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Table 2 Descriptive summary of the studies included in the review

From: A systematic review of the use of health services by immigrants and native populations

Reference Country Year Sample Objectives Information sources Dependent variable Independent variable (migrant definition) Need indicators Socio-economic indicators Results
Almeida LM et al. [33] 2014 Portugal 2012 277 women Migrants (n = 89) Portuguese (n = 188) To evaluate differences in obstetric care between immigrant and native women in a country with free access to health care Register and survey-based study (1) Administrative databases of the four public maternity hospitals (February 1 and December 31, 2012) (2) Telephone survey (1) First appointment at >12 weeks (2) Number of prenatal visits (1) Native: born in Portugal (2) Immigrant: born outside Portugal with both parents born outside Portugal Age Parity Family income Education level Marital status Migrants were more prone to late prenatal care (first pregnancy appointment after 12 weeks of pregnancy, to have fewer than three prenatal visits)
Beiser M et al. [21] 2014 Canada 2009–2010 98,346 individuals Native born (n = 83,949) Established migrants (n = 10,810) Recent immigrants (n = 3587) 20–74 years To examine the effects of chronic health conditions, as well as personal resources and regional context on labour force participation, receipt of government transfer payments and use of health services by short- and long-stay immigrants compared with native-born Canadians Survey-based study Canada Community Health Survey (CCHS) (1) GP visits in the past 12 months (2) Labour force participation (3) Use of government transfer payments (1) Native-born Canadians (2) Recent immigrants (resident in Canada for 10 years or less) (3) Established immigrants (present in Canada for more than 10 years) Age & gender Chronic physical conditions (last 6 months or more) Chronic mental conditions Education level Marital status Official-language ability (English or French) Geographic region Recent immigrants healthy or with chronic health problems made fewer GP visits Established immigrants with chronic conditions did not differ in their use of GP
Berchet C [22] 2013 France 2006–08 12,999 individuals French (n = 11,934) Immigrants (n = 1065) ≥18 years To highlight factors generating healthcare use inequalities relating to immigration Survey-based study Health Survey (l’Enquête sur la santé et la protection sociale-ESPS) (1) GP visits (last year) (2) Specialist medical visits (last year) Nationality and country of birth (subject and parents) Age & gender Self-rated health Chronic disease and functional limitations Health behaviour (smoke, overweight) Health insurance Education level Employment status Family composition Isolation and social support Place of residence GP’s and specialist’s patient load Immigrants present a lower demand for GP and specialist care
Carmona-Alférez MR [23] 2013 Spain (Madrid) 2006–2007 835,401 individuals Natives (n = 694,716) Immigrants (n = 140,685) 25–64 years To evaluate the relationship between birthplace of users of PHC in the Community of Madrid (CM) and the referrals to specialists Register-based study Medical records of PHC (OMI-AP) (1) Referral to specialists (2) Number of referrals Country of birth Age & gender Health problems (last 12 months) Number of visits to the GP (last 12 months) Territorial per capital income GP’s patient load Immigrants from South America had higher probability to be referred for any health problem, while Asiatic immigrants have the lowest overall probability of referrals Immigrants from Western countries, Central America and the Caribbean showed similar referral rates to Spanish natives
De Back TR et al. [34] 2015 Netherlands 2009–2010 60,852 patients with hypertension, ischemic heart disease, cerebrovascular accidents and cardiac failure Native Dutch (n = 55,320) Immigrant Moluccan immigrant (n = 5532) To determine the frequency of visits to the medical specialist and GP and the prescription of cardiovascular agents among Moluccans compared to native Dutch Register-based study Registry data from the Achmea Health Insurance Company (Achmea) (1) Number of GP visits (2) Number of specialist (cardiologist and neurologist) visits Moluccan and Dutch surnames Age & gender Socio-economic status (SES) Area-level SES scores were composed by the Netherlands Institute for Social Research Place of residence Cardiovascular healthcare use of ethnic minority groups may converge towards that of the majority population
