Paediatric emergency department utilisation rates and maternal migration status in the Born in Bradford cohort: A cross-sectional study

Abstract

BackgroundGlobally, international migration is increasing. Population growth, along with other demographic changes, may be expected to put new pressures on healthcare systems. Some studies across Europe suggest that emergency departments (EDs) are used more, and differently, by migrants compared to non-migrant populations, which may be a result of unfamiliarity with the healthcare systems and difficulties accessing primary healthcare. However, little evidence exists to understand how migrant parents, who are typically young and of childbearing age, utilise EDs for their children. This study aimed to examine the association between paediatric ED utilisation in the first 5 years of life and maternal migration status in the Born in Bradford (BiB) cohort study. Methods and findingsWe analysed linked data from the BiB study-an ongoing, multi-ethnic prospective birth cohort study in Bradford. Bradford is a large, ethnically diverse city in the north of England. In 2017, more than a third of births in Bradford were to mothers who were born outside the UK. Between March 2007 and December 2010, pregnant women were recruited to BiB during routine antenatal care, and the children born to these mothers have been, and continue to be, followed over time to assess how social, genetic, environmental, and behavioural factors impact on health from childhood to adulthood. Data analysed in this study included baseline questionnaire data from BiB mothers, and Bradford Royal Infirmary ED episode data for their children. Main outcomes were likelihood of paediatric ED use (no visits versus at least 1 ED visit in the first 5 years of life) and ED utilisation rates (number and frequency of ED visits) for children who have accessed the ED. The main explanatory variable was mother's migrant status (foreign-born versus UK/Irish-born). Multivariable analyses (logistic and zero-truncated negative binomial regression) were conducted adjusting for socio-demographic and socio-economic factors. The final dataset included 10,168 children born between

Parental migration, socioeconomic deprivation and hospital admissions in preschool children: national cohort study

“…25 Unmeasured sources of heterogeneity among our non-UK born sample includes the length of time since migration, reason for migration and English proficiency. 22,26 Health inequity research using country of birth is well established in other European countries, with cited benefits including the objectivity and stability of this measure over time. 27 In contrast, ethnicity, which is commonly used in health inequity research in the UK, is affected by reliability and completeness in routine data (and is missing for more than 20% of maternal records in this study).…”

“…Using hospital data linked to the Born in Bradford cohort study, Credé et al estimated that the odds of accident and emergency use in the first five years of life was 0.92 times lower among children of mothers from UK/Ireland compared to children of mothers from other countries (OR 0.92, 95% CI 0.83, 1.00). 22 Collectively, these findings help to dispel a common (but unevidenced) perception that migrants and their young children place excessive strain on the UK NHS. 34 Two contrasting explanations can be posited for this major finding: that these young children are healthier and therefore require less healthcare interventions (a form of the "healthy migrant effect"); 35 or that migrant parents and their children face barriers in accessing timely and preventative health services, including emergency care where needed.…”

“…34 Two contrasting explanations can be posited for this major finding: that these young children are healthier and therefore require less healthcare interventions (a form of the "healthy migrant effect"); 35 or that migrant parents and their children face barriers in accessing timely and preventative health services, including emergency care where needed. 22 A third explanation, of returning home for hospital treatment, as has been reported by migrants from Eastern Europe, 36 may alternatively explain particularly low admission rates for some groups of children.…”

Migrant and refugee health: Complex health associations among diverse contexts call for tailored and rights-based solutions

“…In a study done in a high-income setting (the city of Bradford in the United Kingdom) where about one-third of mothers had been born in a different country, for example, the proportion of mothers who had visited the emergency department at least once for a consultation involving their children was found to be lower for migrants compared to nonmigrant mothers. However, among all mothers who utilized emergency services, the utilization rate was significantly higher than that of nonmigrant mothers [4]. Such findings can be useful for planning health provision and identifying possible barriers to attendance.…”

Predictors of Mother and Infant Emergency Department Attendance and Admission: A Prospective Observational Study

“…The social determinants of maternal health have a direct physiological, psychological and developmental impact (Vameghi et al, 2018 ) on children’s health in the early years (Minkovitz et al, 2005 ) and on utilisation of emergency department (ED) services (Credé et al, 2020 ; Flynn et al, 2004 ; Morrison et al, 2013 ). Health emergencies for women can be related to acute events but can also linked to chronic, longer term issues for women that may become acute during pregnancy (Cunningham et al, 2017 ).…”