Article Figures & Tables
Tables
- Table 1:
Characteristics of youth with an emergency department first contact visit, by immigration status (2010–2014)
Characteristic Non-immigrants,
n = 109 977 (92.5)Non-refugee immigrants, n = 6680 (5.6) Refugee immigrants, n = 2194 (1.8) Total, n = 118 851 (100) n % n % n % n % Age group, yr 10–13 8994 8.2 253 3.8 69 3.1 9316 7.8 14–17 37 039 33.7 1602 24.0 472 21.5 39 113 32.9 18–21 41 632 37.9 2837 42.5 919 41.9 45 388 38.2 22–24 22 312 20.3 1988 29.8 734 33.5 25 034 21.1 Sex Female 58 765 53.4 3505 52.5 1138 51.9 63 408 53.4 Male 51 212 46.6 3175 47.5 1056 48.1 55 443 46.6 Income quintile 1 (low) 25 369 23.1 1706 25.5 910 41.5 27 985 23.5 2 21 647 19.7 1369 20.5 528 24.1 23 544 19.8 3 20 873 19.0 1304 19.5 351 16.0 22 528 19.0 4 21 366 19.4 1320 19.8 253 11.5 22 939 19.3 5 (high) 20 722 18.8 981 14.7 152 6.9 21 855 18.4 Urban Yes 98 935 90.0 6602 98.8 2187 99.7 107 724 90.6 Usual provider of primary care Yes 104 297 94.8 6395 95.7 2090 95.3 112 782 94.9 Primary care model GP or FP enrolment program 91 106 82.8 5499 82.3 1702 77.6 98 307 82.7 GP or FP fee-for-service 8170 7.4 736 11.0 316 14.4 9222 7.8 Pediatrician 5021 4.6 160 2.4 72 3.3 5253 4.4 No UPC 5680 5.2 285 4.3 104 4.7 6069 5.1 Outpatient primary care visits in prior year (mean ± SD) 6.1 ± 6.9 – 6.8 ± 7.8 – 7.3 ± 14.9 – 6.1 ± 7.2 – ED visits in prior 2 years (mean ± SD) 1.8 ± 2.9 – 1.0 ± 1.9 – 1.2 ± 2.2 – 1.8 ± 2.9 – Low acuity ED visits in prior 2 years (mean ± SD) 0.9 ± 1.8 – 0.4 ± 0.9 – 0.5 ± 1.0 – 0.9 ± 1.7 – Mental health diagnosis at ED visit Acute stress 16 079 14.6 816 12.2 243 11.1 17 138 14.4 Anxiety 22 423 20.4 1316 19.7 499 22.7 24 238 20.4 Mood or affective disorder 20 359 18.5 1026 15.4 258 11.8 21 643 18.2 Residual self-harm 10 620 9.7 740 11.1 298 13.6 11 658 9.8 Psychotic disorders 3115 2.8 414 6.2 144 6.6 3673 3.1 Substance-related disorders 28 966 26.3 2022 30.3 651 29.7 31 639 26.6 Other MHA disorders 8415 7.7 346 5.2 101 4.6 8862 7.5 Admitted to hospital Yes 15 164 13.8 1146 17.2 345 15.7 16 655 14.0 Service time ED visit Daytime 30 408 27.6 1531 22.9 478 21.8 32 417 27.3 Evening and after hours 40 712 37.0 2386 35.7 768 35.0 43 866 36.9 Night 38 857 35.3 2763 41.4 948 43.2 42 568 35.8 ED visit on weekend or stat holiday Yes 35 519 32.3 2364 35.4 810 36.9 38 693 32.6 Time since immigration, yr Recent (0 to ≤ 5) – – 871 13.0 342 15.6 1213 1.0 Intermediate (> 5 to ≤ 10) – – 1973 29.5 715 32.6 2688 2.3 Long-term (> 10) – – 3836 57.4 1137 51.8 4973 4.2 Region of origin Africa – – 435 6.5 419 19.1 854 0.7 Central America – – 752 11.3 130 5.9 882 0.7 East Asia and Pacific – – 1212 18.1 88 4.0 1300 1.1 Eastern Europe or Central Asia – – 949 14.2 276 12.6 1225 1.0 Middle East – – 793 11.9 306 13.9 1099 0.9 South America – – 434 6.5 192 8.8 626 0.5 South Asia – – 1166 17.5 607 27.7 1773 1.5 US/UK/Western Europe – – 939 14.0 176 8.0 1115 0.9 Note: ED = emergency department, GP = general practitioner, FP = family practitioner, MHA = mental health and addictions, SD = standard deviation, UPC = usual provider of care.
