Agència de Qualitat i Avaluació Sanitàries de Catalunya, Barcelona, Spain.
Agència de Qualitat i Avaluació Sanitàries de Catalunya, Barcelona, Spain; CIBER de Epidemiología y Salud Pública, Barcelona, Spain; Institut d'Investigació Biomèdica, Barcelona, Spain.
Lancet Planet Health. 2021 May;5(5):e286-e296. doi: 10.1016/S2542-5196(21)00036-X.
In Spain, legislation was passed in 2012 excluding undocumented migrants from the public health-care system. Catalonia was one of the Spanish regions that did not implement this legislation, and continued to guarantee access to health care to the whole population. We aimed to analyse health-care use and health status among undocumented migrants in Catalonia, and compare health-care use and health status with legal residents classified according to their socioeconomic position (SEP).
We did a population-based, cross-sectional study, with administrative individual data. The study included the resident population in Catalonia, Spain, in 2017, aged younger than 65 years and with a maximum annual income of less than €18 000 per year, and classified into three socioeconomic (SEP) groups-low SEP, very low SEP, and undocumented migrants. Indicators regarding health-care service use (primary care, emergency care, mental health care, acute care), drug prescriptions, and selected chronic and infectious diseases were analysed.
Between Jan 1 and Dec 31, 2017, 4 071 988 residents of Catalonia were included in this study; undocumented migrants represented 2·8% (n=113 450) of this population. Of all undocumented migrants, 25 942 (61·0%) female participants aged 15-64 years and 19 819 (46·0%) male participants aged 15-64 years attended primary health-care centres: these rates were lower than in individuals with a very low SEP (84·8% in female participants and 72·1% in male participants). Hospital admission rates among male participants aged 15-64 years in the very low SEP group were more than three times as high as in undocumented migrants (111·6 vs 35·7). The highest tuberculosis rate was found in undocumented male migrants (incidence rate 4·35 [95% CI 3·55-5·16]).
Undocumented migrants made less use of health-care services than those in the low and very low SEP groups, but for some infectious diseases, incidence was higher in undocumented migrants. These results constitute an additional argument to support the maintenance of universal health coverage for all citizens.
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2012 年，西班牙通过立法将无证移民排除在公共医疗保健系统之外。加泰罗尼亚是西班牙没有实施该立法的地区之一，它继续保障全民获得医疗保健。我们旨在分析加泰罗尼亚无证移民的医疗保健使用情况和健康状况，并将医疗保健使用情况和健康状况与根据社会经济地位（SEP）分类的合法居民进行比较。
我们进行了一项基于人群的横断面研究，使用了个体行政数据。该研究包括西班牙加泰罗尼亚 2017 年年龄在 65 岁以下且年收入最高不超过 18000 欧元的居民，并分为三个社会经济（SEP）组：低 SEP、极低 SEP 和无证移民。分析了医疗保健服务使用（初级保健、急诊、精神保健、急性护理）、药物处方和选定的慢性和传染病的指标。
2017 年 1 月 1 日至 12 月 31 日，加泰罗尼亚有 4071988 名居民纳入了本研究；无证移民占该人群的 2.8%（n=113450）。所有无证移民中，25942 名（61.0%）15-64 岁女性和 19819 名（46.0%）15-64 岁男性参加了初级保健中心：这些比例低于社会经济地位极低的个体（女性参与者 84.8%，男性参与者 72.1%）。15-64 岁男性极低 SEP 组的住院率是无证移民的三倍多（111.6 比 35.7）。最高的结核病发病率是无证男性移民（发病率 4.35[95%CI 3.55-5.16]）。
无证移民比低和极低 SEP 组的人使用医疗保健服务的频率更低，但对于一些传染病，无证移民的发病率更高。这些结果为支持为所有公民提供全民健康覆盖提供了额外的论据。
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