Health and Illness in Newly Arrived Migrants and Refugees Arriving at Europe's Shores: Analysis of the Electronic Personal Health Record System in Seven Countries

Abstract

Background: The electronic Personal Health (ePHR) Record is a health information system for newly arriving migrants that has been implemented in seven European countries (Bulgaria, Croatia, Cyprus, Greece, Italy, Serbia and Slovenia). This is a cross-sectional study of all migrants who attended as part of the health assessment programme established in the reception centres between 2016 and 2019 that provides a comprehensive overview of illness and health in the migrant cohort. Methods: Data were collected on demographics, clinical and laboratory findings and diagnostics performed, including medical records. We classified all diseases using pre-specified algorithms according to information on prespecified variables from the ePHR questionnaire, ICD-10 codes, positive laboratory findings that identified a health condition or review of medical records using natural language processing. Crude and adjusted prevalence ratios or adjusted proportions were estimated using logistic regression modelling. Results: The data set contained a total number of 19,564 clinical episodes in 14,440 individuals, recorded between 5 January 2016 to 4 October 2019. Most individuals (75%) were refugees or asylum seekers (22%) from 92 different nationalities. In total 811 (5.6%) individuals presented with cardiovascular disease and 1083 (8·2%) presented with a neurological condition. Having Diabetes Mellitus (OR 4, [95%CI 2·4-6·6], p<0.001), and neurological disorders (3·6, [95%CI 2·5-5·2], p<0.001) being older (OR 1·07 [95% CI 1·06-1·08]; p<0·001) and being male (OR 0·7, [95% CI 0·5-0·9]; p<0·001) was associated with cardiovascular disorders in the multivariable logistic regression model. Mental health problems were reported in 627 (4·4%) and were associated with older ages. There were 2,531 episodes of infectious diseases reported during the study period; 1283, (47·9%) pharyngo-tonsillitis, 529 (19·8%) scabies, 158 (6·2%) viral hepatitis and 156 (6·1%) lower respiratory infections. Conclusions: We demonstrated that infectious diseases were common, particularly among children, with a significant minority having a range of chronic diseases. Our findings show an important and less known disease burden, making a strong case for the improvement of accuracy and quality of data to improve the efficiency of the health care delivery and the monitoring and surveillance of migrant health needs. Funding: This work has been supported by a grant from the European Commission (N. 20175101).\ Conflict of Interest: All authors declare no competing interest. Ethical Approval: Internal IOM approval was granted, no external approval was needed, as this study is a service evaluation of routine systems and care. The reporting of this study conforms to the STROBE statement