Child (0 - 6 years) primary healthcare use by migratory status in Lisbon: pre/post COVID-19 pandemic

Abstract Immigrant children often face barriers in accessing healthcare, yet evidence of their use of Portugal's National Health Service remains scarce. This study compares primary healthcare utilization between immigrant and non-immigrant children living in four municipalities of the Lisbon Metropolitan Area before, during, and after the COVID-19 pandemic. We conducted a cross-sequential cohort study with 760 children born in 2018 (55.5%) and 2020, recruited from 13 primary healthcare centers. Half were immigrants (born outside the EU or with at least one parent born outside the EU). Data were obtained from electronic health records from 2018 to 2024, including annual healthcare attendance (yes/no), the number of consultations, age-targeted appointment attendance, and whether the child had a family doctor. From 2018 to 2024, immigrant children consistently showed lower healthcare use than non-immigrant peers (χ² test, p < 0.05), including fewer consultations (Mann-Whitney U test, p < 0.05) and lower attendance at age-specific appointments (χ² test, p < 0.05), except at age two (χ² test, p = 0.771). Nonetheless, the gap in utilization narrowed during the pandemic and persisted afterward. Attendance generally declined after the 12-month appointment for both groups. Children born in 2020 had higher overall healthcare use than those born in 2018. Using longitudinal data linked to health records, this study provides rare insight into early childhood healthcare patterns by migratory status in Portugal. It reveals persistent but evolving inequalities in healthcare use by immigrant children living in the Lisbon Metropolitan Area. Findings suggest that structural access barriers, pandemic-related policies, and parental perceptions of care needs may contribute to these disparities. Results support the need for culturally tailored outreach strategies to promote routine pediatric healthcare among immigrant families and improve preparedness for future health crises. Key messages • Identified persistent healthcare access gaps between immigrant and non-immigrant children in Lisbon, guiding targeted outreach and equity-driven health strategies. • Showed how COVID-19 temporarily reduced disparities in child healthcare use, highlighting opportunities to sustain equitable access post-pandemic.