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Try out PMC Labs and tell us what you think. Learn More. The current study is part of a research project at the Norwegian Institute of Public Health. The datasets generated and analysed during this study are not publicly available due to data protection stipulations, but can be made available on a remote access platform to researchers who become project members. Alternatively, these data can be reconstructed anew by applying to each registry. research has generally found lower rates of injury incidence in immigrant populations than in native-born populations.

Most of this literature relies on mortality statistics or hospital data, and we know less about injuries treated in primary health care. The aim of the present study was to assess use of primary and secondary care for treatment of injuries among immigrants in Norway according to geographic origin and type of injury. This cohort was followed through by linking sociodemographic information and injury data from primary and secondary care.

We grouped immigrants into six world regions of origin and identified immigrants from the ten most frequently represented countries of origin. Poisson regression models were fitted to estimate incidence rate ratios separately for injuries treated in primary and secondary care according to immigrant status, geographic origin and type of injury, with adjustment for sex, age, county of residence, marital status and socioeconomic status.

Rates were lower in immigrants for most injury types, and in particular for fractures and poisoning. For a subset of injuries treated in secondary care, we found that immigrants had lower rates than non-immigrants for treatment of self-harm, falls, sports injuries and home injuries, but higher rates for treatment of assault, traffic injuries and occupational injuries. Health care utilisation for treatment of injuries in primary and secondary care in Norway was lower for immigrants compared Seeking a female Elrod Alabama conversation partner non-immigrants.

Like many other European countries, Norway has witnessed a rapid growth in immigration in recent decades. In the capital Oslo, one in three inhabitants had an immigrant background as of January This ongoing demographic change warrants an increased focus on health outcomes of immigrants and their use of health care services Orcutt et al. In this study, we assess one aspect of migrant health in Norway by examining risk of injury.

Injuries remain a major public health challenge, being a leading cause of death for young people worldwide and placing a substantial burden on health care services Polinder et al.

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Research in developed countries comparing injury risk between immigrants and their native-born counterparts has generally found lower incidence rates in immigrant populations Schwebel et al. This advantage occurs despite the presence of various risk factors that ordinarily correlate with worse health outcomes, like lower socioeconomic position Mackenbach et al. Most of the literature exploring injury risk in immigrant populations relies on mortality statistics or hospital data.

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research has shown that a substantial proportion of injured patients in Norway are treated in primary care, either by general practitioners GPs or in out-of-hours emergency primary health care EPHC Ohm et al. This study further showed a different epidemiological pattern for injuries treated exclusively in primary care, in terms of demographic profile age and gender distributions of injured patients and the types of injuries that predominate.

These findings, combined with indications that some immigrant groups may have limited knowledge about the health care system in their host country and may experience barriers to seeking primary health care Norredam et al. Evidence of such differences in utilisation may in turn call for strategies that ensure equity in access to and quality of health services. The main purpose of the current study was to examine injury risk among adult immigrants in Norway, and investigate whether there are differences in their use of primary and secondary care for treatment of injuries.

We first included all immigrants in one group and compared incidence rates of injuries treated in primary and secondary care in the period — to those of non-immigrants, taking into several sociodemographic variables. In this cohort study, we linked sociodemographic information supplied by Statistics Norway with injury diagnoses retrieved from health registers at the individual level using unique personal identification s given to all residents.

We limited the study sample to this age range as younger age groups may not have obtained a stable socioeconomic status, and many older residents receive no labour income. Immigrants in this study were defined as individuals who were born abroad by two foreign-born parents, and were compared to all other residents, here termed non-immigrants.

For injuries treated in primary care, we obtained data from the Norwegian Health Economics Administration database, which contains all electronic reimbursement claims sent by primary care providers in Norway. In this study, only reimbursements from medical doctors were included. For injuries treated in secondary care, we used data from the Norwegian Patient Registry NPRwhich covers all inpatient, day patient and outpatient specialist health services in Norway. Analyses in both primary and secondary care were restricted to contacts where an injury was the principal diagnosis i.

In the period —, a subset of the injuries treated in secondary care contains additional information about the external circumstances of the injury intent, place of occurrence, activity, mechanism etc. Based on this information, these injuries were further classified into the following : self-harm, assault, falls, traffic injuries, occupational injuries, sports injuries and home injuries. We included the following sociodemographic variables as covariates all based on information as of January 1st : sex, age, county of residence, marital status and socioeconomic status SES.

