Background
Access to healthcare for asylum seekers and migrants in Germany
Epidemiological situation and prevention of HIV in Germany
Objective
Methodology
Study design and questionnaire
Definitions
Assessment | |
---|---|
Primary outcome | |
Health insurance status | Comparing HIC vs. MTV and HIC vs. NI |
Secondary outcomes | |
Utilization of medical care | Physician or hospital visit within the last year yes/no |
Uptake of HIV testing | HIV ever been tested yes/no |
Statistical analysis
Results
Study population
Demographic characteristics
Insurance status | Health insurance card | Medical treatment voucher | No health insurance | I do not know | p-value |
---|---|---|---|---|---|
Age group | n (%) | n (%) | n (%) | n (%) | |
18–25 years | 224 (67.3%) | 63 (18.9%) | 34 (10.2%) | 12 (3.6%) | p < 0.001 |
26–35 years | 490 (79.8%) | 82 (13.4%) | 35 (5.7%) | 7 (1.1%) | |
36–45 years | 392 (89.3%) | 21 (4.8%) | 21 (4.8%) | 5 (1.1%) | |
≥ 46 years | 336 (93.9%) | 4 (1.1%) | 16 (4.5%) | 2 (0.6%) | |
Level of education | |||||
Primary/ Secondary School | 328 (70.1%) | 87 (18.6%) | 40 (8.5%) | 13 (2.8%) | p < 0.001 |
High School/ Vocational School | 541 (87.4%) | 52 (8.4%) | 21 (3.4%) | 5 (0.8%) | |
University/ College | 587 (90.7%) | 11 (1.7%) | 44 (6.8%) | 5 (0.8%) | |
No certificate | 93 (73.8%) | 22 (17.5%) | 8 (6.3%) | 3 (2.4%) | |
Other | 11 (64.7%) | 4 (23.5%) | 1 (5.9%) | 1 (5.9%) | |
Level of German language | |||||
Mother tongue | 49 (95.1%) | 1 (2.4%) | 1 (2.4%) | 0 (0.0%) | p < 0.001 |
Very good | 421 (96.6%) | 4 (0.9%) | 10 (2.3%) | 1 (0.2%) | |
Good | 468 (94.9%) | 14 (2.8%) | 8 (1.6%) | 3 (0.6%) | |
Satisfactory | 358 (86.7%) | 38 (9.2%) | 13 (3.1%) | 4 (1.0%) | |
Little | 228 (66.3%) | 72 (20.9%) | 37 (10.8%) | 7 (2.0%) | |
None | 43 (28.9%) | 50 (33.6%) | 44 (29.5%) | 12 (8.1%) | |
Religion | |||||
Christians | 1113 (85.0%) | 108 (8.2%) | 77 (5.9%) | 12 (0.9%) | p = 0.001 |
Muslim | 344 (77.0%) | 58 (13.0%) | 33 (7.4%) | 12 (2.7%) | |
No or other religion | 97 (85.1%) | 10 (8.8%) | 4 (3.5%) | 3 (2.6%) | |
Monthly NET income | |||||
I do not want to answer | 305 (84.5%) | 23 (6.4%) | 27 (7.5%) | 6 (1.7%) | p < 0.001 |
< 500€ | 161 (66.0%) | 64 (26.2%) | 14 (5.7%) | 5 (2.0%) | |
500 – < 1000 € | 333 (95.1%) | 9 (2.6%) | 7 (2.0%) | 1 (0.3%) | |
1000 – < 2000 € | 433 (98.2%) | 3 (0.7%) | 4 (0.9%) | 1 (0.2%) | |
≥ 2000 € | 111 (94.9%) | 2 (1.7%) | 4 (3.4%) | 0 (0.0%) | |
No income | 157 (58.1%) | 52 (19.3%) | 50 (18.5%) | 11 (4.1%) | |
Region of birth | |||||
Western Africa | 815 (80.5%) | 109 (10.8%) | 69 (6.8%) | 20 (2.0%) | p = 0.051 |
