Comparing the health of refugee and asylee patients with that of non-refugee immigrant and US-born patients in a large Urban clinic.

OBJECTIVES: To compare disease burden in refugee/asylee, non-refugee immigrant, and US-born patients in the largest safety net clinic in San Francisco, California. METHODS: This is a retrospective chart review including 343 refugee/asylee, 450 immigrant, and 202 US-born patients in a San Francisco clinic from January 2014 to December 2017. Using electronic medical records, we compared prevalence of several diseases by immigration status. Using Poisson regression models with robust variance, we assessed association of diseases with immigration status, adjusting for sociodemographic characteristics. RESULTS: Diagnoses of non-communicable chronic diseases were less common in refugees/asylees, who had a greater risk of being diagnosed with mental health conditions. In Poisson regression models adjusted for sociodemographic characteristics, compared with refugees/asylees, US-born patients were more likely to have hypertension (IRR[CI] = 1.8 [1.0, 3.7]) and less likely to have depression (IRR[CI] = 0.5 [0.3, 0.8]). US-born (IRR[CI] = 0.06 [0.01, 0.2]) and immigrant patients (IRR[CI] = 0.1 [0.06, 0.2]) were less likely to have post-traumatic stress disorder. CONCLUSIONS: We uncover differences in burden of non-communicable chronic diseases and mental health by immigration status. These results highlight the importance of clinical screenings and research on disease burden in refugees.

Hearing Loss Screening, Diagnosis, and Treatment for Refugees and Asylees in an Urban Clinic, 2014-2017.

Objectives: First, to determine whether using a single-question subjective hearing screen vs gold standard audiometric evaluation is effective for hearing loss screening in refugees and asylees. Second, to understand the clinical pathways for hearing loss diagnosis and treatment. Study Design: This is a case series with chart review from January 2014 to December 2017. Setting: A large urban safety net primary care clinic in San Francisco, California. Methods: Patients were included who had a medical record and completed single-question subjective hearing screening and audiometric evaluation during refugee health examinations. An overall 349 patients met all inclusion criteria. Results: Out of 349 patients, 48% were male; the median age was 29.3 years (SD, 15.1). The majority came from Central or South America (n = 148, 42%) and China (n = 79, 23%). Among all patients, 10 (3%) failed the subjective hearing screen, and 18 (5%) failed audiometric evaluation. Of those who failed the subjective hearing screen, 4 (40%) passed audiometric evaluation. Of those who failed the audiometric evaluation, 12 (66%) passed subjective screening, and only 5 (28%) received a diagnostic audiogram, with 4 diagnosed with hearing loss and 1 receiving hearing aids. The sensitivity of the subjective screening question was 33% and the specificity 99% as compared with audiometric evaluation. Conclusion: Audiometric evaluation is relatively inexpensive and easily administered, while a single subjective question is a poor screening tool. Hearing loss is undertreated in this population. Ensuring appropriate hearing loss screening, diagnosis, and treatment in this population is paramount to improving quality of life.