Cardiovascular risk and access to primary care: Comparisons among Chinese documented and undocumented immigrants

AIMS

The aim of this study was to examine main risk factors of undocumented Chinese migrants living in Italy when compared with Chinese migrants registered with National Health Service (NHS).

METHODS

A cohort of 3435 Chinese first-generation immigrants living in Prato underwent blood pressure (BP) measurement and blood tests. Hypertension was diagnosed for BP ≥ 140/90 mmHg at 2 visits, and/or antihypertensive drug use; type 2 diabetes (T2DM) for fasting glucose ≥ 126 mg/dL at 2 visits, and/or use of hypoglycemic drugs; hypercholesterolemia (HC) for cholesterol ≥ 240 mg/dL and/or statins use. Subjects diagnosed with hypertension, T2DM, or HC unaware of their condition were considered newly diagnosed. Comparisons were performed using multivariable adjusted logistic regression analysis.

RESULTS

A large proportion of Chinese migrants were undocumented (1766, 51 %); newly diagnoses of risk factors were performed especially among undocumented migrants; registration with NHS was associated with higher level of awareness for hypertension and T2DM and with 6 times higher rate of treatment for T2DM. Only a small minority of subjects with high cholesterol were treated with statins.

CONCLUSIONS

Undocumented immigrants had high prevalence of risk factors with lower levels of awareness than migrants registered with the NHS. Health policies targeting this hard-to-reach population needs to be improved.

Health Advocacy for Undocumented Immigrant Pregnant Patients

The challenges of providing prenatal care for undocumented immigrants require patience. Pregnant undocumented immigrant women should receive routine prenatal care tailored to their specific needs, with an emphasis on basic needs (eg, housing, safety, food, transportation to appointment). Financial, cultural, and language barriers can impede undocumented immigrants from receiving adequate or optimal prenatal care. Adverse maternal and fetal outcomes may be more common but have not been well-quantified and cannot be compared with outcomes if care had been provided in their country of origin. An example of a community-funded clinic is described in minimizing cost and optimizing outcomes.

Programa de diabetes: improving diabetes care for undocumented immigrants using the Chronic Care Model at a free community clinic

AIMS

This study examined whether the Chronic Care Model can be successfully applied to improve health outcome measures for uninsured, undocumented immigrants with diabetes at a free, non-federally funded community clinic.

METHODS

Data were collected from 128 uninsured, undocumented immigrants enrolled in Programa de diabetes, a comprehensive diabetes program at People's Health Clinic based on the six core elements of the Chronic Care Model. All study participants self-identified by the Hispanic ethnicity. A longitudinal study design was used to compare baseline diabetic health measures with outcome data after patient program participation over a 12-month enrollment period. Linear mixed effect model was used to determine the patient specific change in HbA1C across time, controlling for gender, age, food insecurity, income level, diabetes type, and literacy. In addition, McNemar tests were conducted to compare the coverage of eye exams and statin use before and after program enrollment.

RESULTS

After program enrollment, individual specific change in HbA1C was expected to be - 0.201 [95% CI 0.244, - 0.158] % per month after controlling for baseline covariates. There were statistically significant improvements in both eye exam coverage (p < 0.01) and statin use (p < 0.01).

CONCLUSIONS

The Chronic Care Model can be successfully applied to improve health outcome measures at a free, non-federally funded community clinic among uninsured, undocumented immigrants, who identify by the Hispanic ethnicity and have the diagnosis of diabetes. Barriers to care including food insecurity, federal poverty level and illiteracy do not preclude glycemic control.

Undocumented immigrants suffering from inequality of vaccination access in Japan: measuring the institutional barriers and exploring the associated factors

OBJECTIVES

Undocumented immigrants (UIs) have been reported to suffer from the unequal distribution of COVID-19 vaccination, but this inequality has never been quantified, and the associated factors have not been measured.

STUDY DESIGN AND METHODS

We interviewed 190 municipal offices throughout Japan about the access to COVID-19 vaccination for UIs and control group foreigners. Using logistic regression, we investigated the association between assured access and municipal characteristics.

RESULTS

Out of the respondent municipalities, 57.5% answered that UIs can apply for a COVID-19 vaccination voucher. Additionally, 31.5% said they had received an inquiry about vaccines from UI individuals. Furthermore, only 23.2% of the municipalities responded that they had issued vouchers for UIs at least once. The control groups were reported to have been given more access to vouchers. Logistic regression showed that the foreign resident ratio, tertiary industry, and university graduation ratio were positively associated with vaccination access.

CONCLUSIONS

This study revealed for the first time that UIs are disproportionately marginalized compared with other visitors, implying that "illegality" plays an important role in the context of vaccination eligibility. The street-level vaccination desks of local governments may refuse to supply vaccines. Vaccine equity will be more readily achievable when vaccination access to all populations including UIs is ensured. Such access will also improve overall public health by increasing the vaccination rate.

Emergency Department Utilization Among Undocumented Latino Patients During the COVID-19 Pandemic

Objective

To determine whether Latino undocumented immigrants had a steeper decline in Emergency Department (ED) utilization compared to Latino Medi-Cal patients in a Los Angeles safety-net hospital, March 13, 2020, to May 8, 2020.

Study Design

The data were extracted from patient medical records for ED visits at LAC + USC Medical Center from January 2018 to September 2020. We analyzed weekly ED encounters among undocumented Latino patients in the nine-week period after COVID was declared a national emergency. We applied time-series routines to identify and remove autocorrelation in ED encounters before examining its relation with the COVID-19 pandemic. We included Latino patients 18 years of age and older who were either on restricted or full-scope Medi-Cal (n = 230,195).

Results

All low-income Latino patients, regardless of immigration status, experienced a significant decline in ED utilization during the first nine weeks of the pandemic. Undocumented patients, however, experienced an even steeper decline. ED visits for this group fall below expected levels between March 13, 2020, and May 8, 2020 (coef. =  − 38.67; 95% CI =  − 71.71, − 5.63). When applied to the weekly mean of ED visits, this translates to a 10% reduction below expected levels in ED visits during this time period.