De Luca G et al. [24] 2013 Italy 2004–2005 102,857 individuals Natives (n = 97,229) Immigrants (n = 5628) 0–64 years To explore differences in utilization of health services between the immigrant and the native-born populations Survey-based study Italian Health Conditions survey (ISTAT-Condizioni di salute e Ricorso ai Servizi Sanitari) (1) GP visits (last 4 weeks) (2) Specialist medical visits (last 4 weeks) (3) Phone consultations (last 4 weeks) (4) ED care visits (last 4 weeks) Country of birth and citizenship criteria (1) Native (Italian citizens born in Italy) (2) First-generation immigrants (individuals born outside of Italy without Italian citizenship) (3) Second-generation immigrants (individuals born in Italy without Italian citizenship) (4) Naturalized Italians (individuals born outside of Italy with Italian citizenship) Age & gender Self-assessed family wealth Self-assessed health status Chronic diseases and disability conditions Health behaviour (smoke, weight-checking, physical activity) Education level Marital status Employment status Number of children in the household Area of residence Immigrants tend to use specialist services and have telephone consultations less frequently, whereas they use ED services more often
Díaz E et al. [13] 2015 Norway 2008 25,915 patients diagnosed with dementia or memory impairment in PHC Natives (n = 25,117) Immigrants (n = 788) ≥50 years To study utilization of primary healthcare services of Norwegians and immigrants with either a diagnosis of dementia or memory impairment Register-based study (1) National Population Register-NPR (2) Norwegian Health Economics Administration database-HELFO (3) Norwegian Prescription Database-NorPD (1) Number of GP visits (2) ED visits (3) Home consultations Country of birth. (Born abroad with both parents from abroad) Age & gender Education level Marital status Length of stay in Norway Place of residence No differences in the use of PHC were found
Díaz E et al. [14] 2014 Norway 2008 3,739,244 individuals Natives (n = 3,349,721) Immigrants (n = 389,523) ≥15 years To describe and compare the use and frequency of use of PHC services between immigrants and natives in Norway To investigate the importance of morbidity burden, socio-economic status and length of stay in Norway for immigrants’ use of PHC services Register-based study (1) National Population Register (2) Norwegian Health Economics Administration database-HELFO (1) Percentage of each population who had used the PHC system (GPs, EPC and both) in 2008 (2) Frequency of use among PHC users Country of birth (1) Natives (born in Norway with both parents born in Norway) (2) Immigrants (born abroad with both parents from abroad) staying at least 6 months, divided according to the World Bank income categories of their country of origin Age & gender Morbidity groups (Johns Hopkins University Adjusted Clinical Groups) Education level Marital status Income level Place of residence Significantly fewer immigrants from all but LIC used their GP and all PHC services, but a higher share of immigrants except those from HIC used the EPC. This higher use did not compensate for less use of GPs in terms of overall use of PHC Among GP users, however, immigrants used the GP at a statistically significant higher rate compared with natives Immigrants 65 years from all but HIC used GPs less than other age groups, and the same was true for overall use of PHC, although older immigrants from LIC used the EPC most The use of PHC services, but not the rate of use, increased with length of stay in Norway
Díaz E et al. [15] 2014 Norway 2008 1,605,873 individuals Natives (n = 1,516,012) Immigrants (n = 89,861) ≥50 years To describe the utilization of PHC in Norway in terms of number of consultations, diagnoses given and procedures undertaken To compare native Norwegians’ use of PHC services with that of different immigrant groups Register-based study (1) National Population Register (2) Norwegian Health Economics Administration database-HELFO (1) Frequency of use of PHC system (GP, EPC) in 2008 (2) Diagnoses received at GP and EPC consultations Country of birth (1) Natives (born in Norway with both parents born in Norway) (2) Immigrants (born abroad with both parents from abroad) staying at least 6 months, divided according to the World Bank income categories of their country of origin Age & gender Morbidity groups (Johns Hopkins University Adjusted Clinical Groups) Education level Marital status Income level Length of stay in Norway Place of residence Reason for migration Age at migration A lower proportion of HIC immigrants used PHC, but utilization was increasingly similar in older age groups The mean number of consultations to both the GP and the EPC, and the mean number of different diagnoses for PHC users were higher for 50 to 65 years old OIC immigrants, but this pattern was reversed for older adults
