Migration and self-rated health: a comparison between Finns living in Sweden and Finns living in Finland

AIMS: There is a lack of studies comparing health among immigrant groups with health among the population in their country of origin. This study compared the prevalence of self-rated poor health between Finns living in Sweden and Finns living in Finland. METHODS: Data were obtained from the Swedish Annual Level of Living Survey between 1996 and 2003 and the Finnish national survey "Health 2000'. Odds ratios (OR) of self-rated poor health were estimated adjusting for age, marital status, education, employment and smoking. The participants were 21,991 Swedes and 836 Finns living in Sweden, and 5,096 Finns living in Finland. RESULTS: For Finnish women living in Sweden the odds of self-rated poor health was significantly higher (OR=1.25, 95% CI=1.02-1.54) than for Finnish women living in Finland. An opposite pattern appeared among men; Finnish men living in Finland tended to have higher odds of self-rated poor health than Finnish men living in Sweden, although not to a statistically significant extent. In addition, Finns in Finland and in Sweden rated their health poorer than Swedes. CONCLUSIONS: Migration may have a different effect on Finnish men's and women's self-rated health. Further studies are needed to investigate the complex pathways between country of residence and self-rated health among immigrants.     

Pattern of health services use by immigrants from different regions of the world residing in Spain

Objective

To determine immigrants?? frequency of use of four health services by place of origin and compare it with that of the Spanish population.

Methods

Based on the 2006 National Health Survey in Spain, we estimated the frequency of use of four health services in men and women from: Spain, Western countries, Eastern Europe, Latin America, North Africa, Sub Saharan Africa and Asia/Oceania. These results were compared with the Spanish population by calculating odds ratios adjusted for age, socioeconomic position, health status, and type of health coverage.

Results

Immigrant men generally use health services less frequently than Spanish nationals. The main exceptions are Latin American men, who more often use emergency services (OR 1.68, 95% CI 1.41?C1.99) and Sub-Saharan men, who use specialists more frequently (OR 2.93, 1.70?C5.05). Immigrant women use health services about as frequently as Spanish women. The main exceptions are North African women, who less frequently use specialists (OR 0.39, 0.22?C0.71) and Sub-Saharan women who more frequently use GPs (OR 4.06, 2.21?C7.44), specialists (OR 2.29, 1.06?C4.95) and emergency services (OR 2.92, 1.49?C5.72).

Conclusions

Health services use by the immigrant population in Spain differs by gender and place of origin.     

The influence of age at migration and length of residence on self-rated health among Swedish immigrants: a cross-sectional study

Objective. Increasing global migration has led to profound demographic changes in most industrialised countries. A growing body of research has investigated various health aspects among immigrant groups and found that some immigrant groups have poorer health than the majority population. It has been suggested that poor acculturation in the host country could lie behind the increased risk of worsened health among certain immigrant groups. The aim was to investigate the cross-sectional association between acculturation, measured as age at migration or length of residence, and self-rated health among young immigrants.

Design. The simple, random samples of 7137 women and 7415 men aged 16–34 years were based on pooled, independent data collected during the period 1992–1999 obtained from the Swedish Annual Level of Living Survey (SALLS). Logistic regression was applied in the estimation of odds ratios (OR) for poor self-rated health, after accounting for age, sex, socioeconomic status (SES) and social networks. The non-response rate varied between 23.6 and 28.3% in the different immigrant groups.

Results. The odds of poor self-rated health increased with increasing age at migration to Sweden among first-generation immigrants. For those who had resided in Sweden less than 15 years the odds of poor self-rated health were significantly increased. In addition, most of the immigrant groups had higher odds of poor self-rated health than the reference group.

Conclusions. Health care workers and policy makers need to be aware that immigrants who arrive in the host country at higher ages and/or have lived in the host country for a shorter period of time might need special attention as they are more likely to suffer from poor self-rated health, a valid health status indicator that can be used in population health monitoring.     