Conclusion

Undocumented immigrants’ health care utilization was influenced by external events that occurred early in the pandemic, such as strict stay-at-home orders and the public charge rule change. Health care institutions and local policy efforts could work to ensure that hospitals are safer spaces for undocumented immigrants to receive care without immigration concerns.

Association between immigration enforcement encounters and COVID-19 testing and delays in care: a cross-sectional study of undocumented young adult immigrants in california

BACKGROUND

Undocumented immigrants are expected to face increased risks related to COVID-19 due to marginalizing restrictive immigration policies. However, few studies have assessed the prevalence of direct encounters with the immigration enforcement system among the undocumented and its impacts on their COVID-related health behaviors and outcomes. In this study, we quantify undocumented immigrants' lifetime exposure to various immigration enforcement tactics and their association with delays in COVID-19 testing and healthcare behaviors.

METHODS

This cross-sectional study included a non-random sample of 326 Asian and Latinx undocumented immigrants in California from September 2020 to February 2021. The primary exposure was immigration enforcement encounter scores ranging from 0-9, assessed through self-reports of direct experiences with the immigration system, immigration officials, and law enforcement. The main outcomes were positive test for COVID-19, had or suspected having COVID-19, and delayed or avoided testing and/or treatment for COVID-19 due to immigration status. We used multivariable logistic regression models to examine the association between the primary exposure and outcomes of interest.

RESULTS

Among 326 participants, 7% had received a positive COVID-19 test result, while 43% reported having or suspected having COVID-19. Almost 13% delayed or avoided COVID-19 testing and/or treatment because of their immigration status. Overall, an increase in immigration enforcement encounters was associated with higher odds of suspecting having had COVID-19 (aOR = 1.13; 95% CI: 1.01,1.26). Reporting an additional enforcement encounter was associated with higher odds of delaying or avoiding testing and/or treatment because of immigration status (aOR = 1.53, 95% CI: 1.26,1.86). Compared to their Latino counterparts, Asian respondents were more likely to report higher odds of delaying or avoiding testing and/or treatment (aOR = 3.13, 95% CI: 1.17,8.42). There were no significant associations between the enforcement score and testing positive for COVID-19. Additionally, while Latinxs were more likely to report immigration enforcement encounters than Asians, there were no differences in the effects of race on COVID-19 testing and healthcare behaviors in models with race as an interaction term (p < 0.05).

CONCLUSIONS

Immigration enforcement encounters compound barriers to COVID-19 testing and treatment for undocumented immigrants.

A healthy migrant effect? Estimating health outcomes of the undocumented immigrant population in the United States using machine learning

This paper investigated whether the commonly observed immigrant health advantage persists among undocumented immigrants in the U.S. and provides nationally representative evidence on the health of this vulnerable population. Data were derived from pooled cross-sections of the National Health Interview Survey (NHIS, 2000-2018). The legal status of foreign-born NHIS respondents is imputed using a non-parametric machine learning model built based on information from the 2004, 2008 and 2014 cohorts of the Survey of Income and Program Participation (SIPP). Multivariate logistic regression analysis indicated that, despite exposure to numerous additional risk factors, the undocumented population experienced a more pronounced Healthy Migrant Effect, with lower odds of reporting fair or poor self-rated health, any physician-diagnosed chronic conditions or being obese. The observed patterns in undocumented health outcomes may be related to the additional challenges and exclusionary policies associated with undocumented migration that could in turn lead to a more pronounced selection of healthy and resilient individuals.

Designing and assessing of an art-based intervention for undocumented migrants

BACKGROUND

Undocumented immigrants and refugees are more likely to suffer from psychosocial disorders.

METHODOLOGY

In this pilot study, an art-based intervention is described and assessed, with a sample of 11undocumented immigrants who recently came to southern Spain on a small boat. The art-based intervention is assessed using a pre-post design and four questionnaires, which consist of The General Health Questionnaire, Beck's Depression Inventory, the Barcelona Immigrant Stress Scale and Carol Ryff's Psychological Well Being Scale. Furthermore, five participants were interviewed before and after the intervention and a thematic analysis of the transcriptions was carried out.

RESULTS

A significant reduction of depressive symptoms with a large effect size was found. An increase of reflexive discourse and the feeling of belonging after the intervention was also observed.

CONCLUSIONS

The study suggests that the art-based intervention decreased depressive symptoms and stress, redirecting the narratives of the participants towards the future and increasing the sense of community.

The political determinants of the health of undocumented immigrants: a comparative analysis of mortality patterns in Switzerland

BACKGROUND

The health of undocumented immigrants is an important concern in most societies. However, there is no conclusive evidence that inclusive health care policies lead to better outcomes for this group of the population. The aim of this study is to analyse whether there is an association between inclusive health care policies and the mortality patterns of undocumented immigrants, or the distribution of different causes of death among those who have died.

METHODS

We analyse individual data concerning the deceased in Switzerland between 2011 and 2017. We proceed in two steps. First, we estimate and compare the patterns of mortality of Swiss citizens, documented immigrants, and undocumented immigrants. Second, we test whether there is an association between cantonal authorities' policies and differing mortality patterns. We use logistic regressions and multinomial regressions to estimate the relationship between legal status and mortality patterns both in Switzerland and across different cantons.

RESULTS

We find a difference in the patterns of mortality between undocumented immigrants and the other groups of the population. Specifically, death from circulatory system diseases is twice as frequent among undocumented immigrants compared to documented immigrants and Swiss citizens. However, this difference is smaller in the Swiss cantons that have more inclusive health care policies towards undocumented immigrants.

CONCLUSIONS

We interpret these results as an indication that policies that expand access to health services lead to better outcomes for undocumented immigrants. This finding has implications for research on civic stratification and public health. Further analysis is needed to evaluate the effects of extending public health care for undocumented immigrants in different contexts.

