title: Emergency hospital services utilization in Lleida (Spain): A cross-sectional study of immigrant and Spanish-born populations.
abstract: BACKGROUND
  The use of emergency hospital services (EHS) has increased steadily in Spain in the last decade while the number of immigrants has increased dramatically. Studies show that immigrants use EHS differently than native-born individuals, and this work investigates demographics, diagnoses and utilization rates of EHS in Lleida (Spain).
  
  
  METHODS
  Cross-sectional study of all the 96,916 EHS visits by patients 15 to 64 years old, attended during the years 2004 and 2005 in a public teaching hospital. Demographic data, diagnoses of the EHS visits, frequency of hospital admissions, mortality and diagnoses at hospital discharge were obtained. Utilization rates were estimated by group of origin. Poisson regression was used to estimate the rate ratios of being visited in the EHS with respect to the Spanish-born population.
  
  
  RESULTS
  Immigrants from low-income countries use EHS services more than the Spanish-born population. Differences in utilization patterns are particularly marked for Maghrebi men and women and sub-Saharan women. Immigrant males are at lower risk of being admitted to the hospital, as compared with Spanish-born males. On the other hand, immigrant women are at higher risk of being admitted. After excluding the visits with gynecologic and obstetric diagnoses, women from sub-Saharan Africa and the Maghreb are still at a higher risk of being admitted than their Spanish-born counterparts.
  
  
  CONCLUSIONS
  In Lleida (Spain), immigrants use more EHS than the Spanish born population. Future research should indicate whether the same pattern is found in other areas of Spain and whether EHS use is attributable to health needs, barriers to access to the primary care services or similarities in the way immigrants access health care in their countries of origin.
authors.affiliation: Biomedical Research Institut, Lleida (IRBLLEIDA), Spain. montse.rue@cmb.udl.cat
authors.forename: Montserrat
authors.initials: M
authors.lastname: Rué
authors.forename: Xavier
authors.initials: X
authors.lastname: Cabré
authors.forename: Jorge
authors.initials: J
authors.lastname: Soler-González
authors.forename: Anna
authors.initials: A
authors.lastname: Bosch
authors.forename: Mercè
authors.initials: M
authors.lastname: Almirall
authors.forename: Maria Catalina
authors.initials: MC
authors.lastname: Serna
mesh_terms: D000293:Adolescent; D000328:Adult; D000349:Africa / Q000208:ethnology; D003430:Cross-Sectional Studies; D004630:Emergencies / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004641:Emigration and Immigration / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality / Q000208:ethnology; D006779:Hospitals, Public; D006784:Hospitals, Teaching; D006801:Humans; D007843:Latin America / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D016012:Poisson Distribution; D012044:Regression Analysis; D012307:Risk Factors; D017678:Sex Distribution; D013030:Spain