Organisation de Coordination pour la lutte contre les Endémies en Afrique Centrale, BP 288, Yaounde, Cameroon
| | - Maurice Marcel Sandeu
- Department of Medical Entomology, Centre for Research in Infectious Diseases, Yaounde, 13591 Cameroon
- Department of Microbiology and Infectious Diseases, School of Veterinary Medicine and Sciences, University of Ngaoundere, PO Box 454, Ngaoundere, Cameroon
| | - Carole Else Eboumbou Moukoko
- Service de Paludisme du Centre Pasteur Cameroun, BP 1274, Yaounde, Cameroon
- Faculté de Médecine et des Sciences Pharmaceutiques de l’Université de Douala (FMSP–UD), BP 2701 Douala, Cameroon
| | - Lawrence Ayong
- Service de Paludisme du Centre Pasteur Cameroun, BP 1274, Yaounde, Cameroon
| | - Parfait Awono-Ambene
- Laboratoire de Recherche sur le Paludisme, Organisation de Coordination pour la lutte contre les Endémies en Afrique Centrale, BP 288, Yaounde, Cameroon
| | - Isabelle Morlais
- Service de Paludisme du Centre Pasteur Cameroun, BP 1274, Yaounde, Cameroon
- UMR MIVEGEC, IRD, CNRS, Université de Montpellier, Institut de Recherche pour le Développement, 911 avenue Agropolis, 34394 Montpellier, France
| | - Sandrine Eveline Nsango
- Service de Paludisme du Centre Pasteur Cameroun, BP 1274, Yaounde, Cameroon
- Faculté de Médecine et des Sciences Pharmaceutiques de l’Université de Douala (FMSP–UD), BP 2701 Douala, Cameroon
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7
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Burns R, Zhang CX, Patel P, Eley I, Campos-Matos I, Aldridge RW. Migration health research in the United Kingdom: A scoping review. J Migr Health 2021; 4:100061. [PMID: 34405201 PMCID: PMC8352015 DOI: 10.1016/j.jmh.2021.100061] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/05/2021] [Accepted: 07/05/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND One in seven people living in the United Kingdom (UK) is an international migrant, rendering migrants an important population group with diverse and dynamic health and healthcare needs. However, there has been no attempt to map contemporary trends within migration health research conducted in the UK. The aim of this scoping review was to describe trends within migration health research and identify gaps for future research agendas. METHODS PubMed and Embase were systematically searched for empirical research with a primary focus on the concepts "health" and "migrants" published between 2001 and 2019. Findings were analysed using the UCL-Lancet Commission on Migration and Health Conceptual Framework for Migration and Health. RESULTS In total, 399 studies were included, with almost half (41.1%; 164/399) published in the last five years of the study period between 2015 and 2019 and a third (34.1%; 136/399) conducted in London. Studies included asylum seekers (14.8%; 59/399), refugees (12.3%; 49/399), and undocumented migrants or migrants with insecure status (3.5%; 14/399), but most articles (74.9%; 299/399) did not specify a migrant sub-group. The most studied health topics were specific disease outcomes such as infectious diseases (24.1% of studies) and mental health (19.1%) compared to examining systems or structures that impact health (27.8%), access to healthcare (26.3%), or specific exposures or behaviours (35.3%). CONCLUSIONS There has been a growing interest in migration health. Ensuring a diverse geographic distribution of research conducted in the UK and disaggregation by migrant sub-group is required for a nuanced and region-specific understanding of specific health needs, interventions and appropriate service delivery for different migrant populations. More research is needed to understand how migration policy and legislation intersect with both the social determinants of health and access to healthcare to shape the health of migrants in the UK.
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Affiliation(s)
- Rachel Burns
- Centre of Public Health Data Science, Institute of Health Informatics, University College London, 222 Euston Road, London NW1 2DA, United Kingdom
- Corresponding author at: Centre of Public Health Data Science, Institute of Health Informatics, University College London, 222 Euston Road, London NW1 2DA, United Kingdom.
