Infectious Disease-Related Visits in Recent Immigrants in an Urban, Tertiary Care Medical Center, 2022-2024

Recent immigrants face unique infectious disease risks related to their country-of-origin, epidemiology, migration routes, limited access to preventative care, and barriers in host countries. The infectious disease burden in this population is incompletely characterized. Emergency departments (EDs) are critical points of access for newly arrived individuals. This study describes the frequency and spectrum of infectious disease-related ED visits among recent immigrants.

We conducted a retrospective cohort study of adults (≥ 18 years) presenting to a tertiary care, academic safety-net hospital from 01/2022 to 02/2024. Because immigration status was not explicitly recorded, recent immigrants were identified as those with a preferred language other than English whose first visit occurred during the study period and who were uninsured or covered by MassHealth Limited. Demographic and clinical data were extracted by the institution’s Clinical Data Warehouse for Research.

There were 4717 patients that met inclusion criteria, and 579 (12.3%) had an infectious disease ICD-10 discharge code. The most prevalent were genitourinary infections (n = 138, 23.8% of infections, 2.9% of ED visits), pulmonary infections (120, 20.7%, ~2.5%), and skin and soft tissue infections (118, 20.4%, ~2.5%). Thirty-seven patients (6.4%) had diagnostic codes indicating sepsis or bacteremia. Many uncommon infections, including active (n = 10) and latent (n = 11) tuberculosis (TB), malaria (n = 2), neurocysticercosis (n = 1) were identified. Sexually transmitted infections were common (n = 64, 11.1%). Average age of those with active TB was 37.8 ± 12.3 years, and 60% were male. Nine were admitted. ED length of stay (LOS) for these patients was 33.25 ± 18.86 hours, significantly longer than average for admitted patients in the cohort (p < 0.0017). Those with latent TB had average LOS of 12.93 ± 6.89 hours, significantly longer than discharged patients in the cohort (p < 0.00001).

Infectious disease-related complaints represent a significant proportion of ED visits among presumed recent immigrant patients, including both common and more rare infections. Concern for TB increased ED LOS for admitted and discharged patients. Sepsis/bacteremia were infrequently diagnosed, raising concern for possible under-identification in this population.