Health screenings administered during the domestic medical examination of refugees and other eligible immigrants in nine US states, 2014–2016: A cross-sectional analysis


Autoři: Clelia Pezzi aff001;  Deborah Lee aff001;  Gayathri S. Kumar aff001;  Breanna Kawasaki aff002;  Lori Kennedy aff002;  Jenny Aguirre aff003;  Melissa Titus aff004;  Rebecca Ford aff005;  Blain Mamo aff006;  Kailey Urban aff006;  Stephen Hughes aff007;  Colleen Payton aff008;  Kevin Scott aff008;  Jessica Montour aff009;  Emily S. Jentes aff001
Působiště autorů: Centers for Disease Control and Prevention, Division of Global Migration and Quarantine, Immigrant, Refugee, and Migrant Health Branch, Atlanta, Georgia, United States of America aff001;  Colorado Department of Public Health and Environment, Disease Control and Environmental Epidemiology Division, Refugee Health Program, Denver, Colorado, United States of America aff002;  Illinois Department of Public Health, Refugee Health Program, Chicago, Illinois, United States of America aff003;  Marion County Public Health Department, Indianapolis, Indiana, United States of America aff004;  University of Louisville Division of Infectious Diseases, Louisville, Kentucky, United States of America aff005;  Minnesota Department of Health, Saint Paul, Minnesota, United States of America aff006;  Bureau of Tuberculosis Control, New York State Department of Health, Albany, New York, United States of America aff007;  Department of Family & Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America aff008;  Texas Department of State Health Services, Austin, Texas, United States of America aff009
Vyšlo v časopise: Health screenings administered during the domestic medical examination of refugees and other eligible immigrants in nine US states, 2014–2016: A cross-sectional analysis. PLoS Med 17(3): e32767. doi:10.1371/journal.pmed.1003065
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003065

Souhrn

Background

Refugees and other select visa holders are recommended to receive a domestic medical examination within 90 days after arrival to the United States. Limited data have been published on the coverage of screenings offered during this examination across multiple resettlement states, preventing evaluation of this voluntary program’s potential impact on postarrival refugee health. This analysis sought to calculate and compare screening proportions among refugees and other eligible populations to assess the domestic medical examination’s impact on screening coverage resulting from this examination.

Methods and findings

We conducted a cross-sectional analysis to summarize and compare domestic medical examination data from January 2014 to December 2016 from persons receiving a domestic medical examination in seven states (California, Colorado, Minnesota, New York, Kentucky, Illinois, and Texas); one county (Marion County, Indiana); and one academic medical center in Philadelphia, Pennsylvania. We analyzed screening coverage by sex, age, nationality, and country of last residence of persons and compared the proportions of persons receiving recommended screenings by those characteristics. We received data on disease screenings for 105,541 individuals who received a domestic medical examination; 47% were female and 51.5% were between the ages of 18 and 44. The proportions of people undergoing screening tests for infectious diseases were high, including for tuberculosis (91.6% screened), hepatitis B (95.8% screened), and human immunodeficiency virus (HIV; 80.3% screened). Screening rates for other health conditions were lower, including mental health (36.8% screened). The main limitation of our analysis was reliance on data that were collected primarily for programmatic rather than surveillance purposes.

Conclusions

In this analysis, we observed high rates of screening coverage for tuberculosis, hepatitis B, and HIV during the domestic medical examination and lower screening coverage for mental health. This analysis provided evidence that the domestic medical examination is an opportunity to ensure newly arrived refugees and other eligible populations receive recommended health screenings and are connected to the US healthcare system. We also identified knowledge gaps on how screenings are conducted for some conditions, notably mental health, identifying directions for future research.

Klíčová slova:

Health screening – Hepatitis B – HIV – Intestinal parasites – Mental health and psychiatry – Screening guidelines – Tuberculosis – United States


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