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Original article

Vol. 151 No. 4344 (2021)

Disparities in emergency department access, resource allocation, and outcomes between migrants and the local population

  • Andrea S. Jauslin
  • Leandra Schultze
  • Daniel Knuchel
  • Noemi R. Simon
  • Christian H.  Nickel
  • Roland Bingisser
DOI
https://doi.org/10.4414/SMW.2021.w30070
Cite this as:
Swiss Med Wkly. 2021;151:w30070
Published
03.11.2021

Summary

AIMS: To characterize a group of migrant emergency department (ED) patients regarding demographics, access to the ED, mode of referral, use of resources, and short-term outcomes, and to compare them to a group of local ED patients.

METHODS: Prospective cohort study with consecutive enrollment of adult patients presenting to the ED of a Swiss tertiary care hospital from October 21st to November 11th, 2013 and February 1st to February 23rd, 2015. In accordance with the International Organization for Migration, we defined migrants as persons who have changed their country of usual residence, irrespective of their legal status. The primary outcome was defined as the number of resources allocated to migrants, as compared to local patients, using uni- and multivariable quasi-Poisson regressions. Acute morbidity, hospitalization, intensive care unit (ICU) admission, and 30-day mortality were assessed as secondary outcomes.

RESULTS: Migrant patients were younger, more often male and self-presenters, and of lower acuity. After adjustment for age, gender and acuity, we observed a non-significant difference of 3.6% in the mean number of resources allocated to migrant patients as compared to local patients (adjusted RR 0.964, CI 0.923-1.006). No difference in 30-day mortality (adjusted OR 0.777, CI 0.346-1.559) was observed between the two patient groups, but migrant patients had lower odds of acute morbidity (adjusted OR 0.652, CI 0.560-0.759), hospitalization (adjusted OR 0.666, CI 0.555-0.799), and ICU admission (adjusted OR 0.649, CI 0.456-0.910).

CONCLUSIONS: ED access approximation, resource allocation, and mortality were comparable between migrant patients and local patients. Lower admission rates to wards and the ICU may raise concerns but can be explained by lower acute morbidity in migrant patients.

