Background: Undocumented migrant women face compounded risk exposure stemming from precarious living and working conditions, legal exclusion, and barriers to healthcare access. Empirical evidence linking their sociodemographic status and health trajectories remains scarce, particularly in Italy and Europe. Methods: We conducted a retrospective observational study of 3,000 women aged >= 18 who attended Naga-a nonprofit primary-care clinic for undocumented migrants in Milan-between January 1, 2022 and February 20, 2025. Integrated records combine first-visit sociodemographic data with ICD-10-coded diagnoses at each consultation (7,463 total visits). We summarize ICD-10 chapter distributions across all consultations to characterize the clinic's diagnostic profile; describe sociodemographic characteristics using the single-visit cohort and the first- visit subsample (where clinical and demographic data are temporally aligned); trace diagnostic trajectories among returning patients; and employ multivariate logistic regression on the first-visit group to assess the extent to which age, education, and occupation correlate with diagnosis at entry. Results: Nearly two-thirds of women had arrived within 12 months and 55% were unemployed, despite over 60% having >= upper-secondary education. Preventive and reproductive care (ICD-10 Chapter XXI) accounted for similar to 16% of visits, followed by musculoskeletal (11%) and genitourinary (10%) disorders. Chronic conditions (endocrine, circulatory, chronic respiratory/genitourinary) comprised 15.7% of visits, and 14.6% of women received a chronic diagnosis over follow-up. Compared with the full sample, first visits concentrate more on preventive/reproductive care-Z30 34.6% vs. 31.8%; Z03 18.1% vs. 13.4%-and show fewer chronic and mental-health diagnoses (Chapter V 2.8% vs. 4.2%). Age emerged as the dominant predictor: older women exhibited sharply higher odds of chronic-disease chapters (e.g., OR 6.1 for endocrine; OR 30.7 for circulatory in those >= 65). Conclusions: This large clinic-based cohort reveals how undocumented migrant women initially seek reproductive and acute care, and over subsequent contacts they are more likely to receive chronic and mental-health diagnoses, in a context of precarity. Extending primary-care enrolment (GP access) could lessen structural disadvantages and strengthen continuity of care. Future research should assess whether, and to what extent, labor-market trajectories are associated with health outcomes, to inform comprehensive policy responses.

Undocumented immigrant workers are particularly exposed to mental health risk factors, including occupational downgrading - i.e. the loss in occupational status upon arrival. This study breaks new ground by examining the relationship between occupational downgrading and mental health among this hard-to-reach population, offering the first-ever investigation of its kind. Leveraging a unique dataset collected by a primary care outpatient clinic in Milan, Italy, which combines medical evaluations with detailed occupational information, we construct a direct measure of occupational downgrading, which adds to the literature. We employ logistic regression models to estimate odds ratios (ORs) for mental and behavioral disorders. The study also offers fresh evidence on the socioeconomic and health status of a sizable sample of undocumented migrants. The study sample consists of 1738 individuals that had their first medical examination in 2017-18. Prevalence of mental health conditions is 5.58%. Data also highlight poor labor market integration: one third of individuals in the sample is employed, mostly in elementary occupations; 66.63% of immigrant workers experienced occupational downgrading. Regression results show that undocumented immigrants who undergo occupational downgrading are at considerably higher risk of mental disorders. ORs range from 1.729 (95% CI 1.071-2.793), when the model only includes individual characteristics determined prior to migration, to 2.659 (CI 1.342-5.271), when it accounts for all the available controls. From a policy perspective, our study underscores the need to consider the broader impact of policies, including restrictive entry and integration policies, on migrant health. Additionally, ensuring access to primary care for all immigrants is crucial for early detection and treatment of mental health conditions.

