Migrants’ primary care utilisation before and during the COVID-19 pandemic in England: An interrupted time series analysis

Zhang, Claire X.; Boukari, Yamina; Pathak, Neha; Mathur, Rohini; Katikireddi, Srinivasa Vittal; Patel, Parth; Campos-Matos, Inês; Lewer, Dan; Nguyen, Vincent; Hugenholtz, Greg C. G.; Burns, Rachel J.; Mulick, Amy; Henderson, Alasdair D; Aldridge, Robert W

doi:10.1016/j.lanepe.2022.100455

Cited by 21 publications

(17 citation statements)

References 35 publications

(52 reference statements)

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“…Moreover, being underweight preconception increases odds of small for gestational age, low birth weight and preterm birth 7 . Conversely, lower odds of many physical and mental health conditions among probable migrants may not be a positive finding: it could indicate lack of diagnosis due to, for example, lower primary care access rates among migrants compared to non-migrants 26 ; lack of diagnosis could mean preconception care that could support a healthy pregnancy does not happen.…”

Section: Discussionmentioning

confidence: 98%

“…Age (years), ethnicity (categorised as white, mixed, Asian, black, other or ‘missing’ ethnicity), number of previous live births, and most deprived IMD decile (as a binary variable) were included as covariates in multivariable models. Ethnicity was included because ethnicity is known to impact maternal outcomes 2,25 and may have a relationship with migration status 26 ; mother’s age and deprivation are also linked to maternal outcomes 2 and may be associated with migration status. Number of previous live births were included within models for previous obstetric complications (because more live births results in more opportunity for previous obstetric complications), health behaviours (because they may have received more pregnancy-related health behaviour advice through previous pregnancies), underweight, overweight and obesity (because weight gain frequently occurs between pregnancies 27 ) and late antenatal booking (because women with more previous live births may be more aware of the antenatal care system and the importance of booking by 10 weeks gestation, or may have childcare commitments that preclude early booking).…”

Section: Methodsmentioning

confidence: 99%

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Preconception health among migrant women in England: a cross-sectional analysis of maternity services data 2018-2019

McGranahan

Augarde

Schoenaker

et al. 2023

Preprint

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ObjectiveTo examine inequalities in preconception health between migrant women in potentially vulnerable situations and non-migrant women.DesignNational cross-sectional study.SettingData from the National Health Service (NHS) Maternity Services Data Set (MSDS) version 1.5, using data submitted by NHS maternity services in England.ParticipantsAll 652,880 women with an antenatal booking appointment between 1/4/2018 and 31/3/2019 were included. Data regarding migration status were available for 66.2% of the study population (n=432,022).Outcome measuresPrevalence of preconception indicators were compared between probable migrants (those with complex social factors and English not their first language), possible migrants due to English not being a first language (without complex social factors), possible migrants due to complex social factors (who speak English as a first language) and unlikely migrants (those who speak English as a first language without complex social factors). Complex social factors include recent migrants, asylum seekers or refugees, difficulty reading or speaking English; alcohol and/or drugs misuse; all those aged under 20; and/or experiencing domestic abuse. Odds ratios were calculated comparing preconception indicators among those identified as migrants compared to unlikely migrants.ResultsWomen identified as probable migrants (n=25,070) had over twice the odds of not taking folic acid before pregnancy and of having their first antenatal booking appointment after the recommended 10 weeks gestation compared to unlikely migrants (n=303,737), after adjusting for area-based deprivation level, mothers age at booking, number of previous live births and ethnicity (odds ratio 2.15 (95% confidence interval 2.06 to 2.25) and 2.25 (2.18 to 2.32) respectively). Probable migrants had increased odds of previous obstetric complications and being underweight at booking, but lower odds of recorded physical and mental health conditions (apart from diabetes and hepatitis b), smoking and obesity in unadjusted and adjusted analyses.ConclusionsInequalities between migrant women in potentially vulnerable situations and non-migrants exist across many preconception indicators. Findings highlight the opportunity to improve preconception health in this population in order to reduce health inequalities and improve perinatal and neonatal outcomes.

