Migrants' primary care utilisation before and during the COVID-19 pandemic in England: An interrupted time series analysis

Claire X Zhang; Yamina Boukari; Neha Pathak; Rohini Mathur; Srinivasa Vittal Katikireddi; Parth Patel; Ines Campos-Matos; Dan Lewer; Vincent Nguyen; Greg C G Hugenholtz; Rachel Burns; Amy Mulick; Alasdair Henderson; Robert W Aldridge

doi:10.1016/j.lanepe.2022.100455

Migrants' primary care utilisation before and during the COVID-19 pandemic in England: An interrupted time series analysis

Lancet Reg Health Eur. 2022 Sep:20:100455. doi: 10.1016/j.lanepe.2022.100455. Epub 2022 Jun 30.

Authors

Claire X Zhang^{1

2

3}, Yamina Boukari^{1

2}, Neha Pathak^{1

4}, Rohini Mathur⁵, Srinivasa Vittal Katikireddi⁶, Parth Patel¹, Ines Campos-Matos^{2

7}, Dan Lewer⁸, Vincent Nguyen^{1

8}, Greg C G Hugenholtz¹, Rachel Burns¹, Amy Mulick⁵, Alasdair Henderson⁵, Robert W Aldridge¹

Affiliations

¹ Institute of Health Informatics, University College London, 222 Euston Rd, London NW1 2DA, United Kingdom.
² Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London SW1H 0EU, United Kingdom.
³ National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford OX3 7LF, United Kingdom.
⁴ Guy's & St Thomas's NHS Foundation Trust, London SE1 9RT, United Kingdom.
⁵ Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.
⁶ MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley Street, Glasgow G3 7HR, United Kingdom.
⁷ UK Health Security Agency, Wellington House, 133-155, Waterloo Road, London SE1 8UG, United Kingdom.
⁸ Institute of Epidemiology and Health Care, University College London, 1-19 Torrington Place, London WC1E 7HB, United Kingdom.

Abstract

Background: How international migrants access and use primary care in England is poorly understood. We aimed to compare primary care consultation rates between international migrants and non-migrants in England before and during the COVID-19 pandemic (2015-2020).

Methods: Using data from the Clinical Practice Research Datalink (CPRD) GOLD, we identified migrants using country-of-birth, visa-status or other codes indicating international migration. We linked CPRD to Office for National Statistics deprivation data and ran a controlled interrupted time series (ITS) using negative binomial regression to compare rates before and during the pandemic.

Findings: In 262,644 individuals, pre-pandemic consultation rates per person-year were 4.35 (4.34-4.36) for migrants and 4.60 (4.59-4.60) for non-migrants (RR:0.94 [0.92-0.96]). Between 29 March and 26 December 2020, rates reduced to 3.54 (3.52-3.57) for migrants and 4.2 (4.17-4.23) for non-migrants (RR:0.84 [0.8-0.88]). The first year of the pandemic was associated with a widening of the gap in consultation rates between migrants and non-migrants to 0.89 (95% CI 0.84-0.94) times the ratio before the pandemic. This widening in ratios was greater for children, individuals whose first language was not English, and individuals of White British, White non-British and Black/African/Caribbean/Black British ethnicities. It was also greater in the case of telephone consultations, particularly in London.

Interpretation: Migrants were less likely to use primary care than non-migrants before the pandemic and the first year of the pandemic exacerbated this difference. As GP practices retain remote and hybrid models of service delivery, they must improve services and ensure primary care is accessible and responsive to migrants' healthcare needs.

Funding: This study was funded by the Medical Research Council (MC_PC 19070 and MR/V028375/1) and a Wellcome Clinical Research Career Development Fellowship (206602).

Keywords: COVID-19; Consultation; General practice; Healthcare access; Healthcare utilisation; Migrant; Primary care.

Abstract

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