- Table 2:
Characteristics of youth with an incident ED visit stratified by immigration status and prior outpatient care for mental health–related concerns (2010–2014)
Characteristic Non-immigrants
n = 109 977Non-refugee immigrants
n = 6680Refugee immigrants
n = 2194SD† No previous outpatient visit Previous outpatient visit No previous outpatient visit Previous outpatient visit No previous outpatient visit Previous outpatient visit n (row % within non-immigrants) n (row % within non-refugee immigrants) n (row % within refugee immigrants)* Overall 56 399 (51.3) 53 578 (48.7) 3845 (57.6) 2835 (42.4) 1344 (61.3) 850 (38.7) - Age group, yr 10–13 4223 (47.0) 4771 (53.0) 141 (55.7) 112 (44.3) 39 (56.5) 30 (43.5) 0.10 14–17 18 894 (51.0) 18 145 (49.0) 970 (60.5) 632 (39.5) 323 (68.4) 149 (31.6) 0.01 18–21 22 305 (53.6) 19 327 (46.4) 1678 (59.1) 1159 (40.9) 586 (63.8) 333 (36.2) 0.07 22–24 10 977 (49.2) 11 335 (50.8) 1056 (53.1) 932 (46.9) 396 (54.0) 338 (46.0) 0.06 Sex Female 28 817 (49.0) 29 948 (51.0) 1949 (55.6) 1556 (44.4) 674 (59.2) 464 (40.8) 0.10 Male 27 582 (53.9) 23 630 (46.1) 1896 (59.7) 1279 (40.3) 670 (63.4) 386 (36.6) Income quintile 1 (low) 13 576 (53.5) 11 793 (46.5) 1004 (58.9) 702 (41.1) 556 (61.1) 354 (38.9) 0.06 2 11 043 (51.0) 10 604 (49.0) 798 (58.3) 571 (41.7) 336 (63.6) 192 (36.4) 0.00 3 10 665 (51.1) 10 208 (48.9) 764 (58.6) 540 (41.4) 213 (60.7) 138 (39.3) 0.00 4 10 705 (50.1) 10 661 (49.9) 753 (57.0) 567 (43.0) 153 (60.5) 100 (39.5) 0.03 5 (high) 10 410 (50.2) 10 312 (49.8) 526 (53.6) 455 (46.4) 86 (56.6) 66 (43.4) 0.03 Rural No 49 753 (50.3) 49 182 (49.7) 3798 (57.5) 2804 (42.5) NR NR 0.19 Yes 6646 (60.2) 4396 (39.8) 47 (60.3) 31 (39.7) NR NR – Usual provider of care No 5351 (94.2) 329 (5.8) 269 (94.4) 16 (5.6) 102 (98.1) NR 1.15 Yes 51 048 (48.9) 53 249 (51.1) 3576 (55.9) 2819 (44.1) 1242 (59.4) NR – Primary care model GP or FP enrolment program 44 539 (48.9) 46 567 (51.1) 3053 (55.5) 2446 (44.5) 1001 (58.8) NR 0.28 GP or FP fee-for-service 4470 (54.7) 3700 (45.3) 447 (60.7) 289 (39.3) 197 (62.3) NR 0.08 Pediatrician 2039 (40.6) 2982 (59.4) 76 (47.5) 84 (52.5) 44 (61.1) NR 0.23 No UPC 5351 (94.2) 329 (5.8) 269 (94.4) 16 (5.6) 102 (98.1) NR 1.15 Mental health diagnosis at ED visit Acute stress 7632 (47.5) 8447 (52.5) 429 (52.6) 387 (47.4) 151 (62.1) 92 (37.9) 0.09 Anxiety 11 298 (50.4) 11 125 (49.6) 699 (53.1) 617 (46.9) 286 (57.3) 213 (42.7) 0.03 Mood or affective disorder 7731 (38.0) 12 628 (62.0) 388 (37.8) 638 (62.2) 100 (38.8) 158 (61.2) 0.34 Residual self-harm 5399 (50.8) 5221 (49.2) 459 (62.0) 281 (38.0) 208 (69.8) 90 (30.2) 0.00 Psychotic disorders 1268 (40.7) 1847 (59.3) 181 (43.7) 233 (56.3) 62 (43.1) 82 (56.9) 0.22 Substance-related disorders 19 358 (66.8) 9608 (33.2) 1526 (75.5) 496 (24.5) 485 (74.5) 166 (25.5) 0.44 Other 3713 (44.1) 4702 (55.9) 163 (47.1) 183 (52.9) 52 (51.5) 49 (48.5) 0.16 Admitted to hospital No 50 527 (53.3) 44 286 (46.7) 3338 (60.3) 2196 (39.7) 1161 (62.8) 688 (37.2) 0.30 Yes 5872 (38.7) 9292 (61.3) 507 (44.2) 639 (55.8) 183 (53.0) 162 (47.0) – Service time ED visit Daytime 13 778 (45.3) 16 630 (54.7) 726 (47.4) 805 (52.6) 256 (53.6) 222 (46.4) 0.25 Evening and after hours 19 547 (48.0) 21 165 (52.0) 1271 (53.3) 