With over one billion people on the move globally, the healthcare of international migrants is increasingly important in the design and delivery of health services. Critically, healthcare is a human right and the recently published UCL-Lancet commission on migration and health emphasises that international migrants should be able to access healthcare as easily as non-migrants. In England, 15.6% of the population (8.6 million people) were born in another country and moved to England either for work, to study, to join families, or to flee persecution and conflict. The health service uptake by this group is poorly studied and it is unclear if their health needs are being adequately met.
This study will use a dataset that links general practice (GP) records, hospital-based healthcare, and death statistics. Our research will initially investigate the potential to study health service uptake by individuals who have experienced migration in English electronic health records. If data are available and of sufficient quality, we will then (a) describe patterns and costs of using general practice and hospital-based healthcare services (b) describe deaths registered in England and their causes. We will study each of these in detail according to disease sub-conditions including diseases resulting in preventable hospital admissions, sexual and reproductive health conditions/interventions, and mental illness. This project is based on research priorities and acceptability of research methods established through patient and public involvement work with international migrants.
With this information, we will make recommendations to improve policies affecting how services are delivered to meet the needs of international migrants as well as providing a way of studying migration health for other researchers.
International migrants are defined as people that move countries either by choice (for work, study or family reasons) or due to conflict, persecution and natural disasters (e.g. refugees and asylum seekers). Despite 8.6 million people or 15.6% of the English population being classed as international migrants, there are no large-scale studies of their health service uptake and it is therefore unclear whether there is an unmet need within this population. Existing studies are limited by small sample sizes or the use of proxy markers for migration e.g. ethnicity. Our research group is currently conducting a large linkage study of migrant records held at Public Health England to Hospital Episodes Statistics (HES) and Office for National Statistics (ONS) mortality data - the Million Migrants study. A major limitation of the Million Migrants study is that it does not include any primary care data, and therefore provides an incomplete picture of health status and health service usage.
In this study, we will use routinely collected data from CPRD linked to HES and ONS mortality data under the existing UCL license. The first stage of the study will be to assess and evaluated the suitability of using codes for migration in primary care data to study health service uptake by individuals who have experienced migration. If quality and completeness of data permit, we will then examine (a) the pattern and costs of primary and secondary healthcare resource utilisation (b) mortality in the migrant cohort compared to non-migrants. We will describe the patterns and costs by identifying existing health conditions and examining primary and secondary care consultations and admission. We will explore all outcomes according to sub-conditions including preventable causes of inpatient admission, sexual and reproductive health conditions/interventions and mental illness. These have been identified as research priorities through patient and public involvement.
The findings of this study would address the gaps identified in migrant health research as well as define a migrant phenotype which will be made available for other researchers to use in migration health studies of primary data. Findings will be disseminated to a wide range of stakeholders and used to inform policy recommendations to ensure equitable access to health services for this potentially underserved group.
The outcomes listed in this section relate to the full study outlined. These will only be completed if the feasibility
study on the development of a migrant phenotype is thought to have sufficient validity in order to proceed further. We have chosen outcomes to be in line with another linkage study on migrant health resource utilisation, the Million Migrants study(1) to allow for triangulation of results. These outcomes are of high interest to researchers, health policy makers as well as the international migrants that attended our patient and public involvement workshops.
Primary outcomes
1. Health resource utilisation of primary care:
a. Consultations (GP, practice nurse, face to face, telephone)
b. Prescriptions
c. Referrals to secondary care
d. Missed GP appointments
e. Diagnosis of existing health conditions (by sub-groups of conditions)
2. Health resource utilisation of secondary care:
a. Hospital attendances (inpatient, outpatient, A&E) attendances
b. Hospital admissions (inpatient)
c. Duration of hospital admission
d. 30 day emergency readmissions
e. Missed outpatient appointments
f. Missed procedures
g. Diagnosis of existing health conditions (by sub-groups of conditions)
Secondary outcomes
1. All-cause mortality
2. Cause-specific mortality (by ICD-10 chapter)
3. Avoidable, amenable and preventable mortality
All outcomes will be explored by sub-groups of health conditions relating to avoidable causes of death, sexual and reproductive health conditions and mental health conditions. These are described in detail in Section N. Exposures, outcomes and covariates.
Robert Aldridge - Chief Investigator - University College London ( UCL )
Robert Aldridge - Corresponding Applicant - University College London ( UCL )
Alexandra Pitman - Collaborator - UCL Division of Psychiatry
Andrew Hayward - Collaborator - University College London ( UCL )
Arturo Gonzalez-Izquierdo - Collaborator - University College London ( UCL )
Caroline Minassian - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Claire Zhang - Collaborator - University College London ( UCL )
Harry Hemingway - Collaborator - University College London ( UCL )
Muhammad Qummer ul Arfeen - Collaborator - University College London ( UCL )
Neha Pathak - Collaborator - University College London ( UCL )
Pam Sonnenberg - Collaborator - University College London ( UCL )
Parth Patel - Collaborator - University College London ( UCL )
Rachel Burns - Collaborator - University College London ( UCL )
Spiros Denaxas - Collaborator - University College London ( UCL )
Yamina Boukari - Collaborator - University College London ( UCL )
CHESS (Hospitalisation in England Surveillance System);HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation;SGSS (Second Generation Surveillance System);COVID-19 Linkages