Health care provision for illegal immigrants: should public health be concerned?

Abstract

Immigrants from developing countries who resided in one of the Health Areas of the Autonomous Community of Madrid (ACM) (Health Area 6), were older than 15 years of age, and had lived in Spain for more than three months were eligible to enter the study. Our research Area was selected because it had the largest share of immigrants in the ACM. The ACM host about one quarter of the immigrants of Spain, and about one fifth of them lived in our study Area. The southern part of the City of Madrid is part of the study Area and was also included as a potential site for recruitment. Stratified cluster sampling with replacement was used to select 300 immigrants. Twelve per cent of the persons who were approached refused to participate in the study and were replaced by other immigrants, therefore reaching the intended number of 300. In the first stage, 30 clusters were systematically assigned to towns with a probability proportional to the registered migrant population and 10 migrants were selected and interviewed in each cluster in the second stage. In the second stage, 10 migrants were systematically selected in each cluster. To select immigrants, interviewers had to direct themselves to a predefined area of the municipality, usually the centre of the town, and from there select randomly a direction that would then be followed. Eligible subjects were approached in the streets, or at the door of their homes or at the entrance of common meeting places. Health services and their immediate sorroundings were specifically excluded as potential places for recruitment. Immigrants were systematically approached for interviews irrespective of their nationality or sex. Interviews were conducted starting early in the morning and until late at night. Field work lasted for almost three months. Most often two or even three visits were required to each cluster to complete all the interviews. Survey questionnaire included sociodemographic information, health status and utilisation of health services. Persons who reported having ever been ill in Spain were asked whether they sought medical care for their last episode of illness. Severity of the episode was assessed by a blinded external examiner on the basis of reporting. Administrative legal status was ascertained by one open question: “what is your current administrative status in Spain?” Illegal status was defined as a person who did not have a valid residency permit. As most immigrants to Madrid come from Morocco our questionnaire was translated into Arabic using direct and inverse translation, and completed between February and May of 1997. Data were entered in Epiinfo 6.1, maximum likelihood estimates for odds ratios (ORs) (and 95% confidence intervals) to explore the likeliness of seeking care the last time the person was ill were estimated using the Csample Module. Multiple logistic regresion analyses were used in the final model to adjust for possible confounders using SPSS.