The Association Between Acculturation and Cardiovascular Disease Risk in Ghanaian and Nigerian-born African Immigrants in the United States: The Afro-Cardiac Study

The burden of cardiovascular disease (CVD) risk in ethnic minorities in the United States (US) is high. Acculturation may worsen or improve cardiovascular health in immigrants. We sought to examine the association between acculturation and elevated cardiovascular disease risk in African immigrants, a growing immigrant population in the US. We conducted a cross-sectional study of Ghanaian and Nigerian born-African immigrants in the US. To determine whether acculturation was associated with having elevated CVD risk (defined as ≥3 CVD risk factors or Pooled Cohort Equations score ≥7.5%), we performed unadjusted and adjusted logistic regression analyses. For both outcomes, sex-specific models were fitted. Participants (N?=?253) were aged 35–74 years and resided in Baltimore–Washington-D.C. The mean age (SD) was 49.5 (9.2) years and 58% were female. Residing in the US for ≥10 years was associated with an almost fourfold (95% CI 1.05–14.35) and eightfold (95% CI 2.09–30.80) greater odds of overweight/obesity and elevated CVD risk respectively in males. Females residing in the US for ≥10 years had 2.60 times (95% CI 1.04–6.551) greater odds of hypertension than newer residents. Participants were classified according to acculturation strategies: Integrationists, 166 (66%); Traditionalists, 80 (32%); Marginalists, 5 (2%); and Assimilationists, 2 (1%). Integrationists had a 0.46 (95% CI 0.24–0.87) lower odds of having ≥3 CVD risk factors and 0.38 (95% CI 0.18–0.78) lower odds of having elevated CVD risk (Pooled Cohort Equations score ≥7.5%) than Traditionalists. Although longer length of stay was associated with CVD risk, Integrationists had lower CVD risk than Traditionalists. Our results suggest that coordinated public health responses to the epidemic of CVD risk factors in the US should target this understudied population. Acculturation should be considered as a meaningful contributor of increased CVD risk and acculturation strategies may be used to tailor interventions in African immigrants. Promoting successful integration may reduce immigrants’ CVD risk.     

Infant mortality among the Canadian-born offspring of immigrants and non-immigrants in Canada: a population-based study

Background

Adult immigrants in Canada have a survival advantage over their Canadian-born counterparts. It is unknown whether migrants are able to transmit their survival advantage to their Canadian-born children.

Methods

Neonatal and postneonatal mortality between the Canadian-born population and 12 immigrant subgroups were compared using 1990–2005 linked birth-infant death records. Age-at-death specific mortality rates and rate differences were calculated by nativity status and maternal birthplace. A chi-square statistic was used to compare group differences in maternal sociodemographic characteristics. Multivariate survival analysis was used to estimate the effect of maternal birthplace on neonatal and postneonatal mortality, net of maternal sociodemographic and infant characteristics.

Results

Overall, immigrants had lower rates of neonatal and postneonatal mortality than the Canadian-born population. But the adjusted risk of neonatal mortality was higher for Sub-Saharan African (hazard ratio [HR]?=?1.32; 95 % confidence interval [CI]?=?1.05, 1.66), Haitian (HR?=?2.29, 95 % CI?=?1.90, 2.76), non-Spanish Caribbean (HR?=?1.38; 95 % CI?=?1.01, 1.89), and Pakistani (HR?=?1.87; 95 % CI?=?1.31, 2.68) migrants relative to Canadian-born women. There were fewer significant disparities in postneonatal death, with higher adjusted risks of mortality observed for Pakistani (HR?=?2.67, 95 % CI?=?1.77, 4.02) and Haitian (HR?=?1.41, 95 % CI?=?1.02, 1.97) migrants only.

Conclusion

Inequalities in infant mortality are more concentrated in the neonatal period. Contingent on surviving the first 27 days after birth, the infants of most immigrants (except those from Haiti and Pakistan) have the same chances of survival as the infants of Canadian-born women. Improvements in prenatal care and access to postpartum care may reduce disparities in infant mortality.

