Abstract
BackgroundIn developed countries, health care utilization among immigrant groups differs where the dominant interpretation is unjustified overutilization due to lack of acculturation. We investigated utilization of prescribed drugs in native Dutch and various groups of immigrant elderly.MethodsCross-sectional study using data from the survey "Social Position, Health and Well-being of Elderly Immigrants" (the Netherlands, 2003). Ethnicity-matched interviewers conducted the survey among first generation immigrants aged 55 years and older. Outcome measure is self-reported use of prescribed drugs. Utilization is explained by need, and by enabling and predisposing factors, in particular acculturation; analysis is conducted by multiple logistic regression.ResultsThe study population consisted of immigrants from Turkey (n = 307), Morocco (n = 284), Surinam (n = 308) and the Netherlands Antilles (n = 300), and a native Dutch reference group (n = 304). Prevalence of diabetes mellitus (DM), COPD and musculoskeletal disorders was relatively high among immigrant elderly. Drug utilization in especially Turkish and Moroccan elderly with DM and COPD was relatively low. Drugs use for non-mental chronic diseases was explained by more chronic conditions (OR 2.64), higher age (OR 1.03), and modern attitudes on male-female roles (OR 0.74) and religiosity (OR 0.89). Ethnicity specific effects remained only among Turkish elderly (OR 0.42). Drugs use for mental health problems was explained by more chronic conditions (OR 1.43), better mental health (OR 0.95) and modern attitudes on family values (OR 0.59). Ethnicity specific effects remained only among Moroccan (OR 0.19) and Antillean elderly (OR 0.31). Explanation of underutilization of drugs among diseased with diabetes and musculoskeletal disorders are found in number of chronic diseases (OR 0.74 and OR 0.78) and regarding diabetes also in language proficiency (OR 0.66) and modern attitudes on male-female roles (OR 1.69).ConclusionsNeed and predisposing factors (acculturation) are the strongest determinants for drugs utilization among elderly immigrants. Significant drugs underutilization exists among migrants with diabetes and musculoskeletal disorders.
Highlights
In developed countries, health care utilization among immigrant groups differs where the dominant interpretation is unjustified overutilization due to lack of acculturation
Lower utilization is commonly explained by more or higher thresholds immigrant groups may experience when seeking for medical help
Whether drug utilization in general is increased among immigrants regardless the disease status, or whether specific patterns of over- and maybe underutilization exist, requires separating healthy and diseased persons in the analysis
Summary
Health care utilization among immigrant groups differs where the dominant interpretation is unjustified overutilization due to lack of acculturation. Health care utilization in developed countries is known to differ between immigrant and indigenous groups [1]. High prescription variability has been reported among immigrant groups within Western countries including the Netherlands [4,5,6,7]. This variability cannot be explained by inequality of need alone. Whether drug utilization in general is increased among immigrants regardless the disease status, or whether specific patterns of over- and maybe underutilization exist, requires separating healthy and diseased persons in the analysis. As most studies are population studies with overrepresentation of healthy subjects, these existing studies primarily explain overutilization in healthy persons
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