title: Primary health care utilization by immigrants as compared to the native population: a multilevel analysis of a large clinical database in Catalonia.
abstract: BACKGROUND
  Immigration is a relevant public health issue and there is a great deal of controversy surrounding its impact on health services utilization.
  
  
  OBJECTIVE
  To determine differences between immigrants and non-immigrants in the utilization of primary health care services in Catalonia, Spain.
  
  
  METHODS
  Population based, cross-sectional, multicentre study. We used the information from 16 primary health care centres in an area near Barcelona, Spain. We conducted a multilevel analysis for the year 2008 to compare primary health care services utilization between all immigrants aged 15 or more and a sample of non-immigrants, paired by age and sex.
  
  
  RESULTS
  Overall, immigrants living in Spain used health services more than non-immigrants (Incidence Risk Ratio (IRR) 1.16 (95% Confidence Interval (CI): 1.15-1.16) and (IRR 1, 26, 95% CI: 1.25-1.28) for consultations with GPs and referrals to specialized care, respectively. People coming from the Maghreb and the rest of Africa requested the most consultations involving a GP and nurses (IRR 1.34, 95% CI: 1.33-1.36 and IRR 1.06, 95% CI: 1.03-1.44, respectively). They were more frequently referred to specialized care (IRR 1.44, 95% CI: 1.41-1.46) when compared to Spaniards. Immigrants from Asia had the lowest numbers of consultations with a GP and referrals (IRR 0.76, 95% CI: 0.66-0.88 and IRR 0.76, 95% CI: 0.61-0.95, respectively.
  
  
  CONCLUSIONS
  On average, immigrants living in Catalonia used the health services more than non-immigrants. Immigrants from the Maghreb and other African countries showed the highest and those from Asia the lowest, number of consultations and referrals to specialized care.
authors.affiliation: Catalan Institute of Health and Primary Health Care University Research Institute (IDIAP- Jordi Gol), Barcelona, Spain. mamunoz.bcn.ics@gencat.cat
authors.forename: Miguel-Angel
authors.initials: MA
authors.lastname: Muñoz
authors.forename: Esther
authors.initials: E
authors.lastname: Pastor
authors.forename: Joan
authors.initials: J
authors.lastname: Pujol
authors.forename: José Luis
authors.initials: JL
authors.lastname: Del Val
authors.forename: Silvia
authors.initials: S
authors.lastname: Cordomí
authors.forename: Eduardo
authors.initials: E
authors.lastname: Hermosilla
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D058005:General Practitioners / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013030:Spain; D013038:Specialization; D055815:Young Adult