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. 2022 Sep:20:100455.
doi: 10.1016/j.lanepe.2022.100455. Epub 2022 Jun 30.

Migrants' primary care utilisation before and during the COVID-19 pandemic in England: An interrupted time series analysis

Claire X Zhang  1   2   3 , Yamina Boukari  1   2 , Neha Pathak  1   4 , Rohini Mathur  5 , Srinivasa Vittal Katikireddi  6 , Parth Patel  1 , Ines Campos-Matos  2   7 , Dan Lewer  8 , Vincent Nguyen  1   8 , Greg C G Hugenholtz  1 , Rachel Burns  1 , Amy Mulick  5 , Alasdair Henderson  5 , Robert W Aldridge  1
Affiliations

Migrants' primary care utilisation before and during the COVID-19 pandemic in England: An interrupted time series analysis

Claire X Zhang et al. Lancet Reg Health Eur. 2022 Sep.

Abstract

Background: How international migrants access and use primary care in England is poorly understood. We aimed to compare primary care consultation rates between international migrants and non-migrants in England before and during the COVID-19 pandemic (2015-2020).

Methods: Using data from the Clinical Practice Research Datalink (CPRD) GOLD, we identified migrants using country-of-birth, visa-status or other codes indicating international migration. We linked CPRD to Office for National Statistics deprivation data and ran a controlled interrupted time series (ITS) using negative binomial regression to compare rates before and during the pandemic.

Findings: In 262,644 individuals, pre-pandemic consultation rates per person-year were 4.35 (4.34-4.36) for migrants and 4.60 (4.59-4.60) for non-migrants (RR:0.94 [0.92-0.96]). Between 29 March and 26 December 2020, rates reduced to 3.54 (3.52-3.57) for migrants and 4.2 (4.17-4.23) for non-migrants (RR:0.84 [0.8-0.88]). The first year of the pandemic was associated with a widening of the gap in consultation rates between migrants and non-migrants to 0.89 (95% CI 0.84-0.94) times the ratio before the pandemic. This widening in ratios was greater for children, individuals whose first language was not English, and individuals of White British, White non-British and Black/African/Caribbean/Black British ethnicities. It was also greater in the case of telephone consultations, particularly in London.

Interpretation: Migrants were less likely to use primary care than non-migrants before the pandemic and the first year of the pandemic exacerbated this difference. As GP practices retain remote and hybrid models of service delivery, they must improve services and ensure primary care is accessible and responsive to migrants' healthcare needs.

Funding: This study was funded by the Medical Research Council (MC_PC 19070 and MR/V028375/1) and a Wellcome Clinical Research Career Development Fellowship (206602).

Keywords: COVID-19; Consultation; General practice; Healthcare access; Healthcare utilisation; Migrant; Primary care.

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Conflict of interest statement

CXZ, YB, and IC-M are employed by the Office for Health Disparities and Improvement in the Department of Health and Social Care and contribute to the development of national guidance and policy in migrant health. CXZ is a Trustee for the international charity Art Refuge. YB's spouse is employed by Elsevier as a Software Engineer. NP received funding from a Clinical Research Training Fellowship from the Wellcome Trust [211162]. RM has received consulting fees from Amgen. SVK acknowledges funding from a NRS Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_00022/2), and the Scottish Government Chief Scientist Office (SPHSU17). This work was supported by a Wellcome Clinical Research Career Development Fellowship (206602) to RWA and the research costs for the study have been supported by the MRC Grant Ref: MC_PC 19070 awarded to UCL on 30 March 2020 and MRC Grant Ref: MR/V028375/1 awarded on 17 August 2020. RWA received consultancy fees from Doctors of the World, outside the submitted work to complete the 2021 Médecins du Monde Observatory Report. The views expressed are those of the authors and not necessarily those of the Wellcome Trust, UCL, London School of Hygiene and Tropical Medicine, Department of Health and Social Care, Guy's & St Thomas’ NHS Foundation Trust, University of Oxford, University of Glasgow, or the UK Health Security Agency.

Figures

Figure 1
Figure 1
Data flow diagram with patient and consultation exclusions.
Figure 2
Figure 2
Forest plots of migrant versus non–migrant consultation rate ratios before the pandemic (2015–2019), including by age group (A) and ethnicity (B). *All represents migrants of all ethnic groups compared to White British non-migrants.
Figure 3
Figure 3
Weekly consultation rates by migration status in England: predicted rates from interrupted time-series analysis (solid line) and actual observed rates (dashed line), truncated view July 2019–November 2020.
Figure 4
Figure 4
Weekly consultation rates by migration status and age group in England: predicted rates from interrupted time-series analysis (solid line) and actual observed rates (dashed line), truncated view July 2019–November 2020.
Figure 5
Figure 5
Weekly consultation rates by migration status and ethnicity in England: predicted rates from interrupted time-series analysis (solid line) and actual observed rates (dashed line), truncated view July 2019–November 2020.
See this image and copyright information in PMC

References

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