1115 (46.7) 481 (62.6) 287 (37.4) 0.09 Night 23 074 (59.4) 15 783 (40.6) 1848 (66.9) 915 (33.1) 607 (64.0) 341 (36.0) 0.27 Time since immigration, yr Recent (0 to ≤ 5) – – 558 (64.1) 313 (35.9) 222 (64.9) 120 (35.1) 0.14 Intermediate (> 5 to ≤ 10) – – 1167 (59.1) 806 (40.9) 461 (64.5) 254 (35.5) 0.06 Long-term (> 10) – – 2120 (55.3) 1716 (44.9) 661 (58.1) 476 (41.9) 0.12 Region of origin Africa – – 266 (61.1) 169 (38.9) 274 (65.4) 145 (34.6) 0.11 Central America – – 457 (60.8) 295 (39.2) 84 (64.6) 46 (35.4) 0.06 East Asia and Pacific – – 748 (61.7) 464 (38.3) 55 (62.5) 33 (37.5) 0.08 Eastern Europe/Central Asia – – 500 (52.7) 449 (47.3) 158 (57.2) 118 (42.8) 0.11 Middle East – – 434 (54.7) 359 (45.3) 177 (57.8) 129 (42.2) 0.07 South America – – 249 (57.4) 185 (42.6) 119 (62.0) 73 (38.0) 0.01 South Asia – – 710 (60.9) 456 (39.1) 376 (61.9) 231 (38.1) 0.07 US/UK/Western Europe – – 480 (51.2) 457 (48.8) 101 (57.7) 74 (42.3) 0.14 Note: ED = emergency department, FP = family practitioner, GP = general practitioner, NR = not reported, SD = standardized difference, UPC = usual provider of care.
↵* Some rates for subgroups not reported (NR) owing to small cell sizes. Institutional policy requires suppression of cell sizes < 6.
↵† Standardized differences for categorical variables compare percentage of “no prior outpatient visits” between given level of the covariate versus all other levels of the covariate.
- Table 3:
Rate ratios from modified Poisson models for first contact emergency department mental health visits, full cohort, 2010–2014 (n = 118 851)
Covariate Rate ratio (95% CI) Adjusted rate ratio* (95% CI) Immigration category (ref = non-immigrant) Non-refugee immigrant 1.12 (1.10–1.15) 1.10 (1.08–1.13) Refugee immigrant 1.19 (1.15–1.24) 1.17 (1.13–1.21) Age, yr (ref = 22–24 yr) 10–13 0.95 (0.93–0.98) 1.04 (1.01–1.07) 14–17 1.04 (1.02–1.06) 1.09 (1.08–1.11) 18–21 1.09 (1.07–1.11) 1.09 (1.08–1.11) Sex (ref = female) Male 1.10 (1.08–1.11) 1.05 (1.04–1.06) Rural residence (ref = urban) Rural 1.18 (1.16–1.20) 1.17 (1.15–1.19) Income quintile (ref = 5, high) 1 (low) 1.07 (1.05–1.09) 1.06 (1.04–1.08) 2 1.03 (1.01–1.04) 1.02 (1.01–1.04) 3 1.02 (1.01–1.04) 1.03 (1.01–1.05) 4 1.00 (0.99–1.02) 1.01 (0.99–1.03) Specialty of UPC (reference = GP or FP model) GP or FP fee-for-service 1.12 (1.10–1.14) 1.12 (1.09–1.14) Pediatrician 0.83 (0.80–0.86) 0.84 (0.81–0.87) None 1.91 (1.89–1.92) 1.80 (1.79–1.82) High-acuity ED visits in prior 2 years, visits (reference = none [0 visits]) High (≥ 3) 0.73 (0.71–0.74) 0.76 (0.74–0.78) Moderate (2) 0.81 (0.79–0.83) 0.84 (0.82–0.86) Low (1) 0.87 (0.86–0.88) 0.89 (0.87–0.90) Low-acuity ED visits in prior 2 years, visits (reference = none [0 visits]) High (≥ 3) 0.91 (0.89–0.93) 0.98 (0.96–1.00) Moderate (2) 0.94 (0.92–0.96) 0.99 (0.97–1.01) Low (1) 0.95 (0.94–0.96) 0.98 (0.97–0.99) Visit time (reference = day: weekdays 8:01–16:00) Evening or after hours (16:01–24:00 weekdays, 08:01–16:00 weekends) 1.07 (1.05–1.08) 1.06 (1.05–1.08) Night (00:01–8:00 weekdays, 16:01–8:00 weekends) 1.32 (1.30–1.34) 1.30 (1.28–1.32) Note: CI = confidence interval, ED = emergency department, FP = family practitioner, GP = general practitioner, UPC = usual provider of care.
