Effects of immigrant status on Emergency Room (ER) utilisation by children under age one: a population-based study in the province of Reggio Emilia (Italy)

Abstract

BackgroundThe primary aim of this study was to assess the effect of immigrant status on Emergency Room (ER) utilisation by children under age one, considering all, non-urgent, very urgent, and followed by hospitalisation visits. The second aim was to investigate the role played by mother’s educational level in the relationship between citizenship and ER utilisation.MethodsThe cohort study included all healthy singleton live births in the years 2008–2009 and residing in the province of Reggio Emilia, followed for the first year of life in order to study their ER visits. The outcomes were the ER utilisation rate for all, non-urgent, very urgent, and followed by hospitalisation visits. The main explanatory variable was mother’s citizenship. Other covariates were mother’s educational level, maternal age, parity, and child gender. Multivariate analyses (negative binomial regression and zero inflated when appropriate) were performed. Adjusted utilisation Rate Ratios (RR) and their 95% Confidence Intervals (95% CI) were calculated. Trend for age in months by citizenship is depicted.ResultsThere were 3,191 children (36.4%) with at least one ER visit in the first year of life. Adjusted RR show a significantly greater risk of ER visit for immigrants than for Italians: (RR 1.51; 95% CI 1.39-1.63). Immigrants also had a higher risk of non-urgent visits (RR 1.72; 95% CI 1.48-2.00) and for visits followed by hospitalizations (RR 1.58; 95% CI 1.33-1.89). For very urgent visits, the immigrants had a slightly higher risk compared to Italians (RR 1.25; 95% CI 0.98-1.59).The risk of ER visits is higher in the first two months of life (RR1stvs 3rd-12th 2.08; 95% CI 1.93-2.24 and RR 2ndvs 3rd-12th 1.45; 95% CI 1.33-1.58, respectively). Considering all visits, the ER utilisation rate was inversely related with maternal education only for Italians (low educational level 44.0 and high educational level 73.9 for 100 children; p value for trend test < 0.001).ConclusionsOur study observed a higher use of ER services by immigrant children and, to a lesser extent, by children of less educated Italian mothers. In immigrants, the excess is mostly due to non-urgent visits and only slightly to high acute conditions.

Factors associated with difficulty accessing health care for infants in Canada: mothers’ reports from the cross-sectional Maternity Experiences Survey

“…This is consistent with reports that show Quebec to be the Canadian province with the highest percentage (24.9%) of residents without a family doctor [18]. Similar to previous research [17], we found that, compared to Canadian born mothers, immigrant mothers had increased odds of reporting difficulty accessing health care for their infant. Possible reasons behind immigrant mothers’ increased rates of reporting difficulty may be fewer relationships in the community, a poor knowledge of the Canadian health care system, and a lack of culturally appropriate care in the community [19], suggesting that a comprehensive strategy, which addresses multiple sources of immigrant mothers’ difficulty, may have the greatest effect on increasing health care access for immigrant women and their children.…”

Non‐urgent paediatric emergency department presentation: A systematic review

“…Terms used to describe NUP include low‐acuity, low‐urgency, inappropriate, non‐acute and primary care cases. Eleven studies defined NUPs using ED resources used during visit, while nine studies defined and categorised NUP using triage evaluation . In five studies, NUPs were defined as illnesses that could be seen in the primary care or outpatient setting within 24 h .…”

“…The predictors of NUP were assessed in 16 of the included studies. The predictors were associated with increased or decreased use of the ED for non‐urgent visits, see Table S2 (Supporting Information) . Using Anderson’ Healthcare Utilization Model, the predictors identified were predisposing, enabling and needs factors .…”

Socio‐economic composition of low‐acuity paediatric presentation at a regional hospital emergency department

“…About 23 086 ED visits occurred between 2010 and 2013, and 32.4% of these visits were low acuity, resulting in costs to the health‐care system in excess of A$895 000–A$1 110 000 per year over the 4‐year study period. ED use for low‐acuity visits among paediatric patients is an international concern, with the proportions reported in various studies ranging from 15 to 90% . The costs estimated in this study are the costs that could have been saved if the children had presented at a GP clinic or other primary care centres.…”

“…The proportion of paediatric‐related low‐acuity ED visits ranges from 15 to 90% . Given that paediatric patients are a vulnerable population and require special care for growth and development, the continuous use of the ED for low‐acuity presentation places the child at an increased risk of poor continuity of care .…”