Neurological diseases and health care utilization among first-generation immigrants

Abstract

Migrants may constitute a risk group and should have specific targets for health policy. To identify their health needs, it is important to investigate their epidemiological profile and their access to health services. The aim of this study was to identify the pattern of hospital and neurological services use among immigrants living in Brescia (Italy). The analysis took into account the records of 45,645 immigrants admitted to the ER (Emergency Room) as well as the discharge data of 6419 patients hospitalized in the Department of Neurology of the Azienda Ospedaliera Spedali Civili di Brescia, over a 3.5 years period. To take confounding factors into account, immigrant patients admitted to the department of Neurology were compared to a selection of Italian patients matched by age and sex. The main objectives were to explore causes of admission of the immigrant population-along with socio-demographic characteristics-to the Emergency Room and to the Neurology Units. Immigrants showed a similar pattern of hospital use to the Italian patients, although with a higher frequency of infective diseases and traumatic injuries. They also showed a higher mean Diagnosis-Related Group (DRG) weight than the Italians. Average length of hospitalization was longer in immigrant population. However, the use of neurological services by migrants is less than their demographic share. Poorer economic and social conditions, as well as a worse labor market experienced by immigrants may expose them to risk factors for injuries and infective diseases. Reducing the language and bureaucratic barriers, as well as enhancing cross-cultural skills of physicians, might be crucial in decreasing the length and the cost of hospitalization.

Utilization of health care services by migrants in Europe—a systematic literature review

“…This is viewed by some as an overutilization of services, resulting in higher costs when compared to accessing primary care (2,28,29). Several studies in Germany suggest that cultural differences or different health behaviours (7,11) could lead to an increased disease prevalence among migrants or a longer duration of untreated illness, which worsens the severity of conditions and results in longer hospitalizations (24). The generally higher utilization of A&E services by migrants, however, could also be due to the fact that some European countries provide emergency care free of charge (without any type of co-payment for the patient), which makes these services more affordable (39).…”

“…A study from the Netherlands indicates that, for age groups >45 years, there was a 24% higher chance for Turkish and an 11% higher chance for Surinamese patients to be hospitalized in an unplanned re-admission than for natives (25). In a study in Italy, migrants from Morocco, Turkey, the Antilles and Surinam who were hospitalized were found to have, on average, a longer length of stay of at least three days, which might be partly explained by socio-economic indicators (24).…”

“…Findings on hospitalization are mixed. Some studies, from Spain, Norway, Germany and Italy, found that most migrant groups have a higher utilization of hospital services than natives (7,11,15,24,25). A study from the Netherlands indicates that, for age groups >45 years, there was a 24% higher chance for Turkish and an 11% higher chance for Surinamese patients to be hospitalized in an unplanned re-admission than for natives (25).…”

Access to Norwegian healthcare system – challenges for sub-Saharan African immigrants

“…Access to health care services is often one of the indicators of equity in health care provision [10]. Providing health care on equal terms has become a challenge for the health care system all over the world [11][12][13][14]. Some individuals do not achieve this fairness because of their social position or other socially determined factors, which in essence negatively affect their health and quality of life in general [15].…”

“…Lack of access to healthcare services by immigrants represents a concern for the host countries and the delay in accessing healthcare services may lead to late diagnosis, delayed treatment, and morbidity [27,28]. Social and economic deprivation has been linked to higher burden and greater risk of disease among some immigrant groups from low-income countries in Norway [4,29] and other high-income countries [13]. A number of studies among migrants and ethnic minorities have revealed important barriers in healthcare access [30][31][32].…”