References

  1. Tasioulas J, Vayena E. Getting human rights right in global health policy. Lancet. 2015 Apr;385(9978):e42–4. https://doi.org/10.1016/S0140-6736(14)61418-5
  2. Burkholder TW, Hill K, Calvello Hynes EJ. Developing emergency care systems: a human rights-based approach. Bull World Health Organ. 2019 Sep;97(9):612–9. https://doi.org/10.2471/BLT.18.226605
  3. Raven MC, Lowe RA, Maselli J, Hsia RY. Comparison of presenting complaint vs discharge diagnosis for identifying " nonemergency" emergency department visits. JAMA. 2013 Mar;309(11):1145–53. https://doi.org/10.1001/jama.2013.1948
  4. Nemec M, Koller MT, Nickel CH, Maile S, Winterhalder C, Karrer C, et al. Patients presenting to the emergency department with non-specific complaints: the Basel Non-specific Complaints (BANC) study. Acad Emerg Med. 2010 Mar;17(3):284–92. https://doi.org/10.1111/j.1553-2712.2009.00658.x
  5. Bingisser R, Dietrich M, Nieves Ortega R, Malinovska A, Bosia T, Nickel CH. Systematically assessed symptoms as outcome predictors in emergency patients. Eur J Intern Med. 2017 Nov;45:8–12. https://doi.org/10.1016/j.ejim.2017.09.013
  6. Adams JG. Emergency department overuse: perceptions and solutions. JAMA. 2013 Mar;309(11):1173–4. https://doi.org/10.1001/jama.2013.2476
  7. Grossmann FF, Nickel CH, Christ M, Schneider K, Spirig R, Bingisser R. Transporting clinical tools to new settings: cultural adaptation and validation of the Emergency Severity Index in German. Ann Emerg Med. 2011 Mar;57(3):257–64. https://doi.org/10.1016/j.annemergmed.2010.07.021
  8. Marmot M, Allen J, Bell R, Bloomer E, Goldblatt P ; Consortium for the European Review of Social Determinants of Health and the Health Divide. WHO European review of social determinants of health and the health divide. Lancet. 2012 Sep;380(9846):1011–29. https://doi.org/10.1016/S0140-6736(12)61228-8
  9. Castañeda H, Holmes SM, Madrigal DS, Young ME, Beyeler N, Quesada J. Immigration as a social determinant of health. Annu Rev Public Health. 2015 Mar;36(1):375–92. https://doi.org/10.1146/annurev-publhealth-032013-182419
  10. Bundesamt für Statistik SDuM. https://www.bfs.admin.ch/bfs/de/home/statistiken/bevoelkerung/migration-integration/nach-migrationsstatuts.html. Published 2019. Accessed 28.04.2021.
  11. Bischoff A, Wanner P. The self-reported health of immigrant groups in Switzerland. J Immigr Minor Health. 2008 Aug;10(4):325–35. https://doi.org/10.1007/s10903-007-9089-z
  12. Tarnutzer S, Bopp M ; SNC Study Group. Healthy migrants but unhealthy offspring? A retrospective cohort study among Italians in Switzerland. BMC Public Health. 2012 Dec;12(1):1104. https://doi.org/10.1186/1471-2458-12-1104
  13. Jaeger FN, Hossain M, Kiss L, Zimmerman C. The health of migrant children in Switzerland. Int J Public Health. 2012 Aug;57(4):659–71. https://doi.org/10.1007/s00038-012-0375-8
  14. Gimeno-Feliu LA, Pastor-Sanz M, Poblador-Plou B, Calderón-Larrañaga A, Díaz E, Prados-Torres A. Overuse or underuse? Use of healthcare services among irregular migrants in a north-eastern Spanish region. Int J Equity Health. 2021 Jan;20(1):41. https://doi.org/10.1186/s12939-020-01373-3
  15. Harrison HL, Daker-White G. Beliefs and challenges held by medical staff about providing emergency care to migrants: an international systematic review and translation of findings to the UK context. BMJ Open. 2019 Jul;9(7):e028748. https://doi.org/10.1136/bmjopen-2018-028748
  16. Trappolini E, Marino C, Agabiti N, Giudici C, Davoli M, Cacciani L. Disparities in emergency department use between Italians and migrants residing in Rome, Italy: the Rome Dynamic Longitudinal Study from 2005 to 2015. BMC Public Health. 2020 Oct;20(1):1548. https://doi.org/10.1186/s12889-020-09280-6
  17. Keizer E, Christensen MB, Carlsen AH, Smits M, Wensing M, Senn O, et al. Factors related to out-of-hours help-seeking for acute health problems: a survey study using case scenarios. BMC Public Health. 2019 Jan;19(1):33. https://doi.org/10.1186/s12889-018-6332-6
