Disparities in emergency department access, resource allocation, and outcomes between migrants and the local population

Abstract

AIMS: To characterize a group of migrant emergency department (ED) patients regarding demographics, access to the ED, mode of referral, use of resources, and short-term outcomes, and to compare them to a group of local ED patients. METHODS: Prospective cohort study with consecutive enrollment of adult patients presenting to the ED of a Swiss tertiary care hospital from October 21st to November 11th, 2013 and February 1st to February 23rd, 2015. In accordance with the International Organization for Migration, we defined migrants as persons who have changed their country of usual residence, irrespective of their legal status. The primary outcome was defined as the number of resources allocated to migrants, as compared to local patients, using uni- and multivariable quasi-Poisson regressions. Acute morbidity, hospitalization, intensive care unit (ICU) admission, and 30-day mortality were assessed as secondary outcomes. RESULTS: Migrant patients were younger, more often male and self-presenters, and of lower acuity. After adjustment for age, gender and acuity, we observed a non-significant difference of 3.6% in the mean number of resources allocated to migrant patients as compared to local patients (adjusted RR 0.964, CI 0.923-1.006). No difference in 30-day mortality (adjusted OR 0.777, CI 0.346-1.559) was observed between the two patient groups, but migrant patients had lower odds of acute morbidity (adjusted OR 0.652, CI 0.560-0.759), hospitalization (adjusted OR 0.666, CI 0.555-0.799), and ICU admission (adjusted OR 0.649, CI 0.456-0.910). CONCLUSIONS: ED access approximation, resource allocation, and mortality were comparable between migrant patients and local patients. Lower admission rates to wards and the ICU may raise concerns but can be explained by lower acute morbidity in migrant patients.

Prognosis for older people at presentation to emergency department based on frailty and aggregated vital signs

“…Fourth, though we did not record country of origin in this study, patients with a country of origin other than Central and Northern Europe are underrepresented in our sample. However, another study from the identical setting suggests that this population is on average younger and presents with lower acute morbidity 18 . Finally, the illness trajectory is likely what matters to the older frail patient 31 .…”

“…However, another study from the identical setting suggests that this population is on average younger and presents with lower acute morbidity. 18 Finally, the illness trajectory is likely what matters to the older frail patient. 31 The use of FaP-ED might facilitate considerations about this but is limited by the fact that predicting 30-day mortality tells little about the suffering leading up to this moment.…”

“…The hospitalization rate for those aged 65 or older who presented to the ED was 61% in 2019. An estimated 32% of patients have a country of origin other than Central and Northern Europe (including Switzerland), mostly Mediterranean countries and Southeast or Eastern Europe 18 . Patients with obstetric, pediatric and ophthalmologic conditions are treated at separate locations.…”

Screening for elder mistreatment in a Swiss emergency department: a prospective cohort study

“…This tertiary academic urban hospital has >55,000 emergency department visits per year, of which approximately one-third are aged ≥65 years. Western Europeans (Caucasian) comprise two-thirds of the regional population, with the remainder mainly from Mediterranean countries and Eastern Europe [23]. This prospective observational cohort study was designed for quality control using routine data at emergency department presentation.…”