County of residence was included to for potential geographical variation in demographic composition, risk factors and health care utilisation of immigrants, combined with differences in the way emergency care is organised between treatment levels locally. We next divided income earned in into nine quantiles, and then summed these two scores for each individual, yielding a composite score ranging from two to We finally divided this composite score into quintiles.

We first performed descriptive analyses for the sociodemographic variables by immigrant status immigrants vs. To obtain person-time at risk, each individual was followed from January 1st until first registration of an injury diagnosis, date of emigration, date of death or December 31st end of follow-upwhichever occurred first. Crude incidence rates were calculated as Seeking a female Elrod Alabama conversation partner of injury events divided by the sum of person-time at risk. Observation times and incidence rates were calculated separately for injuries treated in primary and secondary care, regardless of injury diagnoses registered in the other treatment level in the same individual.

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We then estimated IRRs for injury according to region of origin and for ten specific countries of origin, compared with non-immigrants. Finally, for a subset of injuries treated in secondary care where information about external circumstances was available, we computed corresponding IRRs separately for self-harm, assault, falls, traffic injuries, occupational injuries, sports injuries and home injuries.

The cohort comprised 2, adults, of whom The immigrant population was generally younger, in particular for those originating from Africa and Asia, and more likely to be married compared with non-immigrants. Immigrants from Africa and Asia had the highest proportions of individuals in the lowest quintile of SES score. Compared to non-immigrants, immigrants from all regions were more likely to reside in the capital of Oslo, especially for those originating from Africa and Asia. Crude sociodemographic characteristics by immigrant status and region of origin. N and distribution percent.

Of the entire cohort,individuals For both non-immigrants and immigrants, crude incidence rates were higher for men than for women, but showed no clear pattern by age Table 3. As for SES, rates were lowest for those in the highest quintile, but the socioeconomic gradient was much weaker for immigrants. Incidence rates for immigrants from the Americas and Oceania were comparable to non-immigrants. Table 4 shows adjusted IRRs for injuries treated in primary and secondary care according to country of origin for ten specific countries, with non-immigrants as the reference.

In both primary and secondary care, incidence rates were lowest for immigrants from Vietnam. Immigrants from Bosnia-Herzegovina, Iraq and Pakistan also had low rates. Immigrants from Denmark, Sweden and Germany had higher rates than non-immigrants for injuries treated in secondary care, but not for injuries treated in primary care. For most countries, IRRs were lower for injuries treated in primary care than for injuries treated in secondary care, and this difference was considerable for immigrants from Poland and Somalia. Injured patients and incidence rate ratios aby treatment level and country of origin.

Table 5 shows that immigrants had lower incidence rates than non-immigrants for treatment of most injury types, and in particular for poisoning and fractures. Rates for treatment of poisoning were especially low for immigrants originating from Africa, while immigrants from Asia had the lowest rates for treatment of fractures.

Burns was the only injury category where immigrants had higher rates than non-immigrants, although only for treatment in secondary care. Rates for treatment of burns were especially high for immigrants from Asia. For most injury types, IRRs in immigrant groups combined compared with non-immigrants were lower for injuries Seeking a female Elrod Alabama conversation partner in primary care than for injuries treated in secondary care.

This difference was most pronounced for treatment of superficial injuries and open wounds Table 5. Information about external circumstances was available for Table 6 shows adjusted IRRs for this subset by injury type. Immigrants also had lower incidence rates than non-immigrants for treatment of falls, sports injuries and home injuries. Higher rates for immigrants than non-immigrants were observed for treatment of injuries caused by assault, traffic injuries and occupational injuries. Rates for treatment of injuries caused by assault were especially high for immigrants originating from Africa, with a twofold higher risk compared to non-immigrants.

To our knowledge, this register study is the first to include the full spectrum of medically treated injuries to explore injury risk in immigrant populations. The show both similarities and differences in the way adult immigrants in Norway seek primary and secondary care for treatment of injuries.

Overall, observed injury incidence was lower for immigrants than non-immigrants both for injuries treated in primary and secondary care. However, we also found notable differences in injury incidence between primary and secondary care in the immigrant population. Compared with non-immigrants, the relative risk of injury in immigrants was generally lower for injuries treated in primary care than in secondary care. In fact, immigrants from some regions e. Consistent with past research Schwebel et al.

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However, with increasing duration of stay in the host country, this health advantage gradually diminishes as a consequence of changes in lifestyle and adverse socioeconomic conditions World Health Organization As poor health is a risk factor for injuries Hong et al. Other potential explanations may include differences in risk-taking behaviour between the immigrant population and the host population, or different thresholds for seeking medical attention in the case of symptoms of illness and injury. On its own, our register study cannot adjudicate between these alternative explanations.