Durbin A et al. [25] 2015 Canada (Ontario) 1993–2012 1,820,443 individuals Long-term residents (n = 908,329) Immigrants (n = 912,114) 18–105 years Examine the use of primary care and specialty services for non-psychotic mental health disorders by immigrants to Ontario Canada during their first 5 years after arrival Register-based study (1) OHIP claims data (2) Canadian Institute for Health Information’s Discharge Abstract Database (3) Ontario Mental Health Reporting System (4) National Ambulatory Care Reporting System (April 1, 1993–March 31, 2012) 1) Visits to PHC physicians 2) Visits to psychiatrists 3) Composite of ED visits or hospital admissions Country of birth (1) Long-term residents (newcomer before 1985 and Canadian-born) (2) Immigrants (identified through the Ontario Citizenship and Immigration Canada (CIC) database) Age & gender Education level Marital status Income level Length of stay Official language speaking ability Immigrant admission category Neighbourhood Immigrants were more or less likely to access primary mental health care depending on the world region of origin Regarding specialty mental health care (psychiatry and hospital care), immigrants used it less. Across the 3 mental health services, estimates of use by immigrant region groups were among the lowest for newcomers from East Asian and Pacific and among the highest for persons from Middle East and North Africa
Durbin A et al. [16] 2014 Canada (Ontario) 2002–2012 359,673 individuals LT-Residents (n = 163,263) Immigrants (n = 163,298) 18–105 years To compare service use (primary care visits, visits for psychiatric care, and hospital use) for non-psychotic mental disorders by recent immigrants by matched long-term residents Register-based study (1) OHIP claims data (2) Canadian Institute for Health Information’s Discharge Abstract Database (3) Ontario Mental Health Reporting System (4) National Ambulatory Care Reporting System (1) Visits to PHC physicians (2) Visits to psychiatrists (3) Composite of ED visits or hospital admissions Country of birth (1) Long-term residents (newcomer before 1985 and Canadian-born) (2) Immigrants (identified through the Ontario Citizenship and Immigration Canada (CIC) database) Age & gender Education level Income level Official language speaking ability Immigrant admission category Neighbourhood Immigrants in all admission classes and of both sexes were generally less likely to use all three types of mental health service. The exceptions were for primary mental health care, where male refugees were more likely to have at least one visit For PHC, estimates of intensity of use were highest for refugees and lowest for economic class immigrants For psychiatric care and hospital care, estimates were similar across admission class groups
Esscher A et al. [35] 2014 Sweden 1988–2010 74 individuals Natives (n = 48) Immigrants (n = 26) To identify suboptimal factors of maternity care related to maternal death as it occurred in Sweden over a period of increased migration of childbearing women from LIC and MIC Register-based study (1) Swedish official and national registries (1988–2007) (2) Swedish Society of Obstetrics and Gynaecology (SFOG) Maternal Mortality Group (2008–2010) Factors of suboptimal care (1) Delay of care-seeking (non-compliance, late booking) (2) Accessibility of services (language proficiency, legal status, transport) (3) Quality of care (Insufficient surveillance and delayed treatment, miscommunication between providers, limited use of resources) Country of birth divided according to the World Bank Income categories (1) LIC (Ethiopia, Eritrea, Somalia, Democratic Republic of Congo, Zimbabwe, Gambia, and Pakistan) (2) MIC (Poland, Former Yugoslavia, Turkey, Iran, Iraq, Morocco, Philippines, and Thailand) Age Causes of death Suboptimal care was a significantly more frequent contributing factor of maternal death for the foreign-born women. Many of these deaths were associated with communication-related barriers and delays in care-seeking Immigrant lower health coverage represents the first factor generating inequalities in the propensity to contact a GP, while education and income are the most important drivers of inequalities in the propensity to contact a specialist
Fosse-Edorh S et al. [36] 2014 France 2002–2007 13,959 individuals Born in France (n = 12,711) Born in North Africa (n = 327) ≥45 years The objective of the present study was to determine DT2 prevalence and management in immigrants from North Africa living in France to ascertain whether the higher diabetes mortality observed in this population compared with the French-born population reflected a higher prevalence of DT2, poorer health status and or lower quality of care Survey-based study (1) Population-based survey Enquête décennale santé (EDS; Decennial Health Survey) 2002–2003 (2) ENTRED (Échantillon national témoin représentati des personnes diabétiques; National representative sample of people with diabetes) survey 2007 (1)GP visits last year (2) ≥ 1 private specialist (ophthalmologist or endocrinologist) visit last year (3) Hospitalization >24 h last year 4) Length of stay of hospitalization Country of birth (1) Born in France (2) Born in North Africa Age & gender Diabetes complications Smoking Education level Financial difficulty Reflects a greater prevalence of DT2, poorer health status and/or lower quality of care in this population Our present study found no major differences between patient groups in terms of medical visits except for less frequent GP and more frequent dentist visits in the BNA population