Avoidable hospitalizations and access to primary care: comparisons among Italians, resident immigrants and undocumented immigrants in administrative hospital discharge records

BACKGROUND

Immigrants face multiple barriers in accessing healthcare; however, empirical assessment of access presents serious methodological issues, and evidence on undocumented immigrants is scant and based mainly on non-representative samples. We examine avoidable hospitalization (AH) as an indicator of poor access to primary care (PC) in Italy, where a universal healthcare system guarantees access but fails to assign general practitioners to undocumented immigrants.

METHODS

Using anonymized national hospital discharge records in 2019, undocumented immigrants were identified through an administrative financing code. Potential effects of poor access to PC were measured by focusing on the incidence of AH, differentiated among chronic, acute and vaccine-preventable conditions, comparing Italian citizens, documented (foreign nationals with residence permits) and undocumented immigrants. We estimated odd ratios (ORs) through logistic regression models, controlling for individual and contextual confounders.

FINDINGS

Compared with Italians, undocumented and documented immigrants adjusted odd ratios (OR) for the risk of AH were 1·422 (95% CI 1·322-1·528) and 1·243 (95% CI 1·201-1·287), respectively. Documented immigrants showed ORs not significantly greater than 1 for AH due to chronic diseases compared with Italians, while undocumented immigrants registered higher adjusted OR for all AH categories - chronic (OR 1·187; 95% CI 1·064-1·325), acute (OR 1·645; 95% CI 1·500-1·803) and vaccine-preventable (OR 2·170; 95% CI 1·285-3·664).

INTERPRETATION

Documented and undocumented immigrants face considerably higher risk of AH compared to Italians. Considering the burden of AHs, access to PC (including preventive and ambulatory care) should be provided to undocumented immigrants, and additional barriers to care for all immigrants should be further explored.

FUNDING

None.

Undocumented migrants in French intensive care units in 2011-2018: retrospective nationwide study

PURPOSE

Whether undocumented migrants admitted to intensive care units (ICUs) have specific features is unknown. We aimed to determine the features and outcomes of undocumented migrants admitted to French ICUs.

METHODS

We retrospectively included all undocumented adult migrants admitted in 2011-2018 and compared them to the general ICU population. We also compared these two groups matched on age, sex, severity, comorbidities, reason for ICU admission and public/private hospital.

RESULTS

We identified 14,554 ICU stays, with an increase from 2 to 4‰ of all ICU admissions over time. Shock (16.7%), post-operative care (13.8%), and trauma (10.5%) were the main reasons for ICU admission. Compared to general ICU patients, migrants were younger and had greater disease severity. After adjustment on age and sex, the following were more common in migrants: shock (OR 1.2 [1.14-1.25]; P < 0.0001), infections (1.48 [1.38-1.54]; P < 0.001), acute respiratory failure (1.09 [1.03-1.15]; P = 0.006), acute kidney injury (1.12 [1.05-1.19]; P < 0.001), obstetric events (1.53 [1.66-1.81]; P < 0.0001), and neurological deficits (1.19 [1.12-1.27]; P < 0.0001). In the matched study, migrants more often required vasopressors, mechanical ventilation, and renal replacement therapy; had longer ICU stays (median 4 [2-8] vs. 4 [2-7] days; P < 0.0001) and hospital stays (10 [5-20] vs. 8 [4-15]; P < 0.0001) and had higher hospital costs (14.2 ± 23.6 vs. 13.4 ± 11.5 K€; P < 0.0001). Hospital mortality was similar (6.7% vs. 6.6%; P = 0.69).

CONCLUSION

Admissions of undocumented migrants to French ICUs doubled from 2011 to 2018. The patients were younger and, although sicker, achieved similar outcomes to those in general ICU patients.

The mechanism and pattern of injuries of undocumented immigrants crossing the Texas-Mexico border along the Rio Grande Valley

Background

Apprehensions of undocumented immigrants in the Rio Grande Valley sector of the U.S.-Mexico border have grown to account for nearly half of all apprehensions at the border. The purpose of this study is to report the prevalence, mechanism, and pattern of traumatic injuries sustained by undocumented immigrants who crossed the U.S.-Mexico border at the Rio Grande Valley sector over a span of 5 years and were treated at a local American College of Surgeons verified Level II trauma center.

Methods

A retrospective chart review was conducted from January 2014 to December 2019. Demographics, comorbidities, injury severity score (ISS), mechanism of injury, anatomical part of the body affected, hospital and ICU length of stay (LOS), and treatment costs were analyzed. Descriptive statistics for demographics, injury location and cause, and temporal trends are reported. The impact of ISS or surgical intervention on hospital LOS was analyzed using an analysis of covariance (ANCOVA).

Results

Of 178 patients, 65.2% were male with an average age of 31 (range 0–67) years old and few comorbidities (88.8%) or social risk factors (86%). Patients most commonly sustained injuries secondary to a border fence-related incident (33.7%), fleeing (22.5%), or motor vehicle accident (16.9%). There were no clear temporal trends in the total number of patients injured, or in causes of injury, between 2014 and 2019. The majority of patients (60.7%) sustained extremity injuries, followed by spine injuries (20.2%). Border fence-related incidents and fleeing increased risk of extremity injuries (Odds ratio (OR) > 3; p < 0.005), whereas motor vehicle accidents increased risk of head and chest injuries (OR > 4; p < 0.004). Extremity injuries increased the odds (OR: 9.4, p < 0.001) that surgery would be required. Surgical intervention was common (64%), and the median LOS of patients who underwent surgery was 3 days more than those who did not (p < 0.001).

Conclusion

In addition to border fence related injuries, undocumented immigrants also sustained injuries while fleeing and in motor vehicle accidents, among others. Extremity injuries, which were more likely with border fence-related incidents, were the most common type. This type of injury often requires surgical intervention and, therefore, a longer hospital stay for severe injuries.

Undocumented Older Latino Immigrants in the United States: Population Projections and Share of Older Undocumented Latinos by Health Insurance Coverage and Chronic Health Conditions, 2018-2038

OBJECTIVES

This paper focuses on the older Latino undocumented population and anticipates how their current demographic characteristics and health insurance coverage might impact future population size and health insurance trends.

