Spanish-born Population Research Articles

Interregional migration of human capital in Spain

ABSTRACT While levels of internal mobility have been trending down in many advanced economies, the interregional migration rates of Spanish young adults have increased. This paper analyses the internal movements of the Spanish-born population aged 25–39 between NUTS-2 regions from 1992 to 2018, including sub-periods linked to the Spanish economic context. The analysis incorporates the urban–rural dimension within each region and the educational level of migrants, a variable that has not been included in Spanish internal migration studies. We used flow register data of migration and sociodemographic information from the Labor Force Survey. The results show that migrations between regions have become more unbalanced over time, especially since the 2008 crisis. In addition, a new trend of out-migration from cities in peripheral regions has been detected, which contrasts with the former high level of rural out-migration. A great educational selectivity of out-migrants and a growing internal brain drain have also been found. Moreover, qualified human capital accumulation has been increasing in Madrid.

Equity in the Use of Health Care Services by Immigrants in the Spanish National Health Care System

The increasing proportion of immigrants in the Spanish society is creating pressures for the National Health Care System to accommodate the needs of this population group while keeping their costs under control. The Spanish health care system establishes that all people, regardless of their nationality, should be entitled to use health care services with the same conditions as Spanish citizens provided that they are registered in the local population census. Empirical evidence about differences in health status or utilisation between immigrant and Spanish-born population is however insufficient. This study uses the 2003 Spanish National Health Survey to explore whether non-Spaniards, for the same level of need, use health care services at the same rate as national citizens. The findings suggest that the nationality of an individual is an important predictor of health care utilisation, independent of other factors. These results may indicate horizontal inequity in the utilisation of health care with respect to nationality.

Brain drain and the Second Wave of Depopulation

The territorial imbalances among the autonomous Spanish communities result in emigration of university-educated people in some regions and concentrations of qualified human capital in others. The hinterland of the peninsula and the Cantabrian coast, where the intensity of outflows became more serious with the turn of the century, are affected by the dynamics of educational decapitalisation and emigration of young people of their cities. Depopulation is no longer a phenomenon that is exclusive to rural areas. It has extended to the urban milieus of the traditional sending autonomous communities. Castile and León is the most affected region, with annual migration losses due to long-distance mobility -interregional and abroad- of -13.4‰ among the young people of the capitals of the province, -9.25‰ in other urban municipalities, and -9.63‰ in rural areas. To this migration deficit must be added the high levels of qualifications of the emigrants, since more than 53.8% of young people who leave have university studies and only 36.7% of who arriving from elsewhere in Spain are equally qualified. Madrid is the main receiver of talent, bringing together 38.7% of the interregional migratory movements of young Spanish people whose inflows present high levels of education. In this group, 64.8% are university degree holders. In this issue of Perspectives Demogràfiques we analyse the migratory movements of Spanish-born population between 25and 39 years who crossed some autonomous region border from 2013 to 2017, focusing on interregional flows, the educational level of these exchanges, and the migratory balance according to the territorial setting (urban and rural). In order to do so, we analyse the data from Statistics on Residential Variations (EVR) and the Active Population Survey (EPA).

The definition of immigrant status matters: impact of nationality, country of origin, and length of stay in host country on mortality estimates

BackgroundMortality is a robust indicator of health and offers valuable insight into the health of immigrants. However, mortality estimates can vary significantly depending on the manner in which immigrant status is defined. Here, we assess the impact of nationality, country of origin, and length of stay in the host country on mortality estimates in an immigrant population in Aragón, Spain.MethodsCross-sectional retrospective study of all adult subjects from the EpiChron Cohort in 2011 (n = 1,102,544), of whom 146,100 were foreign-born (i.e., according to place of birth) and 127,213 were non-nationals (i.e., according to nationality). Directly standardized death proportions between years 2012–2015 were calculated, taking into account the age distribution of the European population in 2013. Binary logistic regression was used to compare the four-year probability of death.ResultsThe age- and sex-standardized number of deaths per 1000 subjects were 45.1 (95%CI 44.7–45.2) for the Spanish-born population, 29.3 (95%CI 26.7–32.1) for the foreign-born population, and 18.4 (95%CI 15.6–21.6) for non-Spanish nationals. Compared with the Spanish-born population, the age- and sex-adjusted likelihood of dying was equally reduced in the foreign-born and non-national populations (OR 0.6; 95%CI 0.5–0.7) when the length of stay was less than 10 years. No significant differences in mortality estimates were detected when the length of stay was over 10 years.ConclusionsMortality estimates in immigrant populations were lower than those of the native Spanish population, regardless of the criteria applied. However, the proportion of deaths was lower when immigrant status was defined using nationality instead of country of birth. Age- and sex-standardized death proportions tended to increase with increased length of stay in the host country.

