Emergency department utilization rates and modalities among immigrant population. A 5-year survey in a large Italian urban emergency department

The rates and modalities of healthcare services utilization for migrant population may differ from natives, since the health needs of the former are influenced by some factors such as health status, self-perceived needs, healthseeking behavior, language barriers and cultural differences. Only scarce and often conflicting data have been published so far on migrants’ utilization of healthcare services in Europe, and even less data are available on emergency departments (EDs). The aim of this cross-sectional study was to compare utilization rates and modalities of presentation to the large urban ED of the University Hospital of Parma, Italy (averaging 85,000 visits per year), by Italian native and foreign-born populations during 2008-2012. Throughout the study period 424,466 ED visits were recorded, 64,435 (15.4%) of which by foreign-born patients. A significant difference between utilization rates was observed for all the triage-codes, with higher rates for foreign-born low-acuity codes (green plus white codes: 87.5 vs 73.9, P<0.0001) and lower rates for high-acuity codes (yellow plus red codes: 12.5 vs 26.1%, P<0.0001). The utilization rate was 253.9 visits per 1000 inhabitants for the Italian-native group and 309.7 per 1000 for the foreign-born group (odds ratio 1.23; 95% CI: 1.01-1.48; P=0.034). Different modalities of presentation were also observed, with a high rate of selfreferrals (82.3 vs 71.4%, P<0.001). The results of this study suggest that a better knowledge of available Italian healthcare services among immigrants is advisable and should be encouraged.