Australia is a multi-ethnic, multi-cultural country with a long history of migration. In 2006, 22% of the population was born overseas. Thai migrants accounted for 0.2% of the population at this time, with a nearly 40% increase from around 19,000 in 1996 to 30,555 in 2006.1 Despite this, little is known about the health of this migrant group. We investigated the health status and health service utilisation of a Thai community through a cross-sectional postal survey conducted from May to September 2010. Participants were members of a Brisbane Thai temple, aged 18 years and older, who self identified as being Thai. Current health status was assessed using the SF-36v22 and self-report of diagnosed medical conditions. Use of health services was assessed using questions adapted from the Welsh Health Survey.3 Socio-demographic variables included gender, age, language spoken at home, year of arrival in Australia and type of health care insurance.
Summary statistics for all variables were calculated and health status was compared to the Australian population4 using two-sample t-tests, Fishers’ exact tests or a z test. Multiple logistic regression examined binary outcomes and the effects of multiple risk factors. SPSS v16.0 was used for data analysis with a significance level of 5%. The University of Queensland's Behavioural and Social Science Ethics Review Committee approved this study.
Of the 101 eligible respondents, 90% were female and 66% spoke English at home. Their mean age was 51 years (range 22–74), with 75% aged 45 years or older. Respondents were older, with a higher proportion of women and higher rates of speaking English at home than the general Brisbane Thai population.5 On average, the respondents had lived in Australian for 20 years with 80% having lived here for more than 10 years. Nearly all respondents (97%) had Medicare (Australia's universal health care insurance) and 39% also had private health insurance (53% in the general population).4
Respondents reported significantly poorer general, physical and mental health (p<0.001) than the general Australian population.4 When stratified by gender, there was no difference in physical or mental health of the male and female respondents, but both female and male respondents had poorer mental health than their counterparts in the general population (Table 1). Speaking English rather than Thai at home was associated with better physical health (p=0.02) and having private health insurance and Medicare rather than Medicare alone was associated with better mental health (p=0.002).
|Mean difference||95% confidence levels||P|
|All respondents||5.82||4.4, 7.2||>0.001|
|Male respondents||5.95||1.6, 10.3||0.012|
|Female respondents||5.70||4.4, 7.2||<0.001|
|All respondents||4.34||2.5, 6.1||>0.001|
|Male respondents||4.27||–4.0, 12.5||0.27|
|Female respondents||3.73||1.9, 5.6||>0.001|
Nearly half (49%) the respondents reported having at least one chronic disease. Compared to the general Australian population, respondents had significantly higher rates of hypertension, diabetes, osteoarthritis, osteoporosis, stroke and cancer of any organ (p<0.05), and higher rates of chronic disease in the 45–54 year age group.4
In the 12 months before the study, 86% of respondents had visited a general practitioner (GP), 65% had used a pharmacist, 19% had attended an out-patients department (OPD) and 25% had been admitted to hospital; 11% had been admitted more than twice. Younger respondents were less likely to visit GPs than older respondents (p=0.002) but use of OPD, inpatients department, emergency department, pharmacists and natural therapists was not associated with gender, age, years in Australia or type of health insurance.
Previous research has found that South-East Asian migrants in Australia have lower overall mortality rates, lower rates of asthma and lower rates of cancer than native-born Australians.6 In contrast, our respondents reported comparable rates of asthma, higher rates of cancer and hospital admissions at more than double the rate of the general Australian population, despite reporting comparable frequency of GP attendances.4,7
In Australian general practice, medications are prescribed, supplied by the GP or an over-the-counter purchase is advised at the rate of 106 medications per 100 encounters.8 That only 65% of respondents reported accessing a pharmacist in the past year despite 86% having attended a GP suggests under-utilisation of pharmaceutical services, although it is possible that respondents were accessing alternative therapies in preference to mainstream medications or were purchasing medications in Thailand where they are cheaper and/or available without prescription.9 Nevertheless, GPs and other health providers need to be aware of the possibility of non-adherence and ensure their Thai patients appreciate the vital role of medications in managing chronic disease and avoiding preventable hospital admissions.
The different pattern of health and illness displayed among our respondents compared to the general population, and other migrants from Southeast Asia, suggests the need for health professionals to be vigilant in ensuring appropriate screening is undertaken and health messages are understood. Further research is needed to understand the cause and effect of the poorer health status and higher prevalence of chronic diseases in younger Thai migrants compared to other South-East Asian migrants. Research is also needed to develop appropriately targeted health promotion campaigns for prevention and management of chronic disease in minority migrant groups, and appropriate health service utilisation.