Avoidable Hospitalization among Migrants and Ethnic Minorities in Developed Economies

Cacciani, Laura; Agabiti, Nera; Davoli, Marina; Zuanna, Teresa Dalla; Canova, Cristina

doi:10.1007/978-3-319-73630-3_7

Cited by 5 publications

(4 citation statements)

References 91 publications

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“…These findings seem to confirm the lower recourse among immigrants to primary and specialist care ( 9 ). In fact, this indicator is based on the rationale that the lack of or delay in preventive, primary, and outpatient care for important health problems result in acute events that require hospitalization ( 21 , 32 ).…”

Section: Discussionmentioning

confidence: 99%

Barriers to Accessing Primary Care and Appropriateness of Healthcare Among Immigrants in Italy

Napoli¹,

Ventura²,

Spadea

et al. 2022

Front. Public Health

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IntroductionThe health status and health care needs of immigrant populations must be assessed. The aim of this study was to evaluate barriers to accessing primary care and the appropriateness of health care among resident immigrants in Italy, using indicators regarding maternal health, avoidable hospitalization, and emergency care.MethodsCross-sectional study using some indicators of the National Monitoring System of Health Status and Healthcare of the Immigrant Population (MSHIP), coordinated by the National Institute for Health, Migration and Poverty (INMP), calculated on perinatal care, hospital discharge, and emergency department databases for the years 2016–2017 in nine Italian regions (Piedmont, Trento, Bolzano, Emilia-Romagna, Tuscany, Umbria, Latium, Basilicata, Sicily). The analyses were conducted comparing immigrant and Italian residents.ResultsCompared to Italian women, immigrant women had fewer than five gynecological examinations (8.5 vs. 16.3%), fewer first examinations after the 12th week of gestational age (3.8 vs. 12.5%), and fewer than two ultrasounds (1.0 vs. 3.8%). Compared to Italians, immigrants had higher standardized rates (× 1,000 residents) of avoidable hospitalizations (males: 2.1 vs. 1.4; females: 0.9 vs. 0.7) and of access to emergency departments for non-urgent conditions (males: 62.0 vs. 32.7; females: 52.9 vs. 31.4).ConclusionsIn Italy, there appear to be major issues regarding accessing services and care for the immigrant population. Policies aimed at improving socioeconomic conditions and promoting integration can promote healthy lifestyles and appropriate access to health care, counteracting the emergence of health inequities in the immigrant population.

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Section: Discussionmentioning

confidence: 99%

Barriers to Accessing Primary Care and Appropriateness of Healthcare Among Immigrants in Italy

Napoli¹,

Ventura²,

Spadea

et al. 2022

Front. Public Health

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“…Though we observed gender and geographical disparities for ACSC rates, we were unable to assess possible ethnic inequities. More research on this is needed in Finland, as there exists minorities whose need for care very likely exceeds those of the majority population [70].…”

Section: Discussionmentioning

confidence: 99%

Trajectory modelling of ambulatory care sensitive conditions in Finland in 1996–2013: assessing the development of equity in primary health care through clustering of geographic areas – an observational retrospective study

Satokangas

Lumme

Arffman

et al. 2019

BMC Health Serv Res

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Background Due to stagnating resources and an increase in staff workload, the quality of Finnish primary health care (PHC) is claimed to have deteriorated slowly. With a decentralised PHC organisation and lack of national stewardship, it is likely that municipalities have adopted different coping strategies, predisposing them to geographic disparities. To assess whether these disparities emerge, we analysed health centre area trajectories in hospitalisations due to ambulatory care sensitive conditions (ACSCs). Methods ACSCs, a proxy for PHC quality, comprises conditions in which hospitalisation could be avoided by timely care. We obtained ACSCs of the total Finnish population aged ≥20 for the years 1996–2013 from the Finnish Hospital Discharge Register, and divided them into subgroups of acute, chronic and vaccine-preventable causes, and calculated annual age-standardised ACSC rates by gender in health centre areas. Using these rates, we conducted trajectory analyses for identifying health centre area clusters using group-based trajectory modelling. Further, we applied area-level factors to describe the distribution of health centre areas on these trajectories. Results Three trajectories – and thus separate clusters of health centre areas – emerged with different levels and trends of ACSC rates. During the study period, chronic ACSC rates decreased (40–63%) within each of the clusters, acute ACSC rates remained stable and vaccine-preventable ACSC rates increased (1–41%). While disparities in rate differences in chronic ACSC rates between trajectories narrowed, in the two other ACSC subgroups they increased. Disparities in standardised rate ratios increased in vaccine-preventable and acute ACSC rates between northern cluster and the two other clusters. Compared to the south-western cluster, 13–16% of health centre areas, in rural northern cluster, had 47–92% higher ACSC rates – but also the highest level of morbidity, most limitations on activities of daily living and highest PHC inpatient ward usage as well as the lowest education levels and private health and dental care usage. Conclusions We identified three differing trajectories of time trends for ACSC rates, suggesting that the quality of care, particularly in northern Finland health centre areas, may have lagged behind the general improvements. This calls for further investments to strengthen rural area PHC. Electronic supplementary material The online version of this article (10.1186/s12913-019-4449-7) contains supplementary material, which is available to authorized users.