Trends in mortality inequalities in an urban area: the influence of immigration

BackgroundNearly 20% of the population in Barcelona is foreign-born and this percentage rises to up to 40% in some neighborhoods. Consequently, migration health patterns may play an important role in trends in socioeconomic geographical inequalities in mortality. The objective of this study was to analyze the trend in socioeconomic inequalities in mortality between neighborhoods in Barcelona during the period 2001–2012 in the foreign-born and Spanish-born population.MethodsRepeated cross-sectional design of the population aged 25–64 years in Barcelona between 2001 and 2012. Hierarchical data consisted of yearly mortality linked-population. The variables analyzed were age, sex, education, and country of birth (Spanish-born, foreign-born), neighborhood of residence, and the socioeconomic level of the neighborhoods using quartiles of unemployment rates. Age-standardized mortality rates were estimated, and mixed Poisson regressions were applied using generalized linear mixed models, including two random effects to consider the intracorrelation within neighborhoods and across years.ResultsThe number of foreign-born residents aged 25–64 increased notably in disadvantaged neighborhoods. Approximately 9% of premature deaths occurred in foreign-born individuals. Premature mortality rates were higher in disadvantaged neighborhoods and in the Spanish-born population in all periods. Despite the stabilized socioeconomic inequalities in mortality in the Spanish-born population, no inequalities were found between neighborhoods in foreign-born men and women.ConclusionsEvidence of the ‘healthy migrant’ effect in mortality and socioeconomic inequalities in mortality was found in Barcelona, which seems to alter the distribution of mortality through time and space, related to the low levels of premature mortality and the selective residence of immigrants in socioeconomically disadvantaged neighborhoods.

The effect of the economic crisis on health in Spain according to educational level and employment status: Does the duration of the crisis also matter?

The objective of this study is to explore the possible impact of the economic crisis on the health of the Spanish-born population not of retirement age (between 30 and 59 years). Specifically, using data from the European Union Statistics on Income and Living Conditions (EU-SILC) for the years 2006, 2010 and 2014, we analyze differences in self-perceived health by socioeconomic profile and position occupied in the household. According to our results, the health of men and women show similar levels of association with certain factors (such as education) and different levels with others (women's health is more sensitive to household income level while men's is more sensitive to employment status). Finally, while substantial improvements in self-perceived health were observed during the first period in almost all socioeconomic groups, during the second period there was almost no change, and for the most disadvantaged men (inactive in the labor market and with low educational levels), health worsened.

Estimating the HIV undiagnosed population in Catalonia, Spain: descriptive and comparative data analysis to identify differences in MSM stratified by migrant and Spanish-born population

ObjectiveUndiagnosed HIV continues to be a hindrance to efforts aimed at reducing incidence of HIV. The objective of this study was to provide an estimate of the HIV undiagnosed population...

Differences between migrants and Spanish-born population through the HIV care cascade, Catalonia: an analysis using multiple data sources.