     

Immigrant status and unmet health care needs

OBJECTIVES: To compare whether unmet health needs differ between immigrants and non-immigrants, and examine whether help-seeking characteristics account for any unmet needs disparities. METHODS: The data are from the Canadian Community Health Survey Cycle 1.1, conducted by Statistics Canada in 2000-2001. The study sample includes 16,046 immigrants and 102,173 non-immigrants aged 18 and older from across Canada. The study employs logistic regression models to examine whether help-seeking behaviours explain unmet needs differences. RESULTS: Logistic regression analysis indicates that immigrants have a 12% (95% CI: 6-18) lower all-cause unmet needs risk (odds ratio) than non-immigrants after controlling for differences in help-seeking characteristics. The unmet needs risk among long-term immigrants (15 years of residence and more), however, is similar to non-immigrants after considering these characteristics. We found differences between immigrants and non-immigrants in reasons for unmet needs, with more immigrants believing that the care would be inadequate, not knowing where to access health care, and having foreign language problems. CONCLUSIONS: The Canadian health care system delivers sufficient health care to immigrants, even though the poverty rate and proportion of visible minorities are comparatively higher within this subpopulation. Nonetheless, these results indicate that some immigrant-specific health care access barriers may exist.     

The relationship between immigration and mental health: what is the role of workplace psychosocial factors

Background

To study the relationship between immigration and mental health considering the psychosocial factors in the workplace.

Methods

Multistage cluster sampling was used (final sample: 7,612 workers). Workers whose country of origin was unknown were excluded from the study (study population: 7,555). The information was collected between 2004 and 2005 using a standardized questionnaire, and interviews were conducted in respondents’ homes. The risk of poor mental health according to psychosocial factor, using the native, non-exposed workers as a reference, was calculated using log-binomial models. The prevalence ratio (PR) and confidence intervals (CI 95%) were estimated from crude data and from data adjusted for sex, age, and occupational category.

Results

Immigrants who experienced high quantitative demands (PR?=?1.46; CI 95%:1.34–1.59), high emotional demands (PR?=?1.42; CI 95%:1.301.56), high demands for hiding emotions (PR?=?1.35; CI 95%:1.21–1.50), low possibilities for development (PR?=?1.21; CI 95%:1.09–1.33), low levels of support from coworkers (PR?=?1.41; CI 95%:1.30–1.53), and low esteem (PR?=?1.53; CI 95%:1.42–1.66) perceived worse mental health. Equally, the study found that the immigrants with a high influence (PR?=?1.19; CI 95%:1.09–1.29) and high control over working times (PR?=?1.25; CI 95%:1.14–1.36) also reported worse mental health. We also found that native workers exposed to these factors also perceived worse mental health than those who were not exposed and that even, at times, they were at greater risk than exposed immigrants.

Conclusions

Differences in mental health between exposed and non-exposed wage earners, whether immigrant or native workers, indicate the importance of taking action to reduce psychosocial factors, as this would benefit both native and immigrant workers.     

Physical Activity and Health Service Utilization Among Older People

BackgroundRising health care use among older people presents a challenge to medical care. Physical activity (PA) is beneficial; however, it is unknown if initiating PA among the very old reduces health service use. We examined the effects of changing PA levels on emergency room (ER) visits and hospitalization at ages 78 and 85.MethodsA representative sample (born 1920–1921) from the Jerusalem Longitudinal Cohort Study (1990–2010) were assessed at ages 78 and 85 for self-reported PA; ER visits and hospitalization; and social, functional, and medical domains.ResultsWe examined 896 and 1173 subjects at ages 78 and 85, respectively. ER usage at ages 78 and 85 respectively was lower among active subjects (15.8% vs 37.4%, P < .0001; 30.6% vs 50.8%, P < .0001), as was hospitalization (10.5% vs 16.7%, P < .05; 22.1% vs 37.8%, P < .0001). We adjusted for gender, education, loneliness, functional dependence, cognitive impairment, depression, diabetes, heart disease, hypertension, neoplasm, renal disease, self-rated health, body mass index, and smoking. PA at age 78 was associated with a reduced likelihood of ER visits (odds ratio [OR] 0.49, 95% confidence interval [CI] 0.27–0.89), but not hospitalization (OR 1.14, 95% CI 0.54–2.42); at age 85 with a reduced likelihood for ER visits (OR 0.72, 95% CI 0.52–0.99) and hospitalization (OR 0.68, 95% CI 0.48–0.98). Compared with subjects consistently active at ages 78 and 85, initiating PA between ages 78 and 85 resulted in similar lower likelihood of ER visits (OR 0.6, 95% CI 0.23–1.56) and hospitalization (OR 1.20, 95% CI 0.48–3.02); stopping PA and never being active between 78 and 85 were respectively associated with increased ER visits (OR 1.72, 95% CI 1.02–2.88; OR 2.18, 95% CI 1.04–4.57) and hospitalization (OR 1.85, 95% CI 1.06–3.23; OR 2.01, 95% CI 0.92–4.4).ConclusionsAmong the oldest old, not only continuing but also becoming physically active is associated with reduced health service use. Initiating PA among the very old should be encouraged.     

