Table 1
Demographic characteristics and patient information of refugee and non-refugee patients who received hospital services in Nebraska between January 1st, 2011, and September 30th, 2015.
| Characteristics | Outpatient clinic visits | Emergency department visits | Hospitalizations | |||
|---|---|---|---|---|---|---|
| Refugee, n (%) | Non-refugee, n (%) | Refugee, n (%) | Non-refugee, n (%) | Refugee, n (%) | Non-refugee, n (%) | |
| Age of visit (years)* | ||||||
| <10 | 688 (12.6) | 385,287 (7.2) | 757 (25.1) | 348,284 (19.0) | 33 (4.3) | 28,421 (3.9) |
| 10–19 | 636 (11.7) | 336,289 (6.3) | 615 (20.4) | 223,875 (12.2) | 83 (10.7) | 31,777 (4.3) |
| 20–29 | 882 (16.2) | 425,939 (8.0) | 467 (15.5) | 304,286 (16.6) | 253 (32.7) | 94,638 (12.9) |
| 30–39 | 764 (14.0) | 470,422 (8.8) | 434 (14.4) | 230,584 (12.6) | 173 (22.3) | 80,183 (10.9) |
| 40–59 | 1,267 (23.2) | 1,433,010 (26.9) | 476 (15.8) | 365,110 (19.9) | 96 (12.4) | 149,158 (20.3) |
| ≥60 | 1,223 (22.4) | 2,280,732 (42.8) | 268 (8.9) | 359,283 (19.6) | 137 (17.7) | 350,860 (47.7) |
| Total | 5,460 | 5,331,679 | 3,017 | 1,831,422 | 775 | 735,037 |
| Gender | ||||||
| Male | 798 (44.3) | 568,021 (41.4) | 514 (49.1) | 322,998 (51.9) | 137 (24.6) | 179,650 (38.3) |
| Female | 1,005 (55.7) | 803,159 (58.5) | 533 (50.9) | 298,947 (48.1) | 421 (75.5) | 289,805 (61.7) |
| Unknown | 0 (0.0) | 1,057 (0.1) | 0 (0.0) | 460 (0.1) | 0 (0.0) | 55 (0.01) |
| Total | 1,803 | 1,372,237 | 1,047 | 622,405 | 558 | 469,510 |
| Hospital charge ($)* | ||||||
| Mean ± SD | 1,671.7±4,366.7 | 1,863.3±5,569.4 | 2,222.0±4,082.4 | 2,361.2±3,656.9 | 31,519.4±80,277.1 | 32,442.3±53,204.8 |
| Total | 16,210,669 | 20,174,729,619 | 8,530,750 | 5,458,345,404 | 28,367,433 | 27,840,593,539 |
| Payer source | ||||||
| Commercial insurance | 622 (34.5) | 885,387 (64.5) | 588 (56.2) | 375,196 (60.3) | 225 (40.3) | 228,718 (48.7) |
| Medicaid | 1,056 (58.6) | 97,034 (7.1) | 401 (38.3) | 60,668 (9.8) | 311 (55.7) | 43,910 (9.4) |
| Self-Pay | 57 (3.2) | 45,453 (3.3) | 43 (4.1) | 83,058 (13.3) | 11 (1.8) | 17,662 (3.8) |
| Medicare | 20 (1.1) | 295,643 (21.5) | 9 (0.9) | 60,194 (9.7) | 10 (1.8) | 163,655 (34.9) |
| Federal program | 48 (2.7) | 48,720 (3.6) | 6 (0.6) | 43,289 (7.0) | 1 (0.2) | 15,565 (3.3) |
| Total | 1,803 | 1,372,237 | 1,047 | 622,405 | 558 | 469,510 |
| Race | ||||||
| Asian | 1,053 (58.4) | **** | 326 (31.1) | **** | 272 (48.7) | **** |
| White | 241 (13.4) | **** | 291 (27.8) | **** | 62 (11.1) | **** |
| African | 333 (18.5) | **** | 257 (24.5) | **** | 164 (29.4) | **** |
| Other | 29 (1.6) | **** | 32 (3.1) | **** | 14 (2.5) | **** |
| Unknown | 147 (8.2) | **** | 141 (13.5) | **** | 46 (8.2) | **** |
| Total | 1,803 | **** | 1,047 | **** | 558 | **** |
| Marital Status | ||||||
| Not married | 871 (48.3) | **** | 694 (66.3) | **** | 183 (32.8) | **** |
| Married | 802 (44.5) | **** | 307 (29.3) | **** | 339 (60.8) | **** |
| Widowed | 106 (5.9) | **** | 34 (3.3) | **** | 27 (4.8) | **** |
| Divorced | 24 (1.3) | **** | 12 (1.2) | **** | 9 (1.6) | **** |
| Total | 1,803 | **** | 1,047 | **** | 558 | **** |
[i] * Records-based information.