Central Africa | 389 (86.3%) | 39 (8.6%) | 22 (4.9%) | 1 (0.2%) | |
Eastern Africa | 209 (83.9%) | 24 (9.6%) | 10 (4.0%) | 6 (2.4%) | |
Southern Africa | 94 (90.4%) | 4 (3.8%) | 6 (5.8%) | 0 (0.0%) |
Access to health care
Factors associated with health insurance status
Duration of residence | Under one year | 1- under 5 years | 5- under 10 years | 10- under 20 years | 20 years and more | Total |
---|---|---|---|---|---|---|
Insurance status | n (%) | n (%) | n (%) | n (%) | n (%) | n (%) |
Health insurance card | 79 (36.1%) | 411 (73.4%) | 324 (93.4%) | 478 (98.0%) | 261 (97.4%) | 1543 (83.2%) |
Medical treatment voucher | 59 (30.9%) | 101 (18.0%) | 10 (2.9%) | 5 (1.0%) | 4 (1.5%) | 179 (9.7%) |
No insurance | 49 (25.7%) | 38 (6.8%) | 11 (3.2%) | 4 (0.8%) | 3 (1.1%) | 105 (5.7%) |
I do not know | 14 (7.3%) | 10 (1.8%) | 2 (0.6%) | 1 (0.2%) | 0 (0.0%) | 27 (1.5%) |
Variable | Model A: HIC (1) vs. MTV (0) | Model B: HIC (1) vs. NI (0) | ||||
---|---|---|---|---|---|---|
aOR | 95% - CI | p-value | aOR | 95% - CI | p-value | |
Sex | ||||||
Men | Ref. | Ref. | ||||
Women | 1.55 | 0.96–2.51 | 0.075 | 1.63 | 0.92–2.89 | 0.092 |
Age group | ||||||
18–25 years | 1.44 | 0.81–2.55 | 0.215 | 1.41 | 0.68–2.93 | 0.361 |
26–35 years | Ref. | Ref. | ||||
36–45 years | 1.44 | 0.69–3.01 | 0.333 | 0.62 | 0.30–1.28 | 0.194 |
≥ 46 years | 3.93 | 1.14–13.57 | 0.300 | 0.49 | 0.19–1.22 | 0.126 |
Length of stay in Germany | ||||||
≤ 1 year |
0.10
|
0.03–0.29
|
< 0.001
|
0.19
|
0.07–0.51
|
0.001
|
1 - < 5 years |
0.19
|
0.08–0.49
|
0.001
| 0.69 | 0.29–1.64 | 0.405 |
5 - < 10 years | Ref. | Ref. | ||||
10 - < 20 years | 0.96 | 0.25–3.72 | 0.957 |
3.82
|
1.10–13.22
|
0.035
|
≥ 20 years | 0.50 | 0.11–2.39 | 0.388 | 4.04 | 0.89–18.34 | 0.105 |
German language skills | ||||||
None |
0.12
|
0.04–0.32
|
< 0.001
|
0.12
|
0.04–0.34
|
< 0.001
|
Little |
0.19
|
0.08–0.44
|
< 0.001
|
0.30
|
0.12–0.76
|
0.011
|
Satisfactory |
0.37
|
0.16–0.87
|
0.022
| 1.24 | 0.41–3.76 | 0.700 |
Good | Ref. | Ref. | ||||
Very good | 1.00 | 0.28–3.60 | 0.998 | 0.56 | 0.19–1.63 | 0.288 |
Mother tongue | 0.00 | < 0.000 | 0.998 | 0.25 | 0.03–2.34 | 0.225 |
Religion | ||||||
Christian | Ref. | Ref. | ||||
Muslim | 1.22 | 0.69–2.16 | 0.497 | 1.25 | 0.64–2.47 | 0.517 |
No or other religion | 1.90 | 0.60–5.98 | 0.272 | 0.96 | 0.25–3.66 | 0.946 |
Education | ||||||
Other | 0.55 | 0.10–2.99 | 0.491 | – | – | – |
No degree or certificate | 1.50 | 0.72–3.14 | 0.284 | 2.38 00.54 | 0.76–7.52 | 0.138 |
Primary or secondary school | Ref. | Ref. | ||||
High −/vocational school | 1.39 | 0.79–2.42 | 0.252 |
