title: The immigrant effect: factors impacting use of primary and emergency department care - a Canadian population cross-sectional study.
abstract: In 2011, Canada had a foreign-born population of approximately 6,775,800. They represented 20.6% of the total population. Immigrants possess characteristics that reduce the use of primary care. This is thought to be, in part, due to a lower education level, employment, and better health status. Our objective was to assess whether, in an immigrant population without a primary care physician, similar socioeconomic factors would also reduce the likelihood of using the emergency department compared to a non-immigrant population without primary care.
  
  
  
  Data regarding individuals ≥ 12 years of age from the Canadian Community Health Survey from 2007 to 2008 were analysed (n=134,073; response rate 93%). Our study population comprised 15,554 individuals identified without a primary care physician who had a regular place for medical care. The primary outcome was emergency department as a regular care access point. Socioeconomic variables included employment, health status, and education. Covariates included chronic health conditions, mobility, gender, age, and mental health. Weighted logistic regression models were constructed to evaluate the importance of individual risk factors.
  
  
  
  The sample of 15,554 (immigrants n=1,767) consisted of 57.3% male and 42.7% female respondents from across Canada. Immigrants were less likely than Canadian-born respondents to use the emergency department as a regular access point for health care (odds ratio=0.48 [95% CI 0.40 - 0.57]). Adjusting for health, education, or employment had no effect on this reduced tendency (odds ratio=0.47 [95% CI 0.38 - 0.58]).
  
  
  
  In a Canadian population without a primary care physician, immigrants are less likely to use the emergency department as a primary access point for care than Canadian-born respondents. However, this effect is independent of previously reported social and economic factors that impact use of primary care. Immigration status is an important but complex component of racial and ethnic disparity in the use of health care in Canada.
authors.affiliation: *Department of Emergency Medicine, School of Epidemiology, Population Health and Preventative Medicine,University of Ottawa,The Ottawa Hospital Research Institute,Ottawa,ON.
authors.forename: Robert
authors.initials: R
authors.lastname: Ohle
authors.affiliation: Undergraduate Department of Medicine,University of Ottawa,Ottawa,ON.
authors.forename: Helena
authors.initials: H
authors.lastname: Bleeker
authors.affiliation: *Department of Emergency Medicine, School of Epidemiology, Population Health and Preventative Medicine,University of Ottawa,The Ottawa Hospital Research Institute,Ottawa,ON.
authors.forename: Krishan
authors.initials: K
authors.lastname: Yadav
authors.affiliation: *Department of Emergency Medicine, School of Epidemiology, Population Health and Preventative Medicine,University of Ottawa,The Ottawa Hospital Research Institute,Ottawa,ON.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Perry
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004630:Emergencies / Q000453:epidemiology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011159:Population Surveillance; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D055815:Young Adult
keywords: emergency department; immigrant; primary care