METHODS

We use the 2013-2018 American Community Survey as a baseline to project growth in the Latino 55+ undocumented population over the next 20 years. We use the cohort component method to estimate population size across different migration scenarios and distinguish between aging in place and new in-migration. We also examine contemporary health insurance coverage and chronic health conditions among 55+ undocumented Latinos from the 2003-2014 California Health Interview Survey. We then project health insurance rates in 2038 among Latino immigrants under different migration and policy scenarios.

RESULTS

If current mortality, migration, and policy trends continue, projections estimate that 40% of undocumented Latino immigrants will be 55 years or older by 2038 - nearly all of whom will have aged in place. Currently, 40% of older Latino undocumented immigrants do not have insurance. Without policies that increase access to insurance, projections estimate that the share who are uninsured among all older Latinos immigrants will rise from 15% to 21%, and the share that is both uninsured and living with a chronic health condition will rise from 5% to 9%.

DISCUSSION

Without access health care, older undocumented immigrants may experience delayed care and more severe morbidity. Our projections highlight the need to develop and enact policies that can address impending health access concerns for an increasingly older undocumented Latino population.

Immigrants' Employment Stability Over the Great Recession and Its Aftermath

We examine immigrant men's employment stability during the Great Recession and its aftermath using a longitudinal approach that draws on data from the Survey of Income and Program Participation (SIPP), a nationally representative panel survey of U.S. residents. Discrete-time event-history models are used to estimate male immigrants' relative risk of experiencing an involuntary job loss or underemployment, defined as working less than full-time involuntarily. The analysis also investigates differences in job stability by immigrant documentation status. Undocumented immigrants are identified using a logical allocation method augmented with external information about whether the respondent was successfully matched with administrative data. We find that immigrants are at significantly higher risk of involuntary job loss, and especially of underemployment relative to native-born workers. Undocumented immigrants face a greater risk of adverse job transitions, particularly underemployment in the first part of the recession. When demographic and job characteristics are taken into account, immigrant-native and documented-undocumented differences attenuate but remain in many instances. A comparison of our findings with those from an earlier nonrecessionary period from 2004 to 2006 suggests that immigrants' higher risk of employment instability may be attributed to the recession.

Physical and mental health impacts of the COVID-19 pandemic among college students who are undocumented or have undocumented parents

Background

The COVID-19 pandemic may have disproportionately affected the mental and physical health of undocumented students and students with undocumented parents.

Methods

We analyzed primary data from 2111 California college students collected March–June 2020. We estimated the odds of mental or physical health being affected “a great deal” by COVID by immigration group and then examined whether this was moderated by campus belonging or resource use.

Results

Students with undocumented parents were least likely to report COVID-related mental and physical health effects. Undocumented students and students whose parents have lawful immigration status did not differ in their COVID-related physical and mental health. For all students, more campus resource use and higher campus belonging were associated with negative mental and physical health effects.

Discussion

Negative COVID-related mental and physical health was widespread. Separation from campus-based resources was detrimental during the early stages of the pandemic.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11606-x.

[Living and health conditions of the immigrant population of the settlements of Huelva.]

OBJECTIVE

Due to the agricultural labor supply in the province of Huelva, the immigrant population has been growing, establishing a situation of irregularity that favors precarious work and hinders access to decent housing. Therefore, our objective was to identify the socio-sanitary needs of the immigrant population facing the living conditions with which they live in the irregular settlements of the province of Huelva.

METHODS

Cross-sectional descriptive study of mixed method on an estimated population of 2500 residents in 23 settlements. A quantitative study of socio-sanitary variables was carried out using a survey and observation guide, and a water, air and soil quality study. Semi-structured interviews were conducted with 13 inhabitants of the settlements until the saturation of the speeches.

RESULTS

The settlements were located far away from the towns. Surrounded by garbage, without running water, electricity, sewer, toilets or showers. Its residents were stocked up on purchased food and water from fields, wells and public fountains, which they stored in jugs of plant protection products. They were mostly in an irregular situation. 49% had a health card and 48% ever went to a health center, declared mostly a good perception of health. They stood out as expressed needs: access to water (main demand), protection from the risk of fire, improvement of the irregular situation and the working conditions, and the need to help and to protect their family of origin.

CONCLUSIONS

These living conditions belong to an underdeveloped environment within an advanced society, with access to water being the main problem. Legal irregularity is key for them, preventing them regularized employment contracts and the perception of being able to access to a better future. Their self-perception of health is good and they do not make a greater use of health services, despite the conditions in which they live.

Transnational health protection strategies and other health-seeking behavior among undocumented and indigenous dairy workers in a rural new immigrant destination

Latin American immigrants in new immigrant destinations (NIDs) experience numerous barriers that negatively impact their access to healthcare. Yet the wide range of health-seeking behaviors deployed in response to these barriers-particularly among those who are undocumented and indigenous-are not well understood. Further, studies of immigrant health in NIDs tend to take place in those locations, rather than using a multi-sited design. Building on NID scholarship, the transnational social protection literature, and work on structural vulnerability, this study uses a multi-sited research design to examine the health-seeking behaviors that undocumented and indigenous immigrant workers exhibit in a rural NID. Data consist of interviews conducted intermittently from 2010 to 2017 in Mexico and the U.S. with 56 individuals from indigenous villages in Veracruz who worked on dairy farms in Wisconsin and Minnesota, as well as expert interviews. We found numerous barriers to healthcare that together constituted a limited resource environment for undocumented dairy workers. This accentuated their structural vulnerability and influenced responses to health problems. Strategies among undocumented and indigenous immigrant dairy workers in a rural NID included: self-care, delaying care, relying on local ties, cross-border health consultation, cross-border health packages, and returning home for health. Furthermore, we found that women in the family or community often facilitated cross-border health activity, and that traditional folk medicine was common. We argue that these workers' health protection strategies not only serve to secure their individual status as productive workers, but on a larger scale, they play an important part in preserving the migrant labor regime in this rural NID. Further, we argue that the indigenous knowledge that is transmitted largely by women via immigrants' informal social networks is an important yet often invisible part of the carework that maintains this relatively new labor force.