Migrants are considered a key group at risk for HIV infection. This study describes differences between migrants and the Spanish-born population as they progress through the HIV care cascade in Catalonia, Spain. This study found that among people reached by prevention activities, migrants had a higher number of barriers to access HIV testing services than Spanish-born people, driven primarily by shared risk factors. Between 2001 and 2013, 9829 new HIV diagnoses were reported in Catalonia, the proportion of migrants increasing from 24% in 2001 to 41% in 2013. Compared with Spanish-born people, migrants had a higher proportion of women at diagnosis (24·6% vs. 16·7%), and were younger (median age of 33 vs. 37). The most frequent at-risk population was MSM (men who have sex with men) in both migrants and Spanish-born people, (40% and 43%, respectively), although there were significant differences by region of origin. People from sub-Saharan Africa had the highest proportion of late diagnosis (63·7%). Compared with the Spanish-born population, migrants on follow-up had a lower proportion of people on antiretroviral therapy (ART) (93·7% vs. 90·8%, P < 0·001) and with viral suppression (87·2% vs. 82·9%, P < 0·001). Migrants have higher number of barriers to access HIV testing services, lower retention rates and proportions on ART as compared with Spanish-born people, these differences not being uniform between migrants from different regions.

Trends and Disparities in Mortality Among Spanish-Born and Foreign-Born Populations Residing in Spain, 1999-2008.

Spain's immigrant population has increased 380% in the last decade, accounting for 13.1% of the total population. This fact has led her to become during 2009 the eighth recipient country of international immigrants in the world. The aim of this article is to describe the evolution of mortality and the main causes of death among the Spanish-born and foreign-born populations residing in Spain between 1999 and 2008. Age-standardised mortality rates (ASRs), average age and comparative mortality ratios among foreign-born and Spanish-born populations residing in Spain were computed for every year and sub-period by sex, cause of death and place of birth as well as by the ASR percentage change. During 1999-2008 the ASR showed a progressive decrease in the risk of death in the Spanish-born population (-17.8% for men and -16.6% for women) as well as in the foreign-born one (-45.9% for men and -35.7% for women). ASR also showed a progressive decrease for practically all the causes of death, in both populations. It has been observed that the risk of death due to neoplasms and respiratory diseases among immigrants is lower than that of their Spanish-born counterparts, but risk due to external causes is higher. Places of birth with the greater decreases are Northern Europe, Eastern Europe, Western Europe, Southern Europe, and Latin America and the Caribbean. The research shows the differences in the reduction of death risk between Spanish-born and immigrant inhabitants between 1999 and 2008. These results could contribute to the ability of central and local governments to create effective health policy. Further research is necessary to examine changes in mortality trends among immigrant populations as a consequence of the economic crisis and the reforms in the Spanish health system. Spanish data sources should incorporate into their records information that enables them to find out the immigrant duration of permanence and the possible impact of this on mortality indicators.

Factors associated with lack of adherence to antenatal care in African immigrant women and Spanish women in northern Spain: The role of social risk factors in combination with language proficiency

Objectiveto examine the association and interaction between language proficiency, social risk factors and lack of adherence to antenatal care in African immigrant women (AIW). Methodologyretrospective cohort study. Two hundred and thirty-one AIW with delivery dates from 2007 to 2010 were identified, and data were collected on knowledge of Spanish, referral to a social worker because of social risk factors, and adequacy of antenatal care using the Kessner Index (KI) and the authors׳ own index (OI). The Spanish-born population sample was obtained by simple random sampling in a 1:3 ratio. Odds ratios (OR) were estimated by non-conditional logistic regression. The term ‘language⁎referral to social worker’ was included in the logistic models to study interaction. Findingseighty-four per cent of AIW had insufficient knowledge of Spanish, and 47% had been referred to a social worker. Of the AIW who had not been referred to a social worker, the association between poor knowledge of Spanish and inadequate antenatal care was weak and not significant (OR for KI 1.31). On the contrary, of the AIW who had been referred to a social worker, the association was stronger and significant (OR for KI 8.98; p interaction=0.026). Social risk factors were the main independent factors associated with inadequate antenatal care in Spanish women (adjusted OR 3.17; 95% confidence interval 1.42–7.06). Conclusionsthis study found that the main factor associated with inadequate antenatal care in AIW is insufficient language proficiency, but only in the presence of social risk factors, which have also been associated with worse antenatal care in Spanish women.

