Marcela Oyarte

Health inequality gap in inmigrant versus local children in Chile

Introduction: Children and young international migrants face different health challenges compared with the local population, particularly if they live in insecure environments or adverse social conditions. This study seeks to identify gaps in health outcomes of children between immigrant and local population in Chile. Methods: This study analyses data from three sources: (i) Born in Chile: Electronic records of antenatal visits from all municipal antenatal clinics of Recoleta in 2012; (ii) Growing up in Chile: Population survey “National Socioeconomic Characterization” (CASEN) from 2013 and (iii) Getting sick in Chile: Data of all hospital discharges in 2012, provided by the department of statistics and health information (DEIS) of the Ministry of Health. Results: (I) Born in Chile: Immigrants more frequently have psychosocial risk (62.3% vs 50.1% in Chileans) and enter later into the program (63.1% vs 33.4% enter later than 14 weeks of pregnancy). All birth outcomes were better among immigrants (e.g. caesarean sections rates: 24.2% immigrants vs % Chileans). (ii) Growing up in Chile: A higher proportion of migrant children is outside the school system and lives in multidimensional poverty (40% immigrants vs 23.2% Chileans). (iii) Getting sick in Chile: Injuries and other external causes were more frequent cause of hospitalisation among migrants (23.6%) than the local population (16.7%) aged between 7 and 14 years. Conclusions: Addressing the needs of the children in Chile, regardless of their immigration status, is an ethical, legal and moral imperative.

Hospitalizations for cancer in international migrants versus local population in Chile

ABSTRACT OBJECTIVE To compare cancer hospital morbidity among the local population and the immigrant population in Chile. METHODS This is a prevalence study based on the analysis of hospital discharges of all the health centers of Chile. Cancer hospital discharges were characterized in 2012 according to the migratory status. The crude and specific rates of hospital morbidity for this cause were estimated for the analysis of their association with migratory status using zero-inflated negative binomial regression, adjusted for sociodemographic variables. RESULTS The neoplasms were the third cause of hospital discharges for immigrants and the seventh one for Chileans. The adjusted rate of cancer hospital discharges was higher for Chileans than immigrants, and the latter had fewer days of hospitalization and greater proportion of surgical interventions. In the group of immigrants, cancer hospital discharges mainly corresponded to patients belonging to the private system (46%), and in the group of Chileans they mainly corresponded to patients in the public system (71.1%). We observed a large difference in the proportion of cancer hospital discharges for patients with no health insurance between the two populations (22.6%: immigrants, 1.0%: Chileans). In both populations, the three most frequent types of cancer were: (i) lymphoid tissue, hematopoietic organs, and related tissues, (ii) digestive organs, and (iii) breast cancer. CONCLUSIONS Models of differentiated care should be considered for immigrants, with the creation of specific programs of information, coverage, and protection against cancer. More information on this problem must be generated at the local and international level.

P89 Structural equation modelling with latent variables to study the relationship between health status, access to health care and socieconomic status in Chile

Background Social inequalities in health are a complex and multidimensional phenomena. There is a great deal of evidence about the relationship between the perception of people’s health, their social position within society and access to healthcare services. However, many of these studies do not consider that these variables are not directly observed (i.e. latent variables) and are collected with a variable degree of error. Structural equation modelling (SEM) with latent variables is a multivariate method that allows researchers to isolate the error of measurement and test of mediation and moderation relations that are useful in this context. This study aimed at demonstrating the applicability of SEM for the understanding of social inequalities in health using data from an anonymous national representative survey in Chile. Methods The national socioeconomic characterisation survey (CASEN) corresponds to one of the main tools for decision-making for social policies in Chile. The main objective of CASEN is to know the socioeconomic situation of households in Chile (demographic aspects, income, health, housing and work) and to assess the impact of social policies in Chile. Using data from the household heads in CASEN 2013 (n = 66.677), a SEM model was fitted to evaluate the relationship between latent variables: people’s health state (10 variables), access to healthcare services (4 variables) and socioeconomic position (9 variables). Afterwards, the model was adjusted using control variables not included as latent like educational level, employment, rurality, age and sex. Results The SEM adjusted appropriately to the data (RMESA = 0.02; CFI = 0.97; TLI = 0.97). In this model the people’s health status is more influenced by access to healthcare (standarized coeficient (βstd) = 0.32, p < 0.01) that the household income (βstd = 0.07; p < 0.01). Income in turn influences significantly on access to healthcare (βstd = 0.17; p < 0.01). This situation suggests a significant mediation of income on population self-reported health status. The direct effect of educational attainment on health is not significant (βstd = 0.02; p > 0.05); however, the (indirect) mediated effect (income, access) and the total effect (direct and indirect) was large and significant (βstd = 0.11; p < 0.01). The lack of influence of the geographical area on the global access to health services is also striking (βstd = 0.04; p > 0.05). Conclusion This study confirmed a strong relationship between income, health status and access to healthcare in Chile. Also showed the importance of the effects of mediation in these relationships. The use of SEM is a useful method to explore these phenomena.

P81 Exploring gendered patterns of cancer in Chile: Focus on universal coverage and international migration

Background Immigration to Chile has grown in recent decades, reaching 2.7% total population in 2014. The Chilean healthcare system is mixed (public and private) but guarantees universal coverage (prevention/diagnosis/treatment) to its beneficiary population for over 80 different prioritised pathologies. This includes the diagnosis and treatment of breast and male genital cancer (largely prostate cancer). Around 8.9% of immigrants in Chile have no healthcare insurance and there are no studies on cancer and migration status in Chile. The purpose of this study was to explore the differences in prevalence rates from breast and male genital cancer, based on national hospital discharge (HDs) records, between the Chilean-born and the international migrant populations in 2012. Methods Prevalence study, based on HDs for all cancers in Chile in 2012 (N = 74.768). Prevalence rates of breast and male genital cancers were compared between the Chilean-born and the international migrant populations, crude and adjusted by relevant demographic (age groups/sex/region/healthcare prevision) and clinical variables (type of cancer/type of treatment/outcome: alive/death). Results Based on HDs, there was 7.728 HDs caused by breast cancer and 5.711 caused by male genital cancer in 2012. Among immigrants, 5.8% of HD in 2012 in Chile were caused by cancer. From these, 16.7% and 3.5% were caused by breast and male genital organs cancers, respectively (versus 10.3% and 7.7% in the Chilean-born). In the case of breast cancer HDs, 63% of all immigrant cases corresponded to women assigned to the private healthcare system, whereas a 47% of HDs for male genital cancer among immigrant men belonged to cases with no healthcare insurance. This was significantly different to the local population, in which for both types of cancer more than 65% of the cases corresponded to events affiliated to the public healthcare system. 72% of breast cancer cases in the Chilean-born required surgery, while only 46% of breast cancer cases required surgical intervention among immigrants. Besides, 76% of the HDs from male genital cancer had surgery among immigrants compared to only 49% of surgical interventions that happened among the Chilean-born. The prevalence of age at diagnosis and death were similar for both types of cancer between comparison groups. Conclusion The prevalence rate of breast cancer was higher in the immigrant population compared to the Chilean-born. Most events for the Chilean-born belonged to the public healthcare system, whereas most events in the migrant population belonged to the private insurance or no healthcare provision.