Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2013

Open Access 01-12-2013 | Research article

Effects of immigrant status on Emergency Room (ER) utilisation by children under age one: a population-based study in the province of Reggio Emilia (Italy)

Authors: Paola Ballotari, Stefania D’Angelo, Laura Bonvicini, Serena Broccoli, Nicola Caranci, Silvia Candela, Paolo Giorgi Rossi

Published in: BMC Health Services Research | Issue 1/2013

Login to get access

Abstract

Background

The primary aim of this study was to assess the effect of immigrant status on Emergency Room (ER) utilisation by children under age one, considering all, non-urgent, very urgent, and followed by hospitalisation visits. The second aim was to investigate the role played by mother’s educational level in the relationship between citizenship and ER utilisation.

Methods

The cohort study included all healthy singleton live births in the years 2008–2009 and residing in the province of Reggio Emilia, followed for the first year of life in order to study their ER visits. The outcomes were the ER utilisation rate for all, non-urgent, very urgent, and followed by hospitalisation visits. The main explanatory variable was mother’s citizenship. Other covariates were mother’s educational level, maternal age, parity, and child gender. Multivariate analyses (negative binomial regression and zero inflated when appropriate) were performed. Adjusted utilisation Rate Ratios (RR) and their 95% Confidence Intervals (95% CI) were calculated. Trend for age in months by citizenship is depicted.

Results

There were 3,191 children (36.4%) with at least one ER visit in the first year of life. Adjusted RR show a significantly greater risk of ER visit for immigrants than for Italians: (RR 1.51; 95% CI 1.39-1.63). Immigrants also had a higher risk of non-urgent visits (RR 1.72; 95% CI 1.48-2.00) and for visits followed by hospitalizations (RR 1.58; 95% CI 1.33-1.89). For very urgent visits, the immigrants had a slightly higher risk compared to Italians (RR 1.25; 95% CI 0.98-1.59).
The risk of ER visits is higher in the first two months of life (RR1st vs 3rd-12th 2.08; 95% CI 1.93-2.24 and RR 2nd vs 3rd-12th 1.45; 95% CI 1.33-1.58, respectively). Considering all visits, the ER utilisation rate was inversely related with maternal education only for Italians (low educational level 44.0 and high educational level 73.9 for 100 children; p value for trend test < 0.001).

