Frequent attenders in general practice and immigrant status in Norway: a nationwide cross-
sectional study
Sammanfattning
Objective. To compare the likelihood of being a frequent attender (FA) to general practice among
native Norwegians and immigrants, and to study socioeconomic and morbidity factors associated
with being a FA for natives and immigrants. Design, setting and subjects. Linked register data for all
inhabitants in Norway with at least one visit to the general practitioner (GP) in 2008 (2 967 933
persons). Immigrants were grouped according to their country of origin into low- (LIC), middle- (MIC),
and high-income countries (HIC). FAs were defined as patients whose attendance rate ranked in the
top 10% (cut-off point > 7 visits). Main outcome measures. FAs were compared with other GP users by
means of multivariate binary logistic analyses adjusting for socioeconomic and morbidity factors.
Results. Among GP users during the daytime, immigrants had a higher likelihood of being a FA
compared with natives (OR (95% CI): 1.13 (1.09-1.17) and 1.15 (1.12-1.18) for HIC, 1.84 (1.78-1.89) and
1.66 (1.63-1.70) for MIC, and 1.77 (1.67-1.89) and 1.65 (1.57-1.74) for LIC for men and women
respectively). Pregnancy, middle income earned in Norway, and having cardiologic and psychiatric
problems were the main factors associated with being a FA. Among immigrants, labour immigrants
and the elderly used GPs less often, while refugees were overrepresented among FAs. Psychiatric,
gastroenterological, endocrine, and non-specific drug morbidity were relatively more prevalent
among immigrant FA compared with natives. Conclusion. Although immigrants account for a small
percentage of all FAs, GPs and policy-makers should be aware of differences in socioeconomic and
morbidity profiles to provide equality of health care.