Older immigrants’ use of general practice in Denmark a register-based cohort study

BACKGROUND: Health care systems in Northern Europe are facing increasing numbers of older immigrants. This study aimed to examine older immigrants' use of daytime general practice in Denmark compared with natives. METHODS: In this register-based cohort study, all citizens aged ≥75 years were grouped into country categories according to four characteristics of their country of birth, including geographic region, gross national income, health expenditure and population density. Frequencies of face-to-face, telephone, email and home visit consultations among immigrants were compared with natives using zero-inflated Poisson regression, adjusted for individual health, geographic and socioeconomic factors. RESULTS: Immigrants from countries with a low percentage of gross domestic product allocated to health care, as well as immigrants from middle-income countries (e.g. Pakistan (incidence rate ratio (IRR) 0.83 (95% confidence interval (95% CI) 0.82; 0.85)) and Bosnia and Herzegovina (IRR 0.82 (95% CI 0.80; 0.83))), generally had fewer consultations in general practice compared with natives. In contrast, immigrants from high-income countries and from countries with high health care spending had more consultations than natives. Seven country categories were identified based on the four characteristics, with low-income countries not represented in any category as they did not meet the threshold of 500 immigrants per category. CONCLUSION: Among older immigrants in Denmark, the use of services in daytime general practice is closely associated with the health care expenditure in the country of birth.