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The Role of Maternal Citizenship on Pediatric Avoidable Hospitalization: A Birth Cohort Study in North-East Italy

  • Andrea Bardin
  • Teresa Dalla Zuanna
  • Susanna Favarato
  • Lorenzo Simonato
  • Loris Zanier
  • Rosanna Irene Comoretto
  • Cristina Canova
Review Article
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Abstract

Objective

Avoidable hospitalization (AH) has been widely studied as a possible measure of primary health care performance. Since studies evaluating AH in migrant children, particularly in Europe, are lacking, the aim of this study was to investigate the role of maternal citizenship on the risk of AH in children.

Methods

The cohort study included all live newborns recorded in the Medical Birth Register (MBR) of Friuli-Venezia Giulia Region (Italy) in the years 1989–2012, followed from 30 d after their birth up to the 14th year of life. Cox regression models were used to estimate Hazard Ratios (HRs) for any AH and for specific conditions.

Results

Among the 213,635 children included in the cohort, authors identified 23,011 AHs in 16,744 children, most of which occurred between 1 and 4 y of age. Children born to mothers from High Migration Pressure Countries had a higher risk of AH for any condition (HR 1.35; 95% CI = 1.27–1.44) than children born to Italian mothers. The risks were higher concerning gastroenteritis (HR 1.74; 1.57–1.94), upper respiratory tract infections (HR 1.58; 1.35–1.84), asthma (HR 1.53; 1.12–2.06) and bacterial pneumonia (HR 1.18; 1.01–1.37). There were no differences in urinary tract infections, short term complications of diabetes and perforated appendix.

Conclusions

Despite the inclusiveness and universality of the Italian healthcare system, children born to immigrant mothers experienced more need of avoidable hospital care than children born to Italian mothers. Access barriers to primary care are plausible causes for the observed disparities.

Keywords

Avoidable hospitalization Migration Children Maternal citizenship Socio demographic factors Italy 

Notes

Author’s Contributions

AB and CC designed the study and wrote the manuscript; LS and LZ participated in coordination of the study; CC performed the statistical analysis; TDZ, SF, LZ and RIC critically revised the manuscript and contributed to the discussion. All authors contributed to results interpretation, read and approved the final manuscript. Prof. Cristina Canova will act as guarantor for this paper.

Compliance with Ethical Standards

Conflict of Interest

None.

Source of Funding

None.

