Abstract
BackgroundGlobal migration toward Europe is increasing. Providing health assistance to migrants is challenging because numerous barriers limit their accessibility to health services. Migrants may be at a greater risk of developing asthma and receiving lower quality healthcare assistance than non-migrants. We aim to investigate whether immigrants as children and adolescents have higher rates of potentially avoidable hospitalization (PAH) for asthma compared to Italians.MethodsWe performed a retrospective longitudinal study using six cohorts of 2–17-year-old residents in North and Central Italy from 01/01/2001 to 31/12/2014 (N = 1,256,826). We linked asthma hospital discharges to individuals using anonymized keys. We estimated cohort-specific age and calendar-year-adjusted asthma PAH rate ratios (HRRs) and 95% confidence intervals (95%CIs) among immigrants compared to Italians. We applied a two-stage random effect model to estimate asthma PAH meta-analytic rate ratios (MHRRs). We analyzed data by gender and geographical area of origin countries.ResultsThree thousand three hundred four and 471 discharges for asthma PAH occurred among Italians and immigrants, respectively. Compared to Italians, the asthma PAH cohort-specific rate was higher for immigrant males in Bologna (HRR:2.42; 95%CI:1.53–3.81) and Roma (1.22; 1.02–1.45), and for females in Torino (1.56; 1.10–2.20) and Roma (1.82; 1.50–2.20). Asthma PAH MHRRs were higher only among immigrant females (MHRRs:1.48; 95%CI:1.18–1.87). MHRRs by area of origin were 63 to 113% higher among immigrants, except for Central-Eastern Europeans (0.80; 0.65–0.98).ConclusionThe asthma PAH meta-analytic rate was higher among female children and adolescent immigrants compared to Italians, with heterogeneity among cohorts showing higher cohort-specific PAH also among males, with some differences by origin country. Access to primary care for children and adolescent immigrants should be improved and immigrants should be considered at risk of severe asthma outcomes and consequently targeted by clinicians.
Highlights
Our objective is to examine whether immigrant children and adolescents living in Italy have higher rates of potentially avoidable hospitalization (PAH) for asthma compared to Italians
The percentage of individuals coming from High Migratory Pressure Countries (HMPCs) was 13.7%, with percentages ranging between 11.0% in Roma and 22.2% in Reggio Emilia, while those coming from High Developed Countries (HDCs) were only 0.7%
Results by geographical area of origin Compared to Italians, 63 to 113% meta-analytic excess overall PAH was found for all the areas of origin, except for immigrants coming from Central-Eastern Europe (MHRR:0.80; 95% CI:0.65–0.98), with some heterogeneity across cohorts (Table 2)
Summary
International migration is increasing and health assistance to migrants is challenging because of barriers which often limit accessibility to healthcare services, even when health systems include assistance to migrants [1]. The main reasons for migration to Italy among non-EU citizens were job opportunities and family reunification (88% in 2001, 74% in 2013, and 64% in 2014, when residence permits for international protection increased in number following the 2011 Arab Spring and the humanitarian emergency of 2014–2015 [3]). In Italy, the prevalence of lifetime asthma was estimated to be 9.3% in children and 10.3% in adolescents [7]. These measures for Italy might be an underestimation, as there is likely to be a pool of asthma patients yet unrecognized by healthcare [8]
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