The shrinking health advantage: unintentional injuries among children and youth from immigrant families

Abstract

BackgroundImmigrants typically arrive in good health. This health benefit can decline as immigrants adopt behaviours similar to native-born populations. Risk of injury is low in immigrants but it is not known whether this changes with increasing time since migration. We sought to examine the association between duration of residence in Canada and risk of unintentional injury.MethodsPopulation-based cross-sectional study of children and youth 0 to 24 years in Ontario, Canada (2011-2012), using linked health and administrative databases. The main exposure was duration of Canadian residence (recent: 0–5 years, intermediate: 6–10 years, long-term: >10 years). The main outcome measure was unintentional injuries. Cause-specific injury risk by duration of residence was also evaluated. Poisson regression models estimated rate ratios (RR) for injuries.Results999951 immigrants were included with 24.2% recent and 26.4% intermediate immigrants. The annual crude injury rates per 100000 immigrants were 6831 emergency department visits, 151 hospitalizations, and 4 deaths. In adjusted models, recent immigrants had the lowest risk of injury and risk increased over time (RR 0.79; 95% CI 0.77, 0.81 recent immigrants, RR 0.90; 95% CI 0.88, 0.92 intermediate immigrants, versus long-term immigrants). Factors associated with injury included young age (0-4 years, RR 1.30; 95% CI 1.26, 1.34), male sex (RR 1.52; 95% CI 1.49, 1.55), and high income (RR 0.93; 95% CI 0.89, 0.96 quintile 1 versus 5). Longer duration of residence was associated with a higher risk of unintentional injuries for most causes except hot object/scald burns, machinery-related injuries, non-motor vehicle bicycle and pedestrian injuries. The risk of these latter injuries did not change significantly with increasing duration of residence in Canada. Risk of drowning was highest in recent immigrants.ConclusionsRisk of all-cause and most cause-specific unintentional injuries in immigrants rises with increasing time since migration. This indicates the need to develop strategies for maintaining the immigrant health advantage over time while balancing the desire to support integration, active living, and healthy child development.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-017-4612-1) contains supplementary material, which is available to authorized users.

Health care utilisation for treatment of injuries among immigrants in Norway: a nationwide register linkage study

“…Our findings also provide further documentation of the heterogeneity of the immigrant population, as injury incidence differed considerably between regions and countries of origin. In accordance with other studies (Aamodt et al 2020 ; Saunders et al 2018 ), we found particularly low incidence rates for immigrants originating from Asia (especially Southeast Asia), whereas rates were highest for immigrants from Western countries, which are culturally more similar to Norway. Our study also corroborates earlier findings from Scandinavian and other Western countries showing lower risk of poisoning (Saunders et al 2017 ) and fractures (Aamodt et al 2020 ) in immigrant groups, but higher risk of burns (Laursen and Moller 2009 ; Karimi et al 2015 ; Elrod et al 2019 ).…”

“…However, we do not expect that these sources of misclassification differ systematically according to immigrant status. Potential extensions to the work reported in the current study include explorations of how immigrants' use of primary and secondary care for treatment of injuries varies according to other factors known to affect health care utilisation, such as duration of stay in the host country and reason for migration (Saunders et al 2018;McDonald and Kennedy 2004;Diaz et al 2015a;Diaz and Kumar 2014;Norredam et al 2014;Diaz et al 2015b;Elstad 2016). Another avenue for future research involves assessing whether health care utilisation among immigrants differs by type of service (i.e., GPs vs. EPHC in primary care and inpatient vs. outpatient treatment in secondary care).…”

“…This advantage occurs despite the presence of various risk factors that ordinarily correlate with worse health outcomes, like lower socioeconomic position (Mackenbach et al 2008 ). However, this general finding disguises considerable variation, as injury incidence in immigrant groups differs substantially according to factors such as region/country of origin, reason for migration, length of stay in the host country and type of injury (Laursen and Moller 2009 ; Sandvik et al 2012 ; Norredam et al 2013 ; Karimi et al 2015 ; Saunders et al 2017 ; Aamodt et al 2020 ; Saunders et al 2018 ).…”

Scoping review of children’s and youth’s outdoor play publications in Canada

“…26 Sample sizes varied widely, depending on the study design, from one parent's observations of their son playing outdoors 27 to 999 951 data points on unintentional injuries among children and youth collected from linked health and administrative databases. 28 Outdoor play themes Figure 3 shows the distribution of included articles according to these priority themes and year of publication.…”

Examen de la portée des publications sur le jeu à l’extérieur chez les enfants et les jeunes au Canada

“…pays dans le cadre d'une seule étude26 . La taille de l'échantillon variait considérablement en fonction du type d'étude, allant des observations d'un seul parent au sujet des jeux en plein air de son enfant27 à 999 951 points de données sur les blessures involontaires chez les enfants et les jeunes tirés de bases de données administratives et sur la santé pertinentes28 .…”