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

Abstract

Background: Immigration is a relevant public health issue and there is a great deal of controversy surrounding its impact on health services utilization. Objective: To determine diff erences between immigrants and non-immigrants in the utilization of primary health care services in Catalonia, Spain. Methods: Population based, cross-sectional, multicentre study. We used the information from 16 primary health care centres in an area near Barcelona, Spain. We conducted a multilevel analysis for the year 2008 to compare primary health care services utilization between all immigrants aged 15 or more and a sample of non-immigrants, paired by age and sex. Results: Overall, immigrants living in Spain used health services more than non-immigrants (Incidence Risk Ratio (IRR) 1.16 (95% Confi dence Interval (CI): 1.15 – 1.16) and (IRR 1, 26, 95% CI: 1.25 – 1.28) for consultations with GPs and referrals to specialized care, respectively. People coming from the Maghreb and the rest of Africa requested the most consultations involving a GP and nurses (IRR 1.34, 95% CI: 1.33 – 1.36 and IRR 1.06, 95% CI: 1.03 – 1.44, respectively). They were more frequently referred to specialized care (IRR 1.44, 95% CI: 1.41 – 1.46) when compared to Spaniards. Immigrants from Asia had the lowest numbers of consultations with a GP and referrals (IRR 0.76, 95% CI: 0.66 – 0.88 and IRR 0.76, 95% CI: 0.61 – 0.95, respectively. Conclusion: On average , immigrants living in Catalonia used the health services more than non-immigrants. Immigrants from the Maghreb and other African countries showed the highest and those from Asia the lowest, number of consultations and referrals to specialized care.