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Unintentional injuries among refugee and immigrant children and youth in Ontario, Canada: a population-based cross-sectional study
  1. Natasha Ruth Saunders1,2,3,4,
  2. Alison Macpherson3,5,
  3. Jun Guan3,
  4. Astrid Guttmann1,2,3,4,6,7
  1. 1 The Hospital for Sick Children, Toronto, Ontario, Canada
  2. 2 Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
  3. 3 Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
  4. 4 Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
  5. 5 York University, Toronto, Ontario, Canada
  6. 6 Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada
  7. 7 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Natasha Ruth Saunders, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; natasha.saunders{at}


Background Unintentional injuries are a leading reason for seeking emergency care. Refugees face vulnerabilities that may contribute to injury risk. We aimed to compare the rates of unintentional injuries in immigrant children and youth by visa class and region of origin.

Methods Population-based, cross-sectional study of children and youth (0–24 years) from immigrant families residing in Ontario, Canada, from 2011 to 2012. Multiple linked health and administrative databases were used to describe unintentional injuries by immigration visa class and region of origin. Poisson regression models estimated rate ratios for injuries.

Results There were 6596.0 and 8122.3 emergency department visits per 100 000 non-refugee and refugee immigrants, respectively. Hospitalisation rates were 144.9 and 185.2 per 100 000 in each of these groups. The unintentional injury rate among refugees was 20% higher than among non-refugees (adjusted rate ratio (ARR) 1.20, 95% CI 1.16, 1.24). In both groups, rates were lowest among East and South Asians. Young age, male sex, and high income were associated with injury risk. Compared with non-refugees, refugees had higher rates of injury across most causes, including for motor vehicle injuries (ARR 1.51, 95% CI 1.40, 1.62), poisoning (ARR 1.40, 95% CI 1.26, 1.56) and suffocation (ARR 1.39, 95% CI 1.04, 1.84).

Interpretation The observed 20% higher rate of unintentional injuries among refugees compared with non-refugees highlights an important opportunity for targeting population-based public health and safety interventions. Engaging refugee families shortly after arrival in active efforts for injury prevention may reduce social vulnerabilities and cultural risk factors for injury in this population.

  • immigration
  • injury
  • Ontario
  • paediatric
  • refugee
  • migration

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  • Contributors NRS conceptualised and designed the study, interpreted the results, drafted the initial manuscript, revised the manuscript and approved the final manuscript as submitted. JG analysed the data, revised the manuscript and approved the final manuscript as submitted. AM and AG conceptualised and designed the study, interpreted the results, revised the manuscript and approved the final manuscript as submitted. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding AG and AM are funded through Applied Chairs in Child Health Services and Policy Research from the Canadian Institutes for Health Research. All data analyses were funded through AG’s Research Chair. This study was supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results and conclusions reported in this paper are those of the authors and are independent of the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI) and Immigration, Refugees and Citizenship Canada (IRCC). However, the analyses, conclusions, opinions and statements expressed herein are those of the authors, and not necessarily those of CIHI or IRCC.

  • Competing interests None declared

  • Ethics approval Hospital for Sick Children and Sunnybrook Health Sciences Centre Research Ethics Boards.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data set from this study is held securely in coded form at the Institute for Clinical Evaluative Sciences (ICES). While data sharing agreements prohibit ICES from making the data set publicly available, access may be granted to those who meet pre-specified criteria for confidential access, available at . The full data set creation plan is available from the authors upon request.