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Section: Discussionmentioning

confidence: 98%

Section: Methodsmentioning

confidence: 99%

Preconception health among migrant women in England: a cross-sectional analysis of maternity services data 2018-2019

McGranahan

Augarde

Schoenaker

et al. 2023

Preprint

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“…Socio-economic disparities, such as living in overcrowded accommodation [8] and working in insecure and low-paid jobs [9], may impact the ability to take preventative measures including self-isolation, wearing personal protective equipment or social distancing [10]. Furthermore, healthcare access barriers [11] and limited linguistically and culturally appropriate public health messaging [12] may affect migrants' awareness of the disease as well as of protective measures, putting them at higher exposure risk, and if infected, may result in later presentation at the hospital with more severe COVID-19 [13], [14].…”

Section: Introductionmentioning

confidence: 99%

The incidence of COVID-19-related hospitalisation in migrants in the UK: Findings from the Virus Watch prospective community cohort study

Fong

Nguyen

Burns

et al. 2023

Preprint

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Background: Migrants in the UK may be at higher risk of SARS-CoV-2 exposure; however, little is known about their risk of COVID-19-related hospitalisation during waves 1-3 of the pandemic. Methods: We analysed secondary care data linked to Virus Watch study data for adults and estimated COVID-19-related hospitalisation incidence rates by migration status. To estimate the total effect of migration status on COVID-19 hospitalisation rates, we ran fixed-effect Poisson regression for wave 1 (01/03/2020-31/08/2020; wildtype), and fixed-effect negative binomial regressions for waves 2 (01/09/2020-31/05/2021; Alpha) and 3 (01/06/2020-31/11/2021; Delta). Results of all models were then meta-analysed. Results: Of 30,276 adults in the analyses, 26,492 (87.5%) were UK-born and 3,784 (12.5%) were migrants. COVID-19-related hospitalisation incidence rates for UK-born and migrant individuals across waves 1-3 were 2.7 [95% CI 2.2-3.2], and 4.6 [3.1-6.7] per 1,000 person-years, respectively. Pooled incidence rate ratios across waves suggested increased rate of COVID-19-related hospitalisation in migrants compared to UK-born individuals in unadjusted 1.68 [1.08-2.60] and adjusted analyses 1.35 [0.71-2.60]. Conclusions: Our findings suggest migration populations in the UK have excess risk of COVID-19-related hospitalisations and underscore the need for more equitable interventions particularly aimed at COVID-19 vaccination uptake among migrants.

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“…in healthcare, hospitality, retail and delivery sectors), increased use of public transport and increased likelihood of living in multi-generational households 3,4 . Barriers to accessing primary care are well documented for migrants [5][6][7][8][9] and may negatively impact vaccine uptake, thus potentially putting migrants at greater risk of infection and severe outcomes from the combination of greater exposure and undervaccination 10 . Migrants in high-income countries have been over-represented in SARS-CoV-2 infections, hospitalisations and deaths [11][12][13] .…”

Section: Introductionmentioning

confidence: 99%

SARS-CoV-2 infections in migrants and the role of household overcrowding: A causal mediation analysis of Virus Watch data

Boukari

Beale

Nguyen

et al. 2022

Preprint

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Background: Migrants are over-represented in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections globally; however, evidence is limited for migrants in England and Wales. Household overcrowding is a risk factor for SARS-CoV-2 infection, with migrants more likely to live in overcrowded households than UK-born individuals. We aimed to estimate the total effect of migration status on SARS-CoV-2 infection and to what extent household overcrowding mediated this effect. Methods: We included a sub-cohort of individuals from the Virus Watch prospective cohort study during the second SARS-CoV-2 wave (1st September 2020-30th April 2021) who were aged at least 18 years, self-reported the number of rooms in their household and had no evidence of SARS-CoV-2 infection pre-September 2020. We estimated total, indirect and direct effects using Buis logistic decomposition regression controlling for age, sex, ethnicity, clinical vulnerability, occupation, income and whether they lived with children. Results: In total, 23,478 individuals were included. 9.07% (187/2,062) of migrants had evidence of infection during the study period versus 6.27% (1,342/21,416) of UK-born individuals. Migrants had 22% higher odds of infection during the second wave (total effect; OR:1.22, 95%CI:1.01-1.47). Household overcrowding accounted for approximately 32% of these increased odds (indirect effect, OR:1.07, 95%CI:1.03-1.12; proportion accounted for: indirect effect[7]/total effect[22]=0.32). Conclusion: Migrants had higher odds of SARS-CoV-2 infection during the second wave compared with UK-born individuals and household overcrowding explained 32% of these increased odds. Policy interventions to reduce household overcrowding for migrants are needed as part of efforts to tackle health inequalities during the pandemic and beyond.

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Migrants’ primary care utilisation before and during the COVID-19 pandemic in England: An interrupted time series analysis

Cited by 21 publications

References 35 publications

Preconception health among migrant women in England: a cross-sectional analysis of maternity services data 2018-2019

Preconception health among migrant women in England: a cross-sectional analysis of maternity services data 2018-2019

The incidence of COVID-19-related hospitalisation in migrants in the UK: Findings from the Virus Watch prospective community cohort study

SARS-CoV-2 infections in migrants and the role of household overcrowding: A causal mediation analysis of Virus Watch data

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