Emergency Department utilization in Switzerland: Comparing Swiss natives with first- and second-generation immigrants

Introduction: Differences in Emergency Department (ED) utilization between immigrant and native populations may reflect inequalities in health status and access to care. This study compares ED use between Swiss natives and first- and second-generation immigrants in Switzerland. Methods: We used pooled data from the Swiss Health Survey 2017 and 2022 (N = 16,183). Logistic regression models were estimated and reported as average marginal effects (AMEs). Models were progressively adjusted for sociodemographic characteristics, health status, health behaviors, and healthcare-use variables. Results: ; 95% CI: 0.017-0.033), but this association disappeared after adjusting for health status (AME = 0.007, SE = 0.006, p = 0.25). For second-generation immigrants, the association remained significant after adjustments (Main model: AME = 0.030, SE = 0.010, p = 0.01; 95% CI: 0.011-0.049) and slightly attenuated when accounting for healthcare-use patterns (AME = 0.022, SE = 0.011, p = 0.06; 95% CI: 0.000-0.042). An alternative analysis based on Oaxaca-Blinder decompositions confirmed that differences between Swiss natives and first-generation immigrants are mainly explained by health status, whereas differences with second-generation immigrants remain largely unexplained. Conclusions: First-generation immigrants do not differ from Swiss natives in ED use once differences in health status are taken into account. Second-generation immigrants (particularly women and individuals from Eastern and South-Eastern Europe) exhibit a persistently higher probability of ED use, partly explained by higher engagement with other healthcare services. These findings highlight the need for targeted interventions to improve equitable access and continuity of care among immigrant populations.