Determinants of Refugee and Migrant Health Status in 10 European Countries: The Mig-HealthCare Project
Abstract
:1. Introduction
Background on the Mig-HealthCare Project
2. Materials and Methods
2.1. Data Collection
2.2. Study Participants (Selection, Questionnaire Administration, Use of Interpreters, etc.)
Inclusion/Exclusion Criteria
2.3. Questionnaire Development and Description
2.4. Statistical Analysis
3. Results
3.1. Sample Characteristics
3.2. Reliability and Validity of SF-36 Questionnaire
3.3. Descriptive Statistics
3.4. Multivariable Linear Regression Analyses
4. Discussion
5. Strengths and Limitations
6. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
- Migration and Migrant Population Statistics—Statistics Explained. Available online: https://ec.europa.eu/eurostat/statistics-explained/index.php/Migration_and_migrant_population_statistics (accessed on 25 June 2020).
- Why Are Migrants Surging into Europe Now? Parallels: NPR. Available online: https://www.npr.org/sections/parallels/2015/09/02/436905795/why-are-migrants-surging-into-europe-now?t=1593040773240 (accessed on 25 June 2020).
- MC_INF_275.pdf. Available online: https://www.iom.int/jahia/webdav/shared/shared/mainsite/about_iom/en/council/88/MC_INF_275.pdf (accessed on 25 June 2020).
- Gil-Salmerón, A.; Valía-Cotanda, E.; Garcés-Ferrer, J.; Karnaki, P.; Zota, D.; Linos, A.; Lebano, A.; Bradby, H.; Hamed, S. 4.2-O1Immigrants and refugees’ principal characteristics across Europe: A literature review. Eur. J. Public Health 2018, 28 (Suppl. 1). Available online: https://0-academic-oup-com.brum.beds.ac.uk/eurpub/article/28/suppl_1/cky047.125/4973170 (accessed on 22 July 2020).
- Pavli, A.; Maltezou, H. Health problems of newly arrived migrants and refugees in Europe. J. Travel Med. 2017, 24. [Google Scholar] [CrossRef] [PubMed]
- Giambi, C.; Del Manso, M.; Marchetti, G.; Olsson, K.; Adel Ali, K.; Declich, S. Immunisation of migrants in EU/EEA countries: Policies and practices. Vaccine 2019, 37, 5439–5451. [Google Scholar] [CrossRef] [PubMed]
- Aelbrecht, K.; De Maesschalck, S. Cancer among immigrant patients. In Migrant Health: A Primary Care Perspective; CRC Press: Boca Raton, FL, USA, 2019; pp. 185–194. [Google Scholar]
- Giannoni, M.; Franzini, L.; Masiero, G. Migrant integration policies and health inequalities in Europe. BMC Public Health 2016, 16, 463. [Google Scholar] [CrossRef] [PubMed]
- Chilunga, F.P.; Boateng, D.; Henneman, P.; Beune, E.; Requena-Méndez, A.; Meeks, K.; Smeeth, L.; Addo, J.; Bahendeka, S.; Danquah, S.; et al. Perceived discrimination and stressful life events are associated with cardiovascular risk score in migrant and non-migrant populations: The RODAM study. Int. J. Cardiol. 2019, 286, 169–174. [Google Scholar] [CrossRef] [PubMed]
- Rosenthal, T. Immigration and acculturation: Impact on health and well-being of immigrants. Curr. Hypertens. Rep. 2018, 20, 70. [Google Scholar] [CrossRef] [PubMed]