The comparison of health status and health services utilisation between Indigenous and non-Indigenous infants in Australia

Objective: To examine the differences in health services utilisation and the associated risk factors between Indigenous and non-Indigenous infants at a national level in Australia.
Methods: We analysed data from a national representative longitudinal study, the Longitudinal Study for Australian Children (LSAC) starting in 2004. We used survey logistic regression and survey multiple linear regression to examine the factors associated with health services utilisation.
Results: Health status of Indigenous infants was poorer than that of non-Indigenous. In comparison to non-Indigenous infants, in the previous 12-month period, the Indigenous infants were significantly less likely to use the following health services: maternal and child health centre or help lines (OR=0.35, 95%CI: 0.24-0.49); maternal and child health nurse visits (OR=0.45, 95%CI: 0.32-0.63); general practitioners (GPs) (OR=0.45, 95%CI: 0.31-0.64); and paediatrician (OR=0.52, 95%CI: 0.35-0.77). In contrast, they were more likely to visit a hospital outpatient clinic (OR=1.82, 95%CI: 1.16-2.85). Mothers' age, education and marital status were associated with certain health services use. Financial status and residential location were the important predictors of the use of health services.
Conclusion: The rates of health services utilisation by Indigenous infants were lower and were associated with mothers' characteristics and socio-economic status.
Implications: The gaps in health services utilisation between Indigenous and non-Indigenous infant requires immediate policy initiatives. Further research is needed to explore the causal pathways between health status, health services utilisation and multiple risk factors at different levels.     

Inmigración y salud: desigualdades entre la población autóctona e inmigrante en el País Vasco

Objective

To analyze health inequalities between native and immigrant populations in the Basque Country (Spain) and the role of several mediating determinants in explaining these differences.

Methods

A cross-sectional study was performed in the population aged 18 to 64 years in the Basque Country. We used data from the Basque Health Survey 2007 (n = 4,270) and the Basque Health Survey for Immigrants 2009 (n = 745). We calculated differences in health inequalities in poor perceived health between the native population and immigrant populations from distinct regions (China, Latin America, the Maghreb and Senegal). To measure the association between poor perceived health and place of origin, and to adjust this association by several mediating variables, odds ratios (OR) were calculated through logistic regression models.

Results

Immigrants had poorer perceived health than natives in the Basque Country, regardless of age. These differences could be explained by the lower educational level, worse employment status, lower social support, and perceived discrimination among immigrants, both in men and women. After adjustment was performed for all the variables, health status was better among men from China (OR: 0.18; 95% confidence interval [CI95%]: 0.04-0.91) and Maghreb (OR: 0.26; 95% CI: 0.08-0.91) and among Latin American women (OR: 0.36; 95% CI: 0.14-0.92) than in the native population.

Conclusions

These results show the need to continue to monitor social and health inequalities between the native and immigrant populations, as well as to support the policies that improve the socioeconomic conditions of immigrants.     

Discrimination,work and health in immigrant populations in Spain

One of the most important social phenomena in the global context is the flow of immigration from developing countries, motivated by economic and employment related issues. Discrimination can be approached as a health risk factor within the immigrant population's working environment, especially for those immigrants at greater risk from social exclusion and marginalisation. The aim of this study is to research perceptions of discrimination and the specific relationship between discrimination in the workplace and health among Spain's immigrant population. A qualitative study was performed by means of 84 interviews and 12 focus groups held with immigrant workers in five cities in Spain receiving a large influx of immigrants (Madrid, Barcelona, Valencia, Alicante and Huelva), covering representative immigrant communities in Spain (Romanians, Moroccans, Ecuadorians, Colombians and Sub-Saharan Africans). Discourse narrative content analysis was performed using pre-established categories and gradually incorporating other emerging categories from the immigrant interviewees themselves. The participants reported instances of discrimination in their community and working life, characterised by experiences of racism, mistreatment and precarious working conditions in comparison to the Spanish-born population. They also talked about limitations in terms of accessible occupations (mainly construction, the hotel and restaurant trade, domestic service and agriculture), and described major difficulties accessing other types of work (for example public administration). They also identified political and legal structural barriers related with social institutions. Experiences of discrimination can affect their mental health and are decisive factors regarding access to healthcare services. Our results suggest the need to adopt integration policies in both the countries of origin and the host country, to acknowledge labour and social rights, and to conduct further research into individual and social factors that affect the health of the immigrant populations.     