**** Information on race and marital status are incomplete/unavailable from Nebraska hospital discharge databases.
Table 2
Comparisons of reasons for hospital visits between female refugee and non-refugee patients who received hospital services in Nebraska between January 1st, 2011, and September 30th, 2015.
| Type of hospital visit | Top reasons among refugees | Refugees, n (%) | Non-refugees, n (%) | RR (95% CI) | P value | |
|---|---|---|---|---|---|---|
| 1. Pregnancy complications (CCS 177–195) | 241 (7.2) | 95,454 (2.9) | 2.49 (2.20–2.81) | <.0001 | * | |
| 2. Normal pregnancy and/or delivery (CCS 196) | 232 (6.9) | 44,553 (1.3) | 5.13 (4.53–5.81) | <.0001 | * | |
| 3. Other screening for suspected conditions (not mental disorders or infectious disease) (CCS 258) | 229 (6.8) | 336,793 (10.2) | 0.67 (0.59–0.76) | <.0001 | * | |
| 4. Abdominal pain (CCS 251) | 146 (4.3) | 93,696 (2.8) | 1.53 (1.31–1.80) | <.0001 | * | |
| 5. Immunizations and screening for infectious disease (CCS 10) | 116 (3.4) | 26,863 (0.8) | 4.25 (3.55–5.09) | <.0001 | * | |
| 6. Spondylosis; intervertebral disc disorders; other back problems (CCS 205) | 97 (2.9) | 80,942 (2.4) | 1.18 (0.97–1.44) | 0.10 | ||
| 7. Medical examination/evaluation (CCS 256) | 94 (2.8) | 148,381 (4.5) | 0.62 (0.51–0.76) | <.0001 | * | |
| 8. Non-traumatic joint disorders (CCS 204) | 91 (2.7) | 94,737 (2.9) | 0.95 (0.77–1.16) | .59 | ||
| 9. Genitourinary symptoms and ill-defined conditions (CCS 163) | 82 (2.4) | 66,893 (2.0) | 1.21 (0.97–1.50) | .08 | ||
| 10. Rehabilitation care; fitting of prostheses; and adjustment of devices (CCS 254) | 79 (2.3) | 77,915 (2.4) | 1.00 (0.80–1.24) | .99 | ||
| Other reasons/conditions | 1,963 (58.2) | 2,252,575 (67.9) | ||||
| Total | 3,370 | 3,318,802 | ||||
| 1. Pregnancy complications (CCS 177–195) | 154 (9.3) | 32,912 (3.3) | 2.83 (2.43–3.29) | <.0001 | * | |
| 2. Upper respiratory infections (CCS 126) | 114 (6.9) | 40,239 (4.0) | 1.71 (1.43–2.04) | <.0001 | * | |
| 3. Abdominal pain (CCS 251) | 97 (5.9) | 50,512 (5.0) | 1.16 (0.96–1.41) | .13 | ||
| 4. Headache; including migraine (CCS 84) | 77 (4.6) | 29,333 (2.9) | 1.59 (1.27–1.97) | <.0001 | * | |
| 5. Urinary tract infections (CCS 159) | 75 (4.5) | 29,087 (2.9) | 1.56 (1.25–1.94) | <.0001 | * | |
| 6. Sprains and strains (CCS 232) | 65 (3.9) | 45,169 (4.5) | 0.87 (0.68–1.10) | .25 | ||
| 7. Nausea and vomiting (CCS 250) | 55 (3.3) | 22,973 (2.3) | 1.45 (1.11–1.88) | .006 | * | |
| 8. Superficial injury; contusion (CCS 239) | 54 (3.3) | 51,716 (5.2) | 0.63 (0.49–0.82) | <.001 | * | |
| 9. Disorders of teeth and jaw (CCS 136) | 39 (2.4) | 11,235 (1.1) | 2.10 (1.54–2.86) | <.0001 | * | |
| 10. Spondylosis; intervertebral disc disorders; other back problems (CCS 205) | 35 (2.1) | 28,408 (2.8) | 0.74 (0.54–1.03) | .08 | ||
| Other reasons/conditions | 894 (53.9) | 660,315 (65.9) | ||||
| Total | 1,659 | 1,001,899 | ||||
| 1. Pregnancy complications (CCS 177–195) | 351 (62.2) | 95,631 (21.6) | 2.88 (2.70–3.08) | <.0001 | * | |
| 2. Normal pregnancy and/or delivery (CCS 196) | 27 (4.8) | 6,105 (1.4) | 3.48 (2.40–5.03) | <.0001 | * | |
| 3. Mood disorders (CCS 657) | 13 (2.3) | 14,037 (3.2) | 0.73 (0.43–1.25) | .24 | ||
| 4. Septicemia (except in labor) (CCS 2) | 9 (1.6) | 10,580 (2.4) | 0.67 (0.35–1.28) | .22 | ||
| 5. Biliary tract disease (CCS 149) | 9 (1.6) | 5,159 (1.2) | 1.37 (0.72–2.62) | .34 | ||
| Other reasons/conditions | 155 (27.5) | 311,647 (70.3) | ||||
| Total | 564 | 443,159 | ||||
[i] * Statistical significance at P < .05.
