Foreign-born Groups Research Articles

Heart failure in first- and second-generation immigrants aged 18-54years in Sweden: A national study.

We aimed at analysing the risk of congestive heart failure (CHF) among first- and second-generation immigrants in younger age groups. All individuals aged 18-54years, n=3973454 in the first-generation study and n=3817560 in the second-generation study, were included. CHF was defined as at least one registered diagnosis in the National Patient Register between 1 January 1998 and 31 December 2018. Cox regression analysis was used to estimate the relative risk [hazard ratios (HRs) with 99% confidence intervals (CIs)] of incident CHF with adjustments for age, co-morbidities and socio-demographics. In the first-generation study, a total of 85719 cases of CHF were registered, 54369 men and 31350 women, where fully adjusted models showed HRs for all foreign-born men of 1.12 (99% CI 1.06-1.17) and for women of 0.99 (0.92-1.05). Groups with higher risk included men from Eastern Europe, Central Europe, Africa and Asia and women from Africa and Asia, and a lower risk was found among Latin American women. In the second-generation study, a total of 88999 cases of CHF were registered, 58403 men and 30596 women, where fully adjusted models showed HRs for second-generation men of 1.04 (0.99-1.09) and women of 0.97 (0.90-1.04). The higher risk in some foreign-born groups needs to be paid attention to in clinical practice. The fact that almost all increased risks were attenuated and absent in second-generation immigrants suggests that lifestyle and environmental factors are more important than genetic differences in the risk of CHF.

Satisfaction With Primary Care Among the Foreign-Born and the General Population in Finland: A Survey-Based study.

Foreign-born people have been found to be less satisfied with health care than native populations across countries. However, studies on differences in satisfaction with treatment between different foreign-born groups are lacking. This study explores differences in satisfaction with primary health care between the foreign-born population from different regions of origins and the general population of Finland. The study uses survey data on foreign-born population (n = 2708) and general population (n = 6671) living in Finland who report using health services. Satisfaction with experienced respect for privacy during treatment, benefit of treatment and smoothness of treatment are predicted by region of origin using logistic regression. Almost all foreign-born groups were less likely to consider treatment appointments beneficial as compared to the general population. Some foreign-born groups (people from Southeast Asia and South and Central Asia) were more satisfied with smoothness of care compared to general population. People from East Asia were less likely than the general population to consider that their privacy had been respected during the examinations and treatment. While we made the positive finding of high overall satisfaction with treatment, we also found important differences between groups. In particular, appointments were found less useful among the foreign-born population. Perceived unusefulness of treatment might lead to underuse of health care, which might result in accumulation of untreated health problems. The results point toward potential development points in the health care system. Addressing these issues might help decrease health disparities between population groups.

The Demographic Intersection of Age, Race, and Immigrant Composition in the United States

This visualization illustrates the proportion of U.S. residents at every age between 0 and 80 years who are foreign born and native born. The author uses a robust cross-sectional sample from the 2022 American Community Survey and groups individuals into nine distinct racial and ethnic (i.e., ethnoracial) groups. Following demographic expectations, age-specific immigrant shares of the total population are largest in midlife. However, across different ethnoracial groups the pattern varies greatly. Among Hispanic White individuals, a presumed immigrant-dominant group, there is no age at which the majority of members are foreign born. Alternatively, among non-Hispanic Asians and Pacific Islanders, Hispanics from other races, and multiracial Hispanics, there is a clear divide between majority foreign-born and majority native-born age groups. These results show the strengths of disaggregating the Hispanic population and the need to consider the intersection of age, race, and immigration when formulating social policy.

