Burns, Rachel Emily; (2024) Using Electronic Health Records to Describe the Healthcare, Hospital Admissions and COVID-19 Vaccination Status of non-EU Migrants and Refugees living in England. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Background: Although 17% of people living in England are migrants, large-scale evaluation of their healthcare needs has been limited. Electronic health records (EHRs) are a low-cost, efficient, and highly powered data source that can explore the complex relationship between migration and health, but information on migration status is not routinely collected in administration health datasets. The aim of this PhD thesis was to develop a large cohort of migrants through linking administrative immigration data and EHRs in order to assess healthcare access and health service provision. / Methods: I conducted a scoping review to identify research gaps within migration and health research in the UK (Chapter 2). I developed and evaluated a cohort of migrants, the Million Migrant cohort, through the linkage of pre-entry tuberculosis screening, refugee pre-arrival health check, and health datasets (Chapter 3). Lastly, I assessed hospital-based healthcare utilisation and COVID-19 vaccination coverage in the Million Migrant cohort compared to the general population in England (Chapter 4 and 5). / Results: Within the migration and health research landscape, I identified a dearth of evidence from large-scale, national studies with data disaggregated by migration status and focusing on secondary care utilisation. To fill this research gap, I deterministically linked migrants and refugees to hospital records and COVID-19 vaccination data. Migrants on refugee, settlement, and dependent visas were more likely to link to at least one hospital record than those on work, student, or working holiday visas. Emergency and planned hospital admissions were lower for almost all migrant groups compared to the general population in England. Older migrants, refugees, and migrants from ethnic minority backgrounds were more likely to be delayed or overdue for second or third COVID-19 vaccination doses. / Conclusions: This PhD generated a cohort of migrants and refugees in England and novel estimations of migrant secondary care utilisation and COVID-19 vaccination coverage. Based on these findings, evidence-based recommendations were made.

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