Impact on and use of an inner-city London Infectious Diseases Department by international migrants: a questionnaire survey.
BACKGROUND
The UK has witnessed a considerable increase in immigration in the past decade. Migrant may face barriers to accessing appropriate health care on arrival and the current focus on screening certain migrants for tuberculosis on arrival is considered inadequate. We assessed the implications for an inner-city London Infectious Diseases Department in a high migrant area.


METHODS
We administered an anonymous 20-point questionnaire survey to all admitted patients during a 6 week period. Questions related to sociodemographic characteristics and clinical presentation. Analysis was by migration status (UK born vs overseas born).


RESULTS
111 of 133 patients completed the survey (response rate 83.4%). 58 (52.2%) were born in the UK; 53 (47.7%) of the cohort were overseas born. Overseas-born were over-represented in comparison to Census data for this survey site (47.7% vs 33.6%; proportional difference 0.142 [95% CI 0.049-0.235]; p = 0.002): overseas born reported 33 different countries of birth, most (73.6%) of whom arrived in the UK pre-1975 and self-reported their nationality as British. A smaller number (26.4%) were new migrants to the UK (< or =10 years), mostly refugees/asylum seekers. Overseas-born patients presented with a broad range and more severe spectrum of infections, differing from the UK-born population, resulting in two deaths in this group only. Presentation with a primary infection was associated with refugee/asylum status (n = 8; OR 6.35 [95% CI 1.28-31.50]; p = 0.023), being a new migrant (12; 10.62 [2.24-50.23]; p = 0.003), and being overseas born (31; 3.69 [1.67-8.18]; p = 0.001). Not having registered with a primary-care physician was associated with being overseas born, being a refugee/asylum seeker, being a new migrant, not having English as a first language, and being in the UK for < or =5 years. No significant differences were found between groups in terms of duration of illness prior to presentation or duration of hospitalisation (mean 11.74 days [SD 12.69]).


CONCLUSIONS
Migrants presented with a range of more severe infections, which suggests they face barriers to accessing appropriate health care and screening both on arrival and once settled through primary care services. A more organised and holistic approach to migrant health care is required.
International Health Unit, Department of Infectious Diseases and Immunity, Faculty of Medicine, Imperial College, Hammersmith Hospital Campus, London, UK. g.cooke@imperial.ac.uk <g.cooke@imperial.ac.uk>
Graham
G
Cooke
Sally
S
Hargreaves
Jana
J
Natkunarajah
Gurjinder
G
Sandhu
Devesh
D
Dhasmana
Joseph
J
Eliahoo
Alison
A
Holmes
Jon S
JS
Friedland
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003141:Communicable Diseases / Q000208:ethnology* / Q000473:pathology / Q000628:therapy; D003710:Demography; D004641:Emigration and Immigration / Q000145:classification / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006748:Hospital Departments / Q000706:statistics & numerical data*; D006773:Hospitals, Municipal / Q000706:statistics & numerical data; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D011635:Public Health Administration / Q000706:statistics & numerical data*; D012036:Refugees / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014504:Urban Health / Q000706:statistics & numerical data*