Racial discrimination and mental health in the context of anti-Asian xenophobia: An intersecting approach of race, ethnicity, nativity, and socioeconomic status

The COVID-19 pandemic, polarized politics, and heightened stigma and discrimination are salient drivers for negative mental health outcomes, particularly among marginalized racial and ethnic minoritized groups. Intersectionality of race, ethnicity, foreign-born status, and educational attainment may distinctively shape an individual's experience of discrimination and mental health during such unprecedented time. The present study examines the differential associations of racial discrimination and mental health based on an individual's race, ethnicity, foreign-born status, and educational attainment during the COVID-19 pandemic. Analyses were based on a nationally representative sample of U.S. adults collected between October and November 2021 (n = 6276). We utilized multivariable linear regressions to identify the multiplicative effects of race, ethnic, foreign-born status and self-reported racial discrimination on mental health, stratified by educational attainment. Among individuals with lower educational attainment, associations between racial discrimination and poor mental health were stronger among Asians (US-born: β = −2.07, p = 0.03; foreign-born: β = −3.18, p = 0.02) and US-born multiracial individuals (β = −1.96, p = 0.02) than their White counterparts. Among individuals with higher educational attainment, foreign-born Hispanics (β = − 3.66, p < 0.001) and US-born Asians (β = −2.07, p = 0.01) reported worst mental health when exposed to racial discrimination out of all other racial, ethnic and foreign-born groups. Our results suggest that association of racial discrimination and mental health varies across racial, ethnic, foreign-born, and education subgroups. Using an intersectional approach to address the widening inequities in racial discrimination and mental health during the COVID-19 pandemic contextualizes unique experience of discrimination and provides crucial insight on the patterns of mental health among marginalized groups.

Toward an emerging model of healthcare access: A theoretical framework.

To conceptualize an emerging framework of healthcare access for foreign-born persons based on well-known access models in the United States. The COVID-19 outbreak significantly impacted all global communities, disproportionately affecting people of color and highlighting preexisting health disparities. Health and immigration policies concerning healthcare access for foreign-born people were examined. Regarding access to social benefits in the United States, the Affordable Care Act underscored initial restrictions imposed by the Deficit Reduction Act of 2005 and the Personal Responsibility and Work Opportunity Reconciliation Act in 1996 on certain underserved groups. Guided by the study's aim, electronic databases, including Scopus, PubMed, Web of Science, and CINAHL, were queried for relevant nursing-related literature published on Penchansky's and Andersen's models from 1968 to 2022. Compared with Penchansky's model, Andersen's model outcome measures have evolved over the years in response to dynamic health policy issues. Penchansky's model has five constructs in its original form, whereas Andersen's model has three. The current study shows that each existing access model provides a unique method for evaluating various policies. In some cases, the studies are limited to a simple application of the original model with few modifications in studies specific to foreign-born groups in the United States. There is a dearth of systematic theorization of access that incorporates social justice and health equity. Health disparities were further explained using metrics from existing access models. An emerging access model conceptualizing existing access models was proposed, using constructs framed within the basic tenets of health equity and social justice. Applying the emerging model's constructs to future studies is anticipated to highlight opportunities for stakeholders such as policymakers, healthcare providers, nursing professionals, and community leaders to support programs that could further reduce health disparities.

An Empirical Examination of the In-Prison Behaviors of Foreign-Born Individuals: Does Nationality Predict Misconduct?

The current study investigates how immigrants cope and adapt to the “pains of imprisonment” by examining a specific maladjustment outcome—disciplinary infractions. Like other groups (e.g., females, LGBTQ, elderly), immigrants are regarded as a special population in prison considering that they encounter a unique set of challenges that the typical incarcerated person does not. At the same time, immigrants are not a monolithic group, and there are reasons why misconduct may differ when we separate them by country of birth. To this end, we explore whether the frequency and probability for institutional misconduct varies across Cubans, Puerto Ricans, Haitians, Jamaicans, Mexicans, as well as immigrants from other countries. We also consider whether any nationality group exhibits a higher (or lower or similar) propensity for in-prison offending than the native-born. Our results reveal there are greater differences in disciplinary infractions among our foreign-born groups than between them and natives, a finding that is obscured when immigrants are lumped into a single measure (i.e., all foreign-born).