Undocumented immigrants' and immigrant women's access to healthcare services in the Basque Country (Spain)

BACKGROUND

Immigrant populations experience diverse barriers to access healthcare services in the host countries. Among them, undocumented immigrants have more restricted legal access conditions and higher risk of having poorer health. Likewise, women are more likely to seek healthcare and face gender-based factors that hinder their access.

OBJECTIVE

This thesis analysed the access of undocumented immigrants and immigrant women to public healthcare services in the Basque Country (Spain).

METHODS

The thesis contained three sub-studies, carried out with qualitative and quantitative methods. For the quantitative approach, the trend in the number of consultations in a free clinic for undocumented immigrants was analysed before and after the launch of a new law, using a negative binomial regression analysis (n = 9,272). For the qualitative approach, qualitative content analysis was applied to 25 in-depth interviews with 14 immigrant women and 11 free clinic healthcare professionals.

RESULTS

No clear relationship was found between the application of more restrictive legal conditions for immigrants to access public healthcare services and the trend of attendance of undocumented immigrants to a free clinic. Access of undocumented immigrants and immigrant women to healthcare services was subject to barriers dependent on their characteristics, health system functioning, legal requirements and a stereotyped and poor social consideration of immigrants, shared by professionals at the health centres. Meanwhile, provision of legal information and support by individual professionals, social organizations and personal networks represented main facilitators for accessing.

CONCLUSIONS

For the access of undocumented immigrants and immigrant women, structural and individual barriers based on their social vulnerability were found. Among others, gender-based violence reduced women's possibility to access healthcare services and being undocumented led to restricted access entitlement and to fear rejection at health centres. Therefore, besides ensuring immigrants' legal entitlement, there is need of promoting rights-based attention to get more inclusive health systems.

The association between social ties and depression among Asian and Pacific Islander undocumented young adults

BACKGROUND

The mental health of Asian and Pacific Islander (API) undocumented young adults has been understudied, despite an increasingly restrictive immigration climate that would ostensibly raise mental health risks. This study examined the role of social ties and depression among API undocumented young adults. We distinguished between two types of social ties, bonding and bridging, and additionally considered the absence of ties (e.g. isolation).

METHODS

We used primary data collected among 143 API undocumented young adults. We first identified correlates for each type of social tie and then examined the association for each measure with depression.

RESULTS

Higher levels of bonding and bridging ties were associated with lower odds of a positive depression screen. In contrast, isolation was associated with higher odds of a positive depression screen. There were no significant associations between total social ties and depression.

CONCLUSIONS

Our findings suggest that both bonding and bridging ties are important factors in the mental health of API undocumented young adults. Factors that facilitate these types of ties, such as DACA, can be effective interventions for improving mental health among this population.

Hardship Among Immigrants and the Native-born in the United States

This study examines the prevalence of several types of hardship (e.g., bill paying and housing hardships) among immigrants by race and ethnicity in the United States using data from the 2008 and 2014 panels of the Survey of Income and Program Participation and logistic regressions. I find that Blacks, and to some extent Hispanics, are more likely to report hardships than Whites and Asians, who are about equally likely to report hardships. Exploring results by nativity and citizenship status, I find that immigrants who became U.S. citizens are less likely than the native-born population to report some kinds of hardship. Undocumented immigrants, however, are more likely to report some kinds of hardships, particularly in the 2008 panel conducted at the time of the Great Recession, which hit immigrants especially hard; this relationship, however, is explained by the lower incomes of undocumented immigrant households in the 2008 panel. Results within racial and ethnic groups are generally in the same direction but are less frequently statistically significant. Overall, these findings suggest that immigrants are not particularly prone to hardship, especially when other characteristics are controlled for. In fact, the lower likelihood of some hardships among foreign-born citizens suggests that they are positively selected: they may have unobserved characteristics that are protective, such as better health, stronger social networks, or money management skills. Because the foreign-born are less likely to be disadvantaged vis-à-vis the native-born when hardship rather than the official income poverty measure is used, this study highlights the importance of using multiple measures when assessing the well-being of immigrants.

The (in)visible victims of disaster: Understanding the vulnerability of undocumented Latino/a and indigenous immigrants

As climate change advances, communities across the United States are adapting to the increased threat of wildfires, drought, heatwaves, and infectious diseases. Such disasters are expected to become more frequent and severe. Now more than ever, it is crucial to understand how these events amplify existing inequalities, and how to lessen the resulting harms. Differences in human vulnerability to disaster stem from a range of social, economic, historical, and political factors. We argue that given their social status, undocumented Latino/a and Indigenous immigrants are particularly vulnerable to disasters and require special consideration in disaster planning. They are disproportionately affected by racial discrimination, exploitation, economic hardships, less English and Spanish proficiency, and fear of deportation in their everyday lives- their pre-disaster marginalized status. In the case of the Thomas Fire in California's Ventura and Santa Barbara counties, we show that emergency response and recovery efforts ignored their needs. Resources were directed toward privileged individuals, leaving local immigrant rights and environmental justice groups to provide essential services such as language access to emergency information in Spanish and Indigenous tongues; labor protections for farmworkers endangered in the fields; and a private disaster relief fund for undocumented immigrants ineligible for federal aid. The article concludes with preliminary participant observations from the COVID-19 pandemic response in the region, indicating how lessons from the fire have informed official actions. As governments grapple with the increasing severity of disasters, understanding the differential impacts on undocumented immigrants can help improve disaster planning to protect the most vulnerable and stigmatized populations.

