{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:30:05Z","timestamp":1753893005508,"version":"3.41.2"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,3,12]],"date-time":"2024-03-12T00:00:00Z","timestamp":1710201600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>Immigrant children often encounter additional barriers in accessing health care than their peers. However, there is a lack of evidence globally regarding how migrant status may have affected access to COVID-19 testing during the pandemic. This study aimed to analyze migrant status as a determinant of COVID-19 testing rates among children in the Lisbon metropolitan area, Portugal. This cross-sequential study included 722 children aged 2\u20138\u2009years (47% non-immigrants; 53% immigrants). We collected data from a national surveillance system on laboratory-confirmed COVID-19 tests conducted between March 2020 and May 2023 and assessed whether children were ever tested for COVID-19 and testing frequency. We employed robust and standard Poisson regression models to estimate Adjusted Prevalence Ratios and Relative Risks with 95% confidence intervals. A total of 637 tests were performed. Immigrant children had lower testing rates (53% vs. 48%) and fewer tests per child (median: 2 vs. 3). Moreover, they were 17% less likely to be ever tested (PR\u2009=\u20090.83, 95% CI: 0.76\u20130.89) and performed 26% fewer tests (RR\u2009=\u20090.74, 95% CI: 0.67\u20130.82) compared to non-immigrant children. Caregiver\u2019s age, education, employment status, child\u2019s birth weight, and perceived health status were associated factors. Our findings suggest that the COVID-19 pandemic has left immigrant children somewhat behind. We conclude that specific interventions targeting vulnerable populations, such as immigrant children, are needed in future health crises.<\/jats:p>","DOI":"10.3389\/fpubh.2024.1286829","type":"journal-article","created":{"date-parts":[[2024,3,12]],"date-time":"2024-03-12T04:54:50Z","timestamp":1710219290000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Have immigrant children been left behind in COVID-19 testing rates? \u2013 A quantitative study in the Lisbon metropolitan area between march 2020 and may 2023"],"prefix":"10.3389","volume":"12","author":[{"given":"Iolanda B.","family":"Alves","sequence":"first","affiliation":[]},{"given":"Silvia","family":"Panunzi","sequence":"additional","affiliation":[]},{"given":"Ant\u00f3nio C.","family":"Silva","sequence":"additional","affiliation":[]},{"given":"Regina B. R.","family":"Loesch","sequence":"additional","affiliation":[]},{"given":"Sofia C. R.","family":"Pereira","sequence":"additional","affiliation":[]},{"given":"M. Ros\u00e1rio O.","family":"Martins","sequence":"additional","affiliation":[]}],"member":"1965","published-online":{"date-parts":[[2024,3,12]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1186\/s12992-018-0370-9","article-title":"Use of health services among international migrant children \u2013 a systematic review","volume":"14","author":"Markkula","year":"2018","journal-title":"Glob Health"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"3320","DOI":"10.3390\/ijerph17093320","article-title":"Access to healthcare for immigrant children in Canada","volume":"17","author":"Salami","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"2293","DOI":"10.3389\/fpubh.2022.920308","article-title":"Are immigrants more vulnerable to the socioeconomic impact of COVID-19? A cross-sectional study in Amadora municipality, Lisbon metropolitan area","volume":"10","author":"O Martins","year":"2022","journal-title":"Front Public Health"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1016\/j.anai.2021.10.022","article-title":"The COVID-19 pandemic: adverse effects on the social determinants of health in children and families","volume":"128","author":"Abrams","year":"2022","journal-title":"Ann. Allergy Asthma Immunol."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"100455","DOI":"10.1016\/j.lanepe.2022.100455","article-title":"Migrants\u2019 primary care utilisation before and during the COVID-19 pandemic in England: an interrupted time series analysis","volume":"20","author":"Zhang","year":"2022","journal-title":"Lancet Reg. Health Eur."},{"year":"","key":"ref6","article-title":"Crise, austeridade e desigualdades de sa\u00fade nos pa\u00edses do sul da Europa"},{"year":"","key":"ref7","article-title":"The COVID pandemic disproportionately affected children in BAME families by exacerbating inequalities"},{"year":"","key":"ref8","article-title":"Overview of testing for SARS-CoV-2, the virus that causes COVID-19"},{"year":"","key":"ref9","article-title":"COVID-19 testing: what you need to know"},{"year":"","key":"ref10","article-title":"What has been the impact of the COVID-19 pandemic on immigrants? An update on recent evidence"},{"first-page":"1","volume-title":"The impact of COVID-19 in the migration area in EU and OECD countries","year":"2021","key":"ref11"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"e073639","DOI":"10.1136\/bmj-2022-073639","article-title":"Hospital admissions linked to SARS-CoV-2 infection in children and adolescents: cohort study of 3.2 million first ascertained infections in England","volume":"382","author":"Wilde","year":"2023","journal-title":"BMJ"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1093\/eurpub\/ckaa249","article-title":"Epidemiological characteristics of COVID-19 cases in non-Italian nationals notified to the Italian surveillance system","volume":"31","author":"Fabiani","year":"2021","journal-title":"Eur J Pub Health"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"102576","DOI":"10.1016\/j.healthplace.2021.102576","article-title":"SARS-CoV-2 testing in North Carolina: racial, ethnic, and geographic disparities","volume":"69","author":"Brandt","year":"2021","journal-title":"Health Place"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1111\/ppe.12865","article-title":"Racial, ethnic and socioeconomic disparities in SARS-CoV-2 infection amongst