BACKGROUND In 2012, the central government of Spain enacted Royal Decree-Law (RDL) 16/2012 and Royal Decree (RD) 1192/2012, which abolished universal healthcare coverage, thus limiting access to care for undocumented immigrants. Free health care was also no longer granted to anyone who has never been employed. In this context, this study investigated the prevalence of late HIV diagnoses (LHDs) among immigrants living in Spain vs. native-born Spaniards. METHODS Data (n = 5943) from the 2010 to 2015 Cohort of the Spanish AIDs Research Network were used, including HIV-positive and antiretroviral therapy (ART)-naïve patients throughout Spain. Multivariate logistic models were fitted to compare the prevalence of LHD among the groups, adjusting for covariates. RESULTS The prevalence of LHD in the total sample was 39.5%. Compared with native-born Spaniards (n = 4445), immigrants (n = 1488) were more likely to have LHD (37.4% vs. 45.7%, respectively; P < 0.001). Multivariate analysis showed that the prevalence ratio of LHD among immigrants vs. native-born Spaniards was 1.15 [95% confidence interval (CI), 1.02-1.28], after adjusting for covariates. This disparity widened from 2010 to 2011 (APR = 1.14, 95% CI, 1.02-1.29) to 2012-15 (APR = 1.28, 95% CI, 1.17-1.39), although the change was not statistically significant. CONCLUSIONS Immigrants in Spain had a higher risk of LHD compared with native-born counterparts. LHD is an important healthcare marker due to the positive benefits of early HIV diagnosis, including prevention, improvements in health outcomes and decreases in overall cost of treatment. More research is needed on the causes of the disparity and potential social and policy interventions to reduce the prevalence of LHD among immigrants.

中文翻译：

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2010-15 年西班牙移民与本土出生的西班牙人之间的艾滋病毒诊断较晚。

背景 2012 年，西班牙中央政府颁布了皇家法令 (RDL) 16/2012 和皇家法令 (RD) 1192/2012，废除了全民医疗保险，从而限制了无证移民获得护理的机会。也不再向从未就业的任何人提供免费医疗保健。在此背景下，本研究调查了居住在西班牙的移民与土生土长的西班牙人之间晚期 HIV 诊断 (LHD) 的流行率。方法 使用西班牙艾滋病研究网络 2010 年至 2015 年队列的数据 (n = 5943)，包括整个西班牙的 HIV 阳性和抗逆转录病毒治疗 (ART) 初治患者。拟合多变量逻辑模型以比较各组间 LHD 的患病率，并调整协变量。结果总样本中LHD的患病率为39.5%。与土生土长的西班牙人（n = 4445）相比，移民（n = 1488）更有可能患有 LHD（分别为 37.4% 和 45.7%；P < 0.001）。多变量分析显示，在调整协变量后，移民与本地出生的西班牙人之间的 LHD 患病率为 1.15 [95% 置信区间 (CI)，1.02-1.28]。这种差异从 2010 年到 2011 年（APR = 1.14, 95% CI, 1.02-1.29）扩大到 2012-15 年（APR = 1.28, 95% CI, 1.17-1.39），尽管这种变化没有统计学意义。结论 与本地出生的同龄人相比，西班牙的移民患 LHD 的风险更高。由于早期 HIV 诊断的积极益处，包括预防、改善健康结果和降低总治疗成本，LHD 是一个重要的医疗保健标志。