- Giacco, D.; Laxhman, N.; Priebe, S. Prevalence of and risk factors for mental disorders in refugees. Semin. Cell Dev. Biol. 2018, 77, 144–152. [Google Scholar] [CrossRef] [PubMed]
- Rousseau, C.; Frounfelker, R.L. Mental health needs and services for migrants: An overview for primary care providers. J. Travel Med. 2019, 26, tay150. [Google Scholar] [CrossRef] [PubMed]
- Lebano, A.; Hamed, S.; Bradby, H.; Gil-Salmerón, A.; Durá-Ferrandis, E.; Garcés-Ferrer, J.; Azzedine, F.; Riza, E.; Karnaki, P.; Zota, D.; et al. Migrants’ and refugees’ health status and healthcare in Europe: A scoping literature review. BMC Public Health 2020. [Google Scholar] [CrossRef] [PubMed]
- Beauclercq, I.; Viello, F.; Petrova-Benedict, R.; Val, E. Overview of migration and health in Europe. In Refugee Migration and Health: Challenges for Germany and Europe; Springer: Berlin/Heidelberg, Germany, 2019; pp. 19–37. [Google Scholar]
- Sesti, F.; Bell, R.; Mirisola, C.; Marceca, M. 1.3-O6Health policies for tackling inequities in migrant health. What can the United Kingdom and Italy learn from each other? Eur. J. Public Health 2018, 28 (Suppl. 1). [Google Scholar] [CrossRef]
- Carballo, M.; Hargreaves, S.; Gudumac, I.; Maclean, E.C. Evolving migrant crisis in Europe: Implications for health systems. Lancet Glob. Health 2017, 5, e252–e253. [Google Scholar] [CrossRef] [Green Version]
- Ward, M.; Kristiansen, M.; Sørensen, K. Migrant health literacy in the European Union: A systematic literature review. Health Educ. J. 2019, 78, 81–95. [Google Scholar] [CrossRef]
- Mig-HealthCare Minimize Health Inequalities and Improve the Integration of Vulnerable Migrants and Refugees Into Local Communities. Available online: https://www.mighealthcare.eu/ (accessed on 22 July 2020).
- Ware, J.E.; Snow, K.K.; Kosinski, M.; Gandek, B. SF-36 Health Survey: Manual & Interpretation Guide; LINCOLN, QualityMetric Incorporated: Lincoln, RI, USA, 2000. [Google Scholar]
- R Core Team. R: A Language and Environment for Statistical Computing; R Core Team: Vienna, Austria, 2016; Available online: https://www.R-project.org/ (accessed on 22 July 2020).
- Chambers, J.M. Linear models. In Statistical Models; Chambers, J.M., Hastie, T.J., Eds.; Wadsworth & Brooks/Cole: Pacific Grove, CA, USA, 1992. [Google Scholar]
- Hastie, T.J.; Pregibon, D. Generalized linear models. In Statistical Models; Chambers, J.M., Hastie, T.J., Eds.; Wadsworth & Brooks/Cole: Pacific Grove, CA, USA, 1992. [Google Scholar]
- Venables, W.N.; Ripley, B.D. Modern Applied Statistics, 4th ed.; Springer: New York, NY, USA, 2002. [Google Scholar]
- Turrini, G.; Purgato, M.; Ballette, F.; Nosè, M.; Ostuzzi, G.; Barbui, C. Common mental disorders in asylum seekers and refugees: Umbrella review of prevalence and intervention studies. Int. J. Ment. Health Syst. 2017, 11, 51. [Google Scholar] [CrossRef] [PubMed]
- Goodman, L.F.; Jensen, G.W.; Galante, J.M.; Farmer, D.L.; Taché, S. A cross-sectional investigation of the health needs of asylum seekers in a refugee clinic in Germany. BMC Fam. Pract. 2018, 19. [Google Scholar] [CrossRef] [PubMed]