Parental economic stress: evidence of an overlooked public health risk among Swedish families

BACKGROUND: Studies have demonstrated that when parents shoulder considerable financial responsibilities, adverse health outcomes may occur. The present study assesses the association between economic stress and self-rated health in a sample of Swedish parents, and especially how this relation is affected by foreign origin and employment status. METHODS: A questionnaire was sent to a random sample of 5,600 individuals between the ages of 21 and 81 in Malm?, Sweden. The total response rate was 69%. Among the respondents, 824 were parents having at least one child living at home. The main exposures were such sociodemographic variables as country of origin and employment status, and economic stress. The outcome variable was self-rated health. RESULTS: Of the parents in the study, the 34.7% coded as exposed to economic stress showed a significantly increased odds ratio for poor self-rated health (OR=3.12, 95% CI: 2.01-4.84) adjusted for age and sex. After controlling for foreign origin and unemployment, the odds ratio remained statistically significant regarding exposure to economic stress (OR=1.94; 1.16-3.23). In the multivariate model, foreign origin and unemployment were also strongly associated with poor self-rated health (OR=1.78, 95% CI: 1.12-2.88; OR=1.67, 95% CI: 1.01-2.75, respectively). The adjusted population-attributable risk for poor self-rated health was estimated to be 27.4% for economic stress, 26.6% for foreign origin, and 16.7% for unemployment. CONCLUSIONS: Parental economic stress was associated with low self-rated health to a statistically significant degree, even when accounting for employment status and foreign origin. It, therefore, deserves to be seriously considered as an potential public health risk factor among Swedish families.     

The association between mental health problems and inflammatory conditions across gender and immigrant status: a population-based cross-sectional study among 10th-grade students

AIM: The aim of this study was to describe the prevalence of and investigate the association between mental health problems, asthma, allergy and eczema in Norwegian and immigrant youths. METHODS: A cross-sectional study was performed of all 10th-grade students in Oslo, Norway, in two school years; 1999-2000 and 2000-2001. Of the 8316 eligible students, 7345 (88.3%) participated. Internalized mental problems were measured using the Hopkins Symptom Check List 10-version, and two subscales of the Strength and Difficulties Questionnaire were used to study externalizing mental health problems. All questions are based on self-report, and 25% of the sample had an immigrant background. RESULTS: Immigrant boys had higher scores on internalizing problems than Norwegian boys. First-generation immigrants reported less asthma and eczema than Norwegians. The strongest association between mental health problems and inflammatory conditions was for allergy and internalizing problems for boys (odds ratio (OR)=2.5 for immigrants and OR=1.8 for Norwegians). For girls, it was allergy in Norwegians (OR=1.6) and asthma for immigrants (OR=2.2). For externalizing problems, the association was strongest for asthma in boys and eczema in girls. Immigrant boys had stronger associations between number of inflammatory conditions and internalizing mental health problems than Norwegians (OR=3.2 vs. OR=2.4). Among girls, the figures were 1.7 for Norwegians and 1.8 for immigrants. CONCLUSIONS: There is a strong association between number of inflammatory conditions and internalizing mental health problems, especially among boys with an immigrant background. The association with externalizing mental health problems was less prominent.     

Help seeking and barriers to utilisation of medical and health social work services among ageing immigrants to Israel from the former Soviet Union

