title: Patterns of pharmaceutical use for immigrants to Spain and Norway: a comparative study of prescription databases in two European countries.
abstract: BACKGROUND
  Although equity in health care is theoretically a cornerstone in Western societies, several studies show that services do not always provide equitable care for immigrants. Differences in pharmaceutical consumption between immigrants and natives are explained by variances in predisposing factors, enabling factors and needs across populations, and can be used as a proxy of disparities in health care use. By comparing the relative differences in pharmacological use between natives and immigrants from the same four countries of origin living in Spain and Norway respectively, this article presents a new approach to the study of inequity in health care.
  
  
  METHODS
  All purchased drug prescriptions classified according to the Anatomical Therapeutic Chemical (ATC) system in Aragon (Spain) and Norway for a total of 5 million natives and nearly 100,000 immigrants for one calendar year were included in this cross-sectional study. Age and gender adjusted relative purchase rates for immigrants from Poland, China, Colombia and Morocco compared to native populations in each of the host countries were calculated. Direct standardisation was performed based on the 2009 population structure of the OECD countries.
  
  
  RESULTS
  Overall, a significantly lower proportion of immigrants in Aragon (Spain) and Norway purchased pharmacological drugs compared to natives. Patterns of use across the different immigrant groups were consistent in both host countries, despite potential disparities between the Spanish and Norwegian health care systems. Immigrants from Morocco showed the highest drug use rates in relation to natives, especially for antidepressants, "pain killers" and drugs for peptic ulcer. Immigrants from China and Poland showed the lowest use rates, while Colombians where more similar to host countries.
  
  
  CONCLUSIONS
  The similarities found between the two European countries in relation to immigrants' pharmaceutical use disregarding their host country emphasises the need to consider specific immigrant-related features when planning and providing healthcare services to this part of the population. These results somehow remove the focus on inequity as the main reason to explain differences in purchase between immigrants and natives.
authors.affiliation: EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), IIS Aragon, Miguel Servet University Hospital, Paseo Isabel La Católica 1-3, 50009, Zaragoza, Spain. lugifel@gmail.com.|San Pablo Health Centre, C/Aguadores 7, 50003, Zaragoza, Spain. lugifel@gmail.com.|Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, C/Domingo Miral s/n, 50009, Zaragoza, Spain. lugifel@gmail.com.|Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, C/Sinesio Delgado 4, 28029, Madrid, Spain. lugifel@gmail.com.
authors.forename: Luis Andres
authors.initials: LA
authors.lastname: Gimeno-Feliu
authors.affiliation: EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), IIS Aragon, Miguel Servet University Hospital, Paseo Isabel La Católica 1-3, 50009, Zaragoza, Spain. acalderon.iacs@aragon.es.|Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, C/Sinesio Delgado 4, 28029, Madrid, Spain. acalderon.iacs@aragon.es.
authors.forename: Amaia
authors.initials: A
authors.lastname: Calderón-Larrañaga
authors.affiliation: EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), IIS Aragon, Miguel Servet University Hospital, Paseo Isabel La Católica 1-3, 50009, Zaragoza, Spain. sprados.iacs@aragon.es.|Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, C/Sinesio Delgado 4, 28029, Madrid, Spain. sprados.iacs@aragon.es.|Department of Microbiology, Preventive Medicine and Public Health, University of Zaragoza, C/Domingo Miral s/n, 50009, Zaragoza, Spain. sprados.iacs@aragon.es.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Prados-Torres
authors.affiliation: Teaching Unit of Preventive Medicine and Public Health, Aragon Health Sciences Institute (IACS), Avda. San Juan Bosco 13, 50009, Zaragoza, Spain. concharevilla@gmail.com.
authors.forename: Concha
authors.initials: C
authors.lastname: Revilla-López
authors.affiliation: Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, 5018, Bergen, Norway. Esperanza.Diaz@uib.no.|Norwegian Centre for Minority Health Research, Gullhaugveien 1-3, 0484, Oslo, Norway. Esperanza.Diaz@uib.no.
authors.forename: Esperanza
authors.initials: E
authors.lastname: Diaz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000208:ethnology; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013030:Spain / Q000208:ethnology