BACKGROUND Globally, international migration is increasing. Population growth, along with other demographic changes, may be expected to put new pressures on healthcare systems. Some studies across Europe suggest that emergency departments (EDs) are used more, and differently, by migrants compared to non-migrant populations, which may be a result of unfamiliarity with the healthcare systems and difficulties accessing primary healthcare. However, little evidence exists to understand how migrant parents, who are typically young and of childbearing age, utilise EDs for their children. This study aimed to examine the association between paediatric ED utilisation in the first 5 years of life and maternal migration status in the Born in Bradford (BiB) cohort study. METHODS AND FINDINGS We analysed linked data from the BiB study-an ongoing, multi-ethnic prospective birth cohort study in Bradford. Bradford is a large, ethnically diverse city in the north of England. In 2017, more than a third of births in Bradford were to mothers who were born outside the UK. Between March 2007 and December 2010, pregnant women were recruited to BiB during routine antenatal care, and the children born to these mothers have been, and continue to be, followed over time to assess how social, genetic, environmental, and behavioural factors impact on health from childhood to adulthood. Data analysed in this study included baseline questionnaire data from BiB mothers, and Bradford Royal Infirmary ED episode data for their children. Main outcomes were likelihood of paediatric ED use (no visits versus at least 1 ED visit in the first 5 years of life) and ED utilisation rates (number and frequency of ED visits) for children who have accessed the ED. The main explanatory variable was mother's migrant status (foreign-born versus UK/Irish-born). Multivariable analyses (logistic and zero-truncated negative binomial regression) were conducted adjusting for socio-demographic and socio-economic factors. The final dataset included 10,168 children born between April 2007 and June 2011, of whom 35.6% were born to migrant mothers. Foreign-born mothers originated from South Asia (28.6%), Europe/Central Asia (3.2%), Africa (2.1%), East Asia/Pacific (1.1%), and the Middle East (0.6%). At recruitment the mothers ranged in age from 15 to 49 years old. Overall, 3,104 (30.5%) children had at least 1 ED visit in the first 5 years of life, with the highest proportion of visits being in the first year of life (36.7%). The proportion of children who visited the ED at least once was lower for children of migrant mothers as compared to children of non-migrant mothers (29.4% versus 31.2%). Children of migrant mothers were found to be less likely to visit the ED (odds ratio 0.88 [95% CI 0.80 to 0.97], p = 0.012). However, among children who visited the ED, the utilisation rate was significantly higher for children of migrant mothers (incidence rate ratio [IRR] 1.19 [95% CI 1.01 to 1.40], p = 0.040). Utilisation rates were higher for children born to mothers from Europe (IRR 1.71 [95% CI 1.07 to 2.71], p = 0.024) and established migrants (≥5 years living in UK) (IRR 1.24 [95% CI 1.02 to 1.51], p = 0.032) compared to UK/Irish-born mothers. Important limitations include being unable to measure children's underlying health status and the urgency of ED attendance, as well as the analysis being limited by missing data. CONCLUSIONS In this study we observed that there is no higher likelihood of first paediatric ED attendance in the first 5 years of life for children in the BiB cohort for migrant mothers. However, among ED users, children of migrant mothers attend the service more frequently than children of UK/Irish-born mothers. Our findings show that patterns of ED utilisation differ by mother's region of origin and time since arrival in the UK.

中文翻译：

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布拉德福德出生人群的儿科急诊科利用率和孕产妇迁移状况：一项横断面研究。

背景技术在全球范围内，国际移徙正在增加。人口增长以及其他人口变化可能会给医疗保健系统带来新的压力。欧洲各地的一些研究表明，与非移民人口相比，移民对急诊室的使用更多，且使用方式有所不同，这可能是由于医疗系统不熟悉以及难以获得基本医疗服务的结果。但是，几乎没有证据可了解通常是年轻且育龄的移徙父母如何为他们的孩子利用ED。这项研究旨在检查出生头5年的小儿ED利用率与布拉德福德出生（BiB）队列研究中的母亲迁徙状况之间的关系。方法和发现我们分析了BiB研究中的关联数据，该研究正在进行中，布拉德福德（Bradford）的多民族前瞻性出生队列研究。布拉德福德（Bradford）是英格兰北部一个大型，种族多元化的城市。2017年，布拉德福德（Bradford）超过三分之一的分娩是在英国境外出生的母亲进行的。在2007年3月至2010年12月之间，孕妇在常规产前检查中被招募到BiB，随着时间的推移，这些母亲所生的孩子一直并将继续受到关注，以评估社会，遗传，环境和行为因素如何影响从童年到成年的健康。这项研究中分析的数据包括来自BiB母亲的基线调查表数据以及其子女的Bradford Royal Infirmary ED情节数据。主要结局是小儿使用ED的可能性（无生命，而在生命的头5年中至少有1次ED访视）和接受ED的儿童的ED利用率（ED访视的次数和频率）。主要的解释变量是母亲的移民身份（外国出生与英国/爱尔兰出生）。进行了多变量分析（逻辑和零截断的负二项式回归），并根据社会人口统计学和社会经济因素进行了调整。最终的数据集包括2007年4月至2011年6月之间出生的10,168名儿童，其中35.6％由移民母亲出生。外国出生的母亲来自南亚（28.6％），欧洲/中亚（3.2％），非洲（2.1％），东亚/太平洋（1.1％）和中东（0.6％）。在招聘时，母亲的年龄从15岁到49岁不等。总计3,104（30。5％）的儿童在生命的头5年内至少进行过一次ED访视，其中访问的比例最高的是生命的第一年（36.7％）。与非移民母亲的孩子相比，移民母亲的孩子至少去过一次急诊科的孩子比例要低一些（29.4％比31.2％）。发现外来母亲的孩子去急诊室的可能性较小（优势比为0.88 [95％CI 0.80至0.97]，p = 0.012）。然而，在访问急诊科的儿童中，流动母亲的儿童的利用率明显更高（发生率[IRR] 1.19 [95％CI 1.01至1.40]，p = 0.040）。来自欧洲母亲的孩子（IRR 1.71 [95％CI 1.07至2.71]，p = 0.024）和成年移民（在英国居住≥5年）的利用率较高（IRR 1.24 [95％CI 1.02至1.51]， p = 0。032）与英国/爱尔兰裔母亲相比。重要的局限性包括无法衡量儿童的基本健康状况和急诊就诊的紧迫性，以及分析由于缺少数据而受到限制。结论在这项研究中，我们观察到在BiB队列中，对于流动母亲而言，儿童在出生后的头5年中首次参加小儿ED的可能性更高。但是，在急诊科使用者中，移民母亲的孩子比英国/爱尔兰裔母亲的孩子参加该服务的频率更高。我们的发现表明，自母亲到达英国以来，ED的利用方式因母亲的出身地区和时间而异。结论在这项研究中，我们观察到在BiB队列中，对于流动母亲而言，儿童在出生后的头5年中首次参加小儿ED的可能性更高。但是，在急诊科使用者中，移民母亲的孩子比英国/爱尔兰裔母亲的孩子参加该服务的频率更高。我们的发现表明，自母亲到达英国以来，ED的利用方式因母亲的出身地区和时间而异。结论在这项研究中，我们观察到在BiB队列中，对于流动母亲而言，儿童在出生后的头5年中首次参加小儿ED的可能性更高。但是，在急诊科使用者中，移民母亲的孩子比英国/爱尔兰裔母亲的孩子参加该服务的频率更高。我们的发现表明，自母亲到达英国以来，ED的利用方式因母亲的出身地区和时间而异。