The study aimed to examine utilisation of medical and health social work services among ageing recent and long-term immigrants, to identify barriers to service utilisation, and to examine factors related to utilisation. Participants (n = 402) recruited from a random community sample of immigrants from the former Soviet Union in Israel, aged 55 and over, residing in urban areas throughout the country were interviewed by telephone. Using an expanded framework of Andersen's behavioural model, the independent variables included predisposing, enabling and need variables, and additional variables--barriers to utilisation or difficulties encountered during utilisation of services. For multivariate analyses of the dependent variables, a linear multiple regression model was employed for utilisation of medical services and a logistic regression model for utilisation of social work services. The main findings show that utilisation rates were high for medical services, but low for social work services. Recent immigrants had similar utilisation rates of medical services but utilised more social work services than long-term immigrants. There were few barriers but numerous difficulties in utilisation of medical services, while there were barriers but negligible difficulties in utilisation of social work services. Predisposing and need variables explained utilisation of medical services, whereas a combination of predisposing, enabling and need variables explained utilisation of social work services. The findings suggest that different factors are associated with the use of non-discretionary versus discretionary (social work) services. There is a need to reduce difficulties in utilisation of medical services and to enhance awareness about health social work services among the immigrants.     

城市新移民自评健康状况及其影响因素分析

目的 了解城市新移民自评健康状况及其影响因素,为提高城市新移民的健康状况提供依据。方法 采用χ2检验比较不同自评健康状况城市新移民之间人口学特征、生活方式和健康状况之间的差异,采用有序Logistic回归得出城市新移民自评健康的影响因素。结果 城市新移民自评健康好、一般、差的人数分别为3 247例（71.8%）、1 092例（24.2%）和181例（4.0%）。多因素分析显示,在城市新移民中18~岁、30~岁和60~岁年龄段人群和70岁及以上年龄段人群相比自评健康更好;初中学历者和高中及以上学历者相比,自评健康状况更好;无工作或者退休者相比有工作者,自评健康状况更差;无两周患病、无慢性病、无一年住院和无抑郁者自评健康状况更好;不喝酒和偶尔喝酒的人群相比于经常喝酒的人群,自评健康状况更差;睡眠时间<6 h者相比与睡眠时间 ≥ 9 h者,自评健康状况更差。结论 应该加强老年人、无业或退休人群、高文化水平等重点人群的健康管理,从而促进相应人群的健康水平。     

Inequalities in mental health care and social services utilisation by immigrant women

Background: The basic assumption of public health policy forimmigrants is that they ought to have equal access to healthservices compared to other population groups In Dutch society.However, little research is done on the actual use of mentalhealth services by immigrants and literature seems to indicateinequalities in services utilisation by immigrant women. Methods:This study was conducted in Amsterdam, The Netherlands. Dataon service utilisation were drawn from patient registers andcame from care providers who were asked to keep up registrationfor some time to count the number of immigrant women referredto and in treatment. Results: Surinamese, Antillean, Turkishand Moroccan women made considerably less use of mental healthcare services than native-born women. On the other hand, immigrantwomen more frequently used social work facilities and womencrisis intervention centres. Overall, they consulted the latterorganizations nearly 1.5 times more frequently than mental healthcare services. The differences in service utilisation betweenthe four immigrant groups are also discussed. Conclusions: Thisstudy explores the reasons for the ethnic differences in serviceutilisation. It argues that cultural and supply factors arelargely responsible for the ethnic differences in use of mentalhealth services. The differential use of social services ismainly ascribed to the socioeconomic status of the women concerned.The results imply that a care policy may improve the accessibilityof mental health services for immigrant women. The most promisingmeasure is by employing more ethnic and bilingual care providers.     

Healthcare-seeking patterns among immigrants in Portugal

Equity of access to health services is a major concern as it is an important precondition for positive health outcomes. However, inequities in use of health services among immigrant populations persist. Despite the increasing research in the field, patterns of healthcare seeking among immigrant populations and its associated factors are not fully understood. This study aimed to investigate healthcare-seeking patterns among immigrants in Portugal and identify factors associated with utilisation of health services. A cross-sectional study was conducted between October 2008 and May 2009 with a sample of 1,375 immigrants residing in the Lisbon region. Data were collected through a structured questionnaire applied by trained interviewers. Two stepwise logistic regressions were conducted to identify which factors were associated with utilisation of the National Health Service (NHS) and with healthcare seeking for the first time in Portugal at the Primary Health Care service, estimated by calculating odds ratios and 95% confidence intervals. Among participants, around 77% reported having used the NHS; 50% sought health-care for the first time at the Primary Health Care service and 33% at the emergency room. Lower odds of having used the NHS were associated with being male, Brazilian or eastern European compared with being African, and undocumented. Lower odds of having sought health-care for the first time at the Primary Health Care service were associated with being male and undocumented. These results suggest that further efforts are needed to tackle inequalities in access to care and promote the utilisation of health services, particularly among the more vulnerable immigrant groups. Increasing appropriate utilisation of health services, including the primary and preventive care services, may lead to better health outcomes. Immigrants' involvement and participation should be incorporated into the development of health strategies to improve access and utilisation of healthcare services.     

