College of Public Health, University of Iowa, Iowa City, IA, USA.
Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
J Immigr Minor Health. 2024 Feb;26(1):110-116. doi: 10.1007/s10903-023-01531-z. Epub 2023 Aug 17.
An unwelcoming policy climate can create barriers to health care access and produce a 'Chilling Effect' among immigrant communities. For undocumented immigrants, barriers may be unique and have a greater impact. We used administrative emergency department (ED) data from 2015 to 2019 for a Midwestern state provided under a data use agreement with the state hospital association. General linear modelling was used to estimate the impact of anti-immigrant rhetoric on ED visit intensity among non-elderly adults who were likely Hispanic/Latino with undocumented status. Compared to 2015, the average ED visit intensity among adults who were likely Hispanic/Latino with undocumented status was significantly higher during 2016-2019 when anti-immigrant rhetoric was heightened. The magnitude of this change increased over time (0.013, 0.014, 0.021, and 0.020, respectively). Additionally, this change over time was not observed in the comparison groups. Our findings suggest that anti-immigrant rhetoric may alter health care utilization for adults who are likely Hispanic/Latino with undocumented status. Limitations to our findings include the use of only those likely to be Hispanic/Latino, data from only one Midwestern state and the loss of data due to non-classification using the NYU ED algorithm. Further research should focus on validating these findings and investigating these identification methods and anti-immigrant rhetoric effects among other undocumented groups including children and adults of different race or ethnicity such as black, both those that identify as Hispanic/Latino and those that do not. Developing strategies to improve health care access for undocumented Hispanic/Latino adults also warrants future research.
不友好的政策环境会给医疗保健的可及性造成障碍，并对移民群体产生“寒蝉效应”。对于无证移民来说，障碍可能是独特的，且影响更大。我们使用了 2015 年至 2019 年期间中西部一个州的行政急诊部（ED）数据，这些数据是根据与州医院协会的数据使用协议提供的。采用广义线性模型来估计反移民言论对可能为西班牙裔/拉丁裔且无证身份的非老年成年人急诊就诊强度的影响。与 2015 年相比，在反移民言论高涨的 2016 年至 2019 年期间，可能为西班牙裔/拉丁裔且无证身份的成年人的急诊就诊强度显著更高。这种变化的幅度随着时间的推移而增加（分别为 0.013、0.014、0.021 和 0.020）。此外，在对照组中没有观察到这种随时间的变化。我们的研究结果表明，反移民言论可能会改变可能为西班牙裔/拉丁裔且无证身份的成年人的医疗保健利用情况。我们研究结果的局限性包括仅使用那些可能为西班牙裔/拉丁裔的人、仅来自中西部一个州的数据以及由于 NYU ED 算法的非分类而导致的数据丢失。进一步的研究应该集中在验证这些发现以及调查这些识别方法和反移民言论对包括儿童和不同种族或族裔（如黑人和那些自认为是西班牙裔/拉丁裔的人和那些不这样认为的人）的其他无证群体的影响。制定策略来改善无证西班牙裔/拉丁裔成年人的医疗保健可及性也值得未来研究。