Background Immigrants face multiple barriers in accessing healthcare; however, empirical assessment of access presents serious methodological issues, and evidence on undocumented immigrants is scant and based mainly on non-representative samples. We examine avoidable hospitalization (AH) as an indicator of poor access to primary care (PC) in Italy, where a universal healthcare system guarantees access but fails to assign general practitioners to undocumented immigrants. Methods Using anonymized national hospital discharge records in 2019, undocumented immigrants were identified through an administrative financing code. Potential effects of poor access to PC were measured by focusing on the incidence of AH, differentiated among chronic, acute and vaccine-preventable conditions, comparing Italian citizens, documented (foreign nationals with residence permits) and undocumented immigrants. We estimated odd ratios (ORs) through logistic regression models, controlling for individual and contextual confounders. Findings Compared with Italians, undocumented and documented immigrants adjusted odd ratios (OR) for the risk of AH were 1.422 (95% CI 1.322-1.528) and 1.243 (95% CI 1.201-1.287), respectively. Documented immigrants showed ORs not significantly greater than i for AH due to chronic diseases compared with Italians, while undocumented immigrants registered higher adjusted OR for all AH categories - chronic (OR 1.187; 95% CI 1.064-1.325), acute (OR 1.645; 95% CI 1.500-1.803) and vaccine-preventable (OR 2.170; 95% CI 1.285-3.664). Interpretation Documented and undocumented immigrants face considerably higher risk of AH compared to Italians. Considering the burden of AHs, access to PC (including preventive and ambulatory care) should be provided to undocumented immigrants, and additional barriers to care for all immigrants should be further explored. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.

Despite recent research evidence that an increased share of immigrants in an area causes an increase in anti-immigrant-party votes, the electoral impact of exposure to immigration appears virtually non-existent-or even contrary-in urban areas. This study thus reassesses the latter using disaggregated data for Milan, Italy's second-largest city. The spatial scale of the analysis addresses the possible bias from aggregating neighbourhoods that are experiencing different immigration inflows. Using a sharp measure of anti-immigration vote and a new instrumental variable to address the possible endogeneity of immigrant share, I find that exposure to immigration has a positive effect on anti-immigration-party votes even in urban contexts. These results are of possible major interest to moderate political forces and European institutions and could usefully guide policy-makers in designing immigrant location policies.

Using unique Italian survey data on both documented and undocumented immigrants, we empirically quantify the correlation between different types of personal contacts and immigrants' documentation probability, while also uncovering the contacts' indirect associations via immigrant labour market outcomes (employment status and job characteristics). Our results indicate that contacts with both natives and family members have a positive and quantitatively large effect on immigrant documentation probability, conditional on a large set of covariates. Contacts with members of the same ethnic group, by contrast, increase documentation probability only moderately, an effect explainable by these co-ethnics' association with employment probability. Moreover, our findings support the hypothesis that native contacts can connect immigrants with jobs that favour documentation.

Despite concern on the impact of coronavirus disease 2019 (COVID-19) pandemic on undocumented immigrants, quantitative evidence on the issue is scant. We analyze socioeconomic and health conditions of 1590 undocumented immigrants in Milan, Lombardy, one of the regions with the highest COVID-19 clinical burden in the world that does not guarantee access to primary care for these individuals. We document a sharp reduction in visit number after lockdown, with 16% frequency of acute respiratory infections, compatible with COVID-19. Moreover, housing conditions make it difficult to implement public health measures. Results suggest the need to foster primary care by undocumented immigrants to face COVID-19 emergency.

