Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
BMC Prim Care. 2022 Apr 20;23(1):89. doi: 10.1186/s12875-022-01691-1.
The impact of unemployment on health is well studied. However, information on associations of unemployment, migration background and general practitioner-patient communication is scarce.
Data from the representative German Health Interview and Examination Survey for Adults (DEGS1) of individuals in working age (n = 5938) were analysed stratified by unemployment and migration background. Using official weighting factors, the prevalence of chronic stress, having ≥1 chronic disease, having a GP and GP visits in the last 12 months was determined. Multivariate regression models were analysed for associations between unemployment, migration background, and other socio-demographic characteristics with GP visits and chronic stress. Data from the General Practice Care-1 (GPCare-1) study (n = 813 patients) were analysed for differences in patient-physician communication between unemployed with and without migration background. Reverse proportional odds models were estimated for associations of unemployment and migration background with physician-patient communication.
In the DEGS1, 21.5% had experienced unemployment (n = 1170). Of these, 31.6% had a migration background (n = 248). Compared to unemployed natives, unemployed with migration background had higher chronic stress (mean: 14.32 vs. 13.13, p = 0.02), while the prevalence of chronic disease was lower (21.7% vs. 30.2%, p = 0.03). They were less likely to have a GP (83.6% vs. 90%, p = 0.02), while GP visits were similar (mean: 3.7 vs. 3.3, p = 0.26). Migration background and unemployment experience were not associated with GP visits, while both factors were significantly associated with higher chronic stress (both: p < 0.01). In GPCare-1, 28.8% had ever experienced unemployment (n = 215). Of these, 60 had a migration background (28.6%). The unemployed with migration background reported less frequently that the GP gives them enough space to describe personal strains (46.5% vs. 58.2%; p = 0.03), and that their problems are taken very seriously by their GP (50.8% vs. 73.8%; p = 0.04). In multivariate analyses, migration background showed a lower probability of having enough space to describe personal strains and feeling that problems were taken very seriously.
Unemployment experience and migration background were associated with higher chronic stress. Only migration background was associated with less satisfaction regarding physician-patient communication.
失业对健康的影响已经得到了充分的研究。然而，关于失业、移民背景和全科医生-患者沟通之间的关联的信息却很少。
对处于工作年龄的个体（n=5938）的具有代表性的德国健康访谈和成人检查调查（DEGS1）数据进行了分析，按失业和移民背景进行了分层。使用官方加权因素，确定了慢性压力、≥1种慢性疾病、有全科医生和在过去 12 个月内有全科医生就诊的患病率。使用多变量回归模型分析了失业、移民背景和其他社会人口统计学特征与全科医生就诊和慢性压力之间的关系。对来自一般实践护理-1（GPCare-1）研究（n=813 名患者）的数据进行了分析，以了解有无移民背景的失业患者与医生-患者沟通之间的差异。对失业和移民背景与医患沟通之间的关系进行了反向比例优势模型估计。
在 DEGS1 中，21.5%（n=1170）的人经历过失业。其中，31.6%（n=248）有移民背景。与没有移民背景的失业者相比，有移民背景的失业者的慢性压力更高（平均值：14.32 对 13.13，p=0.02），而慢性疾病的患病率较低（21.7%对 30.2%，p=0.03）。他们更不可能有全科医生（83.6%对 90%，p=0.02），而全科医生就诊次数相似（平均值：3.7 对 3.3，p=0.26）。移民背景和失业经历与全科医生就诊次数无关，而这两个因素与更高的慢性压力显著相关（两者均：p<0.01）。在 GPCare-1 中，28.8%（n=215）的人曾经历过失业。其中，60 人有移民背景（28.6%）。有移民背景的失业者报告说，全科医生给他们足够的空间来描述个人压力的频率较低（46.5%对 58.2%；p=0.03），以及他们的问题被全科医生非常认真对待的频率较低（50.8%对 73.8%；p=0.04）。在多变量分析中，移民背景与有足够的空间来描述个人压力和感到问题被非常认真对待的可能性较低相关。
失业经历和移民背景与更高的慢性压力有关。只有移民背景与对医患沟通的满意度较低有关。
