Ethnicity as a risk factor for consultations in primary health care and out-patient care

Abstract

Objective: To determine the influence of ethnicity, defined as foreign-born people, on consultation rates, admissions and prescriptions in out-patient care and primary health care.

Design: Prospective study of attenders at four different caregivers during seven consecutive weeks in 1988. Age-and sex-standardized relative risks and odds ratios with 95% confidence interval were calculated.

Setting: A suburban area in Lund, a city located in the south of Sweden, with 28% foreign-born people.

Subjects: This population (N = 5085) made 1,348 consultations.

Main outcome measures: Ethnic group and consultation rates of the local primary health care centre, the emergency department, hospital out-patient department, and private care, admissions to specialist care, prescriptions, and certified sick leave.

Results: Swedes made fewer age-and sex-standardized visits to the emergency department (RR = 0.69(0.48-0.99)) while the foreign-born people showed an opposite non-significant trend (RR = 1.37(0.95-1.99)). Latin Americans (RR = 1.60(1.02-2.51)) visited the local Primary Health Care centre in the residential area more than expected, while people born in Asia and Africa consulted the Primary Health Care centre less than expected (RR = 0.44(0.28-0.69)). There were no differences between Swedes and foreign-born people in being put on the sick-list, but foreign-born people were given significantly fewer prescriptions (RR = 0.07(0.03-0.19)) than Swedes. Foreign-born people, Latin Americans, and non-Swedish Scandinavians were referred significantly more often to hospital than other groups.

Conclusions: There were important differences in consultations between Swedes and foreign-born people. It seems important to study these differences further to find out if they were due to morbidity or cultural differences in order to be able to meet the demands and needs of different ethnic groups.

PIP: For 7 weeks in 1988 in a suburban area of Lund, Sweden, with foreign-born persons comprising 28% of its population, a physician recorded all visits by foreign-born persons and Swedes to the local primary health care center, the City Clinic (a private clinic for emergencies), another private clinic (home visits), and the emergency department and all out-patient clinics of the local hospital. The study examined the effect of ethnicity on consultation rates, admissions, and prescriptions in out-patient and primary health care clinics. Most visits were to the local primary health care center and to the hospital out-patient departments. Scandinavians were used as the standard when the researcher standardized for age and sex. Swedes were much less likely to visit the emergency department (relative risk [RR] = 0.69, 95% CI = 0.48-0.99). Foreign-born persons were more likely to visit the emergency department, but not significantly so (RR = 1.37, 95% CI = 0.95-1.99). Latin Americans had significantly more consultations at the local primary health care center than Scandinavians (RR = 1.6; 95% CI = 1.02-2.51). Persons born in Asia and Africa made significantly fewer visits to the center (RR = 0.44; 95% CI = 0.28-0.69). The numbers of Swedes and foreign-born persons granted sick leave were not different. Foreign-born patients received significantly fewer prescriptions than Swedes (0.84 vs. 0.99 prescriptions/ visit; odds ratio [OR] = 0.07). Foreign-born persons were admitted to the hospital significantly more often than Swedes (0.28 vs. 0.17 admissions/visit; OR = 1.87). Hospital admissions were significantly greater among non-Swedish Scandinavians (OR = 2.9) and Latin Americans (OR = 3.1). These findings reflect differences in health care visits between Swedes and foreign-born persons living in Sweden. Further research should examine whether morbidity or culture accounts for these differences so health providers can better meet the demands and needs of various ethnic groups.