2.45
|
1.10–5.47
|
0.028
|
University degree |
15.41
|
6.67–35.57
|
< 0.001
| 1.44 | 0.73–2.82 | 0.289 |
Monthly NET income | ||||||
I do not want to answer | 0.49 | 0.20–1.20 | 0.119 |
0.32
|
0.12–0.83
|
0.019
|
No income |
0.25
|
0.11–0.58
|
0.001
|
0.23
|
0.09–0.58
|
0.002
|
< 500 € |
0.14
|
0.06–0.33
|
< 0.001
| 0.37 | 0.13–1.03 | 0.057 |
500 € - < 1.000 € | Ref. | Ref. | ||||
1.000 € - < 2.000 € | 6.32 | 0.75–53.04 | 0.090 | 1.72 | 0.46–6.45 | 0.423 |
≥ 2.000 € | 0.40 | 0.07–2.34 | 0.307 | 0.50 | 0.12–2.10 | 0.343 |
Region of birth | ||||||
Western Africa | Ref. | Ref. | ||||
Central Africa | 1.08 | 0.56–2.06 | 0.828 | 0.90 | 0.45–1.78 | 0.753 |
Eastern Africa | 0.74 | 0.35–1.57 | 0.430 | 1.62 | 0.66–4.02 | 0.295 |
Southern Africa | 0.98 | 0.27–3.56 | 0.972 | 1.09 | 0.33–3.57 | 0.885 |
First contact point in case of health problems
Insurance status | Health insurance card | Medical treatment voucher | No insurance | I do not know | Total | p-value |
---|---|---|---|---|---|---|
Contact point | n (%) | n (%) | n (%) | n (%) | n (%) | |
Physician | 1406 (90.0%) | 119 (66.1%) | 47 (41.2%) | 17 (63.0%) | 1589 (84.3%) | < 0.001 |
Hospital | 494 (31.6%) | 61 (33.9%) | 23 (20.2%) | 5 (18.5%) | 583 (30.9%) | 0.027 |
Pharmacy | 352 (22.5%) | 8 (4.4%) | 19 (16.7%) | 2 (7.4%) | 381 (20.2%) | < 0.001 |
African healer | 40 (2.6%) | 2 (1.1%) | 1 (0.9%) | 1 (3.7%) | 44 (2.3%) | 0.422 |
Friends | 92 (5.9%) | 21 (11.7%) | 20 (17.5%) | 5 (18.5%) | 138 (7.3%) | < 0.001 |
I do not knowwhere to go | 3 (0.2%) | 2 (1.1%) | 18 (15.8%) | 3 (11.1%) | 26 (1.4%) | < 0.001 |
Other | 35 (2.2%) | 8 (4.4%) | 16 (14.0%) | 0 (0.0%) | 59 (3.1%) | < 0.001 |
Last consultation for medical care
Variable | % | Univariate Analysis | Multivariate Analysis | ||||
---|---|---|---|---|---|---|---|
OR | 95% - CI | p-value | aOR | 95% - CI | p-value | ||
Sex | |||||||
Men | 75.2% | Ref. | Ref. | ||||
Women | 84.9% |
1.86
|
1.47–2.35
|
< 0.001
|
1.90
|
1.44–2.50
|
< 0.001
|
Age group | |||||||
18–25 years | 76.3% | 0.98 | 0.72–1.34 | 0.900 | 1.12 | 0.77–1.62 | 0.567 |
26–35 years | 76.7% | Ref. | Ref. | ||||
36–45 years | 82.1% |
1.40
|
1.00–1.90
|
0.032
| 1.21 | 0.85–1.72 | 0.293 |
≥ 46 years | 85.0% |
1.72
|
1.22–2.43
|
0.002
|
1.87
|
1.17–2.99
|
0.009
|
Length of stay in Germany | |||||||
≤ 1 year | 69.7% |
0.57
|
0.38–0.85
|
0.006
| 0.66 | 0.36–1.20 | 0.170 |
1 - < 5 years | 77.5% | 0.85 | 0.61–1.18 | 0.340 | 0.92 | 0.61–1.38 | 0.681 |
5 - < 10 years | 80.2% | Ref. | Ref. | ||||
10 - < 20 years | 83.3% | 1.23 | 0.86–1.75 | 0.251 | 1.08 | 0.72–1.64 | 0.707 |