- Kotsiou, O.S.; Kotsios, P.; Srivastava, D.S.; Kotsios, V.; Gourgoulianis, K.I.; Exadaktylos, A.K. Impact of the refugee crisis on the greek healthcare system: A long road to Ithaca. Int. J. Environ. Res. Public Health 2018, 15, 1790. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Di Meco, E.; Di Napoli, A.; Amato, L.M.; Fortino, A.; Costanzo, G.; Rossi, A.; Mirisola, C.; Petrelli, A.; The INMP Team. Infectious and dermatological diseases among arriving migrants on the Italian coasts. Eur. J. Public Health 2018, 28, 910–916. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Hynie, M. The social determinants of refugee mental health in the post-migration context: A critical review. Can. J. Psychiatry 2018, 63, 297–303. [Google Scholar] [CrossRef] [PubMed]
- Hou, W.K.; Liu, H.; Liang, L.; Ho, J.; Kim, H.; Seong, E.; Bonanno, G.A.; Hobfoll, S.E.; Hall, B.J. Everyday life experiences and mental health among conflict-affected forced migrants: A meta-analysis. J. Affect. Disord. 2020, 264, 50–68. [Google Scholar] [CrossRef] [PubMed]
- Hanssens, L.G.; Detollenaere, J.; Hardyns, W.; Willems, S.J. Access, treatment and outcomes of care: A study of ethnic minorities in Europe. Int. J. Public Health 2016, 61, 443–454. [Google Scholar] [CrossRef] [PubMed]
- Stathopoulou, T.; Stornes, P.; Mouriki, A.; Kostaki, A.; Cavounidis, J.; Avrami, L.; McNamara, C.L.; Rapp, C.; Eikemo, T.A. Health inequalities among migrant and native-born populations in Greece in times of crisis: The MIGHEAL study. Eur. J. Public Health 2018, 28 (Suppl. 5), 5–19. [Google Scholar] [CrossRef] [PubMed]
- WHO. Report on the Health of Refugees and Migrants in the WHO European Region. In No Public Health without Refugee and Migrant Health; WHO Regional Office for Europe: Copenhagen, Denmark, 2018; ISBN 978 92 890 5384 6. Available online: https://www.euro.who.int/en/publications/abstracts/report-on-the-health-of-refugees-and-migrants-in-the-who-european-region-no-public-health-without-refugee-and-migrant-health-2018 (accessed on 22 July 2020).
N (%) | |
---|---|
Country of Interview | |
Austria | 126 (8.96) |
Bulgaria | 226 (16.06) |
Cyprus | 110 (7.82) |
France | 64 (4.55) |
Germany | 11 (0.78) |
Greece | 255 (18.12) |
Italy | 271 (19.26) |
Malta | 38 (2.7) |
Spain | 202 (14.36) |
Sweden | 104 (7.39) |
Five Most Frequent Countries of Origin | |
Syria | 294 (21.15) |
Afghanistan | 211 (15.18) |
Iraq | 127 (9.14) |
Nigeria | 118 (8.49) |
Iran | 48 (3.45) |
Final Destination (Yes) | 979 (72.73) |
Asylum (Yes) | 358 (28.94) |
Other kind of permission (Yes) | 619 (46.37) |
Mean ± Standard Deviation | |
Age (years) | 31.98 ± 11.05 |
BMI (kg/m2) | 24.79 ± 4.42 |
Education (years) | 9.1 ± 5 |
Austria (N = 126) | Bulgaria (N = 226) | Cyprus (N = 110) | France (N = 64) | Germany (N = 11) | Greece (N = 255) | Italy (N = 271) | Malta (N = 38) | Spain (N = 202) | Sweden (N = 104) | |
---|---|---|---|---|---|---|---|---|---|---|
Country of Origin | ||||||||||
