Primary health care utilization by immigrants as compared to the native population: a multilevel analysis of a large clinical database in Catalonia

Figures & data

Table I. Sex and country of origin of population studied.

	Sex
	Male n = 34498		Female n = 28759		Total n = 63257
	Visits n (%)	Age (SD)	Visits n (%)	Age (SD)	Visits n (%)	Age (SD)
Spain	17257 (54.6)	35.2 (10.6)	14375 (45.4)	35.2 (11.4)	31632	35.2 (11.4)
All immigrants	17241 (54.5)	35.1 (10.5)	14384 (45.5)	35.1 (11.3)	31625	35.1 (11.3)
EU 15^a	474 (52.0)	38.9 (12.6)	437 (48.0)	38.6 (13.6)	911	38.6 (13.6)
Recent EU^b	1072 (42.7)	36.1 (11.1)	1438 (57.3)	35.3 (11.2)	2510	35.3 (11.2)
Maghreb	3213 (56.2)	34.4 (10.9)	2503 (43.8)	34.2 (11.8)	5716	34.2 (11.8)
Rest of Africa	3979 (73.4)	33.2 (8.4)	1445 (26.6)	33.2 (9.0)	5424	33.2 (9.0)
Latin-America	4701 (41.3)	34.5 (11.1)	6686 (58.7)	35.2 (11.8)	11387	35.2 (11.8)
Asia	895 (71.4)	34.1 (8.9)	358 (28.6)	33.9 (9.5)	1253	33.9 (9.5)
Country of origin not coded	2889 (66.0)	38.8 (10.6)	1490 (34.0)	38.2 (11.1)	4379	38.2 (11.1)
Others	18 (40.0)	42.0 (19.3)	27 (60.0)	41.5 (16.6)	45	41.5 (16.6)

n (%); Age, years; SD, standard deviation.

^aEU 15: European Union countries before 2004, except Spain: Belgium, the Netherlands, Luxembourg, France, Italy, Germany, Ireland, UK, Denmark, Austria, Sweden, Finland, Greece, Portugal.

^bRecent EU : Countries that joined the European Union in 2004: Malta, Cyprus, Estonia, Latvia, Lithuania, Poland, Czech Republic, Slovakia, Slovenia, Hungary.

Table II. Descriptive analysis reflecting health service utilization depending on the country of origin (aggregated in regions).

		Total requested consultations			Consultations with GP			Consultations with nurses			Specialized care referrals
	n	Median	Percentile 25–75		Median	Percentile 25–75		Median	Percentile 25–75		Median	Percentile 25–75
Spain	31 632	3	1	8	2	0	5	0	0	1	1	0	3
All immigrants	31 625	4	1	8	2	0	5	0	0	1	2	0	4
EU 15^a	911	3	1	7	2	0	4	0	0	1	1	0	3
Recent EU^b	2 510	2	0	6	1	0	3	0	0	0	1	0	3
Maghreb	5716	4	1	9	2	1	5	0	0	1	2	0	4
Africa	5 424	4	1	8	2	1	4	0	0	1	2	0	4
Latin-America	11387	4	1	8	2	1	5	0	0	1	2	0	4
Asia	1 253	3	1	8	2	0	4	0	0	1	1	0	4
Others	45	2	0	5	1	0	3	0	0	1	1	0	2
Not coded	4 379	3	1	8	2	0	5	0	0	1	1	0	4

^aEU 15: European Union countries before 2004, except Spain: Belgium, Netherlands, Luxembourg, France, Italy, Germany, Ireland, UK, Denmark, Austria, Sweden, Finland, Greece, Portugal.

^bRecent EU : Countries that joined the European Union in 2004: Malta, Cyprus, Estonia, Latvia, Lithuania, Poland, Czech Republic, Slovakia, Slovenia, Hungary.

Table III. Comparison of health status between Spaniards and immigrants. by using ICD-10 chapters.