Secular growth acceleration in Spain. Spanish Growth Studies 2010. Spanish-born population and immigrant population

En Espana siempre ha existido una amplia tradicion de estudios de crecimiento. Son ejemplos los estudios transversales y longitudinales de la poblacion caucasica autoctona finalizados recientemente en Andalucia, Aragon, Cataluna, Madrid y Pais Vasco. El analisis por separado y la comparacion de los datos procedentes de estos estudios permitio comprobar que no existian entre ellos diferencias con relevancia clinica, por lo que sus datos han sido analizados conjuntamente, dando lugar a los Estudios Espanoles de Crecimiento 2010 (ver anexo 1)1. Los estudios transversales informan sobre la situacion actual de la poblacion evaluada y permiten incluir a un numero importante de sujetos, pero dado que el brote de crecimiento puberal no comienza en todos los sujetos a la misma edad, no dejan evaluar de forma precisa el crecimiento durante el desarrollo puberal. Los estudios longitudinales permiten evaluar de forma individualizada el crecimiento desde el nacimiento hasta alcanzar la talla adulta. Permiten tambien, agrupar a los sujetos por categorias maduradoras de acuerdo con la edad de inicio de su brote de crecimiento puberal (muy tempranos, tempranos, intermedios, tardios y muy tardios) y

Cumplimiento terapéutico para determinar la infranotificación de tuberculosis en una región sanitaria durante los años 2007-2009

IntroductionTo determine the annual incidence of tuberculosis (TB) in the health region of Lleida (RS) through the reported cases, and/or dispensing of the treatment drugs, as well as the level of compliance, based on the prescription drugs dispensed. MethodsDescriptive study of incidence based on reported cases of TB and TB drug dispensing (ATB) in the RS of Lleida, Catalonia in the period 2007-2009. ResultsThe incidence in the Health Region between 2007 and 2009 ranged between 38 to 29 cases per 100,000 population. The majority (72.6%) of cases were notified, while the rest were detected by identifying the treatment drugs dispensed in pharmacies. There was a higher incidence of TB among the immigrant population. Spanish-born patients had a higher percentage of compliance (75.8% versus 61.2%). Among the immigrant groups, those from North Africa had the lowest compliance (43.7%), and those from Latin America had the highest compliance (82.4%). ConclusionsThe incidence of TB in our health region has declined between 2007 and 2009, with the highest incidence among the immigrant population. There is a high amount of non-notified cases of tuberculosis. The Spanish-born population has a greater adherence to treatment. There is a lot of work to be done on disease notification, particularly among primary care doctors, as well as information on treatment adherence for the immigrant population. It would be interesting to study the socioeconomic factors that could determine the incidence and the poor adherence to treatment by immigrant populations.

Utilización de los servicios públicos de salud por parte de la población inmigrante latinoamericana en España

To identify patterns of public health care utilization by Latin American immigrants in Spain as compared to the local population. This analysis is based on information provided by the 2006 National Health Survey on the frequency of visits to general practitioners, specialists and emergency rooms, as well as hospital stays. The study uses a descriptive analysis involving tests of equality of distributions, medians and proportions, and a multivariate analysis with binomial negative and probit models. The distribution of Latin American immigrants show lower utilization rates of public health care services than the native-born population, with the exception of hospital stays. The pattern of health care use by Latin Americans and Spaniards is different, with the exception of hospital stays. The results of the multivariate analysis indicate statistically significant differences only in the case of hospital stays (the probability of staying in a hospital in the last year is 2.8% higher for Latin American immigrants than among locals) and utilization of emergency rooms (0.205 more visits than the Spanish-born population). There is no significant difference in utilization of public health care between Latin American immigrants and native-born populations in Spain, with the exception of a higher frequency of use of emergency rooms by the former.

Estudio observacional del gasto farmacéutico en población inmigrante y autóctona de la región sanitaria de Lleida (Cataluña)

Objective To evaluate whether there are differences in drug spending between immigrant and Spanish-born populations and to assess whether drug consumption is associated with living environment (urban/rural). Design Observational cross-sectional study. Setting Lleida Health Region (LHR). Participants 22,847 immigrants and 174,768 native born subjects, aged 15 to 64 years, residing in the LHR. Main measurements Drug spending during the year 2007, demographical variables, region of origin and residence area (urban/rural). Results Native-born subjects spent more in all therapeutic drug groups than immigrants. In men, the relative risk ratio (RRR) of being in the highest quartile of expenditure was 3.2 (95% CI: 2.96–3.44) for native born versus immigrant and in women it was 2.1 (95% CI: 1.97–2.27). Immigrants from eastern Europe had the lowest risk of being in the highest quartile of expenditure, with statistically significant differences. Residents in the rural environment were more likely to have a higher pharmaceutical consumption than residents in the urban environment. Conclusion Inequalities in drug spending were observed between immigrants and native born subjects. Further studies, either qualitative or mixed, should explore which factors are related to these differences and propose strategies addressed to reducing them.