≥ 20 years | 83.8% | 1.28 | 0.84–1.95 | 0.244 | 0.96 | 0.55–1.65 | 0.869 |
German language skills | |||||||
None | 73.6% | 0.72 | 0.47–1.10 | 0.127 | 1.76 | 0.91–3.42 | 0.096 |
Little | 76.9% | 0.86 | 0.61–1.19 | 0.353 | 1.14 | 0.75–1.75 | 0.541 |
Satisfactory | 82.1% | 1.18 | 0.85–1.65 | 0.323 | 1.46 | 0.99–2.15 | 0.058 |
Good | 79.6% | Ref. | Ref. | ||||
Very good | 80.8% | 1.08 | 0.78–1.49 | 0.639 | 1.01 | 0.76–1.59 | 0.628 |
Mother tongue | 81.0% | 1.09 | 0.49–2.43 | 0.829 | 1.02 | 0.42–2.48 | 0.973 |
Religion | |||||||
Christian | 80.5% | Ref. | Ref. | ||||
Muslim | 79.2% | 0.92 | 0.71–1.21 | 0.559 | 1.17 | 0.85–1.60 | 0.338 |
No or other religion | 73.9% | 0.69 | 0.44–1.07 | 0.092 | 0.82 | 0.49–1.34 | 0.421 |
Education | |||||||
Other | 76.5% | 0.71 | 0.23–2.27 | 0.553 | 0.78 | 0.21–2.92 | 0.710 |
No degree or certificate | 74.6% | 0.64 | 0.40–1.02 | 0.059 |
0.57
00.54
|
0.34–0.97
|
0.039
|
Primary or secondary school | 82.1% | Ref. | Ref. | ||||
High −/vocational school | 79.0% | 0.82 | 0.61–1.11 | 0.200 | 0.78 | 0.54–1.11 | 0.167 |
University degree | 79.4% | 0.84 | 0.62–1.16 | 0.255 | 0.85 | 0.59–1.24 | 0.399 |
Monthly NET income | |||||||
I do not want to answer | 76.8% | 0.86 | 0.60–1.22 | 0.396 | 1.09 | 0.73–1.63 | 0.675 |
No income | 75.6% |
0.80
|
0.55–1.17
|
0.250
| 1.05 | 0.67–1.67 | 0.821 |
< 500 € | 78.0% | 0.92 | 0.62–1.36 | 0.666 | 1.11 | 0.70–1.75 | 0.661 |
500 € - < 1.000 € | 79.4% | Ref. | Ref. | ||||
1.000 € - < 2.000 € | 82.0% | 1.18 | 0.83–1.69 | 0.353 | 1.33 | 0.89–2.00 | 0.167 |
≥ 2.000 € | 87.1% | 1.74 | 0.96–3.18 | 0.067 | 1.89 | 0.98–3.65 | 0.059 |
Health insurance status | |||||||
Health insurance card | 81.2% | Ref. | Ref. | ||||
Medical treatment voucher | 79.4% | 0.90 | 0.61–1.32 | 0.578 | 1.03 | 0.62–1.71 | 0.905 |
No insurance | 60.5% |
0.36
|
0.24–0.53
|
< 0.001
|
0.36
|
0.21–0.60
|
< 0.001
|
Uptake of HIV testing
Variable | % | Univariate Analysis | Multivariate Analysis | ||||
---|---|---|---|---|---|---|---|
OR | 95% - CI | p-value | aOR | 95% - CI | p-value | ||
Sex | |||||||
Men | 62.2% | Ref. | Ref. | ||||
Women | 70.4% |
1.44
|
1.19–1.75
|
< 0.001
|
1.59
|
1.24–2.05
|
< 0.001
|
Age group | |||||||
18–25 years | 42.1% |
0.36
|
0.27–0.47
|
< 0.001
|
0.42
|
0.30–0.56
|
< 0.001
|
26–35 years | 67.0% | Ref. | Ref. | ||||
36–45 years | 77.8% |
1.72
|
1.30–2.28
|
< 0.001
|
2.03
|
1.43–2.88
|
< 0.001
|
≥ 46 years | 70.2% | 1.16 | 0.87–1.53 | 0.308 |
1.85
|
1.21–2.82
|
0.005
|
Length of stay in Germany | |||||||
≤ 1 year | 55.7% |
0.56
|
0.39–0.80
|
0.002
| 1.82 | 1.00–3.33 | 0.051 |
1 - < 5 years | 61.7% |
0.72
