The effect of perceived discrimination on the health of immigrant workers in Spain

Background: Discrimination is an important determinant of health inequalities, and immigrants may be more vulnerable to certain types of discrimination than the native-born. This study analyses the relationship between immigrants' perceived discrimination and various self-reported health indicators. Methods: A cross-sectional survey was conducted (2008) amongst a non-random sample of 2434 immigrants from Ecuador, Morocco, Romania and Colombia in four Spanish cities: Barcelona, Huelva, Madrid and Valencia. A factorial analysis of variables revealed three dimensions of perceived discrimination (due to immigrant status, due to physical appearance, and workplace-related). The association of these dimensions with self-rated health, mental health (GHQ-12), change in self-rated health between origin and host country, and other self-reported health outcomes was analysed. Logistic regression was used adjusting for potential confounders (aOR-95%CI). Subjects with worsening self-reported health status potentially attributable to perceived discrimination was estimated (population attributable proportion, PAP %). Results: 73.3% of men and 69.3% of women immigrants reported discrimination due to immigrant status. Moroccans showed the highest prevalence of perceived discrimination. Immigrants reporting discrimination were at significantly higher risk of reporting health problems than those not reporting discrimination. Workplace-related discrimination was associated with poor mental health (aOR 2.97 95%CI 2.45-3.60), and the worsening of self-rated health (aOR 2.20 95%CI 1.73- 2.80). 40% (95% CI 24-53) PAP of those reporting worse self-rated health could be attributable to discrimination due to immigrant status. Conclusions: Discrimination may constitute a risk factor for health in immigrant workers in Spain and could explain some health inequalities among immigrant populations in Spanish society.This work was supported by the following sources: Carolina Foundation (Spain), Healthcare Research Fund of the Spanish Ministry of Health and Consumption (references PI050497, PI052202, PI052334, PI061701, and PI0790470

Characterisation of data quality in electronic healthcare records

The use of electronic healthcare systems for recording patient treatment history is well established across the UK healthcare sector, the potential benefits of using such systems being numerous. Within the primary care setting, electronic healthcare records (EHR) can provide a near complete picture of patient care over time. This not only affords the opportunity to improve patient care directly through effective monitoring and identification of care requirements but also offers a unique platform for both clinical and service-model research [1] essential to the longer term development of the health service. The potential for using routinely collected patient records for research purposes has been steadily increasing [2] with recent advances and diminishing technical barriers in data storage and information processing. There are, however, significant challenges in using EHRs effectively in the research setting and in ensuring the quality of data recorded for this purpose. Incorrect or missing data can render records as useless or indeed misleading such that conclusions drawn from the data could have a negative impact. The aim of this chapter is to outline both the key challenges to the management and assessment of data quality in EHRs and the key considerations for meeting these challenges. The Clinical Practice Research Datalink database CPRD GOLD, globally recognised as being one of the largest and most detailed sources of electronic patient data, will be used as an example throughout. In Sect. 2, the concept of data quality is presented within the setting of primary care databases and a framework for its assessment is set out, based on findings of an investigation carried out on CPRD GOLD. In Sect. 3, the importance of understanding data quality of an individual source of data in relation to alternative sources, both intra- and inter-nationally, is examined, posing the emerging challenges to the future use EHRs for research. Finally Sect. 4 investigates data quality requirements from the perspective of a range of stakeholders through discussion of a day-long CPRD-led data quality workshop and we consider the way forward to a more comprehensive approach to tackling issues of data quality in EHRs