  18. Schwachenwalde S, Sauzet O, Razum O, Sehouli J, David M. The role of acculturation in migrants’ use of gynecologic emergency departments. Int J Gynaecol Obstet. 2020 Apr;149(1):24–30. https://doi.org/10.1002/ijgo.13099
  19. Martinez-Donate AP, Verdecias N, Zhang X, Jesús Eduardo GF, Asadi-Gonzalez AA, Guendelman S, et al. Health profile and health care access of Mexican migration flows traversing the northern border of Mexico. Med Care. 2020 May;58(5):474–82. https://doi.org/10.1097/MLR.0000000000001300
  20. Markkula N, Cabieses B, Lehti V, Uphoff E, Astorga S, Stutzin F. Use of health services among international migrant children - a systematic review. Global Health. 2018 May;14(1):52. https://doi.org/10.1186/s12992-018-0370-9
  21. Rubalcava LN, Teruel GM, Thomas D, Goldman N. The healthy migrant effect: new findings from the Mexican Family Life Survey. Am J Public Health. 2008 Jan;98(1):78–84. https://doi.org/10.2105/AJPH.2006.098418
  22. Abraído-Lanza AF, Dohrenwend BP, Ng-Mak DS, Turner JB. The Latino mortality paradox: a test of the “salmon bias” and healthy migrant hypotheses. Am J Public Health. 1999 Oct;89(10):1543–8. https://doi.org/10.2105/AJPH.89.10.1543
  23. Agyemang C. Comfy zone hypotheses in migrant health research: time for a paradigm shift. Public Health. 2019 Jul;172:108–15. https://doi.org/10.1016/j.puhe.2019.03.025
  24. The Migration Observatory. Who Counts as a Migrant? Definition and their Consequences. https://migrationobservatory.ox.ac.uk/resources/briefings/who-counts-as-a-migrant-definitions-and-their-consequences/. Published 2019. Accessed 30 April 2020.
  25. Vandenbroucke JP, von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, et al.; STROBE initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Ann Intern Med. 2007 Oct;147(8):W163-94. https://doi.org/10.7326/0003-4819-147-8-200710160-00010-w1
  26. Johnson MR, Bhopal RS, Ingleby J, et al. A glossary for the first World Congress on Migration, Ethnicity, Race and Health. Public health. 2019;172.
  27. Lay B, Lauber C, Nordt C, Rössler W. Patterns of inpatient care for immigrants in Switzerland: a case control study. Soc Psychiatry Psychiatr Epidemiol. 2006 Mar;41(3):199–207. https://doi.org/10.1007/s00127-005-0014-2
  28. Thomson MD, Hoffman-Goetz L. Defining and measuring acculturation: a systematic review of public health studies with Hispanic populations in the United States. Soc Sci Med. 2009 Oct;69(7):983–91. https://doi.org/10.1016/j.socscimed.2009.05.011
  29. Clarke A, Isphording IE. Language barriers and immigrant health. Health Econ. 2017 Jun;26(6):765–78. https://doi.org/10.1002/hec.3358
  30. Mackenbach JP, Stirbu I, Roskam AJ, Schaap MM, Menvielle G, Leinsalu M, et al.; European Union Working Group on Socioeconomic Inequalities in Health. Socioeconomic inequalities in health in 22 European countries. N Engl J Med. 2008 Jun;358(23):2468–81. https://doi.org/10.1056/NEJMsa0707519
  31. Wendt C, Frisina L, Rothgang H. Healthcare system types: a conceptual framework for comparison. Soc Policy Adm. 2009;43(1):70–90. https://doi.org/10.1111/j.1467-9515.2008.00647.x
  32. Wendt C. Mapping European healthcare systems: a comparative analysis of financing, service provision and access to healthcare. J Eur Soc Policy. 2009;19(5):432–45. https://doi.org/10.1177/0958928709344247
  33. Braveman P, Gottlieb L. The social determinants of health: it's time to consider the causes of the causes. Public Health Rep. 2014;129 Suppl 2(Suppl 2):19-31.
  34. Schmid F, Malinovska A, Weigel K, Bosia T, Nickel CH, Bingisser R. Construct validity of acute morbidity as a novel outcome for emergency patients. PLoS One. 2019 Jan;14(1):e0207906. https://doi.org/10.1371/journal.pone.0207906