|
0.54–0.95
|
0.021
| 1.05 | 0.71–1.55 | 0.808 |
5 - < 10 years | 69.3% | Ref. | Ref. | ||||
10 - < 20 years | 72.8% | 1.19 | 0.88–1.61 | 0.267 | 0.84 | 0.57–1.24 | 0.381 |
≥ 20 years | 66.2% | 0.87 | 0.62–1.22 | 0.417 |
0.59
|
0.36–0.98
|
0.042
|
German language skills | |||||||
None | 54.7% |
0.66
|
0.46–0.96
|
0.029
| 0.98 | 0.53–1.82 | 0.951 |
Little | 61.7% | 0.87 | 0.67–1.18 | 0.407 | 1.27 | 0.85–1.91 | 0.249 |
Satisfactory | 70.2% | 1.29 | 0.98–1.71 | 0.073 | 1.42 | 1.00–2.01 | 0.050 |
Good | 64.5% | Ref. | Ref. | ||||
Very good | 70.2% | 1.30 | 0.98–1.71 | 0.067 | 1.16 | 0.82–1.63 | 0.405 |
Mother tongue | 66.7% | 1.10 | 0.56–2.14 | 0.783 | 1.67 | 0.70–3.99 | 0.247 |
Religion | |||||||
Christian | 70.3% | Ref. | Ref. | ||||
Muslim | 52.2% |
0.46
|
0.37–0.58
|
< 0.001
|
0.70
|
0.52–0.93
|
0.014
|
No or other religion | 72.2% | 1.10 | 0.72–1.68 |
0.665
| 1.28 | 0.77–2.13 | 0.338 |
Education | |||||||
Other | 58.8% | 1.00 | 0.38–2.68 | 0.993 | 0.52 | 0.15–1.75 | 0.288 |
No degree or certificate | 43.9% |
0.55
|
0.37–0.82
|
0.003
|
0.49
00.54
|
0.31–0.79
|
0.003
|
Primary or secondary school | 58.7% | Ref. | Ref. | ||||
High −/vocational school | 66.8% |
1.42
|
1.10–1.82
|
0.006
|
1.44
|
1.05–1.97
|
0.025
|
University degree | 74.7% |
2.07
|
1.61–2.68
|
< 0.001
|
1.81
|
1.29–2.54
|
0.001
|
Monthly NET income | |||||||
I do not want to answer | 68.5% | 1.10 | 0.80–1.51 | 0.559 | 1.38 | 0.95–2.01 | 0.096 |
No income | 49.4% |
0.49
|
0.36–0.68
|
< 0.001
| 0.68 | 0.45–1.02 | 0.061 |
< 500 € | 63.5% | 0.88 | 0.62–1.24 | 0.458 | 1.17 | 0.77–1.78 | 0.462 |
500 € - < 1.000 € | 66.5% | Ref. | Ref. | ||||
1.000 € - < 2.000 € | 72.1% | 1.31 | 0.96–1.77 | 0.086 | 1.34 | 0.93–1.94 | 0.115 |
≥ 2.000 € | 83.9% |
2.63
|
1.52–4.57
|
< 0.001
|
2.17
|
1.16–4.10
|
0.016
|
Health insurance status | |||||||
Health insurance card | 68.0% | Ref. | Ref. | ||||
Medical treatment voucher | 58.7% |
0.67
|
0.49–0.92
|
0.012
| 1.11 | 0.70–1.78 | 0.655 |
No insurance | 52.7% |
0.52
|
0.36–0.77
|
0.001
|
0.55
|
0.31–0.95
|
0.033
|
Region of birth | |||||||
Western Africa | 60.4% | Ref. | Ref. | ||||
Central Africa | 72.2% |
1.70
|
1.33–2.17
|
< 0.001
|
1.48
|
1.08–2.01
|
0.014
|
Eastern Africa | 73.7% |
1.83
|
1.35–2.50
|
< 0.001
|
1.57
|
1.08–2.27
|
0.018
|
Southern Africa | 73.3% |
1.79
|
1.14–2.84
|
0.011
| 1.28 | 0.75–2.17 | 0.371 |
Administration mode | |||||||
Face-to-face | 62.1% |
0.65
|
0.53–0.79
|
< 0.001
|
0.71
|
0.55–0.91
|
0.008
|
Self-administered | 71.7% | Ref. | Ref. | ||||
Telephone | 59.9% |
0.59
|
0.42–0.83
|
0.002
|
0.53
|
0.35–0.78
|
0.001
|