Disparities in Congenital Adrenal Hyperplasia Screening Follow-up Times Between Immigrants/Refugees and Local Populations in Türkiye: A Cross-Sectional Study.

OBJECTIVE

Congenital adrenal hyperplasia (CAH) requires timely diagnosis to prevent life-threatening adrenal crises. This study aimed to evaluate the first-year results of the CAH screening program in a district with a high refugee density and to compare the screening process timelines between the local population and immigrants/refugees.

METHODS

This retrospective cross-sectional study analyzed data from the National Newborn Screening Program in Sultanbeyli, İstanbul, between January 2022 and January 2023. Newborns were stratified into 2o groups: local population (Turkish citizens) and immigrants/refugees. Screening outcomes, sample collection times, transfer times, and referral results were compared.

RESULTS

The study included 5934 newborns, of whom 14% (n=868) were immigrants/refugees. Analytical screening performance was comparable between groups, with similar rates of second-tier testing (1.76% vs. 1.8%) and recall (0.4%). However, a significant disparity was observed in the median age at sample collection, which was 12 days (range: 1-65) for immigrants/refugees compared to 6 days (range: 0-176) for the local population (P < .001). Being an immigrant was identified as an independent risk factor for delayed sampling, regardless of primary care registration status. Once samples were collected, transfer and approval times were identical for both groups.

CONCLUSION

While the logistical infrastructure of the screening program functions efficiently for all infants, there is a critical delay in the initial access step for refugee newborns. This delay poses a risk for missed early diagnosis of salt-wasting CAH. Targeted interventions, including multilingual education at hospital discharge, are essential to ensure timely screening for this vulnerable population.