Differences in Nutrient Intake and Diet Quality among Non-Hispanic Black Adults by Place of Birth and Length of Time in the United States.

Prior research suggests that migrating to the United States (US) can negatively affect the diets and health of immigrants. There is limited information on how relocating to the US affects the diets of Black-identifying immigrants. To address this gap, this study examined differences in nutrient intake and diet quality among non-Hispanic Black adults by place of birth and length of time in the US. Cross-sectional data from the National Health and Nutrition Examination Survey (2005-2016) were analyzed. Approximately 6508 non-Hispanic Black adults were categorized into three groups: foreign-born (FB) living in the US <10 years (n = 167), FB living in the US ≥ 10 years (n = 493), and US-born (n = 5848). Multivariable-adjusted logistic and linear regression models were evaluated to identify differences in nutrient intake and diet quality (as measured by the Healthy Eating Index (HEI) of 2015) across the three groups when controlling for socio-demographics. Compared to US-born adults, both FB groups had significantly higher HEI-2015 scores and higher odds of meeting dietary recommendations for several nutrients: saturated fat, sodium, and cholesterol. There were no differences in nutrient intake between the two FB groups; however, FB (<10 years) adults had better diet quality than FB (≥10 years) ones. Place of birth and length of time in the US were associated with dietary intake among non-Hispanic Black adults. More research is needed to improve understanding of dietary acculturation among Black-identifying immigrants in the US.

Justice System Contact and Health: Do Immigrants Fair Better or Worse than the Native-Born after Arrest, Probation, or Incarceration?

Despite decades of both macro- and micro-level studies showing immigration to be unassociated or negatively linked to crime, research examining the consequences of justice system contact among immigrants has been comparatively underdeveloped. The current study examines whether justice system contact (arrest, probation, and incarceration) is linked to poorer health and, in turn, whether there were differences in how justice system contact is related to immigrant versus native-born health. Using data from multiple waves of the National Longitudinal Study of Adolescent to Adult Health (Add Health), we construct both ordinal and Poisson regression models predicting poor self-rated health and the prevalence of chronic health conditions for both foreign-born and native-born groups, as well as different generations. The findings suggest important differences by nativity, immigrant generation, and type of justice system contact. Despite lower criminality than the native-born, the health of immigrants is deleteriously impacted by some types of justice system contact, especially incarceration, while probation is more strongly linked to poor health among the native-born. Our findings carry implications for the provision of care for individuals with histories of criminal justice involvement, as well as academic research examining the consequences of justice contact and the immigration–crime nexus.

The human capital and income of immigrants: evidence from Russia

ABSTRACT This study examines how immigration flows caused by the disintegration of states and globalisation change the composition of the labour force and how human capital is transferred from countries of the former Soviet Union to Russia. We estimate the contribution of imperfect human capital transferability to explaining the immigrant–native income differentials by using the Russian Longitudinal Monitoring Survey of 2009–2012. The findings reveal that the income of foreign-born people who moved before the disintegration of the USSR is not significantly different from the income of native-born citizens. In contrast, foreign-born groups who immigrated to Russia after the disintegration of the USSR have lower incomes than the native-born group. In addition, the income premium on education and labour experience received in host countries of the foreign-born group is lower compared to the income premium on education and labour experience received in Russia. An important factor explaining the difference in income between natives and foreign-born people who moved to Russia after the collapse of the USSR is the imperfection in the mechanism of human capital transferability.

Local-scale residential concentration and income inequalities of the main foreign-born population groups in the Spanish urban space. Reaffirming the model of a divided city

ABSTRACT This study presents a spatial analysis of suburban inequalities (residential concentration and income inequalities) among the main foreign-born population groups resident in Spain (Italians, Britons, Chinese, Moroccans and Romanians) in Madrid and Barcelona. Through a local spatial approach at census tract level, a number of relevant issues are highlighted, including the existence, both in Madrid and in Barcelona, of a divided space that shows a marked contrast between the city of the rich and that of the poor. The former includes the foreign-born population from more developed countries, while the latter contains Moroccans and Romanians. The Chinese population seem to follow their own pattern, which cannot be compared to that of the other population groups. It therefore seems that country of birth determines the outcome of spatial distributions and the degree of integration in spatially divided, and therefore more fragile, contexts. The emergent theme of divided cities, especially in its ethnic and spatial dimension, is gaining increased importance in ‘old Europe’.

