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Open Access Research article

Hospital admissions in Alicante (Spain): a comparative analysis of foreign citizens from high-income countries, immigrants from low-income countries, and Spanish citizens

José M Ramos12*, Eva M Navarrete-Muñoz34, Hector Pinargote1, Jaume Sastre5, José M Seguí26 and María J Rugero7

Author Affiliations

1 Department of Internal Medicine, Hospital General Universitario de Alicante, Alicante, Spain

2 Department of Clinical Medicine, Miguel Hernández University of Elche, Alicante, Spain

3 Department of Public Health, Miguel Hernández University of Elche, Alicante, Spain

4 CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain

5 Department of Admissions and Documentation, Hospital General Universitario de Alicante, Alicante, Spain

6 Department of Internal Medicine, Hospital Universitario de San Juan, Alicante, Spain

7 Department of Admissions and Documentation, Hospital Universitario de San Juan, Alicante, Spain

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BMC Health Services Research 2013, 13:510  doi:10.1186/1472-6963-13-510

Published: 9 December 2013

Abstract

Background

Over the last decade, the number of foreign citizens (FCs) in Spain has increased. There is no doubt that their health has become a relevant subject from the point of view of public healthcare. Our study aimed to describe hospital admission rates, diagnoses at hospital discharge, and mortality during hospital admissions in FCs from high-income countries (FCHICs), FCs from low-income countries (FCLICs), and autochthonous citizens (ACs).

Methods

A cross-sectional study was performed at two public hospitals in the city of Alicante (Spain) and its surrounding area. Utilization rates were estimated. Multivariate analysis adjusting for age and sex was performed on hospital admission rates, diagnoses at hospital discharge, service of admission, and mortality during hospital admission in FCHICs and FCLICs compared with ACs (adjusted odds ratio [AOR] with 95% confidence intervals [CI]).

Results

42,839 patients ≥15 years were discharged from the hospitals. The utilization rate was lower in FCs than ACs, whose crude rate ratio was 0.676 (95% CI: 0.656-0.696). FCHICs had more risk of being diagnosed at discharge in the categories of the circulatory system (AOR: 1.55; 95% CI: 1.35-1.77), neoplasms (AOR: 1.21; 95% CI: 1.03-1.42), and injury and poisoning (AOR: 1.33; 95% CI: 1.11-1.58). FCLICs had more risk of being diagnosed in the categories of pregnancy, childbirth & puerperium (AOR: 1.33; 95% CI: 1.29-1.59), and injury and poisoning (AOR: 1.19; 95% CI: 1.03-1.36), and less risk in the mental disorder category (AOR: 0.32; 95% CI: 0.22-0.45). The length of hospitalization (in days) was lower in FCLICs (median: 3; IQR: 2–6) than both ACs (median: 4; IQR: 2–8) and FCHICs (median: 4; IQR: 2–8) (p < 0.001). The mortality rates on admission of ACs, FCHICs, and FCLICs were 4.2%, 3.3%, and 1.3%, respectively, but after adjusting for age and sex, the mortality rate risks were similar in FCHICs and FCLICs.

Conclusion

First, FCs utilized hospitalization less when compared with ACs. Second, the hospitalization profile for FCHICs was similar to ACs, with more problems in the circulatory system, and the hospitalization profile for FCLICs was different compared with ACs, with more admissions for pregnancy, childbirth & puerperium.

Keywords:
Immigrants; Foreigners; Public hospitals; Morbidity; Citizens; Low-income countries; High-income countries; Hospitalization