Background: The paper adopts a long-term perspective in analysing the association between health and employment histories, often characterized by substantial mobility over time across multiple statuses and contractual arrangements. The available evidence is largely based on static or short-run dynamic approaches and only compares across few employment statuses. Objective: We investigate how different longitudinal employment trajectories defined over multiple yearly labour market states are associated with self-reported health in middle life. Methods: We use a unique dataset linking the Italian component of the EU-SILC cross-sectional samples (2004-2012) with individuals' complete working histories from the National Social Security registers. We apply sequence and cluster analysis to reconstruct individual working histories between the ages of 15 and 45 and to identify typical trajectories. We then estimate the association between employment trajectory and self-reported health at age 45. Results: Trajectories characterized by intermittent working episodes and long periods of unemployment or inactivity are associated with worse health at age 45. Long-term exposure to blue-collar jobs (potentially physically demanding, more vulnerable to work accidents, and allowing for low levels of individual control) operates similarly to persisting/intermittent joblessness in terms of health outcomes. Contribution: Unlike 'point-in-time' approaches, our sequence analysis application provides unique insights into the fact that the association between the configuration of complete trajectories as they unfold over time and health in middle life are significant and substantive over and above the time spent in specific labour market arrangements (e.g., unemployment) and type of occupation (e.g., blue collar).

This article estimates the causal effect of the prospect of legal status on the employment outcomes of undocumented immigrants. The identification strategy exploits a natural experiment provided by an Italian amnesty program that introduced an exogenous discontinuity in eligibility based on date of arrival. The authors find that immigrants who are potentially eligible for legal status under the amnesty program have a significantly higher probability of being employed relative to undocumented immigrants who are not eligible. The size of the estimated effect is equivalent to about half the increase in employment that undocumented immigrants in our sample normally experience during their first year in Italy. These findings are robust to several checks and falsification exercises.

This paper addresses the effect of personal contacts on immigrants’ legal status by focusing particularly on the contacts’ direct links to legal status and indirect associations with the labor market. The overall effect of these contacts is theoretically unsigned and likely to vary across contact type and contextual factors. Our empirical analysis, based on unique Italian survey data on both documented and undocumented immigrants, tests two hypotheses regarding native contacts: (i) that they are more likely to be associated with a higher immigrant documentation probability and (ii) that they are more likely to introduce immigrants to jobs that facilitate access to employment-based legalization initiatives. Our results indicate that contacts with both natives and family members have a direct, positive, and quantitatively large effect on immigrant documentation probability, whereas contacts with members of the same ethnic group only indirectly increase documentation probability by raising the probability of employment. Our findings also support the hypothesis that native contacts connect immigrants with better jobs.

Il lavoro utilizza tre diverse basi di microdati per quantificare l'effetto della recessione economica sugli immigrati irregolari e mettere a confronto i loro esiti occupazionali con quelli sperimentati nello stesso periodo dai nativi e dagli immigrati regolarmente soggiornanti in Italia. Questo e il primo studio a documentare un fortissimo peggioramento degli esiti lavorativi e della condizione abitativa durante la crisi economica iniziata nel 2008 fra gli immigrati privi di regolare permesso di soggiorno. In particolare, l'analisi dimostra che il calo della percentuale di occupati fra i lavoratori stranieri regolari e circa un terzo di quello degli immigrati irregolari. Inoltre, contrariamente a quanto osservato per la componente regolare dell'immigrazione, il calo dell'occupazione colpisce indistintamente entrambi i generi. La popolazione irregolare pare quindi caratterizzata da una particolare vulnerabilita sul mercato del lavoro, che si somma a quella che affligge la popolazione immigrata regolare.

Purpose The purpose of this paper is to empirically assess whether immigrants suffer from unequal access to health care services, that add to prevailing socioeconomic barriers to care. Design/methodology/approach Using a uniquely rich Italian health survey, the authors estimate the correlation between immigrant status and the probability of accessing health services, conditional on a rich set of individual and territorial characteristics. Findings Results show that foreigners are more likely to contact emergency services and less likely to visit specialist doctors and use preventive care. Similar results hold for second-generation immigrants. Originality/value The authors discuss the sources of observed inequities and suggest tentative policy implications to promote equal access.

