title: Frequent attenders in general practice and immigrant status in Norway: a nationwide cross-sectional study.
abstract: OBJECTIVE
  To compare the likelihood of being a frequent attender (FA) to general practice among native Norwegians and immigrants, and to study socioeconomic and morbidity factors associated with being a FA for natives and immigrants.
  
  
  METHODS
  Linked register data for all inhabitants in Norway with at least one visit to the general practitioner (GP) in 2008 (2 967 933 persons). Immigrants were grouped according to their country of origin into low- (LIC), middle- (MIC), and high-income countries (HIC). FAs were defined as patients whose attendance rate ranked in the top 10% (cut-off point > 7 visits).
  
  
  METHODS
  FAs were compared with other GP users by means of multivariate binary logistic analyses adjusting for socioeconomic and morbidity factors.
  
  
  RESULTS
  Among GP users during the daytime, immigrants had a higher likelihood of being a FA compared with natives (OR (95% CI): 1.13 (1.09-1.17) and 1.15 (1.12-1.18) for HIC, 1.84 (1.78-1.89) and 1.66 (1.63-1.70) for MIC, and 1.77 (1.67-1.89) and 1.65 (1.57-1.74) for LIC for men and women respectively). Pregnancy, middle income earned in Norway, and having cardiologic and psychiatric problems were the main factors associated with being a FA. Among immigrants, labour immigrants and the elderly used GPs less often, while refugees were overrepresented among FAs. Psychiatric, gastroenterological, endocrine, and non-specific drug morbidity were relatively more prevalent among immigrant FA compared with natives.
  
  
  CONCLUSIONS
  Although immigrants account for a small percentage of all FAs, GPs and policy-makers should be aware of differences in socioeconomic and morbidity profiles to provide equality of health care.
authors.affiliation: Department of Global Public Health and Primary Care, University of Bergen , Norway.
authors.forename: Esperanza
authors.initials: E
authors.lastname: Diaz
authors.forename: Luis-Andrés
authors.initials: LA
authors.lastname: Gimeno-Feliu
authors.forename: Amaia
authors.initials: A
authors.lastname: Calderón-Larrañaga
authors.forename: Alexandra
authors.initials: A
authors.lastname: Prados-Torres
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D054242:Emigrants and Immigrants; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data*; D006300:Health Services Misuse / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends*; D009664:Norway / Q000453:epidemiology; D011247:Pregnancy; D011320:Primary Health Care / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Emigrants and immigrants; Norway; general practice; health care research; morbidity; primary health care; registries; socioeconomic factors