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      Differences in the Use of Primary Care Services Between Spanish National and Immigrant Patients

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          Abstract

          Knowing what real use is made of health services by immigrant population is of great interest. The objectives are to analyze the use of primary care services by immigrants compared to Spanish nationals and to analyze these differences in relation to geographic origin. Retrospective observational study of all primary care visits made in 26 urban health centers. Main variable: total number of health centre visits/year. Dependent variables: type of clinician requested; type of attention, and origin of immigrants. The independent variable was nationality. Statistics were obtained from the electronic medical records. The 4,933,521 appointments made in 2007 were analyzed for a reference population of 594,145 people (11.15 % immigrants). The adjusted annual frequency for nationals was 8.3, versus whereas 4.6 for immigrants. The immigrant population makes less use of primary care services than national population. This is evident for all age groups and regardless of the immigrants’ countries of origin. This result is important when planning health care resources for immigrant population.

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          Most cited references 32

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          The inverse care law.

           J T Hart (1971)
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            Trends and disparities in socioeconomic and behavioural characteristics, life expectancy, and cause-specific mortality of native-born and foreign-born populations in the United States, 1979-2003.

            Immigrants are a growing segment of the US population. In 2003, there were 33.5 million immigrants, accounting for 12% of the total US population. Despite a rapid increase in their numbers, little information exists as to how immigrants' health and mortality profile has changed over time. In this study, we analysed trends in social and behavioural characteristics, life expectancy, and mortality patterns of immigrants and the US-born from 1979 to 2003. We used national mortality and census data (1979-2003) and 1993 and 2003 National Health Interview Surveys to examine nativity differentials over time in health and social characteristics. Life tables, age-adjusted death rates, and logistic regression were used to examine nativity differentials. During 1979-81, immigrants had 2.3 years longer life expectancy than the US-born (76.2 vs 73.9 years). The difference increased to 3.4 years in 1999-2001 (80.0 vs 76.6 years). Nativity differentials in mortality increased over time for major cancers, cardiovascular diseases, diabetes, respiratory diseases, unintentional injuries, and suicide, with immigrants experiencing generally lower mortality than the US-born in each period. Specifically, in 1999-2001, immigrants had at least 30% lower mortality from lung and oesophageal cancer, COPD, suicide, and HIV/AIDS, but at least 50% higher mortality from stomach and liver cancer than the US-born. Nativity differentials in mortality, health, and behavioural characteristics varied substantially by ethnicity. Growing ethnic heterogeneity of the immigrant population, and its migration selectivity and continuing advantages in behavioural characteristics may partly explain the overall widening health gaps between immigrants and the US-born.
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              Migrants' utilization of somatic healthcare services in Europe--a systematic review.

              Utilization of services is an important aspect of migrants' access to healthcare. The aim was to review the European literature on utilization of somatic healthcare services related to screening, general practitioner, specialist, emergency room and hospital by adult first-generation migrants. Our study question was: 'Are there differences in migrants' utilization of somatic healthcare services compared to non-migrants?' Publications were identified by a systematic search of PUBMED and EMBASE. Appropriateness of the studies was judged independently by two researchers based on the abstracts. Additional searches were conducted via the references of the selected articles. The final number of studies included was 21. The results suggested a diverging picture regarding utilization of somatic healthcare services by migrants compared to non-migrants in Europe. Overall, migrants tended to have lower attendance and referral rates to mammography and cervical cancer screening, more contacts per patient to general practitioner but less use of consultation by telephone, and same or higher level of use of specialist care as compared to non-migrants. Emergency room utilization showed both higher, equal and lower levels of utilization for migrants compared to non-migrants, whereas hospitalization rates were higher than or equal to non-migrants. Our review illustrates lack of appropriate epidemiological data and diversity in the categorization of migrants between studies, which makes valid cross-country comparisons most challenging. After adjusting for socio-economic factors and health status, the existing studies still show systematic variations in somatic healthcare utilization between migrants and non-migrants.
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                Author and article information

                Contributors
                +34976201272 , +34976405231 , lugifel@gmail.com
                Journal
                J Immigr Minor Health
                J Immigr Minor Health
                Journal of Immigrant and Minority Health
                Springer US (Boston )
                1557-1912
                1557-1920
                22 May 2012
                22 May 2012
                June 2013
                : 15
                : 3
                : 584-590
                Affiliations
                [ ]Aragon Health Sciences Institute (IACS), Zaragoza, Spain
                [ ]Aragonese Primary Care Research Group-Research Network on Preventative Activities an Health Promotion (redIAPP), Zaragoza, Spain
                [ ]Departament of Medicine, Zaragoza University, Zaragoza, Spain
                [ ]San Pablo Health Centre, SALUD (Aragon Health Service), Aguadores St 7, 50003 Zaragoza, Spain
                [ ]Arrabal Health Centre, SALUD, Zaragoza, Spain
                [ ]Fuentes de Ebro Health Centre, SALUD, Zaragoza, Spain
                [ ]Canal Imperial Health Centre, SALUD, Zaragoza, Spain
                [ ]Hellin Health Centre, SESCAM (Castilla-La Mancha Health Service), Albacete, Spain
                Article
                9647
                10.1007/s10903-012-9647-x
                3632716
                22618356
                © The Author(s) 2012
                Categories
                Original Paper
                Custom metadata
                © Springer Science+Business Media New York 2013

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