Health service utilization in immigrants with multiple sclerosis

Abstract

Background Access to neurology specialty care can influence outcomes in individuals with multiple sclerosis (MS), but may vary based on patient sociodemographic characteristics, including immigration status. Objective To compare health services utilization in the year of MS diagnosis, one year before diagnosis and two years after diagnosis in immigrants versus long-term residents in Ontario, Canada. Methods We identified incident cases of MS among adults aged 20-65 years by applying a validated algorithm to health administrative data in Ontario, Canada, a region with universal health insurance and comprehensive coverage. We separately assessed hospitalizations, emergency department (ED) visits, outpatient neurology visits, other outpatient specialty visits, and primary care visits. We compared rates of health service use in immigrants versus longterm residents using negative binomial regression models with generalized estimating equations adjusted for age, sex, socioeconomic status, urban/rural residence, MS diagnosis calendar year, and comorbidity burden. Results From 2003 to 2014, there were 13,028 incident MS cases in Ontario, of whom 1,070 (8.2%) were immigrants. As compared to long-term residents, rates of hospitalization were similar (Adjusted rate ratio (ARR) 0.86; 95% CI: 0.73-1.01) in immigrants the year before MS diagnosis, but outpatient neurology visits (ARR 0.93; 95% CI: 0.87-0.99) were slightly less frequent.

The role of ethnicity and native-country income in multiple sclerosis: the Italian multicentre study (MS-MigIT)

“…These findings suggest that patients of both groups had similar access to care and treatment opportunities across Italian MS Centres, independently of their birthplace, and that patients with a more aggressive disease at onset/diagnosis might have undergone a high-efficacy DMT. These data are in line with evidence from different HI Countries, supporting the belief that healthcare services and treatment strategies are equally available for MS patients who visit academic medical Centre or MS specialty Clinics [ 25 , 36 ].…”

High prevalence of comorbidities at diagnosis in immigrants with multiple sclerosis

“…Datasets were linked by unique encoded identifiers and analyzed at ICES as previously described. 11 , 13 ICES (formerly known as the Institute for Clinical Evaluative Sciences) is an independent, non-profit research institute whose legal status under Ontario’s health information privacy law allows it to collect and analyze healthcare and demographic data, without consent, for health system evaluation and improvement. Data concerning immigrants arriving in Canada since 1985 are captured by the Immigration Refugees and Citizenship Canada’s (IRCC) electronic Permanent Resident Database.…”

Multiple sclerosis disease-modifying drug use by immigrants: a real-world study

“…Prior work from Ontario, Canada found that, as compared to long-term residents, immigrants with MS had a lower socioeconomic status (SES) and also differed in terms of health care use. For example, while the rates of outpatient neurology visits were somewhat lower in the year before MS diagnosis (adjusted rate ratio 0.93; 95% confidence interval [CI] 0.87–0.99), rates were higher in the year during and after MS diagnosis (adjusted rate ratios 1.17; 95% CI 1.12–1.23 and 1.16; 95% CI 1.10–1.23, respectively) 4 . Hospitalization rates were higher during the year of diagnosis, but lower post-diagnosis.…”