| | - Claire X. Zhang
- Centre of Public Health Data Science, Institute of Health Informatics, University College London, 222 Euston Road, London NW1 2DA, United Kingdom
- Public Health England, Wellington House, 133-155 Waterloo Rd, South Bank, London SE1 8UG, United Kingdom
| | - Parth Patel
- Centre of Public Health Data Science, Institute of Health Informatics, University College London, 222 Euston Road, London NW1 2DA, United Kingdom
| | - Ida Eley
- Centre of Public Health Data Science, Institute of Health Informatics, University College London, 222 Euston Road, London NW1 2DA, United Kingdom
| | - Ines Campos-Matos
- Public Health England, Wellington House, 133-155 Waterloo Rd, South Bank, London SE1 8UG, United Kingdom
- Collaborative Centre for Inclusion Health, Institute of Epidemiology and Healthcare, University College London, 1-19 Torrington Place, London WC1E 7HB, United Kingdom
| | - Robert W. Aldridge
- Centre of Public Health Data Science, Institute of Health Informatics, University College London, 222 Euston Road, London NW1 2DA, United Kingdom
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Aldridge RW, Burns R, Kirkby V, Elsay N, Murray E, Perski O, Navaratnam AM, Williamson EJ, Nieto-Martínez R, Miranda JJ, Hugenholtz GCG. Health on the Move (HOME) Study: Using a smartphone app to explore the health and wellbeing of migrants in the United Kingdom. Wellcome Open Res 2020; 5:268. [PMID: 33842695 PMCID: PMC8008349 DOI: 10.12688/wellcomeopenres.16348.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 11/20/2022] Open
Abstract
Background/Aim: We have a limited understanding of the broader determinants of health of international migrants and how these change over time since migration to the United Kingdom (UK). To address this knowledge gap, we aim to conduct a prospective cohort study with data acquisition via a smartphone application (app). In this pilot study, we aim to 1) determine the feasibility of the use of an app for data collection in international migrants, 2) optimise app engagement by quantifying the impact of specific design features on the completion rates of survey questionnaires and on study retention, 3) gather preliminary profile health status data, to begin to examine how risk factors for health are distributed among migrants. Methods: We will recruit 275 participants through a social media campaign and through third sector organisations that work with or support migrants in the UK. Following consent and registration, data will be collected via surveys. To optimise app engagement and study retention, we will quantify the impact of specific design features (i.e. the frequency of survey requests, the time of day for app notifications, the frequency of notifications, and the wording of notifications) via micro-randomised process evaluations. The primary outcome for this study is survey completion rates with numerator as the number of surveys completed and denominator as the total number of available surveys. Secondary outcomes are study retention rates and ratings of interest after app usage. Ethics and dissemination: We have obtained approval to use consented patient identifiable data from the University College London Ethics Committee. Improving engagement with the app and gathering preliminary health profile data will help us identify accessibility and usability issues and other barriers to app and study engagement prior to moving to a larger study.
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Affiliation(s)
- Robert W. Aldridge
- UCL Public Health Data Science Research Group, Institute of Health Informatics, University College London, London, Camden, NW1 2DA, UK
| | - Rachel Burns
- UCL Public Health Data Science Research Group, Institute of Health Informatics, University College London, London, Camden, NW1 2DA, UK
| | - Victoria Kirkby
- UCL Public Health Data Science Research Group, Institute of Health Informatics, University College London, London, Camden, NW1 2DA, UK
| | - Nadia Elsay
- UCL Public Health Data Science Research Group, Institute of Health Informatics, University College London, London, Camden, NW1 2DA, UK
| | - Elizabeth Murray
- Primary Care & Population Health, Institute of Epidemiology & Health Care, University College London, London, NW3 2PF, UK
| | - Olga Perski
- Behavioural Science and Health, Faculty of Population Health Sciences, Institute of Epidemiology & Health Care, University College London, London, WC1E 6BT, UK
| | - Annalan M. Navaratnam
- UCL Public Health Data Science Research Group, Institute of Health Informatics, University College London, London, Camden, NW1 2DA, UK
| | - Elizabeth J. Williamson
- Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | | | - J. Jaime Miranda
- Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- The George Institute for Global Health, UNSW, Sydney, Australia
| | - Greg C. G. Hugenholtz
- UCL Public Health Data Science Research Group, Institute of Health Informatics, University College London, London, Camden, NW1 2DA, UK
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9
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Pathak N, Patel P, Burns R, Haim L, Zhang CX, Boukari Y, Gonzales-Izquierdo A, Mathur R, Minassian C, Pitman A, Denaxas S, Hemingway H, Hayward A, Sonnenberg P, Aldridge RW. Healthcare resource utilisation and mortality outcomes in international migrants to the UK: analysis protocol for a linked population-based cohort study using Clinical Practice Research Datalink (CPRD), Hospital Episode Statistics (HES) and the Office for National Statistics (ONS). Wellcome Open Res 2020. [DOI: 10.12688/wellcomeopenres.15931.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