Prevalence of non-communicable diseases and access to care among non-camp Syrian refugees in northern Jordan

Background

Tackling the high non-communicable disease (NCD) burden among Syrian refugees poses a challenge to humanitarian actors and host countries. Current response priorities are the identification and integration of key interventions for NCD care into humanitarian programs as well as sustainable financing. To provide evidence for effective NCD intervention planning, we conducted a cross-sectional survey among non-camp Syrian refugees in northern Jordan to investigate the burden and determinants for high NCDs prevalence and NCD multi-morbidities and assess the access to NCD care.

Methods

We used a two-stage cluster design with 329 randomly selected clusters and eight households identified through snowball sampling. Consenting households were interviewed about self-reported NCDs, NCD service utilization, and barriers to care.We estimated the adult prevalence of hypertension, diabetes type I/II, cardiovascular- and chronic respiratory conditions, thyroid disease and cancer and analysed the pattern of NCD multi-morbidities. We used the Cox proportional hazard model to calculate the prevalence ratios (PR) to analyse determinants for NCD prevalence and logistic regression to determine risk factors for NCD multi-morbidities by calculating odds ratios (ORs).

Results

Among 8041 adults, 21.8%, (95% CI: 20.9–22.8) suffered from at least one NCD; hypertension (14.0, 95% CI: 13.2–14.8) and diabetes (9.2, 95% CI: 8.5–9.9) were the most prevalent NCDs. NCD multi-morbidities were reported by 44.7% (95% CI: 42.4–47.0) of patients. Higher age was associated with higher NCD prevalence and the risk for NCD-multi-morbidities; education was inversely associated.Of those patients who needed NCD care, 23.0% (95% CI: 20.5–25.6) did not seek it; 61.5% (95% CI: 54.7–67.9) cited provider cost as the main barrier. An NCD medication interruption was reported by 23.1% (95% CI: 20–4-26.1) of patients with regular medication needs; predominant reason was unaffordability (63.4, 95% CI: 56.7–69.6).

Conclusion

The burden of NCDs and multi-morbidities is high among Syrian refugees in northern Jordan. Elderly and those with a lower education are key target groups for NCD prevention and care, which informs NCD service planning and developing patient-centred approaches.Important unmet needs for NCD care exist; removing the main barriers to care could include cost-reduction for medications through humanitarian pricing models. Nevertheless, it is still essential that international donors agencies and countries fulfill their commitment to support the Syrian-crisis response.

     

Impacts of Medicaid Expansion on Health Insurance and Coverage Transitions among Women with or at Risk for HIV in the United States

BackgroundAs employment, financial status, and residential location change, people can gain, lose, or switch health insurance coverage, which may affect care access and health. Among Women's Interagency HIV Study participants with HIV and participants at risk for HIV attending semiannual visits at 10 U.S. sites, we examined whether the prevalence of coverage types and rates of coverage changes differed by HIV status and Medicaid expansion in their states of residence.MethodsGeocoded addresses were merged with dates of Medicaid expansion to indicate, at each visit, whether women lived in Medicaid expansion states. Age-adjusted rate ratios (RRs) and rate differences of self-reported insurance changes were estimated by Poisson regression.ResultsFrom 2008 to 2018, 3,341 women (67% Black, 71% with HIV) contributed 43,329 visits at aged less than 65 years (27% under Medicaid expansion). Women with and women without HIV differed in their proportions of visits at which no coverage (14% vs. 19%; p < .001) and Medicaid enrollment (61% vs. 51%; p < .001) were reported. Women in Medicaid expansion states reported no coverage and Medicaid enrollment at 4% and 69% of visits, respectively, compared with 20% and 53% of visits for those in nonexpansion states. Women with HIV had a lower rate of losing coverage than those without HIV (RR, 0.81; 95% confidence interval [CI], 0.70 to 0.95). Compared with nonexpansion, Medicaid expansion was associated with lower coverage loss (RR, 0.62; 95% CI, 0.53 to 0.72) and greater coverage gain (RR, 2.32; 95% CI, 2.02 to 2.67), with no differences by HIV status.ConclusionsBoth women with HIV and women at high risk for HIV in Medicaid expansion states had lower coverage loss and greater coverage gain; therefore, Medicaid expansion throughout the United States should be expected to stabilize insurance for women and improve downstream health outcomes.     

