Migration context of emergency department patients and patterns of their in- and outpatient healthcare utilization – analysis of three INDEED study centers in Berlin

BACKGROUND: Increasing sociocultural diversity has implications for emergency department (ED) care. Individuals with a migration context face challenges that can manifest as barriers in healthcare access and use. Therefore, our aim was to examine differences in healthcare delivery for and utilization of ED patients in Germany regarding their migration context. METHODS: We utilized routine healthcare data from the INDEED project. Patient records from three EDs in Berlin, Germany, from 2016 were linked with associated outpatient treatment data spanning 2014 to 2017. Using an onomastic approach, patients were assigned to one of nine regions of origin (refers to "migration context") based on their names in addition to citizenship. Demographic and clinical data were compared between patients with and without a presumed migration context. Regression analyses were conducted to determine the association of migration context on triage category, hospital admission, frequent ED use (more than two visits within one year), and the number of outpatient presentations, adjusting for sex, age in years and multimorbidity (more than three different diagnoses over three calendar quarters within four consecutive calendar quarters before the first ED visit). RESULTS: In total, 123 572 (49 003 (40.2%), 74 569 (59.8%) without presumed migration context) cases were examined. ED patients with a presumed migration context were younger and more often male than those without. Adjusted regression analyses demonstrated that the overall migration context was associated with a slightly higher likelihood of more urgent triage categorization (adjusted odds ratio: 1.03; 95%-confidence interval: 1.01-1.04), while it was also associated with fewer hospital admissions after the ED stay (adjusted odds ratio 0.92; 95%-confidence interval 0.90-0.96), being a frequent ED user (1.22; 1.15-1.30), and fewer contacts with outpatient healthcare services (exponentiated estimates 0.86; 0.85-0.86). CONCLUSION: Our routine data analysis highlighted differences in healthcare pathways between ED patients with and without a presumed migration context in Germany. The likely complex and multifactorial reasons behind these disparities warrant further investigation, preferably by prospective studies. Understanding these factors can enhance the promotion of healthcare provision that is more sensitive to a diverse society.