Conclusions

Our study observed a higher use of ER services by immigrant children and, to a lesser extent, by children of less educated Italian mothers. In immigrants, the excess is mostly due to non-urgent visits and only slightly to high acute conditions.
Appendix
Available only for authorised users
Literature
1.
Norredam M, Krasnik A, Sorensen TM, Keiding N, Michaelsen JJ, Nielsen AS: Emergency room utilization in Copenhagen: a comparison of immigrants groups and Danish-born residents. Scand J Public Health. 2004, 32: 53-59. 10.1080/14034940310001659.CrossRefPubMed
2.
Rué M, Cabré X, Soler-Gonzalez J, Bosch A, Almirall M, Serna MC: Emergency hospital services utilization in Lleida (Spain): A cross-sectional study of immigrants and Spanish-born population. BMC Health Serv Res. 2008, 8: 81-10.1186/1472-6963-8-81.CrossRefPubMedPubMedCentral
3.
Bonvicini L, Broccoli S, D’Angelo S, Candela S: Emergency room services utilization in the province of Reggio Emilia: a comparison between immigrants and Italians. Epidemiol Prev. 2011, 35: 259-266.PubMed
4.
Buja A, Fusco M, Furlan P, Bertoncello C, Baldovin T, Casale P, Marcolongo A, Baldo V: Characteristics, processes, management and outcome of accesses to accident and emergency departments by citizenship. Int J Public Health. 2013, Epub ahead of print
5.
Durden E: Usual source of health care for Hispanic children: the implication of immigration. Med Care. 2007, 45: 753-760. 10.1097/MLR.0b013e318054688e.CrossRefPubMed
6.
Sharma V, Simon SD, Bakewell JM, Ellerbeck EF, Fox MH, Wallace DD: Factors Influencing Infant Visits to Emergency Departments. Pediatrics. 2000, 106: 1031-1039. 10.1542/peds.106.5.1031.CrossRefPubMed
7.
Plakht Y, Abu Tailakh M, Barabi T, Shiyovich A: Ethnic disparities in emergency department utilization patterns in southern Israel: a population-based study. Intern Emerg Med. 2012, 7: 547-555. 10.1007/s11739-012-0835-4.CrossRefPubMed
8.
De Luca G, Ponzo M, Andrés AR: Health care utilization by immigrants in Italy. Int J Health Care Finance Econ. 2013, 13: 1-31. 10.1007/s10754-012-9119-9.CrossRefPubMed
9.
Buron A, Cots F, Garcia O, Vall O, Castells X: Hospital emergency department utilisation rates among the immigrants population in Barcelona, Spain. BMC Health Serv Res. 2008, 8: 51-10.1186/1472-6963-8-51.CrossRefPubMedPubMedCentral
10.
Norredam M, Mygind A, Nielsen AS, Bagger J, Krasnik A: Motivation and relevance of emergency room visits among immigrants and patients of Danish origin. Eur J Public Health. 2007, 17: 497-502. 10.1093/eurpub/ckl268.CrossRefPubMed
11.
Cots F, Castells X, Garcia O, Riu M, Felipe A, Vall O: Impact of immigration on the cost of emergency visits in Barcelona (Spain). BMC Health Serv Res. 2007, 7: 9-10.1186/1472-6963-7-9.CrossRefPubMedPubMedCentral
12.
Farchi S, Giorgi Rossi P, Chini F, Baglio G, Cacciani L, Lori G, Borgia P, Guasticchi G: I traumi negli immigrati da paesi non industrializzati: analisi degli accessi in pronto soccorso nel Lazio nell’anno 2000. Ann Ig. 2005, 17: 335-342.PubMed
13.
Tritschler T, Snnhauserr FH, Frey B: Are immigrants children admitted to intensive care at increased risk?. Swiss Med Wkly. 2011, 141: w13190.PubMed
14.
WHO/CSDH: Closing the gap in a generation: Health equity through action on the social determinants of health. Final report of the commission of social determinants of health. 2008, Geneva: WHO
15.
Paraponaris A, Obadia Y, Ben Diane MK, Bertrand F, Moatti JP: Health care consumption. Empirical evidence from a survey in a regional university hospital. Presse Med. 2004, 33: 228-234. 10.1016/S0755-4982(04)98542-9.CrossRefPubMed
16.
Owens MD, Beckles GL, Ho KK, Gorrell P, Brady J, Kaftarian JS: Women with diagnosed diabetes across the life stages: underuse of recommended preventive care services. J Womens Health (Larchmt). 2008, 17: 1415-1423. 10.1089/jwh.2008.1125.CrossRef
17.