References

  1. 1.
    ISTAT - Indicatori demografici sintetici [Internet]. Available at http://dati.istat.it. Accessed 19 Nov 2019.
  2. 2.
    Scheppers E, van Dongen E, Dekker J, Geertzen J, Dekker J. Potential barriers to the use of health services among ethnic minorities: a review. Fam Pract. 2006;23:325–48.CrossRefGoogle Scholar
  3. 3.
    Asanin J, Wilson K. “I spent nine years looking for a doctor”: exploring access to health care among immigrants in Mississauga, Ontario, Canada. Soc Sci Med. 2008;66:1271–83.CrossRefGoogle Scholar
  4. 4.
    Pérez-Escamilla R, Garcia J, Song D. Health care access among Hispanic immigrants: ¿Alguien Está Escuchando? [Is anybody listening?]. NAPA Bull. 2010;34:47–67.CrossRefGoogle Scholar
  5. 5.
    Rechel B, Mladovsky P, Devillé W. Monitoring migrant health in Europe: a narrative review of data collection practices. Health Policy. 2012;105:10–6.CrossRefGoogle Scholar
  6. 6.
    Norredam M, Nielsen SS, Krasnik A. Migrants’ utilization of somatic healthcare services in Europe--a systematic review. Eur J Pub Health. 2010;20:555–63.CrossRefGoogle Scholar
  7. 7.
    Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83:457–502.CrossRefGoogle Scholar
  8. 8.
    van Loenen T, van den Berg MJ, Westert GP, Faber MJ. Organizational aspects of primary care related to avoidable hospitalization: a systematic review. Fam Pract. 2014;31:502–16.CrossRefGoogle Scholar
  9. 9.
    Thygesen LC, Christiansen T, Garcia-Armesto S, Angulo-Pueyo E, Martínez-Lizaga N, Bernal-Delgado E. Potentially avoidable hospitalizations in five European countries in 2009 and time trends from 2002 to 2009 based on administrative data. Eur J Pub Health. 2015;25:35–43.CrossRefGoogle Scholar
  10. 10.
    Billings J, Zeitel L, Lukomnik J, Carey TS, Blank AE, Newman L. Impact of socioeconomic status on hospital use in New York City. Health Aff (Millwood) Spring. 1993;12:162–73.Google Scholar
  11. 11.
    Agabiti N, Pirani M, Schifano P, et al. Income level and chronic ambulatory care sensitive conditions in adults: a multicity population-based study in Italy. BMC Public Health. 2009;9:457.CrossRefGoogle Scholar
  12. 12.
    Shi L, Samuels ME, Pease M, Bailey WP, Corley EH. Patient characteristics associated with hospitalizations for ambulatory care sensitive conditions in South Carolina. South Med J. 1999;92:989–98.CrossRefGoogle Scholar
  13. 13.
    Culler SD, Parchman ML, Przybylski M. Factors related to potentially preventable hospitalizations among the elderly. Med Care. 1998;36:804–17.CrossRefGoogle Scholar
  14. 14.
    Chang CF, Pope RA. Potentially avoidable hospitalizations in Tennessee: analysis of prevalence disparities associated with gender, race, and insurance. Public Health Rep. 2009;124:127–37.CrossRefGoogle Scholar
  15. 15.
    Friedman B, Basu J. Health insurance, primary care, and preventable hospitalization of children in a large state. Am J Manag Care. 2001;7:473–81.PubMedGoogle Scholar
  16. 16.
    Dalla Zuanna T, Spadea T, Milana M, et al. Avoidable hospitalization among migrants and ethnic minority groups: a systematic review. Eur J Pub Health. 2017;27:861–8.CrossRefGoogle Scholar
  17. 17.
    AHRQ - Quality Indicators [Internet]. Available at: http://www.qualityindicators.ahrq.gov/modules/pdi_overview.aspx. Accessed 19 Nov 2019.
  18. 18.
    Pirani M, Schifano P, Agabiti N, Davoli M, Caranci N, Perucci CA. Potentially avoidable hospitalisation in Bologna, 1997–2000: temporal trend and differences by income level. Epidemiol Prev. 2006;30:169–77.PubMedGoogle Scholar
  19. 19.
    Oakes JM, Rossi PH. The measurement of SES in health research: current practice and steps toward a new approach. Soc Sci Med. 2003;56:769–84.CrossRefGoogle Scholar
  20. 20.
    Malmusi D, Borrell C, Benach J. Migration-related health inequalities: showing the complex interactions between gender, social class and place of origin. Soc Sci Med. 2010;71:1610–9.CrossRefGoogle Scholar
  21. 21.
