The Role of Maternal Citizenship on Pediatric Avoidable Hospitalization: A Birth Cohort Study in North-East Italy
- 68 Downloads
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.
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.
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.
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.
KeywordsAvoidable hospitalization Migration Children Maternal citizenship Socio demographic factors Italy
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
Source of Funding
- 1.ISTAT - Indicatori demografici sintetici [Internet]. Available at http://dati.istat.it. Accessed 19 Nov 2019.
- 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
- 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.Google Scholar
- 17.AHRQ - Quality Indicators [Internet]. Available at: http://www.qualityindicators.ahrq.gov/modules/pdi_overview.aspx. Accessed 19 Nov 2019.
- 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.Google Scholar
- 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.Google Scholar
- 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.Google Scholar
- 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.Google Scholar
- 29.Bhopal RS. Migration, Ethnicity, Race, and Health in Multicultural societies. 2nd ed. Oxford, USA: Oxford University Press; 2014.Google Scholar
- 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.
- 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.Google Scholar
- 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.