Avoidable hospitalization among migrants and ethnic minority groups: a systematic review

Zuanna, Teresa Dalla; Spadea, Teresa; Milana, Marzio; Petrelli, Alessio; Cacciani, Laura; Simonato, Lorenzo; Canova, Cristina

doi:10.1093/eurpub/ckx113

Cited by 27 publications

(29 citation statements)

References 58 publications

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“… 26 Most such research has been in the USA and New Zealand. 27 In the USA, where ethnicity and race are more strongly related to socioeconomic circumstances than in the UK, studies have found higher amenable mortality among black than white populations. 28 , 29 Similarly, ethnic and racial minorities in the USA have been found to have an increased risk of ambulatory care-sensitive conditions 30 , 31 and lower levels of receipt of high-quality treatment white ethnic groups.…”

Section: Discussionmentioning

confidence: 99%

“… 35 The evidence is especially scarce within Europe. A 2017 systematic review 27 found no studies of avoidable hospital admissions within Europe by ethnicity, race, or migration status, and only three longitudinal studies worldwide. A study by de Bruijne and colleagues, 11 which found ethnic variations in unplanned readmissions and excess length of stay in the Netherlands, seems to be the only study to investigate the quality of health-care delivery by ethnicity in Europe.…”

Section: Discussionmentioning

confidence: 99%

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Assessment of health care, hospital admissions, and mortality by ethnicity: population-based cohort study of health-system performance in Scotland

Katikireddi

Cézard

Bhopal

et al. 2018

The Lancet Public Health

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SummaryBackgroundEthnic minorities often experience barriers to health care. We studied six established quality indicators of health-system performance across ethnic groups in Scotland.MethodsIn this population-based cohort study, we linked ethnicity from Scotland's Census 2001 (April 29, 2001) to hospital admissions and mortality records, with follow-up until April 30, 2013. Indicators of health-system performance included amenable deaths (ie, deaths avertable by effective treatment), preventable deaths (ie, deaths avertable by public health policy), avoidable deaths (combined amenable and preventable deaths), avoidable hospital admissions, unplanned readmissions, and length of stay. We calculated rate ratios and odds ratios (with 95% CIs) using Poisson and logistic regression, which we multiplied by 100, adjusting first for age-related covariates and then for socioeconomic-related and birthplace-related covariates. The white Scottish population was the reference (rate ratio [RR] 100).FindingsThe results are based on 4·61 million people. During the 50·5 million person-years of study, 1·17 million avoidable hospital admissions, 587 740 unplanned readmissions, and 166 245 avoidable deaths occurred. South Asian groups had higher avoidable hospital admissions than the white Scottish group, with the highest reported RRs in Pakistani groups (RR 140·6 [95% CI 131·9–150·0] in men; RR 141·0 [129·0–154·1] in women). There was little variation between ethnic groups in length of stay or unplanned readmission. Preventable and amenable mortality were higher in the white Scottish group than several ethnic minorities including other white British, other white, Indian, and Chinese groups. Such differences were partly diminished by adjustment for socioeconomic status, whereas adjustment for country of birth had little additional effect.InterpretationThese data suggest concerns about the access to and quality of primary care to prevent avoidable hospital admissions, especially for south Asians. Relatively high preventable and amenable deaths in white Scottish people, compared with several ethnic minority populations, were unexpected. Future studies should both corroborate and examine explanations for these patterns. Studies using several indicators simultaneously are also required internationally.FundingChief Scientist's Office, Medical Research Council, NHS Research Scotland, Farr Institute.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Assessment of health care, hospital admissions, and mortality by ethnicity: population-based cohort study of health-system performance in Scotland

Katikireddi

Cézard

Bhopal

et al. 2018

The Lancet Public Health

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“…Several studies have shown the consequences of cultural and linguistic diversity for the care offered by health services, such as cultural misunderstandings, increased stress and anxiety of professionals or language barrier [6][7][8][9]. The different characteristics of the migrant population can hinder patient access and/or decrease the quality of healthcare received [10], leading to considerations of the foreign patient as complicated [11] and problematic [12]. From the nursing perspective, theories and models have emerged that aim to improve health care for this diverse population [6,[13][14][15][16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Hospitalization Experience of Muslim Migrants in Hospitals in Southern Spain—Communication, Relationship with Nurses and Culture. A Focused Ethnography