↵* Adjusted for all predictors of interest except mental health diagnosis and immigrant-specific predictors.
- Table 4:
Rate ratios from modified Poisson models for first contact emergency department mental health visits, urban immigrants only, 2010–2014 (n = 8874)
Covariate Rate ratio (95% CI) Adjusted rate ratio* (95% CI) Immigration category (ref = non-refugee immigrant) Refugee immigrant 1.06 (1.02–1.11) 1.06 (1.02–1.10) Age, yr (ref = 22–24 yr) 10–13 1.05 (0.94–1.16) 1.11 (1.00–1.24) 14–17 1.17 (1.12–1.23) 1.21 (1.15–1.27) 18–21 1.13 (1.08–1.18) 1.12 (1.07–1.16) Sex (ref = female) Male 1.08 (1.04–1.11) 1.05 (1.01–1.09) Income quintile (ref = 5, high) 1 (low) 1.11 (1.04–1.18) 1.07 (1.00–1.14) 2 1.10 (1.03–1.18) 1.07 (1.01–1.14) 3 1.10 (1.03–1.18) 1.08 (1.01–1.16) 4 1.07 (1.00–1.14) 1.06 (0.99–1.13) Specialty of UPC (reference = GP or FP model) GP or FP fee-for-service 1.09 (1.03–1.15) 1.08 (1.03–1.14) Pediatrician 0.92 (0.81–1.05) 0.91 (0.80–1.03) None 1.69 (1.64–1.75) 1.57 (1.52–1.63) High-acuity ED visits in prior 2 years, visits (reference = none [0 visits]) High (≥ 3) 0.66 (0.60–0.73) 0.73 (0.66–0.80) Moderate (2) 0.79 (0.73–0.86) 0.84 (0.78–0.91) Low (1) 0.83 (0.79–0.87) 0.87 (0.82–0.91) Low-acuity ED visits in prior 2 years, visits (reference = none [0 visits]) High (≥ 3) 0.78 (0.69–0.89) 0.92 (0.81–1.04) Moderate (2) 0.82 (0.74–0.90) 0.92 (0.84–1.01) Low (1 visit) 0.91 (0.87–0.96) 0.97 (0.92–1.01) Visit time (reference = day: weekdays 8:01–16:00) Evening/after hours (16:01–24:00 weekdays, 08:01–16:00 weekends) 1.14 (1.08–1.21) 1.14 (1.08–1.21) Night (00:01–8:00 weekdays, 16:01–8:00 weekends) 1.36 (1.29–1.43) 1.36 (1.29–1.43) Duration of residence (reference = long-term, > 10 yr) Recent (0 to ≤ 5) 1.15 (1.10–1.21) 1.10 (1.05–1.16) Intermediate (> 5 to ≤ 10) 1.08 (1.04–1.13) 1.05 (1.01–1.10) Region of origin (ref = US, UK or Western Europe) Africa 1.21 (1.12–1.31) 1.15 (1.06–1.24) Central America 1.18 (1.09–1.27) 1.17 (1.08–1.26) East Asia and Pacific 1.19 (1.11–1.28) 1.12 (1.05–1.20) Eastern Europe or Central Asia 1.03 (0.95–1.11) 1.01 (0.94–1.09) Middle East 1.07 (0.99–1.16) 1.03 (0.96–1.11) South America 1.13 (1.03–1.23) 1.10 (1.01–1.20) South Asia 1.18 (1.10–1.26) 1.12 (1.05–1.20) Note: CI = confidence interval, ED = emergency department, FP = family practitioner, GP = general practitioner, UPC = usual provider of care.
↵* Adjusted for all predictors of interest.