Drolet M, Boily MC, Greenaway C, Deeks SL, Blanchette C, Laprise JF, Brisson M: Sociodemographic inequalities in sexual activity and cervical cancer screening: implications for the success of human papillomavirus vaccination. Cancer Epidemiol Biomarkers Prev. 2013, 22: 641-652. 10.1158/1055-9965.EPI-12-1173.CrossRefPubMed
18.
Acevedo-Garcia D, Soobader MJ, Berkman LF: The differential effect of foreign born status on low birth weight by race/ethnicity and education. Pediatrics. 2005, 115: e20-e30.PubMed
19.
Auger N, Luo Z-C, Platt RW, Daniel M: Do mother’s education and foreign born status interact to influence birth outcomes? Clarifying the epidemiological paradox and the healthy immigrant effect. J Epidemiol Community Health. 2008, 62: 402-409. 10.1136/jech.2007.064535.CrossRefPubMed
20.
Caranci N, Pacelli B, Ballotari P, Bonvicini L, Lupi C, Battaglia S, Perrone E, Candela S: Citizenship and mother’s educational level effect on pregnancy assistance, perinatal outcomes and hospital access in the first year of age in Emilia-Romagna region. Proceeding of 4th EUPHA Conference on Immigrants and Ethnic Minority Health in Europe: 21-23 June 2012. 2012, Milano: Università Bocconi, 51.
21.
Karl-Trummer U: Is immigrant status a determinant of health independent of socio-economic status? A first analysis of eight European countries. Proceeding of 4th EUPHA Conference on Immigrants and Ethnic Minority Health in Europe: 21-23 June 2012. 2012, Milano: Università Bocconi, 154.
22.
23.
24.
Regione Emilia Romagna: La nascita in Emilia Romagna: 9° rapporto sui dati del Certificato di Assistenza al parto (CEDAP), anno 2011. 2012, Bologna: Regione Emilia-Romagna
25.
G.U. n. 285 del 7/12/2001: Accordo tra il Ministro della salute, le regioni e le province autonome sul documento di linee-guida sul sistema di emergenza sanitaria concernente: “Triage intraospedaliero (valutazione gravita” all’ingresso) e chirurgia della mano e microchirurgia nel sistema dell’emergenza - urgenza sanitaria”. 2001, Roma: Istituto poligrafico e Zecca dello Stato
26.
Giorgi Rossi P, Farchi S, Chini F, Camilloni L, Borgia P, Guasticchi G: Road Traffic Injuries in Lazio, Italy: A Descriptive Analysis From an Emergency Department–Based Surveillance System. Ann Emerg Med. 2005, 46: 152-157. 10.1016/j.annemergmed.2005.01.033.CrossRefPubMed
27.
28.
Long JS: Regression Models for Categorical and Limited Dependent Variables. 1997, Thousand Oaks, CA: Sage Publications
29.
Afifi AA, Kotlerman JB, Ettner SL, Cowan M: Methods for Improving Regression Analysis for Skewed Continuous or Counted Responses. Annu Rev Public Health. 2007, 28: 95-111. 10.1146/annurev.publhealth.28.082206.094100.CrossRefPubMed
30.
LaCalle E, Rabin E: Frequent users of emergency departments: the myths, the data, and the policy implications. Ann Emerg Med. 2010, 56: 42-48. 10.1016/j.annemergmed.2010.01.032.CrossRefPubMed
31.
Gallagher RA, Porter S, Monuteaux MC, Stack AM: Unscheduled return visits to the emergency department: the impact of language. Pediatr Emerg Care. 2013, 29: 579-583. 10.1097/PEC.0b013e31828e62f4.CrossRefPubMed
32.
Carret MLV, Fassa AG, Kawachi I: Demand for emergency health service: factor associated with inappropriate use. BMC Health Serv Res. 2007, 7: 31-10.1186/1472-6963-7-31.CrossRef
33.
Lippi Bruni M, Mammi I, Ugolini C: Emergency department utilisation for non-urgen care: are there difference between immigrants and native patients?. Proceeding of 4th EUPHA Conference on Immigrants and Ethnic Minority Health in Europe: 21-23 June 2012. 2012, Milano: Università Bocconi, 66.
34.
Baken E, Bazzocchi A, Bertozzi N, Celeste C, Chattat R, D’Augello V, Marchetti L, Palazzi M, Prati E, Reali C, Ranieri C, Righi F, Sukaj E, Vitali P: La salute materno-infantile degli stranieri e l’accesso ai servizi: analisi quali-quantitativa del territorio cesenate. Quaderni acp. 2007, 14: 56-60.
35.
