Understanding Patterns of Healthcare Utilization, Outcomes, and Climate-Related Migration of Immigrant Populations in Atlanta, Georgia Público

Edelson, Hannah Claire (Spring 2022)

Permanent URL: https://etd.library.emory.edu/concern/etds/dj52w597x?locale=pt-BR
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Abstract

The global population of refugees and immigrants continues to rise, with an estimated 82.4 million forcibly displaced people in 2020 (3). Climate change is now widely recognized as a major contributing and exacerbating factor in global migration, displacement and conflict(4). The United States continues to have a significant population of immigrants and refugees, with over 40 million foreign-born individuals in 2016 (5). Patterns of healthcare utilization and climate migration of immigrants in the U.S., particularly in the southeast region, remain poorly understood (6,7). We developed a triage screen to identify refugees and immigrants in an ethically appropriate manner. We piloted the triage screen in the Grady Hospital Emergency Department (ED), conducted a mixed quantitative/qualitative follow-up survey and chart review to assess health status, healthcare encounters, and climate migration. 49/134 (36.57%) patients screened positive for foreign birth. 15 countries were represented, with 28/49 (57.14%) from Mexico. 5/49 (10.20%) of patients reported climate or weather-related factors influencing their migration to the U.S. Barriers to accessing care included worry about health insurance status (38.78%), language (20.41%), and country of origin (4.08%). Our patient sample experiences higher uninsurance (86.67%, p<0.001), compared to the general Grady patient population (21.55%) and state of Georgia population (22.20%), lack of primary care provider visits (44.44%, p<0.05), and higher prevalence of diabetes (44.44%, p<0.001) and myocardial infarction (11.11%, p<0.05). The ED, often the first access point to the healthcare system, is uniquely positioned to design interventions and advise preparation of system-level changes to provide high quality, accessible healthcare for immigrants and refugees—a growing population as a result of and multiplied by climate change. 

Table of Contents

Table of Contents

Introduction..................................................................................................................................... 1

Immigrant and Refugee Health in the US................................................................................... 2 Methods........................................................................................................................................... 4

Literature Review........................................................................................................................ 4

Phase I......................................................................................................................................... 4

Phase II........................................................................................................................................ 5

Phase III ...................................................................................................................................... 6

Data Analysis .............................................................................................................................. 6 Results............................................................................................................................................. 6 

Phase II: Triage Screen and Follow-Up Survey ......................................................................... 6

Table 1. Triage Screen Questions and Results..........................................................6

Figure 1. Arrival Year in the U.S. ...........................................................................7

Figure 2. Map of Country of Origin Reported by Follow-Up Survey Participants............9

Table 2. Follow-Up Survey Results........................................................................11 

Phase III: Chart Review ............................................................................................................12

Table 3. Demographics, Healthcare Access, and Health Status Indicators...................13

Figure 3. Disparities in Healthcare access and Health Status....................................14

Figure 4. Patients' Chief Complaints in the ED......................................................15

Table 4. Healthcare Encounters, Preventive Screenings, Medication for Non-HD/HD

Cohorts................................................................................................................17 

Discussion ..................................................................................................................................... 18

Study Limitations...................................................................................................................... 18

Climate migration ..................................................................................................................... 19

Inequities in Health and Healthcare Access.............................................................................. 20

Future Directions ...................................................................................................................... 22

Conclusion .................................................................................................................................... 23 References..................................................................................................................................... 24 Appendix....................................................................................................................................... 27

Appendix A............................................................................................................................... 27 

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