ICD 10 Chapter^a	Spain n (%)	All immigrants n (%)	EU 15 n (%)	Recent EU n (%)	Maghreb n (%)	Africa n (%)	Latin-America n (%)	Asia n (%)	Others n (%)	Not coded n (%)
I	2153 (6.8)	2023 (6.4)*	44 (4.8)*	138 (5.5)*	293 (5.1)*	424 (7.8)*	717 (6.3)	73 (5.8)	1 (2.2)	333 (7.6)
II	801 (2.5)	532 (1.7)*	29 (3.2)	48 (1.9)	71 (1.2)*	53 (1.0)*	249 (2.2)*	10 (0.8)*	0 (0)	72 (1.6)*
III	559 (1.8)	816 (2.6)*	13 (1.4)	42 (1.7)	150 (2.6)*	163 (3.0)*	302 (2.7)*	23 (1.8)	1 (2.2)	122 (2.8)*
IV	5038 (15.9)	3532 (11.2)*	147 (16.1)	250 (10.0)*	538 (9.4)*	306 (5.6)*	1703 (15.0)*	103 (8.2)*	4 (8.9)	481 (11.0)*
V	8869 (28.0)	3621 (11.4)*	164 (18.0)*	401 (16.0)*	562 (9.8)*	437 (8.1)*	1267 (11.1)*	86 (6.9)*	11 (24.4)	693 (15.8)*
VI	1193 (3.8)	849 (2.7)*	26 (2.9)	61 (2.4)*	137 (2.4)*	83 (1.5)*	408 (3.6)	22 (1.8)*	1 (2.2)	111 (2.5)*
VII–VIII	1901 (6.0)	1312 (4.1)*	36 (4.0)*	69 (2.7)*	262 (4.6)*	208 (3.8)*	489 (4.3)*	41 (3.3)*	2 (4.4)	205 (4.7)*
IX	4265 (13.5)	4305 (13.6)	144 (15.8)*	310 (12.4)	781 (13.7)	689 (12.7)	1617 (14.2)	133 (10.6)*	8 (17.8)	623 (14.2)
X	4655 (14.7)	2645 (8.4)*	112 (12.3)*	148 (5.9)*	459 (8.0)*	400 (7.4)*	946 (8.3)*	81 (6.5)*	7 (15.6)	492 (11.2)*
XI	2418 (7.6)	2555 (8.1)*	73 (8.0)	172 (6.9)	396 (6.9)	397 (7.3)	1030 (9.0)*	76 (6.1)*	4 (8.9)	407 (9.3)*
XII	1614 (5.1)	1449 (4.6)*	41 (4.5)	115 (4.6)	284 (5.0)	191 (3.5)*	599 (5.3)	48 (3.8)*	2 (4.4)	169 (3.9)*
XIII	4647 (14.7)	3522 (11.1)*	103 (11.3)*	220 (8.8)*	668 (11.7)*	440 (8.1)*	1321 (11.6)*	96 (7.7)*	5 (11.1)	669 (15.3)
XIV	2045 (6.5)	2162 (6.8)	50 (5.5)	156 (6.2)	382 (6.7)	243 (4.5)*	1027 (9.0)*	55 (4.4)*	5 (11.1)	244 (5.6)*
XV	607 (1.9)	518 (1.6)*	13 (1.4)	40 (1.6)	123 (2.2)	57 (1.1)*	196 (1.7)	18 (1.4)	1 (2.2)	70 (1.6)
XVI	13 (0.0)	13 (0.0)	0 (0)	0 (0)	4 (0.1)	3 (0.1)	5 (0.0)	0 (0)	0 (0)	1 (0.0)
XVII	270 (0.9)	102 (0.3)*	4 (0.4)	6 (0.2)*	7 (0.1)*	13 (0.2)*	48 (0.4)*	1 (0.1)*	1 (2.2)	22 (0.5)*
XVIII	1843 (5.8)	1759 (5.6)	42 (4.6)	130 (5.2)	301 (5.3)	332 (6.1)	619 (5.4)	57 (4.5)	1 (2.2)	277 (6.3)
XIX	2314 (7.3)	1397 (4.4)*	48 (5.3)*	98 (3.9)*	314 (5.5)*	204 (3.8)*	452 (4.0)*	46 (3.7)*	2 (4.4)	233 (5.3)*
XX	809 (2.6)	415 (1.3)*	16 (1.8)	28 (1.1)*	66 (1.2)*	49 (0.9)*	190 (1.7)*	13 (1.0)*	0 (0)	53 (1.2)*

*p < 0.05;

^aI. Infectious and parasitic diseases;

II. Neoplasms;

III. Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism;

IV. Endocrine, nutritional and metabolic diseases;

V. Mental and behavioural disorders;

VI. Diseases of the nervous system;

VII–VIII. Diseases of the eye and ear;

IX. Diseases of the circulatory system;

X. Diseases of the respiratory system;

XI. Diseases of the digestive system;

XII. Diseases of the skin and subcutaneous tissue;

XIII. Diseases of the musculoskeletal system and connective tissue;

XIV. Diseases of the genitourinary system;

XV. Pregnancy, childbirth and the puerperium;

XVI. Certain conditions originating in the perinatal period;

XVII. Congenital malformations, deformations and chromosomal abnormalities;

XVIII. Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified;

XIX. Injury, poisoning and certain other consequences of external causes;

XX. External causes of morbidity and mortality.

Table IV. Multilevel analysis of health service utilization depending on the country of origin aggregated in regions. Reference categories are male and Spain. The model is adjusted by age, sex, and health status.

	Consultations requested with GP		Consultations requested with nurses		Specialized care referrals
	IRR	95% CI	IRR	95% CI	IRR	95% CI
All immigrants	1.16	1.15–1.17	0.94	0.93–0.96	1.26	1.25–1.28
EU 15^a	0.98	0.95–1.00	0.75	0.70–0.81	1.06	1.01–1.11
Recent EU^b	0.91	0.90–0.93	0.82	0.78–0.86	1.04	1.01–1.07
Maghreb	1.34	1.33–1.36	1.06	1.03–1.10	1.44	1.41–1.46
Africa	1.36	1.34–1.37	1.10	1.06–1.14	1.49	1.46–1.52
Latin-American	1.07	1.06–1.08	0.87	0.85–0.89	1.18	1.16–1.19
Asia	0.76	0.66–0.88	0.75	0.54–1.02	0.76	0.61–0.95
Others	1.25	1.22–1.28	1.19	1.12–1.27	1.39	1.34–1.44
Not coded	1.15	1.14–1.17	0.98	0.95–1.01	1.27	1.25–1.30

IRR, Incidence Risk Ratio; CI Confidence Interval.

^aEU15: European Union countries before 2004, except Spain: Belgium, Netherlands, Luxembourg, France, Italy, Germany, Ireland, UK, Denmark, Austria, Sweden, Finland, Greece, Portugal;

^bRecent EU: Countries that joined the European Union in 2004: Malta, Cyprus, Estonia, Latvia, Lithuania, Poland, Czech Republic, Slovakia, Slovenia, Hungary.