Kubicek K, Liu D, Beaudin C, Supan J, Weiss G, Lu Y, Kipke MD: A profile of nonurgent emergency department use in an urban pediatric hospital. Pediatr Emerg Care. 2012, 28: 977-984. 10.1097/PEC.0b013e31826c9aab.CrossRefPubMedPubMedCentral
36.
Spencer NJ, Lewis MA, Stuart L: Diagnostic and socio-demographic changes in multiple hospital admission in children under two over a five-year period. J Public Health Med. 1993, 15: 332-336.PubMed
37.
Braun T, Garcia Castillo-Riesgo L, Krafft T, Diaz-Regañon Vilches G: Frequentación del servicio de urgencia y factores sociodemográficos. Gac Sanit. 2002, 16: 139-144. 10.1016/S0213-9111(02)71645-2.CrossRefPubMed
38.
Thrane N, Søndergaard C, Schønheyder HC, Toft Sørensen H: Socioeconomic factors and risk of hospitalization with infectious diseases in 0 to 2-year-old Danish children. Eur J Epidemiol. 2005, 20: 467-474. 10.1007/s10654-005-0719-2.CrossRefPubMed
39.
Galobardes B, Shaw M, Lawlor DA, Lynch JW, Davey Smith G: Indicators of socioeconomic position (part 1). J Epidemiol Community Health. 2004, 60: 7-12.CrossRef
40.
Winkleby MA, Jatulius DE, Frank E, Fortmann SP: Socioeconomic status and health: how education, income and occupation contribute to risk factors for cardiovascular disease. Am J Public Health. 1992, 82: 816-820. 10.2105/AJPH.82.6.816.CrossRefPubMedPubMedCentral
41.
Luo ZC, Wilkins R, Kramer MS: Effect of neighbourhood income and maternal education on birth outcomes: a population-based study. CMAJ. 2006, 174: 10.CrossRef
42.
Shaw E, Levitt C, Wong S, Kaczorowski J, The McMaster University Postpartum Research Group: Systematic Review of the Literature on Postpartum Care: Effectiveness of Postpartum Support to Improve Maternal Parenting, Mental Health, Quality of Life, and Physical Health. Birth. 2006, 33: 210-220. 10.1111/j.1523-536X.2006.00106.x.CrossRefPubMed
43.
Casey PH, Whitt JK: Effect of the pediatrician on the mother-infant relationship. Pediatrics. 1980, 65: 815-820.PubMed
44.
Yoffe SJ, Moore RW, Gibson JO, Dadfar NM, McKay RL, McClellan DA, Huang TY: A reduction in emergency department use by children from a parent educational intervention. Pediatr Emerg Care. 2012, 28: 977-984. 10.1097/PEC.0b013e31826c9aab.CrossRef
45.
Asole S, Forcella E, Spinelli A, Baglio G, Affronti M, Geraci S, Madoni P, Mondo L, Pellegrini MG, Sartori M, Guasticchi G: A model of home visit for immigrant women in the post-partum period. Proceeding of 4th EUPHA Conference on Immigrants and Ethnic Minority Health in Europe: 21-23 June 2012. 2012, Milano: Università Bocconi, 45.
Metadata
Title
Effects of immigrant status on Emergency Room (ER) utilisation by children under age one: a population-based study in the province of Reggio Emilia (Italy)
Authors
Paola Ballotari
Stefania D’Angelo
Laura Bonvicini
Serena Broccoli
Nicola Caranci
Silvia Candela
Paolo Giorgi Rossi
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2013
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-13-458

Other articles of this Issue 1/2013

BMC Health Services Research 1/2013 Go to the issue

Research article

Feasibility and effect of integrating tuberculosis screening and detection in postnatal care services: an operations research study

Research article

Empirical evidence of the continuing improvement in cost efficiency of an endoscopic surveillance programme for gastric cancer in Singapore from 2004 to 2010

Research article

Patient mobility for cardiac problems: a risk-adjusted analysis in Italy

Research article

Evaluation of a quality improvement intervention to prevent mother-to-child transmission of HIV (PMTCT) at Zambia defence force facilities

Research article

Did hospital mortality in England change from 2005 to 2010? A retrospective cohort analysis

Research article

Feasibility, reliability and validity of a questionnaire on healthcare consumption and productivity loss in patients with a psychiatric disorder (TiC-P)