Franchi C et al. [37] 2016 Italy (Lombardy region) 2010 51,016 individuals Natives (n = 25,508) Immigrants (n = 25,508) 65–94 years To compare healthcare resource utilization (drug prescriptions, hospital admissions and healthcare services) in regular immigrants living in the Lombardy Region of Northern Italy at least 10 years versus native elderly people (65 years or older) Register-based study Administrative databases of Lombardy region (1) Anagraphic database (2) Prescription database (3) Hospital discharge database (4) Outpatient prescriptions by GP (healthcare services utilization) Drug prescription Polytherapy Hospital admissions Healthcare service utilization (1) Regular immigrant (born in a country other than Italy and registered with the Italian NHS) (2) Native (born in Lombardy) Age & gender Older immigrants (65 years and older) present under-utilization of healthcare resources and prescriptions drugs, including those from HIC European countries Only immigrants from Eastern Europe and Eastern Africa have a higher prevalence for hospital admissions. Only immigrants from Northern Africa have higher rate of prescriptions
Garcia-Subirats I et al. [38] 2014 Spain 2006–2007 & 2011–2012 2006–2007 21,818 individuals Natives (n = 18,504) Immigrants (n = 2893) 2011–2012 15,200 individuals (n = 12,559) Immigrants (n = 2390) 16–59 years To analyse the changes in access to health care and the determinants of access among the immigrant and autochthonous populations in Spain between 2006 and 2012 Survey-based study Spanish National Health Survey (SNHS) of 2006–2007 and the SNHS of 2011–2012 (1) Unmet healthcare need in the last 12 months (2) Visits to a GP in the last 4 weeks (3) Visit to a specialist in the last 4 weeks (4) Hospitalization in the last year (5) ED visits in the last year Country of birth (low and middle-income countries according to the World Bank Income classification) Age & gender Self-rated health, suffering from a chronic disease, having suffered an injury in the past year Private health insurance policy Education level Marital status Employment situation Social class (following classification of the Spanish Society of Epidemiology) Length of stay (Immigrants in the SNHS 2011–2012) In 2012 the immigrant population had a higher prevalence of visiting the GP compared to 2006 The immigrant population had a lower prevalence of visiting the specialist both in 2006 and 2012 The difference in use of ED decreased slightly for both groups and the difference between them was maintained from 2006 to 2012; the immigrant population showed a higher prevalence of use of this care level No significant differences were found between both populations in terms of hospitalizations
Gazard B et al. [26] 2015 United Kingdom, UK (Southeast London, Lambeth and Southwark) 2008–2010 1698 individuals Non-immigrant (n = 1010) Immigrants (n = 659) ≥16 years (1) To describe the socio-demographic and socio-economic differences between migrants and non-migrants as broad groupings and by ethnicity, as well as within migrant groups by length of residence in the UK (2) To investigate the associations between migration status and health-related outcomes, including health behaviours, functional limitations, physical and mental health status and health service use (3) To examine whether and how the effect of migration status changes when it is disaggregated by length of residence, first language,reason for migration and combined with ethnicity Survey-based study South East London Community Health (SELCoH) survey (1) Registration with GP (2) Visits to a GP for an emotional problem in the last 12 months (3) Seen a counsellor or mental health specialist in the last 12 months (4) Use of hospital services (accident and emergency and other outpatient department) in the last 12 months (1) Migration status (2) Length of residence in the UK (3) First language (4) Reason for migration (5) Migration status within each ethnic group category Age & gender Ethnicity Educational level Employment status Household income Migrant status Length of residence Migrants who had been in the UK for < 5 years, white migrants and those who migrated for education or work had increased odds of not being currently registered with a GP Migrants who had been in the UK for 5–10 years had increased odds of seeing a GP for an emotional problem. Those who had resided in the UK for <5 years had decreased odds Those who had migrated for education had increased odds of visiting an outpatient department compared to non-migrants decreased odds of seeing a GP for an emotional problem
Gimeno-Feliu LA et al. [27] 2016 Spain (Aragón) & Norway Norway 2008 & Spain 2010 Native born: Spain (n = 1,102,391) Norway (n = 4,351,084) Immigrants: Spain (n = 35,851) Norway (n = 60,733) Analyse all registered pharmacological treatments for immigrants from Poland, China, Morocco and Colombia compared to natives, aiming to identify patterns of drug use for each immigrant group compared to host countries Register-based study (1) Pharmaceutical Billing Database in Aragon (2) Norwegian Prescription Database-NorPD Drug prescription Country of birth (Poland, Chine, Colombia & Morocco) Age & gender In the two countries studied, the proportion of immigrants that purchased drugs was significantly lower than that of the correspondingnative population Immigrants from Morocco showed the highest drug purchase rates in relation to natives, especially for antidepressants, pain killers and drugs for peptic ulcer. Immigrants from China and Poland showed lowest purchasing rates, while Colombians where more similar to host countries
