Characteristics of Undocumented Immigrant Children Hospitalized in a Single Tertiary Medical Center from 2011 to 2019

Background: The undocumented immigrant children in the US is estimated to be one million. However, little is understood about this population due to the lack of funding, language barriers, and their avoidance of contact due to the fears of deportation. Understanding the health status of this population is crucial as it helps clinicians provide more efficient and systematic care. Our objective is to summarize the characteristics of undocumented immigrant children hospitalized at a tertiary medical center close to the US-Mexico border.

Methods: A retrospective cohort study was performed that included undocumented immigrant children hospitalized at a single tertiary medical center in South Texas from 2011 to 2019. Undocumented immigration status is based on non-US citizenship and history of filing for emergent Medicaid while hospitalized. To allow for comparison against the general pediatric population hospitalized in the US, hospital discharge records of children for 1997-2012 from the Kid’s Inpatient Database were used as comparison group. Descriptive statistics were used to summarize and compare against the US general population the demographics and clinical diagnoses based on Clinical Classifications Software (CCS) diagnosis categories. Primary outcome is death during hospitalization and the secondary outcome is length of hospitalization (LOS).

Results: There were 59 undocumented immigrant children hospitalized during the study period. As compared with the US counterpart (n=19,421,189), the undocumented immigrants are younger (mean 7.6 years [SD 7] vs 9.8 years [SD 0.06] , p<0.001]), more likely to be malnourished (9 [15%] vs 414035 (2%), p<0.001), more likely to be Hispanic (59 [100%] vs 3389607 (17%), p<0.001), and more likely to receive procedures during hospitalization (36 [61%] vs 10636236 [55%], p=0.404). The most common nationalities were Mexico (n=31 [58.5%]), El Salvador (n=9 [17.7%]), Guatemala (n=6 [11.3%]) and Honduras (n=6 [11.3%]). The top three CCS diagnostic categories for undocumented immigrants were congenital anomalies (n=23 [29%]), diseases of the nervous system and sense organs (n=6 [10.2%]), and injury and poisoning (n=5 [8.5%]), while the US counterpart were diseases of the genitourinary system (n=3819429 [20%]), diseases of the circulatory system (n=3657614 [19%]), and certain conditions originating in the perinatal period (n=1903229 [10%]), respectively. Of note, undocumented immigrants have a significant higher mortality rate (4 [6.8%] vs 86668 [0.45%], p<0.001), and longer LOS (mean 13.9 days [SD 23.5] vs 4.1 days [SD 0.04], p<0.001]) compared to their US counterparts.

Conclusion: Hospitalized undocumented immigrants are a unique population with demographics and pathologies different from their US counterparts. The results of this study would help clinicians understand the epidemiology of this vulnerable population seeking medical assistance in South Texas.