PUBLI : Patrick Cloos, Valéry Ridde et al., « The negative self-perceived health of migrants with precarious status in Montreal, Canada : A cross-sectional study », PLOS One, Mars 2020

Back­ground

Know­ledge about the health impacts of the absence of health insu­rance for migrants with preca­rious status (MPS) in Canada is scarce. MPS refer to immi­grants with autho­rized but tempo­rary legal status (i.e. tempo­rary foreign workers, visi­tors, inter­na­tional students) and/​or unau­tho­rized status (out of legal status, i.e. undo­cu­mented). This is the first large empi­rical study that examines the social deter­mi­nants of self-perceived health of MPS who are unin­sured and resi­ding in Montreal.

Methods and findings

Between June 2016 and September 2017, we performed a cross-sectional survey of unin­sured migrants in Montreal, Quebec. Migrants without health insu­rance (18+) were sampled through venue-based recruit­ment, snow­ball stra­tegy and media announ­ce­ments. A ques­tion­naire focu­sing on socio­de­mo­gra­phic, socioe­co­nomic and psycho­so­cial charac­te­ris­tics, social deter­mi­nants, health needs and access to health care, and health self-percep­tion was admi­nis­tered to 806 indi­vi­duals : 54.1% were recruited in urban spaces and 45.9% in a health clinic. 53.9% were cate­go­rized as having tempo­rary legal status in Canada and 46% were without autho­rized status. Regions of birth were : Asia (5.2%), Carib­bean (13.8%), Europe (7.3%), Latin America (35.8%), Middle East (21%), Sub-Saharan Africa (15.8%) and the United States (1.1%). The median age was 37 years (range:18–87). The propor­tion of respon­dents repor­ting nega­tive (bad/​fair) self-percep­tion of health was 44.8%: 36.1% among migrants with autho­rized legal status and 54.4% among those with unau­tho­rized status (statis­ti­cally signi­fi­cant diffe­rence ; p<0.001). Factors asso­ciated with nega­tive self-perceived health were assessed using logistic regres­sion. Those who were more likely to perceive their health as nega­tive were those : with no diploma/​primary/​secondary educa­tion (age-adjusted odds ratio [AOR]: 2.49 [95% CI 1.53–4.07, p<0.001] or with a college diploma (AOR : 2.41 [95% CI 1.38–4.20, p = 0.002); whose family income met their needs not at all/​a little (AOR : 6.22 [95% CI 1.62–23.85], p = 0.008) or met their needs fairly (AOR : 4.70 [95% CI 1.21–18.27], p = 0.025); with no one whom they could ask for money (AOR : 1.60 [95% CI 1.05–2.46], p = 0.03); with percep­tion of racism (AOR : 1.58 [95% CI 1.01–2.48], p = 0.045); with a feeling of psycho­lo­gical distress (AOR : 2.17 [95% CI 1.36–3.45], p = 0.001); with unmet health care needs (AOR : 3.45 [95% CI 2.05–5.82], p<0.001); or with a health issue in the past 12 months (AOR : 3.44 [95% CI 1.79–6.61], p<0.001). Some variables that are asso­ciated with nega­tive self-perceived health varied accor­ding to gender : region of birth, lower formal educa­tion, having a family income that does not meet needs perfectly /​very well, insa­lu­brious housing, not knowing someone who could be asked for money, and having ever received a medical diagnosis.

Conclu­sions

In our study, almost half of immi­grants without health insu­rance perceived their health as nega­tive, much higher than reports of nega­tive self-perceived health in previous Cana­dian studies (8.5% among recent immi­grants, 19.8% among long-term immi­grants, and 10.6% among Cana­dian-born). Our study also suggests a high rate of unmet health care needs among migrants with preca­rious status, a situa­tion that is corre­lated with poor self-perceived health. There is a need to put social poli­cies in place to secure access to resources, health care and social services for all migrants, with or without autho­rized status.