Cancer Screening in Refugees and Immigrants: A Global Perspective.

ABSTRACT.Clinicians in the United States are trained to screen for cancer based on patient age, gender, family history, and environmental risk factors such as smoking. These cancers generally include, breast, cervical, colon, lung, and prostate cancers. We know that refugees and other immigrants to the United States experience dramatic disparities in cancer screening. Additionally, many immigrants experience elevated risks from infection-attributable cancers due to their country or region of origin. U.S.- based clinicians may not routinely consider these unique risk factors. Although this article focuses on refugees, it is also intended to guide clinicians caring for other foreign-born immigrant groups living in the United States (hereafter referred to as “immigrants”). The document contains two sections: 1) special considerations for U.S. Preventive Services Task Force guidelines cancer screening recommendations in immigrants and 2) cancer risks and screening recommendation unique to certain immigrant groups. Disparities in cancer screening and prevalence are often greater for specific immigrant groups than for broader racial or ethnic groups (e.g., Black, Asian, Hispanic) into which they may fit. Disaggregation of data by language or country of origin is useful to identify such disparities and to design intervention opportunities within specific communities that are culturally distinct and/or who have different environmental exposures. Unique cancer risks and disparities in screening support a nuanced approach to cancer screening for immigrant and refugee populations, which is the focus of this narrative review.

Disability and self-rated health: Exploring foreign- and U.S.-born differences across adulthood

There is limited inquiry regarding how immigrant status intersects with disability to influence health across adulthood. As the U.S. population continues to age, especially immigrants, understanding how disability influences health is imperative. Using 2010–2018 National Health Interview Survey data (n = 461,010) and logistic regression models, we investigate how differences in reporting Activity of Daily Living (ADL) disability influence reports of self-rated health (SRH) between foreign- and U.S.-born respondents (ages 25+) by race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, and non-Hispanic Asian) by age group (25–64 and 65+). Among those ages 25–64, foreign-born respondents generally report lower or similar rates of fair/poor SRH and ADL disability when compared to their U.S.-born peers. Among those ages 65+, we find that foreign-born respondents are at greater risk of fair/poor SRH compared to their U.S.-born peers. Additionally, while having ADL disability greatly increases the likelihood of fair/poor SRH, the impact of this association differs by race/ethnicity/nativity and age. Among those 25–64, having ADL disability appears to be especially, negatively impactful for SRH among foreign-born groups, particularly Hispanics and non-Hispanic Whites. However, among those ages 65+, having ADL disability is less impactful on the SRH of foreign-born respondents, especially non-Hispanic Blacks and Hispanics. Our findings shed new light on marginalization-related diminished returns by showing how ADL disability influences SRH differently between foreign-born groups across adulthood.

Social intergroup and temporal intrapersonal comparisons: Responses to perceived discrimination and protective mechanisms of eudaimonic well-being

Discrimination has a negative impact on minority group members’ wellbeing, particularly immigrants. Yet, empirical research investigating coping mechanisms against perceived discrimination among immigrants remains scarce. The present study examined the association between perceived ethnic discrimination and eudaimonic (psychological and social) wellbeing among immigrants by assessing the role of intergroup (downward and upward) and intrapersonal (temporal) comparisons as coping mechanisms in this association. Using a representative sample comprising five foreign-born immigrant groups (N = 1250) in Spain, we found that immigrants tend to engage in more favorable downward and upward intergroup comparisons in response to perceived discrimination, but lower temporal intrapersonal comparisons. Downward intergroup comparison was related to lower psychological wellbeing and upward intergroup comparison was associated with higher psychological wellbeing. Temporal intrapersonal comparison was predominately predictive of psychological and social wellbeing. We further discuss specific indirect effects and the important roles of intergroup and intrapersonal comparisons for immigrants’ wellbeing.

