Sex-specific differences in healthcare utilization and preventive service uptake between immigrant and native-born populations in Spain: a matched analysis of the 2023 national health survey

OBJECTIVE: To assess sex-specific differences in healthcare utilization and preventive service uptake between immigrant and native-born populations in Spain in 2023, and to determine whether these differences persist after adjustment for sociodemographic characteristics, comorbidities, and lifestyle factors. METHODS: We conducted a population-based cross-sectional study using data from the 2023 Spanish National Health Survey. The study included 5,044 participants (2,522 immigrants and 2,522 native-born individuals) selected through a 1:1 matched design according to sex, age, and autonomous community of residence. Healthcare utilization (primary care, specialist consultations, psychology, physiotherapy, dental care, emergency visits, and hospitalization) and adherence to preventive activities (cancer screening, influenza vaccination, cholesterol testing, and blood glucose testing) were analyzed. Analyses were stratified by sex. Conditional logistic regression models estimated adjusted odds ratios (ORs) and 95% confidence intervals (95%CIs), progressively adjusting for sociodemographic variables, comorbidities, and lifestyle-related factors. RESULTS: Immigrant men and women showed lower utilization of specialist and outpatient services, including psychologist, physiotherapy, and dental care, with lower participation in preventive activities, particularly cancer screening and influenza vaccination. No differences were observed in primary care use, emergency department visits, or hospitalizations. These differences were more pronounced among women. After full adjustment, immigrant status was not associated with primary care utilization, emergency visits, or hospital admissions. However, native-born men and women showed higher adjusted odds of outpatient service utilization, including specialist consultations (men: OR 1.28; women: OR 1.31), psychologist visits (men: OR 1.56; women: OR 1.96), physiotherapy (men: OR 2.06; women: OR 2.04), and dental care (men: OR 1.39; women: OR 1.32). Native-born participants also showed higher adjusted odds of colorectal cancer screening, cholesterol testing, and blood glucose testing, whereas immigrant women had lower odds of breast and cervical cancer screening and influenza vaccination. CONCLUSION: Immigrant populations in Spain exhibit lower healthcare utilization and preventive service uptake than native-born individuals. However, these differences were partly attenuated after adjustment for sociodemographic characteristics, health status, and lifestyle factors, suggesting that these factors contribute to the observed disparities. Inequalities were especially pronounced in preventive care among women, highlighting the need for gender-sensitive, culturally tailored strategies addressing social determinants to achieve equitable healthcare utilization.