An analysis of intra-uterine growth retardation in rural Malawi

OBJECTIVE: (1) To describe the sex-specific, birth weight distribution by gestational age of babies born in a malaria endemic, rural area with high maternal HIV prevalence; (2) to assess the contribution of maternal health, nutritional status and obstetric history on intra-uterine growth retardation (IUGR) and prematurity. METHODS: Information was collected on all women attending antenatal services in two hospitals in Chikwawa District, Malawi, and at delivery if at the hospital facilities. Newborns were weighed and gestational age was assessed through post-natal examination (modified Ballard). Sex-specific growth curves were calculated using the LMS method and compared with international reference curves. RESULTS: A total of 1423 live-born singleton babies were enrolled; 14.9% had a birth weight <2500 g, 17.3% were premature (<37 weeks) and 20.3% had IUGR. A fall-off in Malawian growth percentile values occurred between 34 and 37 weeks gestation. Significantly associated with increased IUGR risk were primiparity relative risk (RR) 1.9; 95% CI 1.4--2.6), short maternal stature (RR 1.6; 95% CI 1.0--2.4), anaemia (Hb<8 g/dl) at first antenatal visit (RR 1.6; 95% CI 1.2--2.2) and malaria at delivery (RR 1.4; 95% CI 1.0--1.9). Prematurity risk was associated with primiparity (RR 1.7; 95% CI 1.3--2.4), number of antenatal visits (RR 2.2; 95% CI 1.6--2.9) and arm circumference <23 cm (RR 1.9; 95% CI 1.4--2.5). HIV infection was not associated with IUGR or prematurity. CONCLUSION: The birth-weight-for-gestational-age, sex-specific growth curves should facilitate improved growth monitoring of newborns in African areas where low birth weight and IUGR are common. The prevention of IUGR requires improved malaria control, possibly until late in pregnancy, and reduction of anaemia.     

Diarrhoea prevention in a high-risk rural Kenyan population through point-of-use chlorination, safe water storage, sanitation, and rainwater harvesting

Lack of access to safe water and sanitation contributes to diarrhoea moribidity and mortality in developing countries. We evaluated the impact of household water treatment, latrines, shallow wells, and rainwater harvesting on diarrhoea incidence in rural Kenyan children. We compared diarrhoea rates in 960 children aged <5 years in 556 households in 12 randomly selected intervention villages and six randomly selected comparison villages during weekly home visits over an 8-week period. On multivariate analysis, chlorinating stored water [relative risk (RR) 0.44, 95% confidence interval (CI) 0.28-0.69], latrine presence (RR 0.71, 95% CI 0.54-0.92), rainwater use (RR 0.70, 95% CI 0.52-0.95), and living in an intervention village (RR 0.31, 95% CI 0.23-0.41), were independently associated with lower diarrhoea risk. Diarrhoea risk was higher among shallow well users (RR 1.78, 95% CI 1.12-2.83). Chlorinating stored water, latrines, and rainwater use all decreased diarrhoea risk; combined interventions may have increased health impact.     

Behavioral Health Service Use by Military Children During Afghanistan and Iraq Wars

Medical claims were analyzed from 2810 military children who visited a civilian emergency department (ED) or hospital from 2000 to 2014 with behavioral health as the primary diagnosis and TRICARE as the primary/secondary payer. Visit prevalence was estimated annually and categorized: 2000–2002 (pre-deployment), 2003–2008 (first post-deployment), 2009–2014 (second post-deployment). Age was categorized: preschoolers (0–4 years), school-aged (5–11 years), adolescents (12–17 years). During Afghanistan and Iraq wars, 2562 military children received 4607 behavioral health visits. School-aged children’s mental health visits increased from 61 to 246 from pre-deployment to the second post-deployment period. Adolescents’ substance use disorder (SUD) visits increased almost 5-fold from pre-deployment to the first post-deployment period. Mental disorders had increased odds (OR?=?2.93, 95% CI 1.86–4.61) of being treated during hospitalizations than in EDs. Adolescents had increased odds of SUD treatment in EDs (OR?=?2.92, 95% CI 1.85–4.60) compared to hospitalizations. Implications for integrated behavioral health and school behavioral health interventions are discussed.

