Utilization of Emergency Care by an East African Refugee Community Compared to Local Residents in Central Minnesota: A Cross-Sectional Study

Abstract

Background: Previous studies on emergency service utilization by refugees have been mixed, with some showing overuse and others showing underuse relative to host populations. Much of the previous literature focuses on refugees by continent of origin, which may mask important differences within immigrant groups. Limited research has investigated emergency medicine utilization for East African refugees in the United States. Methods: The current study investigated differences in ED service utilization for East African refugees compared to local residents at an Emergency Trauma Center (Level 2) in Central Minnesota. From a convenience sample of 48 East African refugees and 116 local residents that presented to an emergency department (ED) in Central Minnesota, survey data was collected on self-reported reasons for presenting to ED; chart review data was collected on care received at the emergency department and discharge diagnoses. Results: Logistic regressions showed that refugees were significantly (p < .05) more likely than local residents to self-report difficulties with navigating the primary care settings as a reason for presenting to the ED, and less likely to report needing specialized care. Refugees were also significantly less likely than local residents to call their primary care provider/clinic before presenting to the ED. During the ED visit, refugees were significantly more likely than local residents to receive symptomatic care and less likely to receive advanced imaging. Conclusion: We hope these results spur additional research on this unique population, particularly related to health literacy and health equity in an emergency medicine setting for East African refugees continuing to migrate to the United States at high rates.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This study was funded by an Innovation Research Grant from the Minnesota Academy of Family Physicians.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The Institutional Review Board of Saint Cloud Hospital (CentraCare) gave ethical approval for this work.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.

Yes

Data Availability

All data produced in the present study are available upon reasonable request to the authors.

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