Inequities in Adverse Maternal and Perinatal Outcomes: The Effect of Maternal Race and Nativity.

To evaluate the effect of race and ethnicity on differences in maternal and perinatal outcomes among U.S.-born and foreign-born women, as well as racial and ethnic disparities in outcomes within these groups. This retrospective study analyzed singleton pregnancies (n = 11,518) among women delivering at Boston Medical Center from January 2010-March 2015. Outcomes of interest included preterm birth, early preterm birth, cesarean delivery, hypertensive disorders, diabetes, low birth weight at term (LBW, < 2500g), NICU admission and intrauterine fetal demise (IUFD). Prevalence ratios and 95% confidence intervals comparing outcomes between U.S.- and foreign-born women were calculated and stratified by race. Obstetric outcomes among Black and Hispanic women were compared to those of white women within both U.S.- and foreign-born groups. Preterm birth, hypertensive disorders, LBW and NICU admission were more likely to occur among U.S.-born women and their neonates compared to foreign-born women. Controlling for sociodemographic characteristics did not significantly impact these disparities. Among foreign-born women, Black women had a higher prevalence of many maternal and neonatal complications, while Hispanic women had a lower prevalence of some complications compared to white women. Black woman and infants consistently exhibit worse outcomes regardless of their nativity, while Hispanic women foreign-born women experience less disparate outcomes. Overall, women born in the United States are at higher risk of several adverse perinatal outcomes compared to foreign-born women. Racial and ethnic disparities in birth outcomes exist in both groups. However,the complex interplay between biopsychosocial influences that mediatethese inequities appear to have different effects among U.S- and foreign- born women. A better understanding of these factors can be used to combat disparities and improve outcomes for all women.

Differences in Abortion Rates between Asian Populations by Country of Origin and Nativity Status in New York City, 2011-2015.

Despite the size of the Asian population in New York City (NYC) and the city’s robust abortion surveillance system, abortion-related estimates for this population have not been calculated previously. This study examined the use of abortion services among specific Asian groups in NYC from 2011–2015. Using NYC surveillance data, we estimated abortion rates for Asians, disaggregated by five country of origin groups and nativity status, and for other major racial/ethnic groups. We compared rates between groups and over time. From 2014–2015, the abortion rate for Asian women in NYC was 12.6 abortions per 1000 women aged 15–44 years, lower than the rates for other major racial/ethnic groups. Among country of origin groups, Indian women had the highest rate (30.5 abortions per 1000 women), followed by Japanese women (17.0), Vietnamese women (13.0), Chinese women (8.8), and Korean women (5.1). Rates were higher for U.S.-born Asian groups compared to foreign-born groups, although the differential varied by country of origin. The abortion rate declined or remained steady for nearly all Asian groups from 2011–2015. These findings reinforce the importance of disaggregating data on this population at multiple levels and begin to provide much-needed evidence on the use of abortion services among Asian groups.

Are Refugees Really Welcome? Understanding Northern Ireland Attitudes Towards Syrian Refugees