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“…To our knowledge, all studies comparing AH for HF in immigrants/ethnic minorities have been published outside Europe, and none has compared immigrant groups to the autochthonous population. 44 Concerning the available studies on overall hospitalization for HF in the European setting (also including hospitalizations accompanied by cardiac procedures codes and of subjects of all ages), the results have been mixed and have mainly depended on composition by geographic area of origin, as well as on possible differences in the study designs July 2021 773 and methods. Two Italian studies on a large population from different regions found that immigrants from HMPC had lower hospitalization rates for HF than their Italian counterparts.…”

Section: Discussionmentioning

confidence: 99%

Avoidable Hospitalization for Heart Failure Among a Cohort of 18- to 64-Year-Old Italian Citizens and Immigrants: Results From the Italian Network for Longitudinal Metropolitan Studies

Zuanna

Cacciani

Barbieri

et al. 2021

Circ: Heart Failure

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Background: Heart failure (HF) represents a severe public health burden. In Europe, differences in hospitalizations for HF have been found between immigrants and native individuals, with inconsistent results. Immigrants face many barriers in their access to health services, and their needs may be poorly met. We aimed to compare the rates of avoidable hospitalization for HF among immigrants and native individuals in Italy. Methods: All 18- to 64-year-old residents of Turin, Venice, Reggio Emilia, Modena, Bologna, and Rome between January 1, 2001 and December 31, 2013 were included in this multicenter open-cohort study. Immigrants from high migratory pressure countries (divided by area of origin) were compared with Italian citizens. Age-, sex-, and calendar year-adjusted hospitalization rate ratios and the 95% CIs of avoidable hospitalization for HF by citizenship were estimated using negative binomial regression models. The hospitalization rate ratios were summarized using a random effects meta-analysis. Additionally, we tested the contribution of socioeconomic status to these disparities. Results: Of the 4 470 702 subjects included, 15.8% were immigrants from high migratory pressure countries. Overall, immigrants showed a nonsignificant increased risk of avoidable hospitalization for HF (hospitalization rate ratio, 1.26 [95% CI, 0.97–1.68]). Risks were higher for immigrants from Sub-Saharan Africa and for males from Northern Africa and Central-Eastern Europe than for their Italian citizen counterparts. Risks were attenuated adjusting for socioeconomic status, although they remained consistent with nonadjusted results. Conclusions: Adult immigrants from different geographic macroareas had higher risks of avoidable hospitalization for HF than Italian citizens. Possible explanations might be higher risk factors among immigrants and reduced access to primary health care services.

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Avoidable Hospitalization among Migrants and Ethnic Minorities in Developed Economies

Cited by 5 publications

References 91 publications

Barriers to Accessing Primary Care and Appropriateness of Healthcare Among Immigrants in Italy

Barriers to Accessing Primary Care and Appropriateness of Healthcare Among Immigrants in Italy

Trajectory modelling of ambulatory care sensitive conditions in Finland in 1996–2013: assessing the development of equity in primary health care through clustering of geographic areas – an observational retrospective study

Avoidable Hospitalization for Heart Failure Among a Cohort of 18- to 64-Year-Old Italian Citizens and Immigrants: Results From the Italian Network for Longitudinal Metropolitan Studies

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