Receptionists, doctors, and social workers: Examining undocumented immigrant women's perceptions of health services

In this paper, we examine the attitudes, experiences, and perceptions of health care among unauthorized immigrant women in Philadelphia, Pennsylvania. Research on health care utilization among undocumented immigrants usually focuses on barriers to securing health care access, but little attention has been paid to how these barriers shape patients' experiences. Patients' experiences are important because they affect persistence in care seeking, adherence to treatment regimens, and self-reported health. Drawing from interviews with undocumented Mexican women, we find that receptionists, staff, and social workers play an important role in shaping women's perceptions of health care. In contrast to previous research which finds that negative experiences with providers lead undocumented immigrants to withdraw from seeking medical services, without fail, our respondents persisted and sought care elsewhere. This strategy ensured that all women eventually found care with which they were satisfied, but sometimes after significant delays.

Association between immigration status and anxiety, depression, and use of anxiolytic and antidepressant medications in the Hispanic Community Health Study/Study of Latinos

PURPOSE

The purpose of this study was to investigate the association between undocumented immigration status and anxiety, depression, and use of anxiolytic or antidepressant medications in the Hispanic Community Health Study/Study of Latinos.

METHODS

Cross-sectional analysis of data collected between 2014 and 2017. Participants were categorized as U.S.-born citizens, naturalized citizens, documented noncitizens, or undocumented noncitizens. We calculated prevalence and prevalence ratios for anxiety, depression, and use of anxiolytic or antidepressant medication, by immigration status.

RESULTS

Of 9257 participants, 1403 (15%) were undocumented noncitizens, 2872 (31%) were documented noncitizens, 3766 (41%) were naturalized citizens, and 1216 (13%) were U.S.-born citizens. Prevalence of anxiety was lower among undocumented than documented noncitizens (9 vs. 15%, P < .0001) but not significantly different in adjusted analyses. Prevalence of depression was similar among undocumented and documented noncitizens (20 vs. 24%, P = .07) and not significantly different in adjusted analyses. Among participants with depression, 7% of undocumented and 27% of documented noncitizens reported use of antidepressants (adjusted prevalence ratio 0.49, 95% CI 0.27-0.87).

CONCLUSIONS

Undocumented noncitizens had similar likelihood of anxiety and depression, but lower likelihood of antidepressant use, compared with documented noncitizens. These results may reflect the resilience of an undocumented population facing multiple stressors but suggest that this group may be undertreated for depression.

Sub-Saharan African immigrant women's experiences of (lack of) access to appropriate healthcare in the public health system in the Basque Country, Spain

Background

Immigrant populations face diverse barriers to accessing appropriate healthcare services on several levels. In the Basque Country, Sub-Saharan African women were identified as facing the largest barriers to access them. The aim of the study is to analyse Sub-Saharan African immigrant women's perceptions and experiences of access to appropriate healthcare in the public health system in the Basque Country, Spain.

Methods

Fourteen women from eight Sub-Saharan African countries who have used the Basque public healthcare services were interviewed. A qualitative content analysis was applied: meaning that units were identified, coded and the resulting codes were then organized into three categories.

Results

The first category, Fearing to enter a health system perceived as not friendly for immigrants, included factors, mainly those related to legal conditions for accessing healthcare services and lack of lawful documentation, that made women avoid or discontinue seeking out healthcare.

The second category, Being attended on professionals' own communication terms, comprised how the lack of effective communication compromised not only the access of the immigrant women to healthcare services, but also their health.

Lastly, the third category, Is mistreatment based on racism or merely on bad luck? described how being an immigrant and black influenced the way they were (mis)treated in the health system.

Conclusion

For Sub-Saharan African immigrant women, accessing appropriate healthcare in the Basque Country was perceived to be subject to institutional barriers. At the legal level, barriers included lack of entitlement, difficulties in fulfilling legal access conditions and lack of documentation. The lack of communication with health centre staff and their attitudes, guided by a stereotyped social image of immigrants and black people, also hindered their possibilities of receiving appropriate healthcare. Facilitators for accessing healthcare included strategies from individual professionals, personal networks and social actors to help them to cope with the barriers. There is a need of reinforcing inclusion values and rights-based approach to attention among staff at the health centres to have more non-discriminatory and culturally appropriate health systems.

Five Years Later: The Impact of a Hunger Strike on Undocumented Migrant Workers in Brussels

Five years after a hunger strike of undocumented migrant workers, participants were interviewed to find out about the long term consequences and what the post-factum evaluation of their participation was. A longitudinal observational study was set up, interviewing 46 of the 100 ex-hunger strikers and combining quantitative and qualitative research. This grassroots study shows that one out of six did not derive any benefit from their participation. Half regretted their participation, especially the ones who lost again their legal permit, mentioning health consequences and the fact that their situation hadn't improved. Given the growing number of asylum seekers around the world who are being refused legal permits, hunger strikes will remain a pressing topic. Health professionals, confronted with this possible health and life threatening action, should be informed about the long term impact of voluntary fasting on body and mind of ex-participants.

Health care service utilization of documented and undocumented hired farmworkers in the U.S

This article analyzes issues related to U.S. hired farmworkers' utilization of health care services and their specific choices among health care provider and health bill payment method options. Using data from the National Agricultural Workers Surveys for the years 2000-2012, this article employs propensity score matching and probit estimation techniques to examine the health care utilization of hired farmworkers. This study's results indicate that undocumented hired farmworkers are 10.7 and 3% less likely to use U.S. and foreign health care, respectively, compared to documented farmworkers. Health insurance is found to significantly increase hired farmworkers' use of U.S. health care by 22.3%. Notably, compared to their documented working peers, undocumented workers are much less likely to patronize private clinics. They are even less likely to rely on migrant health centers even when these providers are their most viable sources of health care service.

HBV molecular epidemiology and clinical condition of immigrants living in Italy

INTRODUCTION

We investigated 170 HBsAg-positive immigrants living in Italy for 1-7 years to ascertain whether they may have become infected in the host country.

METHODS

Of 2032 adult immigrants interviewed, 1727 (85%) voluntarily adhered to a screening program for bloodborne or sexually transmitted infections. HBsAg was detected in 170 (9.8%) screened immigrants who completed the diagnostic, clinical and therapeutic process at the nearest clinic of infectious diseases. HBV molecular biology was performed applying a homemade technology. Phylogenetic signal of the datasets was obtained by a likelihood-mapping analysis using TreePuzzle.

