title: Primary healthcare usage and morbidity among immigrant children compared with non-immigrant children: a population-based study in Norway.
abstract: Health status, disease spectrum and use of healthcare have been reported to vary across groups of migrants and according to the different phases of migration. However, most studies are conducted among adults. This study assesses usage of primary healthcare (PHC) by children with immigrant background compared with non-immigrant children in Norway and describes their relative morbidity burden.
  
  
  
  Population-based retrospective cohort study.
  
  
  
  This study used 3 linked population-based registers in Norway for children under 18 years of age in 2008.
  
  
  
  Immigrants were defined as children with both parents born abroad, and further classified into first and second generation, and according to the World Bank income categories of their parents' country of origin. Usage and morbidity were assessed with negative binomial regression and logistic regression analyses, respectively. Further, population-attributable fraction analyses on PHC visits were conducted to estimate the impact on the primary health system.
  
  
  
  1 168 365 children including 119 251 with immigrant background.
  
  
  
  The mean number of visits to PHC for non-immigrant children was 1.40 compared with 1.19 for immigrants from high-income countries (HIC) and 1.76 for immigrants from low-income countries (LIC). Compared with non-immigrants, first generation immigrants used PHC significantly less after adjusting for age and sex (incidence risk ratio (IRR) 0.70 (HIC) to 0.93 (LIC)) while second generation immigrant children generally used PHC more (IRR 1.03 (HIC) to 1.43 (LIC)); however, the median number of visits were similar between all groups. The morbidity spectrum also varied between the groups.
  
  
  
  Compared with non-immigrants, the excess number of consultations attributable to immigrant groups corresponds to around 1.3% of PHC visits among children.
authors.affiliation: Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway Department of Clinical Dentistry, University of Bergen, Bergen, Norway.
authors.forename: Lars T
authors.identifier: 0000-0001-8757-2092
authors.initials: LT
authors.lastname: Fadnes
authors.affiliation: Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
authors.forename: Kathy Ainul
authors.initials: KA
authors.lastname: Møen
authors.affiliation: Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway Norwegian Centre for Minority Health Research, Norway.
authors.forename: Esperanza
authors.initials: E
authors.lastname: Diaz
mesh_terms: D000293:Adolescent; D002648:Child; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D009017:Morbidity / Q000639:trends*; D009664:Norway / Q000453:epidemiology; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012042:Registries; D012189:Retrospective Studies; D014600:Utilization Review
keywords: PRIMARY CARE; PUBLIC HEALTH