     

Prevalence of Chronic Disease and Insurance Coverage among Refugees in the United States

Little is known about the health status of refugees beyond the immediate post-arrival period in the US. Using data from the 2003 New Immigrant Survey, a nationally representative survey of immigrants who had recently become legal permanent residents, we determined the prevalence of chronic conditions and health insurance coverage among adult refugees who had lived in the US for at least 1?year (n?=?490). We compared their health status with that of other immigrants (n?=?3,715) using multivariable logistic regression. The median duration of US residency was 5.6 and 8.0?years among refugees and other immigrants, respectively. Refugees were more likely than other immigrants to report at least one chronic condition (24.7 vs. 15.6?%, P?<?0.001). After adjusting for sociodemographic differences, the odds of the following conditions remained significantly higher among refugees: arthritis (adjusted odds ratio [AOR]?=?1.67, 95?% confidence interval [CI]?=?1.07, 2.61), heart disease (AOR?=?2.49, 95?% CI?=?1.30, 4.74), stroke (AOR?=?5.87, 95?% CI?=?1.27, 27.25), activity-limitation due to pain (AOR?=?1.96, 95?% CI?=?1.31, 2.93), and any chronic condition (AOR?=?1.37, 95?% CI?=?1.03, 1.81). Although similar percentages of refugees (49.0?%) and other immigrants (47.4?%) were uninsured, 46.5?% of refugees with chronic conditions lacked health insurance. Refugees have a high burden of chronic disease and would benefit from expanded insurance coverage for adults with preexisting conditions.     

Behavioral Health Services use Among Racial and Ethnic Groups: Results from the California Health Interview Survey (CHIS)

Access and utilization of behavioral health services is a public health issue, yet disparities among racial/ethnic groups persist, resulting in fewer access points and lower utilization. Using pooled 2015 and 2016 California Health Interview Survey (N?=?42,089) data of diverse adults, this study examines provider access points for behavioral health services use. Latinx (OR?=?0.55, 95% CI, 0.38–0.80), Asian (OR?=?0.32, 95% CI, 0.17–0.59), and first generation (OR?=?0.56, 95% CI, .38-.83) individuals, reported lower odds of accessing specialty care behavioral health services, compared to no services. First generation adults reported lower odds accessing a primary care physician (OR?=?0.66, 95% CI, 0.44–0.98), compared to none. Results advance knowledge of behavioral health services access points among racial, ethnic and immigrant groups, following passage of the California Mental Health Services Act. Findings suggest primary care may be an important entry point for behavioral health service use engagement among underserved populations.

     

Assessing association of waist-height ratio (WHtR) and body mass index (BMI) with non-communicable disease risk factors

Aim

The aim of this study is to determine the potential of the waist-height ratio (WHtR) and body mass index (BMI) as predictors of non-communicable disease (NCD) risk factors.

Subjects and methods

A retrospective study using data from the 2016 National NCD survey (STEPS). A total of 3808 data points were retrieved including sociodemographic factors, anthropometric measurements, NCD prevalence and risk factors. Multiple logistic and linear regression was applied for analysis.

Results

Men (OR?=?0.77, 95% CI: 0.63, 0.95), aged ≥ 45 years (OR?=?4.24, 95% CI: 3.15, 0.97), of Malay ethnicity, with no formal schooling, and with existing hypertension and diabetes had significantly higher odds of having WHtR > 0.5. BMI ≥ 25 and BMI?≥?30 are significantly associated with age group, ethnicity, education level, alcohol consumption, hypertension, diabetes and hypercholesterolaemia.

Conclusion

Both WHtR and BMI were important predictors of NCD prevalence. These findings can contribute to the validity of the WHtR in clinical application and encourage the use of these anthropometric indices in clinical settings.