Discrimination, work and health in immigrant populations in Spain

One of the most important social phenomena in the global context is the flow of immigration from developing countries, motivated by economic and employment related issues. Discrimination can be approached as a health risk factor within the immigrant population's working environment, especially for those immigrants at greater risk from social exclusion and marginalisation. The aim of this study is to research perceptions of discrimination and the specific relationship between discrimination in the workplace and health among Spain's immigrant population. A qualitative study was performed by means of 84 interviews and 12 focus groups held with immigrant workers in five cities in Spain receiving a large influx of immigrants (Madrid, Barcelona, Valencia, Alicante and Huelva), covering representative immigrant communities in Spain (Romanians, Moroccans, Ecuadorians, Colombians and Sub-Saharan Africans). Discourse narrative content analysis was performed using pre-established categories and gradually incorporating other emerging categories from the immigrant interviewees themselves. The participants reported instances of discrimination in their community and working life, characterised by experiences of racism, mistreatment and precarious working conditions in comparison to the Spanish-born population. They also talked about limitations in terms of accessible occupations (mainly construction, the hotel and restaurant trade, domestic service and agriculture), and described major difficulties accessing other types of work (for example public administration). They also identified political and legal structural barriers related with social institutions. Experiences of discrimination can affect their mental health and are decisive factors regarding access to healthcare services. Our results suggest the need to adopt integration policies in both the countries of origin and the host country, to acknowledge labour and social rights, and to conduct further research into individual and social factors that affect the health of the immigrant populations.

Emergency hospital services utilization in Lleida (Spain): A cross-sectional study of immigrant and Spanish-born populations

BackgroundThe use of emergency hospital services (EHS) has increased steadily in Spain in the last decade while the number of immigrants has increased dramatically. Studies show that immigrants use EHS differently than native-born individuals, and this work investigates demographics, diagnoses and utilization rates of EHS in Lleida (Spain).MethodsCross-sectional study of all the 96,916 EHS visits by patients 15 to 64 years old, attended during the years 2004 and 2005 in a public teaching hospital. Demographic data, diagnoses of the EHS visits, frequency of hospital admissions, mortality and diagnoses at hospital discharge were obtained. Utilization rates were estimated by group of origin. Poisson regression was used to estimate the rate ratios of being visited in the EHS with respect to the Spanish-born population.ResultsImmigrants from low-income countries use EHS services more than the Spanish-born population. Differences in utilization patterns are particularly marked for Maghrebi men and women and sub-Saharan women. Immigrant males are at lower risk of being admitted to the hospital, as compared with Spanish-born males. On the other hand, immigrant women are at higher risk of being admitted. After excluding the visits with gynecologic and obstetric diagnoses, women from sub-Saharan Africa and the Maghreb are still at a higher risk of being admitted than their Spanish-born counterparts.ConclusionIn Lleida (Spain), immigrants use more EHS than the Spanish born population. Future research should indicate whether the same pattern is found in other areas of Spain and whether EHS use is attributable to health needs, barriers to access to the primary care services or similarities in the way immigrants access health care in their countries of origin.