Gimeno-Feliu LA et al. [39] 2013 Spain (Aragón) 2007 594,145 individuals Natives (n = 527,881) Immigrants (n = 66,264) All ages (1) To analyse the use of primary care services by immigrants compared to Spanish nationals, adjusted by age and sex (2) To analyse the differences in frequency of visits to primary care in relation to geographic origin Register-based study Electronic medical records register (OMI: Computerized Medical Office) (1) GP appointments (2) Paediatric appointments (3) Nurse appointments (4) Midwife appointments (5) Physiotherapy appointments (6) Dental appointments (7) Social worker appointments (8) PHC team appointments Nationality Age & gender The immigrant population makes less use of PHC services. This is evident for all age groups and regardless of immigrants’ countries of origin
Klaufus L et al. [40] 2014 Netherlands 2008 14,131 individuals Native born (n = 11,678) Immigrants (n = 2453) >14 years To investigate ethnic differences as a factor in mental healthcare consumption in patients with medium & high risk of CMD (common mental disorders) and to identify determinants that may explain possible ethnic differences Survey-based study Health survey conducted by Public Health Services (Amsterdam, Rotterdam, Utrecht and the Hague) (1) GP visits (last year) (2) Mental health visit (psychiatrist, psychologist or a mental health care facility) last year Country of birth (subject and parents) (1) Native Dutch (2) First-generation immigrant (foreign born and almost one parent foreign born) (2) Second-generation immigrant (born in Netherland with at least one parent foreign born) Age & gender Physical health problems Education level Marital status Employment status Financial situation Social loneliness Ethnic minority groups contacted the GP significantly more often than native Dutch people, with the exception of Antillean/Aruban immigrants First-generation immigrants tended to contact the GP more often than second-generation immigrants The four ethnic minority groups visited a mental healthcare specialist more often than the Dutch; this was significantly higher among the Turks
Kerkenaar M et al. [41] 2013 Austria October 2010–September 2011 3448 individuals Natives (n = 2930) Immigrants (n = 518) ≥15 years To study: (1) the prevalence of dysphoric disorders among different groups of migrants (first and second generation from different regions) in comparison to the native Austrian population using a validated questionnaire (2) The influence of gender, socio-economic factors, fluency of host language and length of stay in Austria on this prevalence (3) The utilization of healthcare services of migrants and Austrians with and without a dysphoric disorder Survey-based study (Telephone survey ad hoc and PHQ-4) (1) Visits to a GP in the last 4 weeks (2) Visits to specialists in their own practices in the last 4 weeks (3) Out or inpatient hospital care in the last 4 weeks (4) Prevalence of dysphoric disorders Country of birth and country of birth of fathers Age & gender Chronic disease Education level Employment status Living area Persons in house No significant difference was found in the utilization of healthcare services associated with dysphoric disorders, except for a higher utilization of secondary/tertiary care by female migrants with a dysphoric disorder Immigrant males without dysphoric disorders had a lower utilization rate
Koopmans GT et al. [17] 2013 Netherlands 2001–2003 9077 individuals Native Dutch (n = 7772) Immigrants (n = 1305) ≥18 years To investigate ethnic-related differences in utilization in outpatient mental health care Survey-based study Dutch Second National Survey of General Practice (A representative sample of 104 GP practices) Contact with any mental health service during the last 12 months Place of birth (subject and parents) Surinamese, Dutch, Antilleans, Moroccans and Turks Age & gender Self-reported mental health Education level Marital status Proficiency in Dutch language Orientation towards modern western values Lay views on illness and treatment Migrant group’s utilization is about half the level of the native Dutch
Lee CH et al. [42] 2013 Singapore 2008–2010 374 patients with diagnosis of STEMI Singapore-born citizens (n = 286) Immigrants (n = 88) To study disparities in accessibility to high quality health care, and if patients’ psychosocial condition after discharge was associated with their immigration status Survey-based study Survey at university-affiliated hospital in Singapore Patients treated with primary percutaneous coronary intervention, median symptom-to-balloon time, median door-to-balloon time and prescription of evidence-based medical therapy Place of birth and citizenship (1) Singapore-born citizens (2) Foreign-born citizens (3) Permanent residents Cardiovascular risk factor profile Admission pathway Education level Occupation Average monthly household income There were no major disparities in access to high quality health care for patients with different immigration status
