# The Neurosurgical Immigrant Experience in Italy: Analysis of a Northeast Tertiary Center

## TL;DR

This study examines healthcare access differences between immigrants and Italians in a neurosurgical setting in Italy, finding higher emergency use among Asian and African immigrants.

## Contribution

The paper provides insights into immigrant healthcare patterns in neurosurgery, highlighting disparities and suggesting policy improvements for better integration.

## Key findings

- Patients from Asia and Africa more frequently accessed inpatient care compared to outpatient services.
- Immigrants had higher additional visit rates, especially for spinal issues and among younger patients.
- No significant difference in new visits by sex was observed between immigrants and Italians.

## Abstract

Italy’s immigrant population has risen in the last two decades. Integration into society, including access to healthcare, is critical for the well-being of this population. Objectives: We compared regular immigrants and Italians to determine whether the groups received different care. Methods: Inpatient and outpatient medical records were collected from January 2017 to December 2021. We abstracted the identification code, nationality, sex, age, ICD-9 codes, date of the first and additional visits, and surgical intervention. Pathologies were categorized with ICD-9 codes. Patients were grouped according to geographical origin: European Union (EU), Central and Eastern Europe, Asia, North Africa, Central and South Africa, North America, and Central and South America. Results: More patients from Asia and Africa presented to inpatient than outpatient clinics (p-value: 0.001). The median age was lower for patients from Asia and Eastern Europe than from the EU. More patients presented with acute spine pain (26.4% versus 19.6%, p-value: 0.001) as inpatients, while patients presented as outpatients more for degenerative spine issues (77.1% versus 69.0%, p-value: <0.001) but less for brain neoplasms (p-value: 0.009). Additional visit rates were higher for immigrants than for Italians (IRR 1.32 visits/year, 95% CI 0.99–1.77 visits/year, p-value: 0.06), especially for patients with spinal issues (spinal versus cranial: 1.27 visits/year, 95% CI 1.14–1.43 visits/year, p-value: <0.001) and younger patients (<65 years old: 1.52 visits/year, 95% CI 1.39–1.71 visits per year, p-value: <0.001). There was no difference in the incidence of new visits when stratified by sex. Conclusions: Access to emergency care and additional visits were more prevalent in the recent immigrant population, especially from Asia, reflecting unconsolidated health habits. Immigrants from Central and Eastern Europe or North Africa seemed fully integrated. A healthcare policy tailored to the needs of immigrants—taking into account their cultural and social backgrounds and ensuring effective communication—can be highly beneficial. Specifically, it is essential to reintegrate general practitioners and guide individuals toward the most appropriate services.