This study aims to identify any differences between Italians’ and immigrants’ access to health services that cannot be ascribed to the distinct characteristics of these groups. The study uses the 2005 edition of the Italian National Health Survey to estimate the correlation between being an immigrant and the probability of accessing various health services (e.g., general practitioners, specialist doctors, hospitals, emergency departments, tests for blood cholesterol). Fitted regression models control for various individual characteristics, including socioeconomic conditions, demographics, need variables, and lifestyle habits, as well as for territorial characteristics. Immigrants, both first and second generation, are identified by crossing information on citizenship with information on birthplaces. The results show that foreigners and foreign-born people suffer from unequal access to health care services. They are more likely to contact emergency services and less likely to visit specialist doctors and use preventive care. Similar results appear for second-generation immigrants, who display a lower probability of visiting specialist doctors and higher hospitalization rates. Vast heterogeneity across areas of birth also is documented.

This paper studies the relationship between internal mobility and overeducation. Using a large survey on the Italian labour market, it estimates the effect of workers’ spatial flexibility (precise information on commuting and migration) on their probability of being overeducated. The analysis tries to deal with two possible causes of misspecification, which can bias the correlation between migration and overeducation downward: the endogeneity of migration and the omission of relevant job characteristics. This adds to the received literature. It also deals with selection into employment and controls for area and personal characteristics, including several proxies for individual’s ability. Results show that commuting is positively correlated with the quality of the education-job match. On the contrary, the conventional wisdom that internal migration unambiguously reduces the incidence of overeducation does not receive empirical support. The negative correlation between migration and overeducation vanishes once job characteristics are included in the analysis and becomes positive when migration is instrumented. These findings can be easily rationalized by incorporating some of the suggestions of the literature on international migration into the standard framework used in spatiallybased explanations for overeducation. From a policy perspective, it seems fair to conclude that the link between internal migration and overeducation remains unclear and that further research is needed in order to better ground policy prescriptions.

This paper identifies the migration policies that emerge when both the sending country and the receiving country wield power to set migration quotas, when controlling migration is costly, and when the decision of how much human capital to acquire depends, among other things, on the migration policies. The paper analyzes the endogenous formation of bilateral agreements in the shape of transfers to support migration controls, and in the shape of joint arrangements regarding the migration policy and the cost-sharing of its implementation. The paper shows that in equilibrium both the sending country and the receiving country can participate in setting the migration policy, that bilateral agreements can arise as a welfare-improving mechanism, and that the sending country can gain from migration even when it does not set its preferred policy.

This paper studies the relationship between internal mobility and overeducation. Using a large survey on the Italian labour market, it estimates the effect of workers’ spatial flexibility (precise information on commuting and migration) on their probability of being overeducated. The analysis tries to deal with two possible causes of misspecification, which can bias the correlation between migration and overeducation downward: the endogeneity of migration and the omission of relevant job characteristics. This adds to the received literature. It also deals with selection into employment and controls for area and personal characteristics, including several proxies for individual’s ability. Results show that commuting is positively correlated with the quality of the education-job match. On the contrary, the conventional wisdom that internal migration unambiguously reduces the incidence of overeducation does not receive empirical support. The negative correlation between migration and overeducation vanishes once job characteristics are included in the analysis and becomes positive when migration is instrumented. These findings can be easily rationalized by incorporating some of the suggestions of the literature on international migration into the standard framework used in spatiallybased explanations for overeducation. From a policy perspective, it seems fair to conclude that the link between internal migration and overeducation remains unclear and that further research is needed in order to better ground policy prescriptions.

This paper addresses the role of mobility costs in shaping the effects of trade integration on wage inequality and welfare. We present a three-factor, two-sector model in which the production technology exhibits capital-skill complementarity and the cost of moving across sectors differs between unskilled and skilled workers. Results show that trade integration increases aggregate welfare, but it also raises wage inequality, both within and across skill categories. We also model a public re-training program, financed by a proportional tax levied on skilled workers, which reduces the mobility cost of unskilled workers. We show that even if the re-training programme entails some welfare losses, it can reduce both within and between wage inequality, while still making free trade Pareto superior with respect to the no-trade regime.