# Emergency Department Visits for Minor Illnesses Among Recent Refugee and Immigrant Children

## TL;DR

Recent immigrant children in Ontario are less likely than local-born children to visit emergency departments for minor illnesses, suggesting good access to primary care.

## Contribution

This study is among the first to compare ED use for minor illnesses between refugee and immigrant children and their Ontario-born peers using population-level data.

## Key findings

- Refugee and immigrant children had significantly lower ED use for minor illnesses compared to Ontario-born children in the first two years after arrival.
- The lower ED use among immigrant children remained significant but decreased slightly in the second two years of follow-up.
- Findings suggest that newcomer children are not disproportionately using EDs for minor illnesses, indicating adequate access to primary care.

## Abstract

Do recent immigrant children have a higher mean percentage of all minor illness visits seen in emergency departments (EDs) than Ontario-born children?

In this population-based matched cohort study including 458 597 children, adjusted differences in the mean percentage of all minor illnesses seen in the ED were significantly lower for refugee groups (government-assisted refugees,−5.11%; privately sponsored refugees, −5.24%; successful asylum-seekers, −3.73%) and nonrefugee immigrants (−4.24%) compared with Ontario-born children.

These findings suggest that recently arrived immigrant children were not more likely to use emergency departments over primary care for minor illness compared with Ontario-born children.

This cohort study examines refugee and immigrant access to primary care by analyzing the percentage of all minor illness visits seen in emergency departments (EDs) in Ontario, Canada.

Health care resource constraints across North America are leading to decreased access to primary care, particularly for newcomers. In Canada, several pathways to permanent residency shape early navigation to the publicly funded health care system.

To explore access to primary care by analyzing the percentage of all minor illness visits seen in an emergency department (ED) in recently arrived refugee and immigrant children compared with their Ontario-born peers.

This population-based cohort study took place in Ontario, Canada, and included immigrant children who arrived between 2008 and 2017 and Ontario-born children. Participants were aged 0 to 14 years and followed up for 4 years after index date (ie, 1 year after health care eligibility). Data were analyzed between November 2023 and December 2025.

Government-assisted refugees (GARs), privately sponsored refugees (PSRs), successful asylum-seekers (referred to as protected persons [PPs] in Canada), nonrefugee immigrant (NRIs), each matched 1:4 to Ontario-born children by age, sex, and urban area.

The percentage of minor illness ED visits (ie, primary care plus ED visits for equivalent reasons) in the first and second 2-year periods after eligibility was calculated for each child with at least 1 minor illness visit. The difference in mean percentage was modeled using linear regression and compared each immigrant group to Ontario-born children adjusting for morbidity, material resources quintile, and primary care affiliation.

Overall, 458 597 children were included (mean [SD] age, 8.0 [4.3] years; 221 237 females [48%]; 237 360 males [52%]; GARs, 10 211 [2.23%]; PSRs, 7810 [1.70%]; PPs, 11 540 [2.52%]; NRIs, 83 537 [18.22%]; Ontario-born matches, 345 499 [75.34%]). In the first 2 years, immigrant groups had significantly lower adjusted differences in the mean percentage of minor illnesses seen in the ED compared with their Ontario-born matches (GARs: −5.11% [95% CI, −5.63% to −4.57%]; PSRs: −5.24% [95% CI, −5.80% to −4.67%]; PPs: −3.37% [95% CI, −3.86% to −2.87%]; NRIs: −4.24% [95% CI, −4.40% to −4.09%]). In the second 2 years, differences were attenuated but remained significantly lower.

In this cohort study, refugee and nonrefugee immigrant children in their early resettlement period were less likely to use the ED than Ontario-born children for minor illnesses, suggesting adequate access to primary care.