Table 3
Comparisons of reasons for hospital visits between male refugee and non-refugee patients who received hospital services in Nebraska between January 1st, 2011, and September 30th, 2015.
| Type of hospital visit | Top reasons among refugees | Refugees, n (%) | Non-refugees, n (%) | RR (95% CI) | P value | |
|---|---|---|---|---|---|---|
| 1. Immunizations and screening for infectious disease (CCS 10) | 113 (5.4) | 11,007 (0.6) | 9.88 (8.25–11.83) | <.0001 | * | |
| 2. Abdominal pain (CCS 251) | 88 (4.2) | 46,278 (2.3) | 1.83 (1.49–2.25) | <.0001 | * | |
| 3. Lower respiratory disease (CCS 133) | 70 (3.4) | 65,321 (3.3) | 1.03 (0.82–1.30) | .79 | ||
| 4. Administrative/social admissions (CCS 255) | 69 (3.3) | 22,582 (1.1) | 2.94 (2.33–3.71) | <.0001 | * | |
| 5. Disorders of teeth and jaw (CCS 136) | 64 (3.1) | 7,755 (0.4) | 7.94 (6.23–10.12) | <.0001 | * | |
| 6. Spondylosis; intervertebral disc disorders; other back problems (CCS 205) | 64 (3.1) | 58,555 (2.9) | 1.05 (0.83–1.34) | .68 | ||
| 7. Rehabilitation care; fitting of prostheses; and adjustment of devices (CCS 254) | 62 (3.0) | 60,242 (3.0) | 0.99 (0.78–1.27) | .94 | ||
| 8. Essential hypertension (CCS 98) | 57 (2.7) | 55,076 (2.7) | 1.00 (0.77–1.29) | .98 | ||
| 9. Genitourinary symptoms and ill-defined conditions (CCS 163) | 57 (2.7) | 30,542 (1.5) | 1.80 (1.39–2.32) | <.0001 | * | |
| 10. Medical examination/evaluation (CCS 256) | 57 (2.7) | 88,888 (4.4) | 0.62 (0.48–0.80) | <.001 | * | |
| Other reasons/conditions | 1,389 (66.5) | 1,565,105 (77.8) | ||||
| Total | 2,090 | 2,011,351 | ||||
| 1. Upper respiratory infections (CCS 126) | 101 (7.4) | 34,789 (4.2) | 1.77 (1.47–2.14) | <.0001 | * | |
| 2. Superficial injury; contusion (CCS 239) | 91 (6.7) | 48,303 (5.8) | 1.15 (0.94–1.40) | .17 | ||
| 3. Abdominal pain (CCS 251) | 61 (4.5) | 27,774 (3.4) | 1.34 (1.05–1.71) | .02 | * | |
| 4. Sprains and strains (CCS 232) | 61 (4.5) | 35,548 (4.3) | 1.05 (0.82–1.34) | .71 | ||
| 5. Viral infection (CCS 7) | 43 (3.2) | 12,274 (1.5) | 2.14 (1.59–2.87) | <.0001 | * | |
| 6. Nausea and vomiting (CCS 250) | 42 (3.1) | 14,606 (1.8) | 1.76 (1.30–2.37) | < 001 | * | |
| 7. Open wounds of extremities (CCS 236) | 42 (3.1) | 43,832 (5.3) | 0.58 (0.43–0.79) | <.001 | * | |
| 8. Fracture of upper limb (CCS 229) | 41 (3.0) | 18,367 (2.2) | 1.36 (1.01–1.84) | .045 | * | |
| 9. Headache; including migraine (CCS 84) | 36 (2.7) | 12,562 (1.5) | 1.75 (1.27–2.42) | <.001 | * | |
| 10. Otitis media and related conditions (CCS 92) | 36 (2.7) | 16,391 (2.0) | 1.34 (0.97–1.85) | .07 | ||
| Other reasons/conditions | 804 (59.2) | 564,508 (68.1) | ||||
| Total | 1,358 | 828,954 | ||||
| 1. Mood disorders (CCS 657) | 14 (6.6) | 10,575 (3.6) | 1.83 (1.10–3.04) | .02 | * | |
| 2. Acute cerebrovascular disease (CCS 109) | 12 (5.7) | 6,194 (2.1) | 2.68 (1.55–4.64) | .002 | * | |
| 3. Schizophrenia and other psychotic disorders (CCS 659) | 7 (3.3) | 2,762 (0.9) | 3.51 (1.69–7.27) | .004 | * | |
| 4. Epilepsy; convulsions (CCS 83) | 6 (2.8) | 2,271 (0.8) | 3.65 (1.66–8.05) | .007 | * | |
| 5. Fracture of lower limb (CCS 230) | 6 (2.8) | 2,800 (1.0) | 2.96 (1.35–6.53) | .02 | * | |
| Other reasons/conditions | 166 (78.7) | 267,220 (91.6) | ||||
| Total | 211 | 291,822 | ||||
[i] * Statistical significance at P < .05.