Marchesini G et al. [43] 2014 Italy 2010 7,856,348 patients Italy-born Italian citizens (n = 7,328,383) Foreign-born no Italian citizens (n = 527,965) All ages To assess whether prevalence, treatment and direct costs of drug-treated diabetes were similar in migrants and in people of Italian citizenship Register-based study Administrative data sources of all Italian residents in 30 health districts (ARNO observatory) (1) Prescriptions (2) Hospitalizations (3) Healthcare services (consultations, laboratory tests and other diagnostic procedures) Place of birth Age & gender Place of residence Migrants show a higher risk of diabetes but less intense treatment
Pourat N et al. [44] 2014 USA (California) 2009–2010 59,938 individuals Natives (n = 8602) Immigrants (n = 388) All ages Test the validity of the assertion that undocumented immigrants are more frequent users of health care Survey-based study California Health Interview Survey (CHIS) (1) Number of doctor visits in the past year (2) Percentage of respondents with an ED visits among children and adults in the past year (3) Percentage of children who had a doctor visit in the past year (1) US-born (2) Naturalized citizen (3) Legal permanent resident or other authorized immigration status (4) Undocumented immigrants Age & gender Ethnicity Self-assessed health status Number of chronic conditions Insurance coverage Official Employment status Household income Family status Family size Language (English) proficiency Region of residence Place of residence Utilization among undocumented immigrants in all analyses was lower than or similar to that of other groups
Ramos JM et al. [28] 2013 Spain (Alicante) 2011 42,839 individuals Natives (n = 38,620) Immigrants (n = 4219) ≥15 years To compare hospital admission rates, diagnoses at hospital discharge, service of admission at hospital discharge, and mortality between FCs and autochthonous citizens (ACs) Register-based study Hospital discharges registries from hospital information systems (Hospital General Universitario de Alicante (HGUA) and Hospital Universitario de Sant Joan d’Alacant (HUS)) Hospital admissions Foreign citizen (FC) (people without Spanish citizenship) (1) FCs from high income countries (born in 25 European Union countries, Switzerland, Iceland, Norway, the USA, Canada, Japan, and Australia) (2) FCs from low income countries (born elsewhere: North Africa and the Middle East, Latin America, Eastern Europe, Sub-Saharan Africa, and Asia) Age & gender Diagnosis at discharge Unit of admission Destination at discharge Length of stay The utilization rate was lower in foreign citizens
Rucci P et al. [18] 2015 Italia (Bologna) 2010–2011 8990 individuals Natives (n = 8602) Immigrants (n = 388) All ages To determine whether disparities exist in mental healthcare provision to immigrants and natives with severe mental illness Register-base study Information system of the Departments of Mental Health (DMH), Emilia-Romagna (1) Receiving psychosocial rehabilitation the following year (2) Days admitted to hospital wards or to residential facilities the following year Citizenship (immigrants comprise regular immigrants, non-documented immigrants, no Italian citizenship) Age & gender Mental illness diagnosis Age at first contact Duration of episode Education level Marital status Working status Living arrangement CMHC area Although the probability of receiving any mental health intervention is similar between immigrants and Italians, the number of interventions and the duration of admissions are lower for immigrants Immigrants spend less days of residential care in licensed psychiatric facilities or other facilities
Smith-Nielsen S et al. [45] 2015 Denmark June–August 2007 3,573 individuals Natives (n = 1131) Labour immigrants (n = 808) RGE immigrants (n = 1634) 18–64 years To investigate whether potential differences exist in the use of private practicing psychiatrists and psychologists Register and survey-based study Survey and registry study on health and health behaviour of individuals registered at the Danish Civil Registration System (CPR number) Use of psychiatrist or psychologist last year Citizenship: (1) Ethnic Danes (at least one parent born in Denmark with Danish citizenship) (2) Immigrant (people residing in Denmark for a minimum of 3 years and born in a foreign country to parents without Danish citizenship) (RGC: Refugee Generating Countries: Turkey, Pakistan, Iraq, Iran, Lebanon, Syria, Somalia and Yugoslavia) Age & gender Mental health status Physical health symptoms Marital status Education level Employment status Household income Length of stay in Denmark Oral Danish proficiency Immigrants from RGC have similar or higher use of psychiatrists and psychologists in private practice when taking mental health into account Labour immigrants in general, except for women using psychiatrists, have lower use of psychiatrists and psychologists