RESULTS

Of the 170 HBsAg-positive immigrants, 133 were inactive carriers, 29 had chronic hepatitis and 8 compensated cirrhosis. HBV genotype was identified in 109 of the 113 HBV-DNA-positive immigrants and HBV-genotype-E predominated (68.9%). Of these 109, 6 (5.5%) subjects showed an HBV genotype absent or extremely rare in their native country: HBV-genotype-E in three from Eastern Europe and in one from Sri Lanka, possibly acquired from other immigrants from sub-Saharan countries, HBV-genotype-D1 in one from Burkina Faso and one from Senegal, possibly acquired in Italy.

CONCLUSION

The data suggest that immigrants may acquire HBV infection in Italy and, therefore, HBV vaccination programs should be extended to all immigrants living in Italy.

Drinking and Driving Among Undocumented Latino Immigrants in Miami-Dade County, Florida

There is concern that by failing to understand fully the risks associated with driving under the influence (DUI), some Latino immigrants-undocumented in particular-may be overrepresented in alcohol-related crashes. Until now, data on undocumented immigrants has been absent. Data came from an ongoing longitudinal sample of Latino immigrants to Miami-Dade County, FL. Descriptive analyses and regression techniques were applied. Compared with permanent residents, undocumented drivers are more likely to binge drink, less likely to understand DUI laws, and less likely to perceive the risks associated with DUI-three factors largely associated with high DUI rates. Despite facing these risk factors, undocumented immigrants showed low DUI rates, partly due to their limited amount of driving. Differences in risk perceptions and actual DUI events between Latino immigrants of different residency statuses suggest the possibility of early interventions aimed at reducing DUI among Latino immigrants.

Trends in food insecurity among California residents from 2001 to 2011: Inequities at the intersection of immigration status and ethnicity

Although immigrants are healthier than non-immigrants on numerous outcomes, the reverse appears to be true with regards to food insecurity. Most studies ignore heterogeneity in the risk for food insecurity within immigration status and by ethnicity, even though significant variation likely exists. We consider how immigration status and ethnicity are related to trends in food insecurity among Latinos and Asians in California from 2001 through 2011. Data come from the 2001 to 2011 restricted California Health Interview Survey (n=245,679). We categorized Latinos and Asians as US-born, naturalized/legal permanent residents (naturalized/LPR), and non-LPRs (students, temporary workers, refugees, and undocumented persons). Multivariable weighted logistic regression analyses assessed temporal trends over the 10-year period after adjustment for demographics, socioeconomic characteristics, and program participation. Across this period, US-born Asians reported similar levels of food insecurity as US-born Whites. Conversely, Latinos, regardless of immigration status or nativity, and Asian immigrants (i.e., naturalized/LPR and non-LPR) reported greater food insecurity than US-born Whites. Further, from 2001 through 2009, non-LPR Latinos reported higher risk of food insecurity than naturalized/LPR Latinos. Thus, food insecurity differs between ethnic groups, but also differs within ethnic group by immigration status. Efforts to reduce food insecurity should consider the additional barriers to access that are faced by immigrants, particularly those without legal permanent residency.

Emerging from the database shadows: characterizing undocumented immigrants in a large cohort of HIV-infected persons

Little is known about how HIV affects undocumented immigrants despite social and structural factors that may place them at risk of poor HIV outcomes. Our understanding of the clinical epidemiology of HIV-infected undocumented immigrants is limited by the challenges of determining undocumented immigration status in large data sets. We developed an algorithm to predict undocumented status using social security number (SSN) and insurance data. We retrospectively applied this algorithm to a cohort of HIV-infected adults receiving care at a large urban healthcare system who attended at least one HIV-related outpatient visit from 1997 to 2013, classifying patients as "screened undocumented" or "documented". We then reviewed the medical records of screened undocumented patients, classifying those whose records contained evidence of undocumented status as "undocumented per medical chart" (charted undocumented). Bivariate measures of association were used to identify demographic and clinical characteristics associated with undocumented immigrant status. Of 7593 patients, 205 (2.7%) were classified as undocumented by the algorithm. Compared to documented patients, undocumented patients were younger at entry to care (mean 38.5 years vs. 40.6 years, p < 0.05), less likely to be female (33.2% vs. 43.1%, p < 0.01), less likely to report injection drug use as their primary HIV risk factor (3.4% vs. 18.0%, p < 0.001), and had lower median CD4 count at entry to care (288 vs. 339 cells/mm³, p < 0.01). After medical record review, we re-classified 104 patients (50.7%) as charted undocumented. Demographic and clinical characteristics of charted undocumented did not differ substantially from screened undocumented. Our algorithm allowed us to identify and clinically characterize undocumented immigrants within an HIV-infected population, though it overestimated the prevalence of patients who were undocumented.

From undocumented to lawfully present: Do changes to legal status impact psychological wellbeing among latino immigrant young adults?

Exclusionary immigration policies, as a form of structural racism, have led to a sizeable undocumented population that is largely barred from access to resources in the United States. Existing research suggests that undocumented immigration status detrimentally impacts mobility, yet few studies have tested the impacts of legal status on psychological wellbeing. Most importantly, we know little about how changes to legal status impact wellbeing. Announced in 2012, the Deferred Action for Childhood Arrivals (DACA) program allows eligible undocumented youth to apply for temporary lawful status. Drawing on cross-sectional survey data from 487 Latino immigrant young adults in California collected in 2014 and 2015, we analyze the predictors of three specialized outcomes related to immigrants' psychological wellbeing-distress, negative emotions, and deportation worry before and after a transition from undocumented to lawfully present status. Results show that retrospective reports of past psychological wellness, when all respondents were undocumented, are predicted primarily by socioeconomic status. However, reports of current psychological wellness are predicted by DACA status. Our results demonstrate, for the first time, the positive emotional consequences of transitioning out of undocumented status for immigrant young adults.

