San Antonio refugees: Their demographics, healthcare profiles, and how to better serve them

Abstract

Objective The recent refugee crisis has resulted in the largest burden of displacement in history, with the US being the top resettlement country since 1975. Texas welcomed the second most US-bound refugees in 2016, with a large percentage arriving in San Antonio. Yet, the composition of the San Antonio refugees has not been described and their healthcare needs remain ill-defined. Through this study, we aim at elucidating their demographics and healthcare profiles, with the goal of devising recommendations to help guide refugee program development and guide other refugee resettlement programs. Methods Data from 731 charts belonging to 448 patients at the San Antonio Refugee Health Clinic (SARHC) were extracted and analyzed. Data included age, gender, country of origin, first language, interpretation need, health insurance status, medical history, vital signs, diagnoses, and prescribed medications. Results Women constituted the majority of patients (n = 267; 56.4%), and the median age of all patients was 39 (Q1:26, Q3:52). Nepali-speaking Bhutanese patients were the most represented group (n = 107, 43.1%), followed by Iraqi (n = 35, 14.1%), Burmese (n = 30, 12.1%), and Iranian (n = 19, 7.7%) refugees. Of those who responded, 200 (86.6%) did not have any form of health insurance. Additionally, 262 (50.9%) had a body-mass index (BMI) in the overweight or obese range. Further, 61.4% (n = 337) had blood pressures in the hypertensive range, while 9.3% (n = 51) had an elevated blood pressure. On average, each patient had 1.9 complaints, with abdominal pain, headaches, and cough being the predominant complaints. Allergic rhinitis, viral upper respiratory infections, and elevated blood pressure were the most common diagnoses. However, the list of common diagnoses differed per country of origin. Conclusion The SARHC demographics were different from those of other Texas refugees. The rate of the uninsured and the burden of non-communicable diseases were high. Furthermore, each refugee subgroup had a different set of common problems. These findings reveal important considerations for refugee healthcare providers and the unique approach that may be required for different communities.

Prevalence of otolaryngological disease in a refugee population compared to US‐born patients

“…Prior reports have listed allergic rhinitis, viral upper respiratory infections, and elevated blood pressure as the most common diagnoses among refugees resettled in Texas. 21 Interestingly we found a much higher proportion of refugees/asylees with allergic rhinitis (45%) compared to that study (7.5%). 21 Additionally, previous work showed allergic rhinitis to be among the top five diagnoses in Syrian refugees living in Turkey.…”

“… 21 Interestingly we found a much higher proportion of refugees/asylees with allergic rhinitis (45%) compared to that study (7.5%). 21 Additionally, previous work showed allergic rhinitis to be among the top five diagnoses in Syrian refugees living in Turkey. 22 Some groups have postulated that the very little prevalence of allergic rhinitis in these populations is due to the “hygiene hypothesis”—where increased exposure to environmental allergens is a protective factor for allergies, asthma, and eczema.…”

Health services access, utilization, and barriers for Arabic-speaking refugees resettled in Connecticut, USA

“…A similar result was found in the Iraqi refugee population in Michigan, where 100% of refugees surveyed one year after arrival were covered by Medicaid [32]. Conversely, 86.6% of refugees in San Antonio, Texas did not have any form of health insurance [33]. This variation in health coverage is likely attributable to differences in Medicaid eligibility requirements from state to state [34], with states adopting Medicaid expansion under the Patient Protection and Affordable Care Act, such as Michigan and Connecticut [35], providing increased access to healthcare for refugees in comparison to states that have not adopted the expansion, such as Texas.…”

Utilization, satisfaction and barriers to access of health services for Arabic-speaking refugees resettled in Connecticut, USA after completion of Refugee Medical Assistance (RMA)

“…Conversely, 86.6% of refugees in San Antonio, Texas did not have any form of health insurance[26]. This variation in health coverage is likely attributable to differences in Medicaid eligibility requirements from state to state[27], with states adopting Medicaid expansion under the Affordable Care Act, such as Michigan and Connecticut, providing increased access to healthcare for refugees in comparison to states that have not adopted the expansion, such as Texas.…”