An estimated 14.2% (9.34 million people) of people living in the UK in 2019 were international migrants. Despite this, there are no large-scale national studies of their healthcare resource utilisation and little is known about how migrants access and use healthcare services. One ongoing study of migration health in the UK, the Million Migrants study, links electronic health records (EHRs) from hospital-based data, national death records and Public Health England migrant and refugee data. However, the Million Migrants study cannot provide a complete picture of migration health resource utilisation as it lacks data on migrants from Europe and utilisation of primary care for all international migrants. Our study seeks to address this limitation by using primary care EHR data linked to hospital-based EHRs and national death records. Our study is split into a feasibility study and a main study. The feasibility study will assess the validity of a migration phenotype, a transparent reproducible algorithm using clinical terminology codes to determine migration status in Clinical Practice Research Datalink (CPRD), the largest UK primary care EHR. If the migration phenotype is found to be valid, the main study will involve using the phenotype in the linked dataset to describe primary care and hospital-based healthcare resource utilisation and mortality in migrants compared to non-migrants. All outcomes will be explored according to sub-conditions identified as research priorities through patient and public involvement, including preventable causes of inpatient admission, sexual and reproductive health conditions/interventions and mental health conditions. The results will generate evidence to inform policies that aim to improve migration health and universal health coverage.
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10
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Saunders CL, Steventon A, Janta B, Stafford M, Sinnott C, Allen L, Deeny SR. Healthcare utilization among migrants to the UK: cross-sectional analysis of two national surveys. J Health Serv Res Policy 2020; 26:54-61. [PMID: 32192359 PMCID: PMC7734958 DOI: 10.1177/1355819620911392] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To contribute objective evidence on health care utilization among migrants to the UK to inform policy and service planning. Methods We analysed data from Understanding Society, a household survey with fieldwork from 2015 to 2017, and the European Health Interview Survey with data collected between 2013 and 2014. We explored health service utilization among migrants to the UK across primary care, inpatient admissions and maternity care, outpatient care, mental health, dental care and physiotherapy. We adjusted for age, sex, long-term health conditions and time since moving to the UK. Results Health care utilization among migrants to the UK was lower than utilization among the UK-born population for all health care dimensions except inpatient admissions for childbirth; odds ratio (95%CI) range 0.58 (0.50–0.68) for dental care to 0.88 (0.78–0.98) for primary care). After adjusting for differences in age and self-reported health, these differences were no longer observed, except for dental care (odds ratio 0.57, 95%CI 0.49–0.66, P < 0.001). Across primary care, outpatient and inpatient care, utilization was lower among those who had recently migrated, increasing to the levels of the nonmigrant population after 10 years or more since migrating to the UK. Conclusions This study finds that newly arrived migrants tend to utilize less health care than the UK population and that this pattern was at least partly explained by better health, and younger age. Our findings contribute nationally representative evidence to inform public debate and decision-making on migration and health.
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Affiliation(s)
- Catherine L Saunders
- Senior Research Associate, Primary Care Unit, University of Cambridge, Cambridge, UK
| | - Adam Steventon
- Director of Data Analytics, The Health Foundation, London, UK
| | | | - Mai Stafford
- Principal Data Analyst, The Health Foundation, London, UK
| | - Carol Sinnott
- NIHR Clinical Lecturer in General Practice, THIS Institute, University of Cambridge, Cambridge, UK
| | | | - Sarah R Deeny
- Assistant Director of Data Analytics, The Health Foundation, London, UK
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11
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Harrison HL, Daker-White G. Beliefs and challenges held by medical staff about providing emergency care to migrants: an international systematic review and translation of findings to the UK context. BMJ Open 2019; 9:e028748. [PMID: 31371292 PMCID: PMC6677953 DOI: 10.1136/bmjopen-2018-028748] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Migration has increased globally. Emergency departments (EDs) may be the first and only contact some migrants have with healthcare. Emergency care providers' (ECPs) views concerning migrant patients were examined to identify potential health disparities and enable recommendations for ED policy and practice. DESIGN Systematic review and meta-synthesis of published findings from qualitative studies. DATA SOURCES Electronic databases (Ovid Medline, Embase (via Ovid), PsycINFO (via OVID), CINAHL, Web of Science and PubMed), specialist websites and journals were searched. ELIGIBILITY CRITERIA Studies employing qualitative methods published in English. SETTINGS EDs in high-income countries. PARTICIPANTS ECPs included doctors, nurses and paramedics. TOPIC OF ENQUIRY Staff views on migrant care in ED settings. DATA EXTRACTION AND SYNTHESIS Data that fit the overarching themes of 'beliefs' and 'challenges' were extracted and coded into an evolving framework. Lines of argument were drawn from the main themes identified in order to infer implications for UK policy and practice. RESULTS Eleven qualitative studies from Europe and the USA were included. Three analytical themes were found: challenges in cultural competence; weak system organisation that did not sufficiently support emergency care delivery; and ethical dilemmas over decisions on the rationing of healthcare and reporting of undocumented migrants. CONCLUSION ECPs made cultural and organisational adjustments for migrant patients, however, willingness was dependent on the individual's clinical autonomy. ECPs did not allow legal status to obstruct delivery of emergency care to migrant patients. Reported decisions to inform the authorities were mixed; potentially leading to uncertainty of outcome for undocumented migrants and deterring those in need of healthcare from seeking treatment. If a charging policy for emergency care in the UK was introduced, it is possible that ECPs would resist this through fears of widening healthcare disparities. Further recommendations for service delivery involve training and organisational support.