Trauma care in a multiethnic population: effects of being undocumented

BACKGROUND

Epidemiologic studies have shown that undocumented immigrants (UIs) display characteristics of having a low socioeconomic status and are primarily of ethnic minorities. These social determinants of health are known to be associated with diminished health care access and poor clinical outcomes. We therefore investigated the impact of documentation status on the clinical outcomes of patients with traumatic injuries.

MATERIALS AND METHODS

We conducted a retrospective review of the trauma registry at our safety net institution for all adult patients who were admitted from 2010 to 2014. UIs were identified by the absence of a valid social security number within their medical records. Multivariate regression analysis was used to determine the impact of documentation status on in-hospital mortality, length of stay (LOS), and the odds of rehab placement.

RESULTS

4924 trauma patients met the study criteria, of which 1050 (21.3%) were UIs. There was no significant difference in mortality rates between the two populations. Multivariate regression analyses revealed a longer average LOS and a decreased likelihood for placement in an in-patient rehabilitation facility following hospitalization for UIs, even after accounting for insurance, age, injury severity, and other possible confounders known to affect these outcomes.

CONCLUSIONS

There was no association between in-hospital mortality and documentation status; however, UIs had a longer average LOS and were less likely to be placed into rehab following their hospitalization. A longer LOS and a decreased likelihood for rehabilitation placement suggest that disparities in trauma care exist for UIs, putting them at risk for worse clinical and functional outcomes.

Pathogenic Policy: Immigrant Policing, Fear, and Parallel Medical Systems in the US South

Medical anthropology has a vital role in identifying health-related impacts of policy. In the United States, increasingly harsh immigration policies have formed a multilayered immigrant policing regime comprising state and federal laws and local police practices, the effects of which demand ethnographic attention. In this article, I draw from ethnographic fieldwork in Atlanta, Georgia, to examine the biopolitics of immigrant policing. I underscore how immigrant policing directly impacts undocumented immigrants' health by producing a type of fear based governance that alters immigrants' health behaviors and sites for seeking health services. Ethnographic data further point to how immigrant policing sustains a need for an unequal, parallel medical system, reflecting broader social inequalities impacting vulnerable populations. Moreover, by focusing on immigrant policing, I demonstrate the analytical utility in examining the biopolitics of fear, which can reveal individual experiences and structural influents of health-related vulnerability.

Riding with Impaired Drivers Among Recent Latino Immigrants in Southern Florida

In a previous effort we showed that compared with immigrants who are permanent residents, undocumented immigrants are more likely to binge drink, but less likely to drink while impaired (DWI) partly due to their limited amount of driving. This report examines a related risk: riding with an impaired driver (RWI). Data came from an ongoing longitudinal sample of Latino immigrants to Miami-Dade County, FL. Descriptive analyses and regression techniques were applied. While DWI rates among Latino immigrants is heavily limited by their access to a car, RWI rates were not restricted by driving limitations, nor related to participants' legal immigration status (LIS). RWI rates were linked only to heavy drinking. Because it is not affected by driving limitations, RWI for these Latino immigrants is perhaps a more immediate risk than DWI. Addressing RWI among Latino immigrants should be a priority for traffic safety to Miami/Dade country.

The Distress of Citizen-Children with Detained and Deported Parents

In immigration enforcement, many undocumented immigrants with children are often detained and deported. But it is their US-born citizen-children that have been overlooked in immigration debates and enforcement policies and practices. Citizen-children are at risk for negative psychological outcomes when families are fractured and destabilized by arrest, detention, and deportation. The children risk being torn from their parents and, often, their undocumented siblings. To add to the small but growing empirical base on the effects of living under the threat of deportation and actual deportation of parents, we compared the psychological status of three groups of citizen-children: (1) a group living in Mexico with their deported parents; (2) a group in the US with parents affected by detention or deportation; and (3) a comparison group of citizen-children whose undocumented parents were not affected by detention or deportation. We compared children on self-report and parent-report measures of behavioral adjustment, depression, anxiety, and self-concept. Across the three groups we found elevated levels of distress, and differences between children who had experienced a parent's detention or deportation and those who had not. We discuss findings in the context of children's clinical needs, future research, and implications for immigration enforcement policy and practices.

Dialysis for undocumented immigrants in the United States

The United States offers near-universal coverage for treatment of ESRD. Undocumented immigrants with ESRD are the only subset of patients not covered under a national strategy. There are 2 divergent dialysis treatment strategies offered to undocumented immigrants in the United States, emergent dialysis and chronic outpatient dialysis. Emergent dialysis, offering dialysis only when urgent indications exist, is the treatment strategy in certain states. Differing interpretations of Emergency Medicaid statute by the courts and state and federal government have resulted in the geographic disparity in treatment strategies for undocumented immigrants with ESRD. The Patient Protection and Affordable Care Act of 2010 ignored the health care of undocumented immigrants and will not provide relief to undocumented patients with catastrophic illness like ESRD, cancer, or traumatic brain injuries. The difficult patient and provider decisions are explored in this review. The Renal Physicians Association Position Statement on uncompensated renal-related care for noncitizens is an excellent starting point for a framework to address this ethical dilemma. The practice of "emergent dialysis" will hopefully be found unacceptable in the future because of the fact that it is not cost effective, ethical, or humane.

The impact and implications of undocumented immigration on individual and collective health in the United States

A nation of immigrants, the United States currently has more foreign-born residents than any other country; approximately 28% of these foreign-born residents are undocumented immigrants--individuals who either entered or are currently residing in the country without valid immigration or residency documents. The complex and constantly changing social, political, and economic context of undocumented migration has profound effects on individuals, families, and communities. The lack of demographic and epidemiologic data on undocumented immigrants is a major public health challenge. In this article, we identify multiple dimensions of vulnerability among undocumented persons; examine how undocumentedness impacts health and health care access and utilization; and consider the professional, practice, and policy issues and implications for nurses.