However, Seeking a female Elrod Alabama conversation partner finding that the difference in injury incidence between immigrants and non-immigrants was larger for treatment in primary care suggests that the threshold for seeking medical attention for injuries may be higher among immigrants. These injuries are usually less severe than injuries requiring specialist care, and are more susceptible to individual considerations about whether or not to seek medical treatment.

However, this observed difference could also reflect language barriers or practical barriers in access to primary care, a general dissatisfaction with primary health care services, or poor knowledge and insufficient information about the organisation of the health care system. In support of the latter explanation, a Norwegian study reported lower utilisation of GPs but higher utilisation of EPHC among immigrants compared to non-immigrants Diaz et al.

Most likely, differences in health care utilisation such as those suggested in our study are multifaceted and the product of a combination of factors. Our findings also provide further documentation of the heterogeneity of the immigrant population, as injury incidence differed considerably between regions and countries of origin. In accordance with other studies Aamodt et al. Our study also corroborates earlier findings from Scandinavian and other Western countries showing lower risk of poisoning Saunders et al. Our analyses of the external circumstances in a smaller subset of injuries treated in secondary care reveal yet more heterogeneity in injury risk among immigrants.

Consistent with past research, we found that immigrants had lower risk of injuries caused by self-harm than non-immigrants, but higher risk of injuries caused by assault Norredam et al. Our study also adds to an extensive literature showing higher rates of occupational injuries among immigrants Salvatore et al. Risk of sports injuries, on the other hand, was lower for immigrants Seeking a female Elrod Alabama conversation partner non-immigrants.

Explanation of such differences will likely need to invoke a variety of factors, including biological, cultural and social factors. Less substance abuse among immigrants Adebe et al. Higher rates of occupational injuries among immigrants may be explained by a higher risk of occupational hazards, combined with language barriers and inadequate safety training Moyce and Schenker Regardless of mechanisms, a novel feature of the present study is that many of these findings applied to treatment in both primary and secondary care, suggesting that differences according to immigrant status are robust and common for a wide range of injury severity.

Additional strengths of this study include the use of population-based registers and the ability to control for important sociodemographic confounders at the individual level. An important limitation, however, is that only immigrants eligible for residency i. Consequently, this study does not include temporary or undocumented immigrants, who may be characterised by a different risk profile for injuries.

For this reason, our findings do not necessarily generalise to the entire population of immigrants in Norway. Likewise, our analyses of the external circumstances in a smaller subset of injuries treated in secondary care are primarily based on data from the capital Oslo and may not be representative for the whole country.

Another limitation concerns our method of calculating incidence rates, which may not necessarily reflect the true incidence of injury. As some patients undergo treatment for the same injury in both primary and secondary care i. On the other hand, this method will not capture separate injury events occurring in an individual within the same treatment level during the observation period. For this reason, it is more precise to describe these estimates as rates of contact, as they reflect health care utilisation rather than true injury incidence. However, we do not expect that these sources of misclassification differ systematically according to immigrant status.

Another avenue for future research involves assessing whether health care utilisation among immigrants differs by type of service i. EPHC in primary care and inpatient vs.

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In order to understand the mechanisms or pathways for the observed patterns in injury incidence, it would also be worthwhile to examine how differences in health care utilisation according to immigrant background is mediated by age, gender and other important sociodemographic variables.

Finally, we do not know if our findings extend to children and older adults, nor how health care utilisation for treatment of injuries differs between immigrants and their descendants. In both primary and secondary care, health care utilisation for treatment of injuries in Norway was lower for immigrants compared to non-immigrants. Injury incidence among immigrants was lowest for treatment of fractures, poisoning, self-harm and sports injuries.

Data from the Norwegian Patient Register have been used in this publication. The interpretation and reporting of these data are the sole responsibility of the authors, and no endorsement by the Norwegian Patient Register is intended or should be inferred.

EO conceived and deed the study, conducted the analyses and drafted the manuscript. KH, MKRK and CM participated in the de of the study, contributed to the interpretation of the findings and critically revised the manuscript. All authors read and approved the final manuscript. This research was internally funded and received no specific grant from any funding agency.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Eyvind Ohm, : on. Kristin Holvik, : on. Christian Men, : on. National Center for Biotechnology InformationU. Journal List Inj Epidemiol v.

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