🤖 AI Summary
This study investigates diagnostic inequities in multimorbidity among international migrants attributable to barriers in healthcare access. Leveraging approximately 13 million hospital records from Austria between 2015 and 2019, the authors constructed a 1:1 matched cohort of Austrian-born and foreign-born patients using propensity score matching. Through multimorbidity network modeling and statistical comparison, they reveal for the first time that migrant patients exhibit significantly fewer multimorbidity connections—particularly between mental and metabolic conditions—not due to lower actual disease burden, but likely reflecting structural healthcare barriers. The analysis further uncovers gender-specific patterns: migrant women show clustering of depression, somatization, and back pain, whereas migrant men are characterized by a higher incidence of acute somatic conditions, highlighting systemic disparities in diagnostic recognition.
📝 Abstract
International migrants face well-documented barriers to healthcare access, yet the extent to which these barriers shape patterns of disease co-occurrence remains poorly understood. Drawing on a nationwide dataset of approximately 13 million hospital admissions from around 4 million individuals in Austria (2015-2019), we constructed and compared comorbidity networks between Austrian nationals and non-Austrian migrants, matched 1:1 by age, sex, and time of first hospital admission (272,779 per group). Following matching, metabolic and cardiovascular diagnoses, including type 2 diabetes and myocardial infarction, were more common among non-Austrians, while depression was more common among Austrians. Comorbidity network analysis showed that among all disease pairs that differed significantly between groups, 70% showed stronger co-occurrence in Austrian patients and 30% in non-Austrian patients. Distinct sex-specific patterns appeared: Austrian males showed stronger associations between alcohol use disorder and mental health diagnoses, whereas non-Austrian males more frequently presented with acute somatic conditions. Among non-Austrian women, a pronounced cluster of recurrent depression, somatoform disorders, and dorsalgia was observed. We interpret the disproportionately fewer comorbidity links observed in non-Austrians not as evidence of lower disease burden, but as a likely reflection of structural access barriers, including language differences, cultural factors, and crisis-oriented admission patterns, that prevent comprehensive diagnostic assessment, though a contribution from the healthy migrant effect cannot be excluded. These findings stress the need for culturally aware care strategies and earlier identification of high-risk multimorbidity profiles in migrant populations.