Disparities in emergency department use between Italians and migrants residing in Rome, Italy: the Rome Dynamic Longitudinal Study from 2005 to 2015

Abstract

Background The Emergency Department (ED) can be considered an indicator of accessibility and quality and can be influenced in period of economic downturns. In the last fifteen years, the number of migrants in Italy has doubled (from 2.4 million in 2005 to 5.2 in 2019, 4.1 and 8.7% of the total population, respectively). However, evidence about migrants’ healthcare use is poor, and no studies focused on the ED utilisation rate during the Great Recession are available. This study aims to analyse trends in all-cause and cause-specific ED utilisation among migrants and Italians residing in Rome, Italy, before and after 2008. Methods Longitudinal study based on data from the Municipal Register of Rome linked to the Emergency Department Register from 2005 to 2015. We analysed 2,184,467 individuals, aged 25–64 in each year. We applied a Hurdle model to estimate the propensity to use the ED and to model how often individuals accessed the ED. Results Migrants were less likely to be ED users than Italians, except for Africans (RR = 1.46, 95%CI 1.40–1.52) and Latin Americans (RR = 1.04, 95%CI 1.00–1.08) who had higher all-cause utilisation rates than non-migrants. Compared to the pre-2008 period, in the post-2008 we found an increase in the likelihood of being an ED user (OR = 1.34, 95%CI 1.34–1.35), and a decrease in ED utilisation rates (RR = 0.96, 95%CI 0.96–0.97) for the whole population, with differences among migrant subgroups, regardless of cause. Conclusions This study shows differences in the ED utilisation between migrants and Italians, and within the migrant population, during the Great Recession. The findings may reflect differentials in the health status, and barriers to access primary and secondary care among migrants. In this regard, health policies and cuts in health spending measures may have played a key role, and interventions to tackle health and access disparities should include policy measures addressing the underlying factors, adopting a Health in All Policies perspective. Further researches focusing on specific groups of migrants, and on the causes and diagnoses related to the ED utilisation, may help to explain the differences observed.

Gendering health differences between nonmigrants and migrants by duration of stay in Italy

“…They also exhibit lower mortality rates (Fedeli et al 2015;Pacelli et al 2016) and are less likely to report functional limitations and chronic illnesses (Caselli, Loi, and Strozza 2017). Moreover, a recent study shows that hospital emergency department use varies according to migrants' country of origin (Trappolini et al 2020). Finally, studies of hospitalisation rates report mixed results (Cacciani et al 2011;Casadei et al 2016).…”

Mortality differences between migrants and Italians residing in Rome before, during, and in the aftermath of the great recession. A longitudinal cohort study from 2001 to 2015

“…It could also be explained by the economic downturn compounding precarious employment conditions and low socioeconomic status. Certainly, there is evidence that migrant health worsens with longer residence in the host country [44,[75][76][77]. However, in the absence of information about the length of stay, we cannot confirm this hypothesis.…”

“…A longitudinal population-based open cohort study was conducted, using data from the Rome Dynamic Longitudinal Study cohort, which is part of the Italian Network of Longitudinal Metropolitan studies (IN-liMeS) [41,42,44]. The dynamic cohort is based on the Municipal Register of Rome, which provides individual demographic information (sex, age, birthdate, birthplace, date of registration in the Municipality of Rome, and date of cancellation from the population register) for all who have been resident in Rome from 1st January 2001 to 31st December 2015 (4,143,462 records, which correspond to 3,978,400 individuals).…”

Health status and fertility intentions among migrants

“…by reducing access barriers to health services) and improving their living and working conditions might be a prerequisite to allow them to maintain (and to actually realize) their fertility intentions, contributing to raise national fertility levels. This might also be the case of countries, such as Italy, where equity remains a fundamental principle of the health system (see MIPEX health index, IOM, 2016) but disparities in the use of health services persist (Trappolini et al, 2020).…”