Spinogatti F et al. [29] 2015 Italy 2001–2010 139,775 individuals >17 years To analyse the differences in mental health service utilization by immigrant and native populations Register-base study Regional mental health information system Departments of Mental Health (DHM), Lombardy (1) Contact with psychiatric services (2) Hospitalization in acute psychiatric wards Country of birth Age & gender Mental disorder Marital status Education level Employment status The treated prevalence of native patients outnumbers that of immigrant ones, although immigrant patients use acute mental health services more frequently
Straiton M et al. [19] 2014 Norway 2008 2,712,974 individuals Natives (n = 2,604,757) Immigrants (n = 108,217) 18–67 years To explore treatment options in primary care for immigrant women with mental health problems compared with non-immigrant women Register-base study National registries (1) National Population Register (2) Norwegian Health Economics Administration database-HELFO (3) Norwegian Prescription Database-NorPD PHC services (1) GP psychological consultations (2) EPC psychological consultation Country of birth (1) Natives (born in Norway with both parents born in Norway) (2) Immigrants (born abroad with both parents from abroad) staying at least 6 months Age & gender GP and EPC non-psychological consultation Marital status Income level Length of stay Reason for migration Place of residence Overall, immigrants are less likely to use a GP or EPC services for mental health problems Immigrant women are somewhat underrepresented in PHC care services for mental health problems
Straiton ML et al. [20] 2016 Norway 2008 1,283,437 individuals Natives (n = 1,230,175) Immigrants (n = 53,262) 20–67 years (1) To identify in which forms of treatment immigrant women are over or under represented compared with native Norwegians, and if this varied by country of origin (2) To determine whether use of an interpreter increases the likelihood of accessing different treatment types Register-base study National registries (1) National Population Register (2) Norwegian Health Economics Administration database-HELFO (3) Norwegian Prescription Database-NorPD Mental health services (1) Conversational therapy (2) Psychiatric referrals (3) Psychotropic medication (4) Certificates for sickness leave and disability applications Country of birth (1) Natives (born in Norway with both parents born in Norway) (2) Immigrants (born abroad with both parents from abroad) staying at least 6 months, divided according to the World Bank income categories of their country of origin Age Diagnosis Use of interpreter Marital status Income level Length of stay Place of residence Women are somewhat underrepresented in PHC services for mental health problems A higher percentage of Norwegian women had had a Psychiatric consultation than any of the 6 immigrant groups Psychiatric referral rates did not differ by country of origin
Tarraf W et al. [30] 2014 USA 2000–2008 167,889 individuals US-born (n = 133,102) Naturalized FB-citizens (n = 14,338) Non-citizens (n = 20,449) ≥18 years (1) Provide a detailed accounting of ED use with policy-relevant immigrant classifications (2) Examine associations between ED use and citizenship status using a Behavioural Model of healthcare access and utilization (3) Determine the most important factors associated with differences in immigrants’ ED services use Survey-based study (1) Medical Expenditures Panel Survey (MEPS) (2) National Health Interview Survey Self-reported past-year ED use Immigration status and place of birth (1) US-born citizens (2) Naturalized foreign-born (FB) citizens (immigrants who have obtained US citizenship) (3) FB non-citizens (legal permanent residents, as well as undocumented and “other” immigrants) Age & gender Self-reported ethnicity/race Self-rated health Medical conditions Past-year healthcare provider visits Past-year hospital discharges Insurance status Usual source of care availability Education level Household income-to-poverty Place of residence (urbanity) Region Immigrants, and particularly non-citizens, were less likely to use ED services Non-citizens are less likely to use ED services and showed that they are also less likely to be repeat users
Tormo MJ et al. [31] 2015 Spain (Murcia) 2006–2008 2453 individuals Natives (n = 1303) Immigrants (n = 1303) 18–64 years To describe the utilization of health services among immigrant and male and female native populations Survey-based study (1) Spanish National Health Survey (SNHS) (2) Health and Culture Survey (SyC) (1) Unmet healthcare need in the last 12 months (2) Visit to a GP in the last year (3) Visit to dentist in the last year (4) Hospitalization and ED visit in the past year (5) Drug consumption it last 2 weeks Immigrants with Health Insurance Card (Tarjeta Sanitaria Individual-TSI) Age & gender Self-assessed health status Health problems last year Activity limitation last 2 weeks Education level Social class Migrants showed a lower use of PHC services specialists, but a higher use of ED
