Abstract
BackgroundRoutine public health databases contain a wealth of data useful for research among vulnerable or isolated groups, who may be under-represented in traditional medical research. Identifying specific vulnerable populations, such as resettled refugees, can be particularly challenging; often country of birth is the sole indicator of whether an individual has a refugee background. The objective of this article was to review strengths and weaknesses of different methodological approaches to identifying resettled refugees and comparison groups from routine health datasets and to propose the application of additional methodological rigour in future research.DiscussionMethodological approaches to selecting refugee and comparison groups from existing routine health datasets vary widely and are often explained in insufficient detail. Linked data systems or datasets from specialized refugee health services can accurately select resettled refugee and asylum seeker groups but have limited availability and can be selective. In contrast, country of birth is commonly collected in routine health datasets but a robust method for selecting humanitarian source countries based solely on this information is required. The authors recommend use of national immigration data to objectively identify countries of birth with high proportions of humanitarian entrants, matched by time period to the study dataset. When available, additional migration indicators may help to better understand migration as a health determinant. Methodologically, if multiple countries of birth are combined, the proportion of the sample represented by each country of birth should be included, with sub-analysis of individual countries of birth potentially providing further insights, if population size allows. United Nations-defined world regions provide an objective framework for combining countries of birth when necessary. A comparison group of economic migrants from the same world region may be appropriate if the resettlement country is particularly diverse ethnically or the refugee group differs in many ways to those born in the resettlement country.SummaryRoutine health datasets are valuable resources for public health research; however rigorous methods for using country of birth to identify resettled refugees would optimize usefulness of these resources.
Highlights
Routine public health databases contain a wealth of data useful for research among vulnerable or isolated groups, who may be under-represented in traditional medical research
Australia’s migration program consists of the Family Stream which seeks to reunite Australian residents with family members, the Skill Stream for those with abilities that will contribute to the Australian economy and the Humanitarian Program containing a number of visa types for refugees and asylum seekers [4]
As one of the largest health service providers in Australia and with a substantial and diverse migrant population, the dataset had the potential to make a valuable contribution to our understanding of migration as a health determinant
Summary
Routine public health databases contain a wealth of data useful for research among vulnerable or isolated groups, who may be under-represented in traditional medical research. A wealth of data exists in routine hospital and primary care databases that may be valuable for research involving vulnerable or isolated populations, who for linguistic, cultural or societal reasons may under-represented in traditional medical research These datasets have been created prior to generation of specific research questions and researchers face challenges concerning how to use these identify probable resettled refugee and comparison groups accessing health services. The objective of this article is to discuss strengths and weaknesses of different methodological approaches to selecting resettled refugee and comparison groups from routine health datasets These methodological considerations are illustrated by examples from peer-reviewed literature and from a locally developed study to illustrate how some of the challenges can be addressed. While this article focuses on resettled refugees mainly within the context of maternal health, the issues raised are applicable to general migration health research
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