Differences in pharmaceutical consumption and expenses between immigrant and Spanish-born populations in Lleida, (Spain): A 6-months prospective observational study

BackgroundThere are few studies comparing pharmaceutical costs and the use of medications between immigrants and the autochthonous population in Spain. The objective of this study is to evaluate whether there are differences in pharmaceutical consumption and expenses between immigrant and Spanish-born populations.MethodsProspective observational study in 1,630 immigrants and 4,154 Spanish-born individuals visited by fifteen primary care physicians at five public Primary Care Clinics (PCC) during 2005 in the city of Lleida, Catalonia (Spain). Data on pharmaceutical consumption and expenses was obtained from a comprehensive computerized data-collection system. Multinomial regression models were used to estimate relative risks and confidence intervals of pharmaceutical expenditure, adjusting for age and sex.ResultsThe percentage of individuals that purchased medications during a six-month period was 53.7% in the immigrant group and 79.2% in the autochthonous group. Pharmaceutical expenses and consumption were lower in immigrants than in autochthonous patients in all age groups and both genders. The relative risks of being in the highest quartile of expenditure, for Spanish-born versus immigrants, were 6.9, 95% CI = (4.2, 11.5) in men and 5.3, 95% CI = (3.5, 8.0) in women, with the reference category being not having any pharmaceutical expenditure.ConclusionPharmaceutical expenses are much lower for immigrants with respect to autochthonous patients, both in the percentage of prescriptions filled at pharmacies and the number of containers of medication obtained, as well as the prices of the medications used. Future studies should explore which factors explain the observed differences in pharmaceutical expenses and if these disparities produce health inequalities.

Brote por virus de la parotiditis G1 en la provincia de Almería en el año 2005

Despite high levels of triple MMR vaccinations being recorded on Spain, epidemic mumps outbreaks are still being reported. This study is aimed at describing an outbreak reported in the province of Almeria in 2005 and of evaluating the degree to which the vaccinated population was affected. Descriptive study of reported cases. Basic Health District, municipality, age, sex, type of population (Spanish-born and foreign), date of symptom onset, symptoms, complications, vaccination status, vaccine strain and diagnostic testing. disease reporting files, epidemiological surveys, microbiological data, vaccination card, District vaccine software and Andalusian Institute of Statistics demographic data. Rates per 100,000 inhabitants were calculated by age groups and population type. The Student's t-test was used for comparing means. A total of 145 cases from 17 municipalities were reported. A total 63.4% were males. The group showing the highest incidence was that of 10-14 years of age, with a rate of 405 per 100,000. The highest rate was among the Spanish-born population (128.7). A total of 52.4% of the cases were found to have been administered some dose of vaccine, 69.7% of them with two doses and 71.1% some Jeryl Lynn strain. Mumps virus was confirmed in 43 cases, the G1 genotype having been identified in 6 cases. An outbreak of G1 genotype mumps virus is confirmed, the Spanish-born population of different age groups having been affected to a greater extent. Over half of the cases were vaccinated individuals.

Impact of immigration on the cost of emergency visits in Barcelona (Spain)

BackgroundThe impact of immigration on health services utilisation has been analysed by several studies performed in countries with lower levels of immigration than Spain. These studies indicate that health services utilisation is lower among the immigrant population than among the host population and that immigrants tend to use hospital emergency services at the expense of primary care. We aimed to quantify the relative over-utilisation of emergency services in the immigrant population.MethodsEmergency visits to Hospital del Mar in Barcelona in 2002 and 2003 were analysed. The country of origin, gender, age, discharge-related circumstances (hospital admission, discharge to home, or death), medical specialty, and variable cost related to medical care were registered. Immigrants were grouped into those from high-income countries (IHIC) and those from low-income countries (ILIC) and the average direct cost was compared by country of origin. A multivariate linear mixed model of direct costs was adjusted by country of origin (classified in five groups) and by the individual variables of age, gender, hospital admission, and death as a cause of discharge. Medical specialty was considered as a random effect.ResultsWith the exception of gynaecological emergency visits, costs resulting from emergency visits by both groups of immigrants were lower than those due to visits by the Spanish-born population. This effect was especially marked for emergency visits by adults.ConclusionImmigrants tend to use the emergency department in preference to other health services. No differences were found between IHIC and ILIC, suggesting that this result was due to the ease of access to emergency services and to lack of knowledge about the country's health system rather than to poor health status resulting from immigrants' socioeconomic position. The use of costs as a variable of complexity represents an opportunistic use of a highly exhaustive registry, which is becoming ever more frequent in hospitals and which overcomes the lack of clinical information related to outpatient activity.