    Craig E, Anderson P, Jackson G, Jackson C. Measuring potentially avoidable and ambulatory care sensitive hospitalisations in New Zealand children using a newly developed tool. N Z Med J. 2012;125:38–50.PubMedGoogle Scholar
  22. 22.
    Gaskin DJ, Hoffman C. Racial and ethnic differences in preventable hospitalizations across 10 states. Med Care Res Rev MCRR. 2000;57:85–107.CrossRefGoogle Scholar
  23. 23.
    Hale N, Probst J, Robertson A. Rural area deprivation and hospitalizations among children for ambulatory care sensitive conditions. J Comm Health. 2016;41:451–60.CrossRefGoogle Scholar
  24. 24.
    Lessard LN, Alcala E, Capitman JA. Pollution, poverty, and potentially preventable childhood morbidity in Central California. J Pediatr. 2016;168:198–204.CrossRefGoogle Scholar
  25. 25.
    Matheson D, Reidy J, Tan L, Carr J. Good progress for children coupled with recalcitrant inequalities for adults in New Zealand’s journey towards universal health coverage over the last decade. N Z Med J. 2015;128:14–24.PubMedGoogle Scholar
  26. 26.
    Shi L, Lu N. Individual sociodemographic characteristics associated with hospitalization for pediatric ambulatory care sensitive conditions. J Health Care Poor Underserved. 2000;11:373–84.CrossRefGoogle Scholar
  27. 27.
    Tan L, Carr J, Reidy J. New Zealand evidence for the impact of primary healthcare investment in Capital and Coast District Health Board. N Z Med J. 2012;125:7–27.PubMedGoogle Scholar
  28. 28.
    Hakim RB, Bye BV. Effectiveness of compliance with pediatric preventive care guidelines among Medicaid beneficiaries. Pediatrics. 2001;108:90–7.CrossRefGoogle Scholar
  29. 29.
    Bhopal RS. Migration, Ethnicity, Race, and Health in Multicultural societies. 2nd ed. Oxford, USA: Oxford University Press; 2014.Google Scholar
  30. 30.
    Russo CA, Andrews RM, Coffey RM. Racial and ethnic disparities in potentially preventable hospitalizations, 2003: statistical brief #10. Healthc Cost Util Proj HCUP Stat Briefs [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2006. Available at: http://www.ncbi.nlm.nih.gov/books/NBK63497/. Accessed 19 Nov 2019.
  31. 31.
    Netuveli G, Hurwitz B, Levy M, et al. Ethnic variations in UK asthma frequency, morbidity, and health-service use: a systematic review and meta-analysis. Lancet. 2005;365:312–7.CrossRefGoogle Scholar
  32. 32.
    Hjern A, Haglund B, Bremberg S, Ringbäck-Weitoft G. Social adversity, migration and hospital admissions for childhood asthma in Sweden. Acta Paediatr. 1999;88:1107–12.CrossRefGoogle Scholar
  33. 33.
    Li X, Sundquist J, Calling S, Zöller B, Sundquist K. Mothers, places and risk of hospitalization for childhood asthma: a nationwide study from Sweden. Clin Exp Allergy. 2013;43:652–8.PubMedGoogle Scholar
  34. 34.
    Ikram UZ, Mackenbach JP, Harding S, et al. All-cause and cause-specific mortality of different migrant populations in Europe. Eur J Epidemiol. 2016;31:655–65.CrossRefGoogle Scholar
  35. 35.
    MINISTERO DELL’INTERNO, Diritti, doveri, identità, partecipazione. Come diventare cittadini italiani [Internet]. Minist. Dell‘Interno. Available at: http://www.interno.gov.it/it/temi/cittadinanza-e-altri-diritti-civili/cittadinanza. Accessed 19 Nov 2019.
  36. 36.
    Giannoni M, Franzini L, Masiero G. Migrant integration policies and health inequalities in Europe. BMC Public Health. 2016;16:463.CrossRefGoogle Scholar
  37. 37.
    Malmusi D. Immigrants’ health and health inequality by type of integration policies in European countries. Eur J Pub Health. 2015;25:293–9.CrossRefGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2019

Authors and Affiliations

  • Andrea Bardin
    • 1
  • Teresa Dalla Zuanna
    • 1
  • Susanna Favarato
    • 1
  • Lorenzo Simonato
    • 1
  • Loris Zanier
    • 2
  • Rosanna Irene Comoretto
    • 1
  • Cristina Canova
    • 1
  1. 1.Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public HealthUniversity of PaduaPaduaItaly
  2. 2.Epidemiological Service, Health Directorate, Friuli Venezia-Giulia RegionUdineItaly

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