title: Hospital emergency department utilisation rates among the immigrant population in Barcelona, Spain.
abstract: BACKGROUND
  The recent increase in the number of immigrants of Barcelona represents a challenge for the public healthcare system, the emergency department being the most used healthcare service by this group. However, utilisation rates in our environment have not yet been studied. We aimed to compare emergency department utilisation rates between Spanish-born and foreign-born residents in a public hospital of Barcelona.
  
  
  METHODS
  The study population included all adults residing in the area of study and visiting the emergency department of Hospital del Mar in 2004. The emergency care episodes were selected from the Emergency Department register, and the population figures from the Statistics Department of Barcelona. Emergency care episodes were classified into five large clinical categories. Adjusted rate ratios (RR) of utilisation among foreign-born vs. Spanish-born residents were assessed through negative binomial regression.
  
  
  RESULTS
  The overall utilisation rate was 382 emergency contacts per 1,000 persons-years. The RR for foreign-born versus Spanish-born residents was 0.62 (95% CI: 0.52; 0.74%). The RR was also significantly below one in surgery (0.51, 95% CI: 0.42; 0.63), traumatology (0.47, 95% CI: 0.38; 0.59), medicine (0.48, 95% CI: 0.38; 0.59) and psychiatry (0.42, 95% CI: 0.18; 0.97). No differences were found in utilisation of gynaecology and minor emergency services.
  
  
  CONCLUSIONS
  The overall lower utilisation rates obtained for foreign-born residents is consistent with previous studies and is probably due to the "healthy immigrant effect". Thus, the population increase due to immigration does not translate directly into a corresponding increase in the number of emergency contacts. The lack of differences in minor and gynaecological emergency care supports the hypothesis that immigrants overcome certain barriers by using the emergency department to access to health services. The issue of healthcare barriers should therefore be addressed, especially among immigrants.
authors.affiliation: Health Services Evaluation and Clinical Epidemiology Department, IMIM-Hospital del Mar, Barcelona, Spain. aburon@imas.imim.es
authors.forename: Andrea
authors.initials: A
authors.lastname: Buron
authors.forename: Francesc
authors.initials: F
authors.lastname: Cots
authors.forename: Oscar
authors.initials: O
authors.lastname: Garcia
authors.forename: Oriol
authors.initials: O
authors.lastname: Vall
authors.forename: Xavier
authors.initials: X
authors.lastname: Castells
mesh_terms: D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D003953:Diagnosis-Related Groups; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004641:Emigration and Immigration / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016012:Poisson Distribution; D012044:Regression Analysis; D013030:Spain; D014600:Utilization Review