Desigualdades en salud en los grupos de inmigrantes viviendo en la Comunidad Autónoma del País Vasco

Abstract

Background: the great diversity of situations associated with the characteristics of migration and living conditions of immigrants in host countries puts us in a field of study with great complexity. The study of health and utilization of health services by the immigrant population, requires us to explore the influence of social determinants of health inequalities so as to facilitate the determination of what the mechanisms by which they occur are and what initiatives should be developed to improve equality in health and health services for these communities. Objective: the overall objective of this thesis is to analyze health inequalities by place of birth and its main determinants in immigrants from China, Latin America, North Africa and Senegal who live in the Basque Country. Specific objectives include: 1) identifying the social determinants that explain differences in the perceived health status of the immigrants studied, 2) identify knowledge about HIV in immigrants studied, 3) to identify the social determinants that explain the differences in the use of health services by the group of immigrants studied. In summary, we will be identifying the social determinants that explain differences in the perceived health status, knowledge about HIV and the use of health services among Immigrants from China, Latin America, North Africa and Senegal who live in the Basque Country. Methods: we conducted a descriptive study based on data from the Health Survey of the Basque Immigrant Population, 2009 (ESPICAV-09) which included 765 immigrants, 237 from Maghreb (63% male and 37% female) 74 (men) from Senegal, 368 from Latin America (39% male and 61% female) and 86 from China (50% male and 50% female). There was an Odds ratio (95% CI) from logistic regression models were used to measure the association between the dependent variables: the perceived state of poor health, inadequate knowledge about HIV (including transmission and prevention and where diagnostic testing is available) and use of health services (Primary Care and Hospital Emergency) with independent variables. Statistical analysis was performed using SPSS (version 19). Results: the factors associated with the perceived status of poor health of those who come from Africa (Maghreb and Senegal), included being female, being unemployed, a lack of social support and having perceived discrimination. The effect of low social support, perceived discrimination and difficulty understanding Spanish was higher in women. Those at greatest risk of possessing inadequate knowledge about HIV were associated with place of birth (from Maghreb and China), women with low educational level, being in an irregular situation, having difficulty understanding Spanish, not having heard about STIs and not have received medical advice about AIDS from primary care services. Factors associated with the use of health services for primary care included: place of birth, with a significant positive relationship for people born in Maghreb and negative for those born in Senegal and China. Being female, having a poor perceived health status and having perceived discrimination in healthcare increased the likelihood of using the services of Primary Care. The administrative irregularity and lower educational level were associated with a lower likelihood of using this level of care. The differences in the probability of using emergency services related to the birthplace included a significant positive relationship for people born in Senegal. Being female was also associated with a greater likelihood of using this level of care, as well as having perceived poor health. Conclusions: the results highlight the importance of structural and intermediate determinants, such as psychosocial factors and discrimination in poor health perceived differences and in the use of health services and knowledge about HIV. The results indicate the need to develop policies to reduce social inequalities in health for those considered on the unequal axis who are less able to identify opportunities to enjoy good health. In addition to necessary initiatives to promote equality in health services, including clinical guidelines on the specific needs of different groups of immigrants and integration of their gender. Measures that can help in the case of HIV include increasing the perception of risk, reducing stigma and discrimination and improving the accessibility and acceptability of HIV testing which would thus reduce the number of HIV infections and delay in diagnosis