Health of war-affected Karen adults 5 years post-resettlement

Abstract

Background An estimated 140 000 refugees from Burma have resettled to the USA since 2009, comprising 21% of total resettlement in the USA over the last decade. Our objective was to describe patterns of longitudinal health outcomes in a cohort of Karen refugees resettled in the USA for 5 years, and to translate these findings to a primary healthcare context. Methods The study was a retrospective cohort study focused on the analysis of the first 5 years of electronic health records of a sample of 143 Karen refugees who were initially resettled between May 2011 and May 2013. Results Through descriptive, inferential and survival statistics, we described patterns of retention in primary care, biometric trends, condition prevalence and survival probabilities. Highest prevalence health conditions documented at any point in the 5-year period included diagnoses or symptoms associated with pain (52%); gastrointestinal disturbance (41%); metabolic disorder (41%); infectious process (34%); mental health condition (31%) and central nervous system disorder (24%). Conclusions This study is the first retrospective longitudinal analysis of patterns of health in Karen refugees originating from Burma and resettled to the USA. Findings identified in the 5-year, the post-resettlement period provided important clinical insights into the health trajectories of war-affected populations. Burden of illness was high although results did not demonstrate the extent of trauma-associated physical health conditions reported in the literature. Indicators such as significant increases in body mass index (BMI), the overall prevalence of dyslipidaemia and others suggested that the cohort may be exhibiting an early trajectory towards the development of these conditions. Authors summarize potential protective factors experienced by the cohort that promoted aspects of health frequently challenged in forced migration.

Systematic review of electronic health records to manage chronic conditions among displaced populations

“…4 10 17 19 20 22 25 Results from asylum countries also showed that EHRs helped to develop focused screening guidelines and increase adherence to those guidelines. [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] This in turn can lead to a reduction in health disparities between asylum seeking patients and the general population. [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] This review identified a number of barriers to successful implementation of EHRs across development, deployment and data analysis.…”

“…[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] This in turn can lead to a reduction in health disparities between asylum seeking patients and the general population. [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] This review identified a number of barriers to successful implementation of EHRs across development, deployment and data analysis. 10 17 19 20 22 26 27 31 45 48 49 This review also found improved usability in EHR systems that were easily adaptable or able to interlink with systems management.…”

“…4 10 17-26 Nineteen studies assessed the impact of EHRs on health outcomes in populations after arriving in an asylum country. [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] Quality assessment of included studies According to the critical appraisal tools described in the methods section, 20 articles were of medium-high quality, nine were of medium quality and three were low-quality. The qualitative studies demonstrated acceptable methodological quality but did not report on the influence of the researcher.…”

“…Nineteen studies assessed the impact of EHRs on chronic disease health outcomes for asylum seekers. [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] The uses of EHRs in these studies ranged from screening measures to characterising the chronic diseases in a population to improving guidelines and reducing the health disparities in asylum populations compared with the general population. [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] Several studies commented on the utility of EHRs as screening tools for asylum populations.…”

“…[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] The uses of EHRs in these studies ranged from screening measures to characterising the chronic diseases in a population to improving guidelines and reducing the health disparities in asylum populations compared with the general population. [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] Several studies commented on the utility of EHRs as screening tools for asylum populations. Higgins et al showed that using a pharmacist to systematically review patients flagged by EHRs for possible chronic diseases led to better pharmaceutical recommendations to optimise medical management.…”