Access to preventive health services of migrants in five EU countries

Abstract

Background: The goal of preventive health care services (PHS) is to reduce morbidity and mortality through the prevention or detection of disease. Migrants have different lifestyles, health beliefs and risk factors. This may influence access to health services and participation in prevention programs. The objective of the study is to compare the use of PHS between migrants and native populations in five EU countries: Belgium, Italy, Malta, Portugal and Spain. Methods: We analysed four indicators according to the ‘‘European Core Health Indicators’’ definitions, namely access to mammography, cervical smear test, colorectal cancer screening and flu vaccination. These indicators were calculated for nationals, migrants with EU and Non-EU citizenship. These were then analysed using logistic regression. Odds Ratios (OR) with limits of 95% confidence interval were calculated, using nationals as reference. Data from the Health Interview Surveys were used, respectively 2008 for Malta, 2011 for Spain, 2012-13 for Italy, 2013 for Belgium and 2014 for Portugal. Results: Overall 163,763 subjects were interviewed, with 2% of EU migrants and 4% non-EU migrants. The risks, in terms of OR, to have a poorer access to mammography was 2.5 (2.0-3.1) for migrants from EU and 2.6 (2.1-3.1) for migrants from non EU countries; to cervical smear test was 1.5 (1.3-1.6), and 1.7 (1.6-1.9); to colorectal cancer screening was 1.4 (1.1-1.7) and 2.1 (1.7-2.5); to flu vaccination was 3.1 (2.4-3.9) and 5.7 (4.7-6.9). The OR were similar among selected EU countries for Cervical smear test and colorectal screening, higher variability was observed for mammography and flu vaccination, with higher risks in Italy and lower in Belgium. Conclusions: The use of PHS is significantly reduced among migrants, particularly for those coming from non-EU countries. This may lead to the deterioration of health status, particularly among the most vulnerable people.