Abstract In 2018, Northern Ireland (NI) government officials, journalists, and preliminary research declared that NI citizens had provided a ‘welcoming society’ to Syrian refugees settling in local communities across the country. However, this claim starkly contrasted with other reports of growing violence towards foreign-born groups, particularly Muslims, which lead to NI being identified as the ‘Race Hate Capital of Europe.’ Using the 2015 Northern Ireland Life and Times Survey (NILT), we problematize and empirically-test these initial conclusions about NI attitudes towards Syrian refugees by testing four prominent social theories. We first examine whether economic self-interest and social exposure (i.e., contact hypothesis) predict NI attitudes towards Syrian refugees. We also recognize NI's unique conflictual ethnic history by testing whether cultural marginality and ethnic competition theories further explain attitudes. The findings suggest that multiple theories explain NI citizen views towards Syrians. Results provide partial support for economic self-interests and direct and preferential social exposure as predictors. However, when considering racism and sectarianism measures, the results require a nuanced understanding of the context of NI people’s attitudes. We found that identity politics related to NI's citizens' religious and nationalist identity encouraged racist and sectarian disapproval of Syrian refugee resettlement. These findings provide a promising avenue of study in understanding how ethno-identities shape attitudes towards Syrian refugees and other foreign-born groups living in NI. However, we contend more granular research will be needed to highlight these nuances.

Vahvan tunnistautumisen käyttömahdollisuus digitaalisiin palveluihin ei ole itsestäänselvyys kaikissa väestöryhmissä Suomessa

Vahva tunnistautuminen mahdollistaa henkilöllisyyden todentamisen digipalveluissa. Digipalvelut ovat arjen palveluita esimerkiksi laskunmaksu verkkopankissa tai terveystietojen tarkastelu Omakannassa. Selvitämme tutkimuksessa onko eri väestöryhmissä eroja internetin ja vahvan tunnistautumisen käyttömahdollisuudessa.&#x0D; Aineisto muodostettiin väestökyselyistä: 1) Ulkomailla syntyneiden hyvinvointitutkimus (FinMonik, 2018−2019), joka toteutettiin 18 eri kielellä ja vastausprosentiksi muodostui 53 (N=12 877). 2) Koko väestön Kansallinen terveys-, hyvinvointi- ja palvelututkimus (FinSote, 2017−2018), jonka vastausprosentiksi muodostui 45 (N=26 422). Rajasimme vastukset työikäisiin (20−64 vuotiaisiin) ja analyyseissä käytettiin 6 083 vastausta FinMonikista ja 11 029 FinSotesta. Tulosmuuttujille laskettiin ikävakioidut osuudet ja luottamusvälit. Itseilmoitetulle vahvan tunnistautumisen käyttömahdollisuudelle laskettiin vetosuhteet (odds ratio) logistisella regressiomallinnuksella. Estimaattien eroja maaryhmien ja koko väestön välillä tarkasteltiin F-testiin perustuvilla p-arvoilla.&#x0D; Työikäisessä väestössä lähes kaikki (98 %) raportoivat, että heillä oli mahdollisuus käyttää internetiä, mutta ulkomaalaistaustaisen väestössä osuus oli matalampi (92 %, p &lt; 0,001). Itseilmoitetun vahvan tunnistautumisen käyttömahdollisuus oli yleisempää koko väestössä (98 %) kuin ulkomaalaistaustaisessa väestössä (88 %, p &lt; 0,001). Ulkomaalaistaustaisessa väestössä Lähi-itä ja Pohjois-Afrikka -taustaiset raportoivat muita ryhmiä harvemmin, että heillä oli mahdollisuus vahvaan tunnistautumiseen. Molemmissa kyselyissä nuorilla itseilmoitettu vahvan tunnistautumisen käyttömahdollisuus oli yleisempää verrattuna vanhempiin henkilöihin ja opiskelijat ilmoittivat työssä olevia harvemmin vahvan tunnistautumisen käyttömahdollisuudesta.&#x0D; Itseilmoitetussa vahvassa tunnistautumisessa oli väestöryhmittäisiä eroja. Pohdittavaksi jää eritoten palkkatyön merkitys digiosallisuuden kasvattajana. Palkkatyö mahdollistaa varat laitteiden hankintaan, käyttömaksuihin sekä usein kerryttää digiosaamista. Digitaalisia palveluita tarjottaessa huomiota tulisi kiinnittää väestöryhmiin, joissa vahvan tunnistautumisen käyttömahdollisuus on muuta väestöä heikompaa. Digitaalisten palveluiden kehittäminen vaatii rinnalleen ohjausta, jossa huomioidaan neuvonnantarpeet myös vahvan sähköisen tunnistautumisen osalta.

