Potentially avoidable hospitalization for asthma in children and adolescents by migrant status: results from the Italian
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RESEARCH ARTICLE
Open Access
Potentially avoidable hospitalization for asthma in children and adolescents by migrant status: results from the Italian Network for Longitudinal Metropolitan Studies Laura Cacciani1* , Cristina Canova2, Giulia Barbieri2, Teresa Dalla Zuanna2, Claudia Marino1, Barbara Pacelli3ˆ, Nicola Caranci3, Elena Strippoli4, Nicolás Zengarini4, Anteo Di Napoli5, Nera Agabiti1 and Marina Davoli1
Abstract Background: Global migration toward Europe is increasing. Providing health assistance to migrants is challenging because numerous barriers limit their accessibility to health services. Migrants may be at a greater risk of developing asthma and receiving lower quality healthcare assistance than non-migrants. We aim to investigate whether immigrants as children and adolescents have higher rates of potentially avoidable hospitalization (PAH) for asthma compared to Italians. Methods: We performed a retrospective longitudinal study using six cohorts of 2–17-year-old residents in North and Central Italy from 01/01/2001 to 31/12/2014 (N = 1,256,826). We linked asthma hospital discharges to individuals using anonymized keys. We estimated cohort-specific age and calendar-year-adjusted asthma PAH rate ratios (HRRs) and 95% confidence intervals (95%CIs) among immigrants compared to Italians. We applied a two-stage random effect model to estimate asthma PAH meta-analytic rate ratios (MHRRs). We analyzed data by gender and geographical area of origin countries. Results: Three thousand three hundred four and 471 discharges for asthma PAH occurred among Italians and immigrants, respectively. Compared to Italians, the asthma PAH cohort-specific rate was higher for immigrant males in Bologna (HRR:2.42; 95%CI:1.53–3.81) and Roma (1.22; 1.02–1.45), and for females in Torino (1.56; 1.10–2.20) and Roma (1.82; 1.50–2.20). Asthma PAH MHRRs were higher only among immigrant females (MHRRs:1.48; 95%CI:1.18–1.87). MHRRs by area of origin were 63 to 113% higher among immigrants, except for Central-Eastern Europeans (0.80; 0.65–0.98). Conclusion: The asthma PAH meta-analytic rate was higher among female children and adolescent immigrants compared to Italians, with heterogeneity among cohorts showing higher cohort-specific PAH also among males, with some differences by origin country. Access to primary care for children and adolescent immigrants should be improved and immigrants should be considered at risk of severe asthma outcomes and consequently targeted by clinicians. Keywords: Immigrants, Children and adolescents, Potentially avoidable hospitalization, Asthma, Healthcare disparities, Longitudinal study, Italy
* Correspondence: [email protected] ˆBarbara Pacelli passed away prematurely in 2019. She was very much involved in the Italian Network of Longitudinal Metropolitan Studies, which are the basis of the present study. The Authors wish to remember Barbara Pacelli as an outstanding researcher in the field of social epidemiology. 1 Dipartimento di Epidemiologia del Servizio Sanitario Regionale del Lazio, Asl Roma
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