Access to preventive care by immigrant populations

Please see related article: http://www.equityhealthj.com/content/11/1/22 webciteImmigrant and refugee populations suffer a significant burden of disease, and health systems face significant challenges in addressing the health of migrant populations globally [1]. Despite this, there has been comparatively little research on inequities in access to preventive care experienced by immigrant and refugee populations.Patterns of cardiovascular disease are complex in immigrant populations. 'Healthy migrant' selection effects have been observed among migrants in some countries, with associated reduced risk of disease [2]. Certainly, the cardiac risk among migrants in many migration destination countries is highly variable. However, where it is initially lower, their cardiovascular risk usually 'normalizes' to become the same as or worse than the rest of the population [3]. Stroke risk is less equivocal, tending to be consistently higher among immigrants. This is a pattern that is in part attributable to higher rates of hypertension and diabetes [4].A study by Stimpson et al. [5] on cholesterol screening among immigrant populations was recently published in the International Journal of Equity in Health Care. This identifies persistent disparities in self-reported cholesterol screening for immigrants compared to non-immigrants including Hispanic populations. Using data from the 1998 to 2008 National Health and Nutrition Examination Surveys, the authors found 70.9% of immigrants originating from Mexico recalled being screened, compared with 80.1% of those born in the US and 77.8% of US-born Hispanic persons. This is consistent with other studies that have found higher rates of undiagnosed diabetes among US-Mexican border populations [6]. Both are examples of the inverse care law (in which those at greatest need receive less care) [7].The disparities in cholesterol screening in Stimpson et al.'s study disappeared after adjusting for reduced healthcare access related to lack of h