children","volume":"36","author":"Mannheim","year":"2022","journal-title":"Paediatr Perinat Epidemiol"},{"year":"","key":"ref16","article-title":"COVID-19 in immigrants, refugees and other newcomers in Ontario: characteristics of those tested and those confirmed positive, as of June 13, 2020"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1136\/bmjpo-2020-000705","article-title":"Healthcare access for migrant children in England during the COVID-19 pandemic","volume":"4","author":"Wood","year":"2020","journal-title":"BMJ Paediatr Open"},{"year":"","key":"ref18","article-title":"Migrants: healthcare in Portugal"},{"year":"","key":"ref19","article-title":"COVID-19: government grants residence to immigrants and asylum seekers"},{"year":"","key":"ref20","article-title":"Promover a integra\u00e7\u00e3o atrav\u00e9s da equidade em sa\u00fade"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"e061919","DOI":"10.1136\/bmjopen-2022-061919","article-title":"Cohort profile: health trajectories of immigrant children (CRIAS) - a prospective cohort study in the metropolitan area of Lisbon, Portugal","volume":"12","author":"Muggli","year":"2022","journal-title":"BMJ Open"},{"year":"","key":"ref22","article-title":"Munic\u00edpios: Popula\u00e7\u00e3o residente segundo os Censos: total e por naturalidade"},{"year":"","key":"ref23","article-title":"ACES Amadora"},{"year":"","key":"ref24","article-title":"ACES Arco Ribeirinho"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"Doc11","DOI":"10.3205\/psm000089","article-title":"Re-revisiting Andersen\u2019s behavioral model of health services use: a systematic review of studies from 1998-2011","volume":"9","author":"Babitsch","year":"2012","journal-title":"Psychosoc Med"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1186\/s12913-022-07661-8","article-title":"Using Andersen\u2019s model of health care utilization to assess factors associated with COVID-19 testing among adults in nine low-and middle-income countries: an online survey","volume":"22","author":"Pengid","year":"2022","journal-title":"BMC Health Serv Res"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"e0234907","DOI":"10.1371\/journal.pone.0234907","article-title":"Low birth weight and associated risk factors: health facility-based case-control study","volume":"15","author":"Anil","year":"2020","journal-title":"PLoS One"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1186\/1471-2288-8-9","article-title":"A comparison of two methods for estimating prevalence ratios","volume":"8","author":"Petersen","year":"2008","journal-title":"BMC Med Res Methodol"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"33","DOI":"10.19191\/EP22.4S1.054","article-title":"Access to SARS-CoV-2 diagnostic tests: are there barriers for the immigrants in Italy?","volume":"46","author":"D\u00edaz Gonz\u00e1lez","year":"2022","journal-title":"Epidemiol Prev"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"644","DOI":"10.1016\/j.amepre.2021.05.015","article-title":"Racial and ethnic disparities in SARS-CoV-2 testing and COVID-19 outcomes in a Medicaid managed care cohort","volume":"61","author":"Jacobson","year":"2021","journal-title":"Am J Prev Med"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"834","DOI":"10.1007\/s40615-022-01272-z","article-title":"Differential effects of race\/ethnicity and social vulnerability on COVID-19 positivity, hospitalization, and death in the San Francisco bay area","volume":"10","author":"Cho","year":"2023","journal-title":"J Racial Ethn Health Disparities"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1067","DOI":"10.1186\/s12889-022-13388-2","article-title":"Socioeconomic and immigration status and COVID-19 testing in Toronto, Ontario: retrospective cross-sectional study","volume":"22","author":"O\u2019Neill","year":"2022","journal-title":"BMC Public Health"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"870","DOI":"10.1377\/hlthaff.2021.00098","article-title":"Racial\/ethnic disparities in COVID-19 exposure risk, testing, and cases at the subcounty level in California","volume":"40","author":"Reitsma","year":"2021","journal-title":"Health Aff"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"E723","DOI":"10.1503\/cmaj.202608","article-title":"Individual and social determinants of SARS-CoV-2 testing and positivity in Ontario, Canada: a population-wide study","volume":"193","author":"Sundaram","year":"2021","journal-title":"CMAJ"},{"year":"","key":"ref35","article-title":"Portugal: Nados-vivos de m\u00e3es residentes em Portugal: total e por nacionalidade da m\u00e3e"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"519","DOI":"10.18865\/ed.31.4.519","article-title":"Attitudes about COVID-19 testing among black adults in the United States","volume":"31","author":"DeRoo","year":"2021","journal-title":"Ethn Dis"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12889-021-11177-x","article-title":"Geographic and demographic heterogeneity of SARS-CoV-2 diagnostic testing in Illinois, USA, march to December 2020","volume":"21","author":"Holden","year":"2021","journal-title":"BMC Public Health"},{"key":"ref38","doi-asserted-by":"crossref","DOI":"10.9771\/9786556300757.004","article-title":"Indicadores de sa\u00fade e testagem para a COVID-19","volume-title":"Constru\u00e7\u00e3o de conhecimento no curso da pandemia de COVID-19: Aspectos biom\u00e9dicos, cl\u00ednico-assistenciais, epidemiol\u00f3gicos e sociais","author":"Coelho","year":"2020"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1286829\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,12]],"date-time":"2024-03-12T04:54:54Z","timestamp":1710219294000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1286829\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,12]]},"references-count":38,"alternative-id":["10.3389\/fpubh.2024.1286829"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2024.1286829","relation":{},"ISSN":["2296-2565"],"issn-type":[{"type":"electronic","value":"2296-2565"}],"subject":[],"published":{"date-parts":[[2024,3,12]]},"article-number":"1286829"}}