The influence of migratory background and parental education on health care utilisation of children

Abstract

School-entry screening data from North RhineWestphalia (NRW), Germany from 2007 were used to investigate child health care utilisation. We focussed on the influence of migratory background and parental education on children's (1) participation in regularly scheduled early recognition examinations, (2) immunisation uptake and (3) referrals due to a school-entry screen-detected complaint. The study sample consisted of 52,171 children out of 17 NRW districts. Bivariable, stratified and multivariable analyses were performed to identify relevant associations between social determinants and health care utilisation outcome parameters. Multivariable logistic regression showed that children belonging to families with a migratory background or low parental education were more likely to have an incomplete documentation of early recognition examinations and to be referred due to a new diagnosis. Children with migratory background were more likely to be sufficiently immunised than children with parents of German ethnicity. For all studied health care utilisation outcomes, kindergarten visit had a supportive effect. Conclusion: In general, the results of our regional study were in line with the results from national populationbased studies. Additionally, a larger likelihood of referrals due to school-screen-detected deficits in children with migratory background or low parental education was detected.

Inequalities in health care utilization among migrants and non-migrants in Germany: a systematic review

“…A different pattern was shown in terms of vaccination uptake. Subject to the type of vaccination, inequalities substantially vary, so a clear trend cannot be identified [ 41 , 61 , 66 , 67 , 69 – 77 ]. Only two studies examined ethnic inequalities in the utilization of the general health check-up that is offered to every person aged ≥35 years [ 26 , 61 ].…”

“… Early detection (children) 5 [ 25 , 65 – 68 ] – ▪ Consistently lower frequency and probability of participation in the preventive health care program for children with migrant background. Vaccination 13 [ 41 , 61 , 66 , 67 , 69 – 77 ] O ▪ Inequality varies with the type of vaccination. ▪ In some cases, lower frequency and probability of utilization notably among 1st generation migrants, in other cases, lower uptake among natives.…”

Social inequities in vaccination coverage among infants and pre-school children in Europe and Australia – a systematic review

“…The association was only significant for the children with one parent having high education.MediumPoethko-Muller, 2009 [25]Germany, National Sample, Longitudinal 2003–06, n = 14 826Survey data and vaccination cards.MMR (Measles)Parental education (3)93.6Children with high SES background were 3% less vaccinated compared to children in low and mid SES group. Adjusted Odds ratios showed no association between socioeconomic status and vaccination.MediumRosenkotter, 2012 [37]Germany, Regional sample (North Rhine-Westfalia), Cross sectional 2007, n = 52 171Survey and school-screening programMMR and DTP combined as part of a series of vaccinationsParental Education (3)41.3Compared to the group with high educated parents, children of parents with low education had 6% lower coverage and double the odds of having incomplete vaccination uptake. There were no significant differences between children with high and medium educated parents.MediumDanis, 2010 [23]Greece, National Sample, Cross sectional 2004–05, n = 3878Survey and vaccination cardMMR and DTP combined as part of a series of vaccinationsMaternal education (4)63.865% of children of mothers with high-school degree and 69% of children of mothers with university degree were completely vaccinated as compared to 54% of children of low educated mothers.…”

Health service utilisation of rural‐to‐urban migrants in Guangzhou, China: does employment status matter?

“…By 2014, there were 253 million rural‐to‐urban migrants, accounting for about 18% of China's total population . Rural‐to‐urban migrants have long been considered a vulnerable group : because of poor living conditions , insufficient health knowledge , and lack of social support and social integration , they are susceptible to a variety of health problems such as infectious diseases , sexually transmitted diseases and mental health problems . In addition, migrants tend to use health services less .…”