  35. Tzogiou C, Boes S, Brunner B. What explains the inequalities in health care utilization between immigrants and non-migrants in Switzerland? BMC Public Health. 2021 Mar;21(1):530. https://doi.org/10.1186/s12889-021-10393-9
  36. Credé SH, Such E, Mason S. International migrants’ use of emergency departments in Europe compared with non-migrants’ use: a systematic review. Eur J Public Health. 2018 Feb;28(1):61–73. https://doi.org/10.1093/eurpub/ckx057
  37. Graetz V, Rechel B, Groot W, Norredam M, Pavlova M. Utilization of health care services by migrants in Europe-a systematic literature review. Br Med Bull. 2017 Jan;121(1):5–18. https://doi.org/10.1093/bmb/ldw057
  38. Ruud SE, Aga R, Natvig B, Hjortdahl P. Use of emergency care services by immigrants—a survey of walk-in patients who attended the Oslo Accident and Emergency Outpatient Clinic. BMC Emerg Med. 2015 Oct;15(1):25. https://doi.org/10.1186/s12873-015-0055-0
  39. Keidar O, Jegerlehner SN, Ziegenhorn S, Brown AD, Müller M, Exadaktylos AK, et al. Emergency Department Discharge Outcome and Psychiatric Consultation in North African Patients. Int J Environ Res Public Health. 2018 Sep;15(9):1–11. https://doi.org/10.3390/ijerph15092033
  40. Klukowska-Röetzler J, Eracleous M, Müller M, Srivastava DS, Krummrey G, Keidar O, et al. Increased Urgent Care Center Visits by Southeast European Migrants: A Retrospective, Controlled Trial from Switzerland. Int J Environ Res Public Health. 2018 Aug;15(9):E1857. https://doi.org/10.3390/ijerph15091857
  41. Ruud SE, Hjortdahl P, Natvig B. Reasons for attending a general emergency outpatient clinic versus a regular general practitioner - a survey among immigrant and native walk-in patients in Oslo, Norway. Scand J Prim Health Care. 2017 Mar;35(1):35–45. https://doi.org/10.1080/02813432.2017.1288817
  42. Öcek ZA, Çiçeklioğlu M, Yücel U, Özdemir R. Family medicine model in Turkey: a qualitative assessment from the perspectives of primary care workers. BMC Fam Pract. 2014 Feb;15(1):38. https://doi.org/10.1186/1471-2296-15-38
  43. World Health Organization. Regional Office for E, European Observatory on Health S, Policies, et al. Turkey: health system review. Copenhagen: World Health Organization. Regional Office for Europe; 2011.
  44. Basic D, Shanley C, Gonzales R. The Impact of Being a Migrant from a Non-English-Speaking Country on Healthcare Outcomes in Frail Older Inpatients: an Australian Study. J Cross Cult Gerontol. 2017 Dec;32(4):447–60. https://doi.org/10.1007/s10823-017-9333-5
  45. Christ M, Grossmann F, Winter D, Bingisser R, Platz E. Modern triage in the emergency department. Dtsch Arztebl Int. 2010 Dec;107(50):892–8.
  46. Grossmann FF, Zumbrunn T, Ciprian S, Stephan FP, Woy N, Bingisser R, et al. Undertriage in older emergency department patients—tilting against windmills? PLoS One. 2014 Aug;9(8):e106203. https://doi.org/10.1371/journal.pone.0106203
  47. Hillinger P, Twerenbold R, Wildi K, Rubini Gimenez M, Jaeger C, Boeddinghaus J, et al. Gender-specific uncertainties in the diagnosis of acute coronary syndrome. Clin Res Cardiol. 2017 Jan;106(1):28–37. https://doi.org/10.1007/s00392-016-1020-y
  48. Allen L, Cummings J. Emergency Department Use Among Hispanic Adults: The Role of Acculturation. Med Care. 2016 May;54(5):449–56. https://doi.org/10.1097/MLR.0000000000000511
  49. Abraído-Lanza AF, Armbrister AN, Flórez KR, Aguirre AN. Toward a theory-driven model of acculturation in public health research. Am J Public Health. 2006 Aug;96(8):1342–6. https://doi.org/10.2105/AJPH.2005.064980
  50. Volken T, Rüesch P. Health Status Inequality among Immigrants in Switzerland. Open J Prev Med. 2014;04(06):459–69. https://doi.org/10.4236/ojpm.2014.46054
  51. Kangovi S, Barg FK, Carter T, Long JA, Shannon R, Grande D. Understanding why patients of low socioeconomic status prefer hospitals over ambulatory care. Health Aff (Millwood). 2013 Jul;32(7):1196–203. https://doi.org/10.1377/hlthaff.2012.0825

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