Exploring Inequalities between Migrant and Non-Migrant Populations in the Utilization of Emergency Departments: A Systematic Review

Background: Migrants face several barriers when accessing care and tend to rely on emergency services to a greater extent than primary care. Comparing emergency department (ED) utilization by migrants and non-migrants can unveil inequalities affecting the migrant population and pave the way for public health strategies aimed at improving health outcomes. This systematic review aims to investigate differences in ED utilization between migrant and non-migrant populations to ultimately advance research on migrants’ access to care and inform health policies addressing health inequalities. Methods: A literature search was conducted in March 2023 on Pubmed, Scopus, and Web of Science databases. The included studies were limited to those relying on data collected from 2012 and written in English or Italian. Data extracted included information on the migrant population and the ED visit, the differences in ED utilization between migrants and non-migrants, and the challenges faced by migrants prior to, during, and after the ED visit. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: After full-text review, 24 articles met the inclusion criteria. All but one adopted a quantitative methodology. Some studies reported a higher frequency of ED visits among migrants, while others a higher frequency among non-migrants. Migrants tend to leave the hospital against medical advice more frequently than the native population and present at the ED without consulting a general practitioner (GP). They are also less likely to access the ED via ambulance. Admissions for Ambulatory Care Sensitive Conditions (ACSC) were higher for migrants, while still being significant for the non-migrant population. Conclusions: The comparison between migrants’ and non-migrants’ utilization of the ED does not suggest a clear pattern, yet it shows that migrants’ access to care is hindered by barriers such as language barriers, poor insurance coverage, and limited working hours of GPs. Research exploring differences in ED utilization by migrants and non-migrants adopting a qualitative methodology is needed.