Brzoska Patrick
Chemnitz Technical University, Faculty of Behavioral and Social Sciences, Chemnitz, Germany.
PLoS One. 2018 Jan 23;13(1):e0191732. doi: 10.1371/journal.pone.0191732. eCollection 2018.
Immigrants often encounter barriers in the health system that may affect their health care outcomes. In order to better cater to the needs of immigrants, many health care institutions have increased their efforts in recent years to provide services which are more sensitive to the needs of an increasingly diverse population. Little is known about whether these efforts are successful. This study examines difference in outcomes of tertiary prevention between immigrants and the autochthonous population in Germany over the period of 2006-2014.
The analysis is based on a 10% random sample of routine data on completed tertiary preventive treatments in Germany during 2006-2014. Four different indicators of treatment effectiveness were compared between patients with a nationality from Germany, Portugal/Spain/Italy/Greece, Turkey and Former Yugoslavia using logistic regression adjusted for demographic/socioeconomic factors. Interaction terms for year were modeled to examine group differences over time.
Depending on the outcome, Turkish and Former Yugoslavian nationals had an 23%-69% higher chance of a poor treatment effectiveness than Germans (OR = 1.23 [95%-CI = 1.15,1.32] and OR = 1.69 [95%-CI = 1.55,1.83], respectively). Fewer differences were observed between nationals from Portugal/Spain/Italy/Greece and Germans. Disparities did not significantly differ between the years in which services were utilized.
Measures implemented by health care institutions did not reduce existing health care disparities between immigrants and the majority population in Germany. One potential reason is that existing approaches are unsystematic and often not properly evaluated. More targeted strategies and a thorough evaluation is needed in order to improve health care for immigrants sustainably.
移民在医疗系统中经常遇到障碍，这可能会影响他们的医疗保健结果。为了更好地满足移民的需求，近年来许多医疗机构加大了力度，提供对日益多样化人口的需求更敏感的服务。对于这些努力是否成功，人们知之甚少。本研究考察了2006年至2014年期间德国移民与本地人口在三级预防结果方面的差异。
分析基于2006年至2014年期间德国完成的三级预防性治疗常规数据的10%随机样本。使用针对人口统计学/社会经济因素进行调整的逻辑回归分析比较了德国、葡萄牙/西班牙/意大利/希腊、土耳其和前南斯拉夫国籍患者之间四种不同的治疗效果指标。对年份的交互项进行建模，以检验随时间的组间差异。
根据结果，土耳其和前南斯拉夫国民治疗效果不佳的几率比德国人高23% - 69%（分别为OR = 1.23 [95% - CI = 1.15, 1.32]和OR = 1.69 [95% - CI = 1.55, 1.83]）。葡萄牙/西班牙/意大利/希腊国民与德国人之间观察到的差异较少。在使用服务的年份之间，差异没有显著不同。
医疗机构实施的措施并未减少德国移民与多数人口之间现有的医疗保健差距。一个潜在原因是现有方法不系统且往往没有得到适当评估。为了可持续地改善移民的医疗保健，需要更有针对性的策略和全面的评估。