     

Acceptability of Rapid HIV Testing Among Latinos in Washington Heights,New York City,New York,USA

In the United States, human immunodeficiency virus (HIV) has a disproportionately large impact on Latino Americans. This study assessed the acceptability of rapid HIV testing among a sample of Latinos from New York City. A cross-sectional study was conducted with 192 participants from The Washington Heights/Inwood Informatics Infrastructure for Community-Centered Comparative Effectiveness Research (WICER) study. Participants were interviewed and offered rapid HIV testing and post-test counseling. Seventy-five percent (n?=?143) accepted rapid HIV testing when offered. More religious participants were less likely than less religious participants to undergo testing (RR?=?0.73; 95% CI 0.54–0.99). Participants tested for HIV within the past year were less likely than those who had not been tested within the past year to agree to undergo testing (RR?=?0.27; 95% CI 0.11–0.66). Community-based rapid HIV testing is feasible among Latinos in urban environments. Outreach efforts to engage religious individuals and encouraging routine testing should be reinforced.     

加拿大亚洲移民健康状况及影响因素研究

目的 评估加拿大亚洲移民的健康状况及相关影响因素.方法 采用横断面研究,利用加拿大统计局提供的2003年加拿大人群健康状况调查数据进行分析.采用描述性分析比较不同人群中健康影响因素分布差异.通过对患病率进行年龄标化,比较亚洲移民、非移民及其他移民的慢性病患病情况差异.利用多因素logistic回归分析控制可能影响因素,比较不同人群中选定的6种慢性病指标的0R值及95%CI.结果 经年龄标化后,亚洲移民患有1～5种慢性病患病率与非移民无明显差异,患有5种以上慢性病的患病率为3.56%,明显低于非移民慢性病患病率5.31%.亚洲移民患有至少一种慢性病的风险(0R=0.49,95%CI:0.46-0.51)明显低于非移民患病风险(0R=1.00).新移民患病风险(0R=0.34,95%CI:0.31～0.37)低于老移民的患病风险(0R=0.62,95%CI:0.58～0.66).调整社会经济特征和生活方式等冈素后,亚洲移民4种常见病的患病风险仅有微小改变,除心脏病的患病风险变化明显.结论 亚洲移民总体慢性病的患病率及患病风险低于非移民,但这种健康优势随着在加拿大的居住年限的推移逐渐消失.社会经济特征和生活方式的不同不能完全解释亚洲移民和非移民的健康状况差异.     

Willingness to use mental health counseling and antidepressants in older Korean Americans: the role of beliefs and stigma about depression

Objectives: Despite a high prevalence of mental health problems, racial/ethnic minorities are often reluctant to seek mental health services. Their reluctance may be shaped by cultural beliefs and stigma about mental health. The present study examined how beliefs and stigma about depression (e.g. disbelief in depression as a health-related condition, perception of depression as a normal part of aging, and/or depression as a sign of personal weakness/family shame) pose barriers to older Korean Americans’ willingness to use mental health counseling and antidepressants.

Method: Data were drawn from surveys with 420 Korean American older adults (M_age=?71.6, SD?=?7.6) living in the New York City metropolitan area in 2010. Using a separate logistic regression model, the role of beliefs and stigma about depression in predicting participants’ willingness to receive mental health counseling and to take antidepressants was tested. Based on Andersen’s behavioral health service use model, the analysis was conducted in consideration of predisposing characteristics (age, gender, marital status, education, and acculturation), mental health needs (anxiety, depressive symptoms, and self-rated mental health), and enabling/hindering factors (beliefs and stigma).

Results: Similar proportions of the sample (69–70%) indicated their willingness to use mental health counseling or antidepressants. Willingness was more likely among participants who had beliefs about depression as a health-related concern (OR?=?1.94, 95% CI?=?1.15?3.27 for mental health counseling; OR?=?4.47, 95% CI?=?2.59?7.70 for antidepressants) and less likely among those who associated depression with family shame (OR?=?.55, 95% CI?=?0.33?0.91 for mental health counseling; OR?=?.56, 95% CI?=?0.33?0.95 for antidepressants).

Conclusion: In addressing mental health problems and promoting the use of mental health services, cultural beliefs and stigma shared within an ethnic community should be considered. Given that disbelief in the medical model of depression and family shame reduced willingness to use mental health counseling and antidepressants, promoting mental health literacy for older immigrants could be beneficial.     

Racial/ethnic differences in healthcare use among patients with uncontrolled and controlled diabetes

Objectives: To examine racial/ethnic differences in healthcare use among patients classified as having controlled and uncontrolled diabetes.

