加拿大移民的医疗保健利用情况：加拿大社区健康调查的横断面分析。
Utilization of healthcare by immigrants in Canada: a cross-sectional analysis of the Canadian Community Health Survey.
机构信息
Department of Family Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, 1151 Richmond Street, London, ON, N6A 5C1, Canada.
Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada.
出版信息
BMC Prim Care. 2022 Apr 6;23(1):69. doi: 10.1186/s12875-022-01682-2.
BACKGROUND
Immigrants to Canada face unique barriers to health care, which leads to inequities in health care utilization. Lower utilization of health care by immigrants to Canada is associated with the deteriorating health of individual immigrants as well as increased costs to the health care system. The existing literature suggests that time since immigration is an important predictor for utilization of health care for Canadian immigrants; however, few studies have included this variable in their analysis. This study aims to examine the relationships between having a regular health care provider and time since immigration, and number of medical consultations in the past year and time since immigration.
METHODS
A secondary cross-sectional data analysis using Andersen and Newman's Framework of Health Service Utilization and data from the 2015-2016 Canadian Community Health Survey (CCHS) was conducted to examine health care utilization among immigrants in Canada. We used multiple logistic regression to examine the relationship between time since immigration and having a regular physician and negative binomial regression to compare the number of consultations of recent (less than 10 years since immigration) and established (10 or more years since immigration) immigrants.
RESULTS
Eighty four percent of immigrant respondents to CCHS 2015-2016 had a regular health care provider. After controlling for other independent variables, established immigrants were 1.75 (95% confidence interval: 1.45-2.10) times more likely to have a regular health care provider compared to recent immigrants. Immigrants had a mean of 3.37 (standard deviation 4.53) medical consultations in the preceding year. There was no difference in the mean number of medical consultations by recent and established immigrants.
CONCLUSIONS
After controlling for other independent variables, this study found that time since immigration had a significant effect on having a regular provider but not on number of consultations. Differences in health care utilization for recent and for established immigrants observed in this study may be partially explained by Canada's evolving immigration policy and the economic and social integration of immigrants over time.
背景
移民到加拿大的人面临着独特的医疗保健障碍，这导致了医疗保健利用方面的不平等。加拿大移民利用医疗保健的比例较低，这不仅导致个别移民的健康状况恶化，还增加了医疗保健系统的成本。现有文献表明，移民时间是加拿大移民利用医疗保健的一个重要预测因素；然而，很少有研究在分析中包含这个变量。本研究旨在研究有固定医疗服务提供者与移民时间、过去一年的医疗咨询次数与移民时间之间的关系。
方法
使用安德森和纽曼的卫生服务利用框架和 2015-2016 年加拿大社区健康调查（CCHS）的数据进行二次横断面数据分析，以研究加拿大移民的医疗保健利用情况。我们使用多因素逻辑回归分析来研究移民时间与有固定医生之间的关系，使用负二项回归来比较近期（移民时间不到 10 年）和长期（移民时间超过 10 年）移民的咨询次数。
结果
在 2015-2016 年 CCHS 的移民受访者中，84%的人有固定的医疗服务提供者。在控制了其他自变量后，与近期移民相比，长期移民有固定医疗服务提供者的可能性高 1.75 倍（95%置信区间：1.45-2.10）。移民在过去一年中有 3.37 次（标准差为 4.53）的医疗咨询。近期和长期移民的平均医疗咨询次数没有差异。
结论
在控制了其他自变量后，本研究发现移民时间对有固定提供者有显著影响，但对咨询次数没有影响。本研究中观察到的近期和长期移民在医疗保健利用方面的差异，部分可以用加拿大不断变化的移民政策和移民随时间推移的经济和社会融合来解释。
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