Syria | 31(24.60) | 74(32.74) | 26(23.64) | 2(3.13) | 9(81.82) | 105(41.18) | 2(0.74) | 2(5.26) | 2(0.99) | 41(39.42) |
Afghanistan | 10 (7.94) | 74(32.74) | 0(0) | 22(34.38) | 0(0) | 91(35.69) | 1(0.37) | 2(5.26) | 2(0.99) | 9(8.65) |
Iraq | 26(20.63) | 36(15.93) | 21(19.09) | 0(0) | 0(0) | 32(12.55) | 0(0) | 5(13.16) | 0(0) | 7(6.73) |
Nigeria | 9(7.14) | 1(0.44) | 4(3.64) | 0(0) | 0(0) | 0(0) | 97(35.79) | 3(7.89) | 1(0.5) | 3(2.88) |
Iran | 6(4.76) | 21(9.29) | 0(0) | 0(0) | 0(0) | 17(6.67) | 0(0) | 0(0) | 0(0) | 4(3.85) |
Other | 44 (34.92) | 20 (8.85) | 59(53.64) | 40 (62.50) | 2 (18.18) | 10(3.92) | 171(63.10) | 26(68.42) | 197(97.52) | 40(38.46) |
Males (%) | 63 (50) | 142 (62.83) | 65 (59.09) | 45 (70.31) | 3 (27.27) | 149 (58.43) | 236 (87.08) | 25 (65.79) | 114 (56.44) | 47 (45.19) |
Final Destination (%Yes) | 92 (74.19) | 138 (61.61) | 74 (68.52) | 44 (91.67) | 11 (100) | 84 (36.21) | 246 (93.18) | 16 (51.61) | 180 (89.11) | 94 (92.16) |
Asylum (%Yes) | 54 (43.20) | 30 (23.26) | 21 (20.39) | 27 (65.85) | 3 (27.27) | 85 (37.61) | 41 (15.47) | 8 (23.53) | 47 (23.62) | 42 (40.38) |
Other permission (%Yes) | 65 (52.85) | 1 (0.44) | 56 (54.90) | 19 (43.18) | 8 (80) | 101 (44.69) | 211 (79.32) | 30 (90.91) | 72 (35.82) | 56 (53.85) |
Age (years) | 31.63 ± 9.82 | 31.57 ± 12.01 | 34.20 ± 10.43 | 28.92 ± 7.72 | 44.64 ± 16.64 | 34.88 ± 10.20 | 25.27 ± 5.76 | 34.11 ± 11.08 | 35.38 ± 12.86 | 35.32 ± 11.43 |
BMI (kg/m2) | 24.42 ± 4.11 | 24.79 ± 4.62 | 26.29 ± 4.10 | 24.90 ± 5.83 | 26.53 ± 5.21 | 25.03 ± 5.20 | 23.79 ± 2.98 | 24.40 ± 3.77 | 24.90 ± 4.10 | 25.39 ± 5.30 |
N (%) | |
---|---|
Headaches/Migraines | 179 (12.72) |
Presence of mental health problem | 108 (7.68) |
Sleep disorders | 95 (6.75) |
Illness related to bone and muscle | 89 (6.33) |
Gastrointestinal disease | 82 (5.83) |
Respiratory disease | 72 (5.12) |
Diabetes | 59 (4.19) |
Hypertension | 59 (4.19) |
Chronic problems from Injury/accidents | 51 (3.63) |
Heart disease | 44 (3.13) |
Kidney disease | 35 (2.49) |
Tuberculosis | 9 (0.64) |
Cancer | 6 (0.43) |
AIDS/HIV | 5 (0.36) |
Brain stroke | 4 (0.29) |
General Health score (Mean ± Standard deviation) | 63.6 ± 23.4 |
N (%) | |
---|---|
Inability to access health care services during the last 6 months. | 603 (45.2) |
Need for a translator during their interactions with healthcare services: | |
Never | 348 (26.7) |
Few times | 237 (18.2) |
Most times | 253 (19.4) |
Always | 464 (35.6) |
Did you need to take medication and were not able to? | |
Not needed | 430 (38.5) |
Needed and had access | 541 (48.5) |
Needed and was not able to take it | 145 (13.0) |
Do you believe that you have worse access to health services compared to local people? (Yes) | 322 (26.7) |
Independent Variable | Estimate | p-Value | 95% Confidence Interval |
---|---|---|---|
Model 1 (N = 1129) | |||
Age (per year) | −0.06 | 0.312 | (−0.18, 0.06) |
Gender (males) | 4.36 | <0.001 | (1.77, 6.95) |
Presence of mental health problem | −15.45 | <0.001 | (−20.28, −10.63) |