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Affiliation(s)
- Hooi-Ling Harrison
- Emergency Department, Princess Royal University Hospital, King’s College London School of Medical Education, London, UK
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12
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Burns R, Pathak N, Campos-Matos I, Zenner D, Katikireddi SV, Muzyamba MC, Miranda JJ, Gilbert R, Rutter H, Jones L, Williamson E, Hayward AC, Smeeth L, Abubakar I, Hemingway H, Aldridge RW. Million Migrants study of healthcare and mortality outcomes in non-EU migrants and refugees to England: Analysis protocol for a linked population-based cohort study of 1.5 million migrants. Wellcome Open Res 2019; 4:4. [PMID: 30801036 PMCID: PMC6381442 DOI: 10.12688/wellcomeopenres.15007.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2019] [Indexed: 12/13/2022] Open
Abstract
Background: In 2017, 15.6% of the people living in England were born abroad, yet we have a limited understanding of their use of health services and subsequent health conditions. This linked population-based cohort study aims to describe the hospital-based healthcare and mortality outcomes of 1.5 million non-European Union (EU) migrants and refugees in England. Methods and analysis: We will link four data sources: first, non-EU migrant tuberculosis pre-entry screening data; second, refugee pre-entry health assessment data; third, national hospital episode statistics; and fourth, Office of National Statistics death records. Using this linked dataset, we will then generate a population-based cohort to examine hospital-based events and mortality outcomes in England between Jan 1, 2006, and Dec 31, 2017. We will compare outcomes across three groups in our analyses: 1) non-EU international migrants, 2) refugees, and 3) general population of England. Ethics and dissemination: We will obtain approval to use unconsented patient identifiable data from the Secretary of State for Health through the Confidentiality Advisory Group and the National Health Service Research Ethics Committee. After data linkage, we will destroy identifying data and undertake all analyses using the pseudonymised dataset. The results will provide policy makers and civil society with detailed information about the health needs of non-EU international migrants and refugees in England.
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Affiliation(s)
- Rachel Burns
- Centre for Public Health Data Science, University College London, London, UK
| | - Neha Pathak
- Centre for Public Health Data Science, University College London, London, UK
- Institute of Epidemiology and Healthcare, University College London, London, UK
| | | | - Dominik Zenner
- Migration Health Division, International Organization for Migration, Brussels, Belgium
- Institute for Global Health, University College London, London, UK
| | - Srinivasa Vittal Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | | | - J. Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ruth Gilbert
- Institute of Epidemiology and Healthcare, University College London, London, UK
- Administrative Data Research Centre for England, University College London, London, UK
| | - Harry Rutter
- Faculty of Humanities and Social Sciences, University of Bath, Bath, UK
| | - Lucy Jones
- UK programme manager, Doctors of the World, London, UK
| | - Elizabeth Williamson
- Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Andrew C. Hayward
- Institute of Epidemiology and Healthcare, University College London, London, UK
| | - Liam Smeeth
- Department of Non-Communicable Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
| | - Harry Hemingway
- Institute of Health Informatics Research, Faculty of Population Health Sciences, University College London, London, UK
| | - Robert W. Aldridge
- Centre for Public Health Data Science, University College London, London, UK
- Public Health England, London, UK
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