Cacciani Laura, Canova Cristina, Barbieri Giulia, Dalla Zuanna Teresa, Marino Claudia, Pacelli Barbara, Caranci Nicola, Strippoli Elena, Zengarini Nicolás, Di Napoli Anteo, Agabiti Nera, Davoli Marina
Dipartimento di Epidemiologia del Servizio Sanitario Regionale del Lazio, Asl Roma 1, Roma, Italy.
Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, Università di Padova, Padova, Italy.
BMC Public Health. 2020 Dec 4;20(1):1858. doi: 10.1186/s12889-020-09930-9.
Global migration toward Europe is increasing. Providing health assistance to migrants is challenging because numerous barriers limit their accessibility to health services. Migrants may be at a greater risk of developing asthma and receiving lower quality healthcare assistance than non-migrants. We aim to investigate whether immigrants as children and adolescents have higher rates of potentially avoidable hospitalization (PAH) for asthma compared to Italians.
We performed a retrospective longitudinal study using six cohorts of 2-17-year-old residents in North and Central Italy from 01/01/2001 to 31/12/2014 (N = 1,256,826). We linked asthma hospital discharges to individuals using anonymized keys. We estimated cohort-specific age and calendar-year-adjusted asthma PAH rate ratios (HRRs) and 95% confidence intervals (95%CIs) among immigrants compared to Italians. We applied a two-stage random effect model to estimate asthma PAH meta-analytic rate ratios (MHRRs). We analyzed data by gender and geographical area of origin countries.
Three thousand three hundred four and 471 discharges for asthma PAH occurred among Italians and immigrants, respectively. Compared to Italians, the asthma PAH cohort-specific rate was higher for immigrant males in Bologna (HRR:2.42; 95%CI:1.53-3.81) and Roma (1.22; 1.02-1.45), and for females in Torino (1.56; 1.10-2.20) and Roma (1.82; 1.50-2.20). Asthma PAH MHRRs were higher only among immigrant females (MHRRs:1.48; 95%CI:1.18-1.87). MHRRs by area of origin were 63 to 113% higher among immigrants, except for Central-Eastern Europeans (0.80; 0.65-0.98).
The asthma PAH meta-analytic rate was higher among female children and adolescent immigrants compared to Italians, with heterogeneity among cohorts showing higher cohort-specific PAH also among males, with some differences by origin country. Access to primary care for children and adolescent immigrants should be improved and immigrants should be considered at risk of severe asthma outcomes and consequently targeted by clinicians.
全球向欧洲的移民数量在增加。为移民提供医疗援助具有挑战性，因为众多障碍限制了他们获得医疗服务的机会。与非移民相比，移民患哮喘的风险可能更高，且获得的医疗保健援助质量更低。我们旨在调查儿童和青少年移民与意大利人相比，因哮喘导致的潜在可避免住院（PAH）发生率是否更高。
我们进行了一项回顾性纵向研究，使用了2001年1月1日至2014年12月31日期间意大利北部和中部6组2至17岁居民的数据（N = 1,256,826）。我们使用匿名密钥将哮喘住院记录与个体关联起来。我们估计了移民与意大利人相比，特定队列年龄和历年调整后的哮喘PAH发生率比值（HRRs）及95%置信区间（95%CIs）。我们应用两阶段随机效应模型来估计哮喘PAH的荟萃分析发生率比值（MHRRs）。我们按性别和原籍国地理区域分析了数据。
意大利人和移民中分别有3304例和471例因哮喘PAH住院。与意大利人相比，博洛尼亚的移民男性（HRR：2.42；95%CI：1.53 - 3.81）和罗马的移民男性（1.22；1.02 - 1.45），以及都灵的移民女性（1.56；1.10 - 2.20）和罗马的移民女性（1.82；1.50 - 2.20）的哮喘PAH特定队列发生率更高。哮喘PAH的MHRRs仅在移民女性中更高（MHRRs：1.48；95%CI：1.18 - 1.87）。除中东欧人外（0.80；0.65 - 0.98），按原籍地区分的MHRRs在移民中高出63%至113%。
与意大利人相比，儿童和青少年移民女性的哮喘PAH荟萃分析发生率更高，各队列之间存在异质性，男性中特定队列PAH也较高，且因原籍国存在一些差异。应改善儿童和青少年移民获得初级医疗保健的机会，临床医生应将移民视为有严重哮喘后果风险的人群并对其进行针对性治疗。