Heart disease | −15.13 | <0.001 | (−22.89, −7.37) |
Illness related to bone and muscle | −11.24 | <0.001 | (−16.63, −5.86) |
Hypertension | −11.91 | <0.001 | (−18.89, −4.94) |
Gastrointestinal disease | −7.59 | <0.001 | (−12.78, −2.41) |
Respiratory disease | −8.35 | 0.003 | (−13.85, −2.84) |
Cancer | −24.57 | 0.006 | (−42.04, −7.11) |
Tuberculosis | −20.6 | 0.005 | (−34.8, −6.41) |
Kidney disease | −8.87 | 0.041 | (−17.39, −0.35) |
Model 2 (N = 1129) | |||
Age (per year) | −0.1 | 0.119 | (−0.22, 0.02) |
Gender (males) | 4.2 | 0.002 | (1.56, 6.83) |
Presence of mental health problem | −14.31 | <0.001 | (−19.39, -9.23) |
Sleep disorders | 0.54 | 0.841 | (−4.78, 5.87) |
Headaches/Migraines | −1.97 | 0.324 | (−5.88, 1.94) |
Having one disease or chronic condition (morbidity) | −2.74 | 0.085 | (−5.86, 0.38) |
Having at least two diseases or chronic conditions (comorbidity) | −16.65 | <0.001 | (−20.4, −12.9) |
Model 3 (N = 1054) | |||
Age (per year) | −0.16 | 0.014 | (−0.29, −0.03) |
Gender (males) | 5.92 | <0.001 | (3.16, 8.67) |
Germany or Austria as country of interview+ | 8.66 | 0.002 | (3.21, 14.11) |
Bulgaria as country of interview+ | −6.94 | 0.028 | (−13.13, −0.74) |
Spain as country of interview+ | 9.84 | <0.001 | (5.04, 14.65) |
Afghanistan as country of origin+ | −5.42 | 0.032 | (−10.37, −0.47) |
Iraq as country of origin+ | −7.76 | <0.001 | (−12.14, −3.39) |
Nigeria as country of origin+ | −2.38 | 0.393 | (−7.83, 3.08) |
Other country of origin+ | −5.4 | 0.095 | (−11.76, 0.95) |
Having permission with asylum | 0.05 | 0.975 | (−2.98, 3.08) |
Having other kind of permission | 3.23 | 0.034 | (0.24, 6.21) |
Having one disease or chronic condition (morbidity) | −4.94 | 0.003 | (−8.18, −1.71) |
Having at least two diseases or chronic conditions (comorbidity) | −18.15 | <0.001 | (−21.36, −14.93) |
© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Riza, E.; Karnaki, P.; Gil-Salmerón, A.; Zota, K.; Ho, M.; Petropoulou, M.; Katsas, K.; Garcés-Ferrer, J.; Linos, A. Determinants of Refugee and Migrant Health Status in 10 European Countries: The Mig-HealthCare Project. Int. J. Environ. Res. Public Health 2020, 17, 6353. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17176353
Riza E, Karnaki P, Gil-Salmerón A, Zota K, Ho M, Petropoulou M, Katsas K, Garcés-Ferrer J, Linos A. Determinants of Refugee and Migrant Health Status in 10 European Countries: The Mig-HealthCare Project. International Journal of Environmental Research and Public Health. 2020; 17(17):6353. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17176353
Chicago/Turabian StyleRiza, Elena, Pania Karnaki, Alejandro Gil-Salmerón, Konstantina Zota, Maxwell Ho, Maria Petropoulou, Konstantinos Katsas, Jorge Garcés-Ferrer, and Athena Linos. 2020. "Determinants of Refugee and Migrant Health Status in 10 European Countries: The Mig-HealthCare Project" International Journal of Environmental Research and Public Health 17, no. 17: 6353. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17176353