农村流入人口医疗卫生服务利用现状及影响因素分析

目的 通过分析农村流入人口医疗卫生服务利用的现状,探究影响其医疗卫生服务利用的因素,为改进农村流动人口医疗卫生服务提出建议。 方法 筛选2017年全国流动人口卫生计生动态监测调查数据中流入农村的流动人口39 578例,分析农村流入人口医疗卫生服务利用的现状,并利用多因素logistic回归分析影响农村流入人口医疗卫生服务利用的因素。 结果 18 922例最近一年有患病或身体不适的流入农村人口中,10 705例曾就诊,就诊率为56.6%;首诊机构为本地社区卫生站和本地个体诊所的分别占24.5%和18.8%;听说过国家基本公共卫生服务项目（OR = 1.127,95%CI:1.055～1.204）、已建立健康档案（OR = 1.240,95%CI:1.148～1.340）、接受过健康教育（OR = 1.224,95%CI:1.146～1.308）、有医保（OR = 1.128,95%CI:1.003～1.268）的农村流入人口医疗卫生服务利用率高;而有工作的（OR = 0.803,95%CI:0.733～0.880）、随家属迁移的（OR = 0.851,95%CI:0.729～0.994）、自评健康状况健康（OR = 0.514,95%CI:0.444～0.595）的农村流入人口卫生服务利用率较低。 结论 流入农村人口医疗卫生服务利用情况较差;患病后首诊机构多为本地社区卫生站和本地个体诊所;流动原因、就业状况、自评健康状况、健康档案建立情况、健康教育接受情况、是否听说过国家基本公共卫生服务项目以及是否有医保均会影响农村流入人口利用医疗卫生服务。     

Immigrants' use of emergency primary health care in Norway: a registry-based observational study

ABSTRACT: BACKGROUND: Emigrants are often a selected sample and in good health, but migration can have deleterious effects on health. Many immigrant groups report poor health and increased use of health services, and it is often claimed that they tend to use emergency primary health care (EPHC) services for non-urgent purposes. The aim of the present study was to analyse immigrants use of EPHC, and to analyse variations according to country of origin, reason for immigration, and length of stay in Norway. METHODS: We conducted a registry based study of all immigrants to Norway, and a subsample of immigrants from Poland, Germany, Iraq and Somalia, and compared them with native Norwegians. The material comprised all electronic compensation claims for EPHC in Norway during 2008. We calculated total contact rates, contact rates for selected diagnostic groups and for services given during consultations. Adjustments for a series of sociodemographic and socio-economic variables were done by multiple logistic regression analyses. RESULTS: Immigrants as a whole had a lower contact rate than native Norwegians (23.7% versus 27.4%). Total contact rates for Polish and German immigrants (mostly work immigrants) were 11.9% and 7.0%, but for Somalis and Iraqis (mostly asylum seekers) 31.8% and 33.6%. Half of all contacts for Somalis and Iraqis were for non-specific pain, and they had relatively more of their contacts during night than other groups. Immigrants rates of psychiatric diagnoses were low, but increased with length of stay in Norway. Work immigrants suffered less from respiratory and gastrointestinal infections, but had more injuries and higher need for sickness certification. All immigrant groups, except Germans, were more often given a sickness certificate than native Norwegians. Use of interpreter was reduced with increasing length of stay. All immigrant groups had an increased need for long consultations, while laboratory tests were most often used for Somalis and Iraqis. CONCLUSIONS: Immigrants use EPHC services less than native Norwegians, but there are large variations among immigrant groups. Work immigrants from Germany and Poland use EPHC considerably less, while asylum seekers from Somalia and Iraq use these services more than native Norwegians.     

