Notifiable infectious diseases in EU11 migrant workers and use of public health care by skill level

Background

EU11 migrant workers (MWs) form Europe’s largest migrant workforce and are predominantly employed in practically skilled jobs. Socioeconomic disadvantage and migration background are established determinants of increased infectious disease burden (IDB) and barriers to care. This study examined differences in notifiable IDB and subsequent access to and use of public health (PH) care between practically and theoretically skilled EU11 MWs (PSMW and TSMW).

Methods

We conducted a cross-sectional study using electronic health record data of EU11 born adults with infectious diseases notified to 13 Dutch Public Health Service (PHS) (2018-2024). We used UN definition for MW-status and ISCO-08 for skill level. Differences between groups were assessed using Mann–Whitney U and chi-square tests.

Results

We identified 365 PSMW and 54 TSMW. PSMW had significantly more chronic hepatitis C (17,5% vs 3,7%), legionellosis (6,8% vs 0%) and higher hospitalisation rate (19,5% vs 9,3%). TSMW had more acute infections (46,3% vs 27,1%), specifically hepatitis A, whooping cough, mpox and shigellosis. PSMW experienced significantly more PH care delay (16,6 vs 9,1 days) and interpreting needs (51,5% vs 5,9%) and more reliance on non-professional interpreters (13,3% vs 2,0%) during PH care. PSMW had lower general practitioner (GP) registration (68,5% vs 85,2%), less primary care involvement leading up to notification (50,4% vs 72,2%) but more GP involvement (49,0% vs 29,6%) during PH care. Mortality, requesting clinician for laboratory testing and reason for request, test delay use of hospital-based, emergency or cross-border health services, and PHS success rate of contact establishment and appointment attendance were comparable between groups.

Conclusions

PSMW have different notifiable IDB than TSMW and higher hospitalisation. PSMW have poorer access and use of subsequent PH care, marked by PH care delay, higher interpreting needs, and less primary care guided access into PH care.

Key messages

• Practically skilled EU11 migrant workers (PSMW) have more chronic notifiable infectious diseases and suboptimal access and use of public health (PH) care which poses individual and public health risks.

• Reducing this inequity requires tailored approaches, like reducing PH care delays and supporting professional interpreting, improving GP registration, and facilitating primary care PH access for PSMW.