title: Global healthcare use by immigrants in Spain according to morbidity burden, area of origin, and length of stay.
abstract: The healthcare of immigrants is an important aspect of equity of care provision. Understanding how immigrants use the healthcare services based on their needs is crucial to establish effective health policy.
  
  
  
  This retrospective, observational study included the total population of Aragon, Spain (1,251,540 individuals, of whom 11.9 % were immigrants). Patient-level data on the use of primary, specialised, hospital, and emergency care as well as prescription drug use in 2011 were extracted from the EpiChron Cohort and compared between immigrants and nationals. Multivariable standard or zero-inflated negative binomial regression models were generated, adjusting for age, sex, length of stay, and morbidity burden.
  
  
  
  The annual visit rates of immigrants were lower than those of nationals for primary care (3.3 vs 6.4), specialised care (1.3 vs 2.7), planned hospital admissions/100 individuals (1.6 vs 3.8), unplanned hospital admissions/100 individuals (2.7 vs 4.7), and emergency room visits/10 individuals (2.3 vs 2.8). Annual prescription drug costs were also lower for immigrants (€47 vs €318). These differences were only partially attenuated after adjusting for age, sex and morbidity burden.
  
  
  
  In a universal coverage health system offering broad legal access to immigrants, the global use of healthcare services was lower for immigrants than for nationals. These differences may be explained in part by the healthy migration effect, but also reveal possible inequalities in healthcare provision that warrant further investigation.
authors.affiliation: EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, 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, Zaragoza, Spain. lugifel@gmail.com.
authors.forename: Luis A
authors.initials: LA
authors.lastname: Gimeno-Feliu
authors.affiliation: EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain.|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: Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway.|Norwegian Centre for Minority Health Research (NAKMI), Oslo University Hospital, Bergen, Norway.
authors.forename: Esperanza
authors.initials: E
authors.lastname: Diaz
authors.affiliation: EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain.|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: San Pablo Health Centre, C/ Aguadores 7, 50003, Zaragoza, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Macipe-Costa
authors.affiliation: EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain.|Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, Madrid, Spain.|Department of Microbiology, Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Prados-Torres
mesh_terms: D000293:Adolescent; D000328:Adult; D000349:Africa / Q000208:ethnology; D000368:Aged; D001208:Asia / Q000208:ethnology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D054242:Emigrants and Immigrants; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010342:Patient Acceptance of Health Care; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013030:Spain; D055815:Young Adult