Original ResearchThe burden of chronic noncommunicable diseases in undocumented migrants: a 1-year survey of drugs dispensation by a non–governmental organization in Italy
Introduction
Data on the health status and health needs of undocumented migrants are scarce and generally limited to subjects seen in the Emergency Department1, 2 or on the field.3 This is true for Italy and, in general, for all European Union (EU) countries, in spite of the fact that irregular migration to Europe, escaping from war, poverty and religious or political persecution, is continually growing.4
Actually, undocumented migrants find many obstacles in obtaining health care with the exception of emergency and primary services, provided free of charge to all by most EU countries.5
Many studies have acknowledged for decades the so-called ‘healthy migrant effect’, meaning that foreign-born people have better health status than their native-born counterparts when arriving in the destination country.6, 7 This concept has undergone some criticism. First, it is possible that this difference is lost after some years of permanence in the host country.8 Second, significant health status differences seem to exist within the migrant population, for example between refugees and labour and education migrants, upon arrival in the host country.9 Thus, the possibility exists that, on the contrary of what was initially thought, the prevalence of chronic diseases in undocumented migrants is very high. This appears particularly the case for cardiovascular risk factors, as it has been recently pointed out by a consensus document of an ad hoc Working Group of the European Society of Hypertension.10
Their status itself might have a negative impact on their health and well-being; moreover, limitations in the access to care could exacerbate their physical and mental illnesses.11
These issues are difficult to investigate in the population of undocumented migrants. For these persons, no data are available in public registers and they are difficult to obtain for many reasons (unwillingness to be registered, unavailability of a defined residence, poor adherence to treatments, language barriers, etc). This is reflected in the available literature, which, as previously pointed out, is mainly based either on surveys of emergency health problems1, 2, 3 or on very thorough studies of a very small number of subjects.11
These considerations can explain why data on the health conditions and needs of undocumented migrants are so scant in the literature. Therefore, we have tried to obtain a picture of the health status of a large population of undocumented migrants by assessing the therapies that they receive from a major Italian Charity. This method, which has already been useful in giving us preliminary insights,12 is especially useful if a clear correlation exists between a given drug (or group of drugs) and a certain disease and when prescriptions are necessary rather than discretionary.13 It is increasingly used in pharmacoepidemiological studies in different medical settings14, 15 and has recently been employed to evaluate the purchase of medicines by regular migrants in EU countries.16 In the present study, we used it to carry out a prospective 1-year survey in a population of undocumented migrants receiving medical assistance by a major Charity in Milan, Italy, with two aims. First, we tried to get a measure of the burden of chronic noncommunicable diseases in these subjects; second, we evaluated if race-related differences exist among the various ethnic groups of undocumented migrants.
Section snippets
Methods
For this study, we used the data on drug dispensation obtained from the pharmacy of the Opera San Francesco (OSF), a major non–governmental organization (NGO) in Milan, Lombardy (Italy), that provides free health care to undocumented migrants. This is done through the voluntary work of more than 150 doctors representing almost all the medical disciplines, who rotate in the clinics. Thus, each patient is seldom seen twice by the same clinician; this can be a limit, but also prevents the effects
Results
As summarized in Table 1, the five ethnical groups showed significant differences in gender and age distribution. However, neither of them could be considered an independent confounding factor.
All the medicines used by the population of the study could be divided into 56 ATC groups.
In the whole population, drugs for chronic conditions were used significantly more than those for acute diseases (154.2 ± 45.9 vs 51.3 ± 18.4 DDD/1000 patients/day, P < 0.02) and those for both acute and chronic
Discussion
Migration to the EU especially from countries with a high migratory pressure is continuously growing.4 Only a proportion of these people are regular migrants or become documented residents some time after their arrival in the host country. Health data for these regular subjects are usually available through public databases, and our country is no exception.15, 16
In other words, when people, either migrants or natives, are somehow registered, we can evaluate their needs, and possibly help them,
Acknowledgements
The authors gratefully acknowledge the cooperation of Drs. Maria Buiatti and Anna Clementi in the computerization and analysis of the data. The authors are also indebted with the ‘P.E.R.I.PH.E.RY Study Group’ and the ‘Osservatorio Donazione Farmaci, Banco Farmaceutico’, Italy, for their support.
Ethical approval
This study was approved by a local Ethics Committee. The design of the study is an observational analysis of drugs dispensation, and therefore, the Ethics Committee did not require individual informed
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