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

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 

About this Master's Thesis

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School	Rollins School of Public Health
Department	Environmental Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Climate Change
Keyword	Electronic Medical Record (EMR) Refugee Immigrant Climate Migrant Health Equity Emergency Medicine
Committee Chair / Thesis Advisor	Dr. Thomas Clasen, Emory University
Committee Members	Dr. Amy Zeidan, Emory University Dr. Anna Yaffee, Emory University

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