Use of secondary care in England by international immigrants

Objective: Although over half a million migrants arrive in England each year, information about their use of health services is limited. Our aim was to describe the use of secondary care by international immigrants and compare it to people moving within England. Methods: Routine anonymized data were used to identify people who appear as registering with a general practitioner (GP) for the first time in England, yet are aged 15 or over. We assumed that most long-term residents will have registered before the age of 15, and therefore the majority of those registering for the first time later in life will be international immigrants. The study compared hospital admissions among first registrants to the general population of England and to within-England migrants, selected using propensity scoring. Results: The first registrants aged 15 or over had around half the rate of hospital admission asthat of the general population of England. They were also less likely to have a hospital admission than a matched group of within-England migrants. The lower admission rates persisted over several years and were consistent in three consecutive cohorts of first registrants (each consisting of over half a million people). Conclusions: The assumption that international immigrants use more secondary care than the members of the indigenous population appears to be unfounded.