Pino

Cala

Ayala

et al. 2020

IJERPH

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The coast of southern Spain is one of the main entry points for Africans who want to reach Europe; in this area, there is an important immigrant community of African origin, mostly Muslims. The objective of this study is to describe and understand the hospitalization experience of Muslim migrants in public hospitals in southern Spain, especially their relationship with the nurses who care for them. Data were collected from May 2016 to June 2017. This study followed the principles associated with focused ethnography. During data collection, open interviews with 37 Muslim patients were conducted. Three themes emerged from the inductive data analysis: lack of communication with nurses, discriminatory experiences at the hospital and their experience of Islam in the hospital. We conclude that caring for Muslim patients requires specific training not only for nurses but also for other health professionals; existing communication problems must be addressed by establishing the role of the intercultural mediator as an idiomatic and cultural bridge between patients and nurses. In addition, hiring health professionals with migrant backgrounds would help convert hospitals into spaces for intercultural coexistence.

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“…Studies in USA, New Zealand and Scotland have found higher risk of ACSC admission for many ethnic minorities compared with the white majority populations. [4][5][6] A recent Scottish study found that South Asian groups had higher risk of ACSC admission compared with the white majority group. 4 The primary objective of this study was to elucidate whether ethnicity plays an important role in ACSC among emergency admissions in England at a national and regional level.…”

Section: Introductionmentioning

confidence: 99%

Ethnic disparities in preventable hospitalisation in England: an analysis of 916 375 emergency admissions

Petersen¹,

Kandt

Longley³

2021

J Epidemiol Community Health

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ObjectivesTo study ethnic inequalities in ambulatory care sensitive conditions (ACSC) in England.DesignObservational study of inpatient hospital admission database enhanced with ethnicity coding of patient surnames. The primary diagnosis of the first episode in spells with emergency admission were coded with definitions for acute ACSC, chronic ACSC and vaccine-preventable diseases.SettingNational Health Service England.Participants916 375 ACSC emergency admissions in 7 39 618 patients were identified between April 2011 and March 2012.Main outcome measuresORs of ACSC for each ethnic group relative to the White British majority group adjusted for age, sex and area deprivation.ResultsAcute ACSC admission risk adjusted for age and sex was particularly high among Other (OR 1.73; 95% CI 1.69 to 1.77) and Pakistani (1.51; 95% CI 1.48 to 1.54) compared with White British patients. For chronic ACSC, high risk was found among Other (2.02; 95% CI 1.97 to 2.08), Pakistani (2.07; 95% CI 2.02 to 2.12) and Bangladeshi (1.36; 95% CI 1.30 to 1.42). For vaccine-preventable diseases, other (2.42; 95% CI 2.31 to 2.54), Pakistani (1.94; 95% CI 1.85 to 2.04), Bangladeshi (1.48; 95% CI 1.36 to 1.62), Black African (1.45; 95% CI 1.36 to 1.54) and white other (1.38; 95% CI 1.33 to 1.43) groups. Elevated risk was only partly explained in analyses also adjusting for area deprivation.ConclusionsACSC admission was especially high among individuals of Bangladeshi, Pakistani, Black African, white other or other background with up to twofold differences compared with the white British group. This suggests that these ethnic groups are not receiving optimal primary care.

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Avoidable hospitalization among migrants and ethnic minority groups: a systematic review

Abstract: AH has been used, mostly in the US, to compare different racial/ethnic groups, while it has never been used in Europe to assess migrants' access to PHC. Studies comparing AH rates between migrants and natives in European settings can be helpful in filling this lack of evidence.

Cited by 27 publications

References 58 publications

Assessment of health care, hospital admissions, and mortality by ethnicity: population-based cohort study of health-system performance in Scotland

Assessment of health care, hospital admissions, and mortality by ethnicity: population-based cohort study of health-system performance in Scotland

Hospitalization Experience of Muslim Migrants in Hospitals in Southern Spain—Communication, Relationship with Nurses and Culture. A Focused Ethnography

Ethnic disparities in preventable hospitalisation in England: an analysis of 916 375 emergency admissions

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