Better mental health through identifying with locals and country of origin among foreign-born people

Abstract Background Sense of belonging (SoB) is an important determinant of health among foreign-born population and it has previously been found to be associated with perceived health. In this study we examined: 1) which types of SoB are associated with psychological strain (PS), and 2) whether this varies between different country groups. Methods The data were gathered from the cross-sectional Survey on Well-Being among Foreign-Born Population (FinMonik, n = 6 836), conducted in Finland in 2018-19. SoB was assessed by the question “Which of the following areas or groups you feel you belong to?”, classified into 1) both Finns/local municipality and citizens of country of origin CCO (acculturation identity), 2) only Finns/local municipality (local identity), 3) only CCO (origin identity), 4) only Europeans, world citizens, religious, work-related or political group (other identity), and 5) none of the previous. PS was measured by using the MHI-5 (psychological strain: yes; no). Logistic regression was used to test the association between SoB and PS, with age, sex and country of origin as confounding variables. In the analyses, weights were used to reduce non-response bias. Results Compared to the acculturation identity group, PS was more common among those with local identity (OR = 1.60, p &amp;lt; 0.01), origin identity (OR = 1.99, p &amp;lt; 0.001) or other identity (OR = 3.33, p &amp;lt; 0.001) and those with no belonging to any of the groups presented (OR = 5.40, p &amp;lt; 0.001). The last group was more likely to experience PS than the acculturation identity group in all five country groups included in the analysis. Acculturation identity was associated with less PS especially for those born in EU-, EFTA- and North American countries. Conclusions Acculturation identity was strongly associated with less psychological strain, especially when compared with the group reporting no belonging to any of the groups presented. Key messages Sense of belonging is associated with mental health and should be studied more extensively among different foreign-born population groups. Identification with both the local people and one’s own country of origin should be supported.

A Comprehensive, Comparative, Quality Assurance Appraisal of Local and Foreign-Born Patient Groups Utilizing a University-Based, Family Medicine Clinic

Portland, Oregon is home to a large, ethnically diverse, foreign-born population. Many seek health care from the state’s principal academic health center.

Factors Associated With Extrapulmonary Tuberculosis in Spain and Its Distribution in Immigrant Population

IntroductionIn recent decades, there has been an increase in extrapulmonary TB (EP-TB) rates in industrialized countries with a low incidence of tuberculosis (TB), especially among specific foreign-born population groups. The aim of this study was to describe sociodemographic, epidemiological, microbiological, clinical and treatment characteristics of EP-TB cases and associated risk factors in Spain. MethodsWe performed a descriptive, retrospective, multi-center observational study of new TB cases in different regions in Spain (Comunidades Autónomas, CCAA) between 2006 and 2014. We used logistic regression and calculated odd ratios (OR) and 95% confidence intervals (CI) to determine EP-TB-associated factors. ResultsThe proportion of EPTB were higher among the foreign-born population (22.1%) than among native Spaniards (15.9%; p=0.001). Foreign cases were mostly Asian, with up to 42.8% of India-Pakistan cases showing some form of EP-TB. The factors related were: immigrant status (OR:1.62; CI:1.35–1.95); age >50 years; (OR:1.70; CI:1.36–2.13); diagnosis delay of >51 days (OR:1.38; CI:1.17–1.62); co-infection with HIV (OR:1.77; CI:1.21–2.55); negative smear sputum microscopy (OR:3.01; CI:2.50;3.61); negative culture; (OR:8.1; CI:6.57–10.02); poor clinical progression during disease progression (OR:2.93; CI:1.30–6.39). ConclusionsWe detected a high percentage of EP-TB forms in the foreign-born population, mostly in Asian people. Special attention should be devoted to the diagnosis of EP-TB in these groups. Other measures required include increased clinical suspicion and improved microbiological diagnosis to support earlier and adequate treatment.