Design: Data from the Carolinas HealthCare System electronic data warehouse were used. Glycemic control was defined as glycosylated hemoglobin (HbA1c)?<?8% (64?mmol/mol) in 2012 (n?=?9996). Patients with HbA1c?≥?8% (64?mmol/mol) in 2012 were classified as uncontrolled (n?=?2576). Race and ethnicity were jointly classified as non-Hispanic Black, non-Hispanic White or Other. Separate mixed effects negative binomial models estimated the independent effect of race/ethnicity on the number of emergency department (ED) visits, hospitalizations and physician office visits in 2013, in each patient group, adjusting for significant confounding variables.

Results: Rates of diabetes-related ED visits were two to three times higher for non-Hispanic Blacks compared to non-Hispanic Whites (uncontrolled rate ratio [RR]: 3.41 95% CI: 1.41–8.22; controlled RR: 2.95; 95% CI: 1.78–4.91). Similar differences were observed for all-cause ED visits (uncontrolled RR: 1.83, 95% CI: 1.50–2.24; controlled RR: 2.45, 95% CI: 2.17–2.77). Non-Hispanic Blacks with controlled and uncontrolled diabetes also had lower rates of all-cause physician office visits when compared to non-Hispanic Whites (uncontrolled RR: 0.84, 95% CI: 0.77–0.91; controlled RR: 0.81, 95% CI: 0.78–0.84).

Conclusion: Notable racial/ethnic disparities exist in the use of emergency services and physician offices for diabetes care. Strategies such as patient education and care delivery changes that address healthcare access issues in racial/ethnic minorities should be considered to offer better diabetes management and address diabetes disparities.     

Knowledge and utilization of sexual and reproductive healthcare services among Thai immigrant women in Sweden

Background

Migration from Thailand to Sweden has increased threefold over the last 10 years. Today Thailand is one of the most common countries of origin among immigrants in Sweden. Since the year 2000, new HIV cases are also more prevalent among Thai immigrants compared to other immigrant nationalities in Sweden. The purpose of this study was to investigate the association between knowledge and utilization of sexual and reproductive healthcare services, contraceptive knowledge and socio-demographic characteristics and social capital among Thai immigrant women in Sweden.

Methods

This is a cross-sectional study using a postal questionnaire to all Thai women (18–64) in two Swedish regions, who immigrated to the country between 2006 and 2011. The questionnaire was answered by 804 women (response rate 62.3 %). Bivariate and multivariate logistic regression analyses were used.

Results

The majority (52.1 %) of Thai women had poor knowledge of where they should turn when they need sexual and reproductive healthcare services. After controlling for potential confounders, living without a partner (OR?=?2.02, CI: 1.16–3.54), having low trust in others (OR?=?1.61, CI: 1.10–2.35), having predominantly bonding social capital (OR?=?1.50, CI: 1.02–2.23) and belonging to the oldest age group (OR?=?2.65, CI: 1.32–5.29) were identified as risk factors for having poor knowledge. The majority (56.7 %) had never been in contact with healthcare services to get advice on contraception, and about 75 % had never been HIV/STI tested in Sweden. Low utilization of healthcare was associated with poor knowledge about healthcare services (OR?=?6.07, CI: 3.94–9.34) and living without a partner (OR?=?2.53, CI: 1.30–4.90). Most Thai women had knowledge of how to prevent an unwanted pregnancy (91.6 %) and infection with HIV/STI (91.1 %).

Conclusions

The findings indicate that social capital factors such as high trust in others and predominantly bridging social capital promote access to knowledge about healthcare services.However, only one-fourth of the women had been HIV/STI tested, and due to the HIV prevalence among Thai immigrants in Sweden, policy makers and health professionals need to include Thai immigrants in planning health promotion efforts and healthcare interventions.

     

Comparing Oral Health Services Use in the Spanish and Immigrant Working Population

We aim to analyze oral health services use and related factors in the immigrant working population compared to the Spanish counterparts. Cross-sectional study of working population (n?=?8591) that responded Spanish National Health Survey (SNHS), 2011–2012. The association between oral health services use and migration status was estimated using logistic regression. Immigrant men presented a greater probability of oral health service use a year or more prior (aOR 1.63; 95% CI 1.26–2.02), independently of oral health, sociodemographic and socioeconomic characteristics. In immigrant women, greater probability of use of oral health services one year or more prior disappeared after adjusting for the same variables (aOR 1.15; 95% CI 0.91–1.45). Occupational social class and education level could explain better a high percentage of oral health service use one year or more prior in immigrant women but there is a persistent inequality in oral health service use in immigrant men.