title: How do immigrants use primary health care services? A register-based study in Norway.
abstract: BACKGROUND
  Immigrant's use of primary health care (PHC) services differs from that of native's, but studies are non-consistent, and the importance of individual explaining variables like socio-economic status, morbidity burden and length of stay in the host country is uncertain.
  
  
  METHODS
  Registry-based study using merged data from the National Population Register and the Norwegian Health Economics Administration Database for all immigrants and natives ≥ 15 years registered in Norway in 2008 (3 739 244 persons), applying the Johns Hopkins ACG® Case-Mix System. Using multivariate binary logistic and negative binomial regression analyses, respectively, we compared overall use of PHC and number of visits to PHC between immigrants and natives, and investigated the significance of socio-economic, immigration and morbidity variables.
  
  
  RESULTS
  A significantly lower percentage of immigrants used the general practitioner (GP) compared with natives. Among GP users, however, most immigrants used the GP at a 2-15% significantly higher rate compared with natives. Older immigrants used their GP less and at lower rates than younger immigrants. A significantly lower percentage of immigrants from high-income countries, but a higher percentage of all other immigrants used emergency services compared with natives, with no differences in use rates. Morbidity burden and length of stay were essential explaining variables.
  
  
  CONCLUSIONS
  Lower use of PHC among immigrants could be due to better health or to access barriers, and should be further studied, especially for the oldest immigrants. Adjusted high frequency of use may be appropriate, but it might also be a signal of non-effective contacts.
authors.affiliation: 1 Department of Global Public Health and Primary Care, University of Bergen, Norway 2 Norwegian Centre for Minority Health Research, Norway esperanza.diaz@igs.uib.no.
authors.forename: Esperanza
authors.initials: E
authors.lastname: Diaz
authors.affiliation: 3 EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Spain 4 Department of Microbiology, Preventive Medicine and Public Health, University of Zaragoza, Spain 5 Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, Madrid, Spain.
authors.forename: Amaia
authors.initials: A
authors.lastname: Calderón-Larrañaga
authors.affiliation: 3 EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Spain 4 Department of Microbiology, Preventive Medicine and Public Health, University of Zaragoza, Spain 5 Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, Madrid, Spain.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Prado-Torres
authors.affiliation: 3 EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Spain 5 Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, Madrid, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Poblador-Plou
authors.affiliation: 3 EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Spain 6 San Pablo Health Centre, Zaragoza, Spain 7 Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Spain.
authors.forename: Luis-Andrés
authors.initials: LA
authors.lastname: Gimeno-Feliu
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D058005:General Practitioners / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012042:Registries / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013997:Time Factors; D055815:Young Adult