Self-rated health in Canadian immigrants: analysis of the Longitudinal Survey of Immigrants to Canada

Using a multi-level random effects logistic model, we examine the contribution of source country, individual characteristics and post-migration experiences to the self-rated health (SRH) of 2468 male and 2614 female immigrants from the Longitudinal Survey of Immigrants to Canada (2001-2005). Sex/gender differences were found for all categories of health determinants. Source country characteristics explained away some ethnic differentials in health and had independent negative effects, particularly among women. Thus, women from countries lower on the development index appear at greater risk of poor SRH, and should be at the forefront of public health programmes aimed at new immigrants in Canada.     

Poverty and sociocultural factors in the use of maternal health services in Ivory Coast

BACKGROUND: Better health for populations is linked to the adequate access to health services. This is particularly important in developing countries, where a number of economic, social, and geographic barriers exist. Pregnant women are particularly at risk, as they have many health needs and problems. In addition, the use of maternal health services is particularly influenced by economic and socio-cultural factors. Therefore, we intended to appreciate the association between poverty, socio-cultural factors and use of maternal health services in Ivory Coast. METHODS: For this study, our data were from the demographic and health survey in Ivory Coast in 1998. We used the logistic regression models to analyze the relation between poverty, socio-cultural factors and use of services (antenatal care, type of delivery). RESULTS: 62.4% of women used antenatal care adequately and 48.9% delivered in good conditions. Poverty is strongly linked to the use of services whatever the socio-cultural and demographic aspects are, with the poor using less services than the richer. Concerning the impact of socio-cultural characteristics, women living alone or with one adult (OR=1.60; 95% IC=1.06-2.42), those who are Christian (OR=1.83; 95% IC=1.25-2.67) or Akan are more likely to have adequate antenatal care than women living with 5 adults or more, having traditional or no religion, and those who are Senoufo or non Ivorian. Besides, when the number of children increases, they are less likely to consult. Primiparous, Christians (OR=2.45; 95% IC=1.68-3.59) or Muslims (OR=1.73; 95% IC=1.10-2.72) are more likely to deliver in a health center with a qualified assistance. CONCLUSION: Poverty has a negative effect on the use of maternal services but one should also take into account certain socio-cultural characteristics, namely number of adults in the household, parity, ethnicity and religion. While reducing poverty, it appears important to involve family members and religious or ethnic leaders in order to improve this use.     

重庆市农村留守老人自评健康状况及影响因素分析

目的 探索重庆市农村留守老人的自评健康状况及影响因素,为有关部门制定留守老人健康保障政策提供实证参考。方法 采用多阶段随机抽样法对重庆市600名农村留守老人进行问卷调查,描述其自评健康状况,并采用有序logistic回归分析其自评健康状况的影响因素。结果 自评健康为差、一般、好的农村留守老人分别占44%、40.67%、15.33%。高家庭人均年收入（OR = 0.396,95%CI:- 1.349～- 0.505）、未购买商业健康保险（OR = 0.424,95%CI:- 1.344～- 0.370）、两周内未出现不适（OR = 0.601,95%CI:- 0.884～- 0.135）、一年内未住院（OR = 0.448,95%CI:- 1.197～- 0.406）、高BMI指数（OR = 0.406,95%CI:- 1.530～0.301）的农村留守老人自评健康更倾向于积极（OR＜1）,医疗费用负担重（OR = 2.433,95%CI:0.313～1.464）、所患慢性病数多（OR = 5.877,95%CI:1.223～2.319）和不饮酒（OR = 2.948,95%CI:0.637～1.524）的老人自评健康更倾向于消极（OR＞1）。结论 加强农村留守老人医疗卫生服务体系建设,健全农村留守老人的家庭支持和社会支持体系,积极开展农村留守老人专项健康教育行动,降低疾病风险。