Verhagen I et al. [32] 2014 Netherlands 2010 68,214 individuals Natives (n = 33,725) Immigrants (n = 34,489) ≥55 years To study whether healthcare use of the four ethnic minority elderly populations in the Netherlands varies from the ethnic Dutch elderly Register-base study Registry data from the Achmea Health Insurance Company (Achmea) (1) GP services (2) Receipt of prescriptions (3) Physical therapy (4) Hospital services (5) Medical aids to help with a limitation Country of birth or surname Turkish, Moroccan, Surinamese and Moluccan Age & gender Additional health insurance Neighbourhood deprived The use of PHC facilities (GP services and prescriptions) within most ethnic minority groups is higher; however, they generally make less use of hospital care, medical aids, and physical therapy
Villarroel N et al. [46] 2015 Spain 2006 22,224 patients Natives (n = 20,226) Immigrants (n = 1998) 16–64 years (1) To analyse differences in patterns of healthcare use (visits to PC, hospitalizations and emergency visits) between the native Spanish population and immigrants from the seven leading countries in terms of number of immigrants in Spain in 2006 (2) To examine whether the differences are explained by self-perceived health status, educational level, family characteristics, employment status and social support (3) To determine whether the patterns of association differ by gender Survey-based study Spanish National Health Survey (SNHS) 2006–2007 (1) Visit to a GP in the 4 weeks before (2) Hospitalization in the past year (3) ED visits in the past year Country of birth Age & gender Self-perceived health status Marital status Educational level Employment status Social support (adapted from the Duke-UNC Functional Social Support Questionnaire) Social support (adapted from the Duke-UNC Functional Social Support Questionnaire) Immigrants made less than, or about the same use of healthcare services Among men, a lower use of healthcare services was found among those born in Romania for all healthcare levels and among Ecuadorians for hospitalizations Among women a lower use of PHC was found among those born in Argentina, Bolivia and Ecuador, and a higher use among Peruvians. No differences were observed with native-born subjects A higher utilization of healthcare services was only found among men born in Bolivia, who were more likely to use hospitalization
Wang L [47] 2014 Canada 2005–2010 94,948 individuals Canadian-born (n = 73,806) Foreign born (n = 21,142) 18–75 years Explore the relationships among individual socio-economic status, residential neighbourhood characteristics and self-reported health for multiple immigrant groups Survey-based study Canadian Community Health Survey (CCHS) (1) Have a regular physician (2) Stay overnight in hospital (3) Number of dental visits per year (4) Number of physician visits per year Country of birth, ethnic origin and immigrant status (1) Native born (2) Long-standing groups (Italian and Portuguese) (3) Recent groups (Chinese and South Asian) (4) Overall foreign born Age & gender Self-perceived health status Chronic diseases Health behaviour (smoke, overweight, physical activity, vegetable intake) Marital status Education level Household income Language proficiency Length of stay Neighbourhood characteristics (deprivation & ethnic concentration) Immigrants have lower rates of overnight stay in hospital All four selected immigrant groups have higher rates for having a regular physician Immigrants report significantly more physician visits Foreign-born groups report fewer dental visits
Wang L et al. [48] 2015 Canada 2005–2010 161,981 individuals Native born (n = 124,946) Korean immigrants (n = 351) Overall foreign born (n = 36,684) ≥25 years To explore healthcare-seeking behaviour of South Korean immigrants in Toronto, Canada, and how transnationalism shapes post-migration health and health-management strategies Survey-based study Canadian Community Health Survey (CCHS) 2005–2010 (1) Stay overnight in hospital (2) Physician visits (3) Dental visits Country of birth (1) Native born in Canada (2) Overall foreign born (3) Korean immigrant Age & gender Self-perceived health status Chronic diseases Marital status Education level Employment status Household income Immigration category Length of stay Place of residence Of the three groups, Koreans use health services the least They have the lowest rate of having a regular doctor and overnight stay in hospital, the lowest numbers for dental and physician visits in the past 12 months, and the highest rate of no doctor visit in the past 12 months
  1. CMHC Community Mental Health Centers, ED emergency department, EPC emergency primary care, GP general practitioner, HIC high income country, LIC low income country, MIC medium income country, OHIP Ontario Health Insurance Plan, PHC primary health care, STMI ST segment elevation myocardial infarction