Unmet Health Care Needs for Syrian Refugees in Canada: A Follow-up Study

Characteristics of Self-Rated Oral Health among Syrian Refugee Parents in Ontario

Background

Canada has been hosting Syrian refugees since early 2015. Almost half of the Syrian refugee population lives in Ontario, with dental health being at the top of the list of important immediate needs. The objective of the study was to evaluate self-rated oral health and its associated factors among Syrian refugee parents residing in Ontario.

Methods

This was a cross-sectional study where 540 Syrian refugee parents, residing in Ontario and with at least one child less than 18 years of age, were interviewed. Information about self-rated oral health was collected based on the question "In general, how would you rate the health of your teeth and mouth?" with answers ranging from 1 representing "excellent" and 5 representing "very poor." Multiple linear regression analysis was performed to assess the independent relationship between each of the sociodemographic-, migration-, health-, dental-related factors, and self-rated oral health.

Results

The overall prevalence of poor and very poor self-rated oral health was 43.5%. The results showed that the presence of dental health insurance, private sponsorship, improved physical and mental health, and regular visits to the dentist were factors related to improved oral health. Discussion. To achieve better oral health outcomes among refugee populations, including Syrian refugees, efforts should be focused on improving dental care and dental insurance for vulnerable populations.

Primary health care utilization in the first year after arrival by refugee sponsorship model in Ontario, Canada: A population-based cohort study

BACKGROUND

Canada's approach to refugee resettlement includes government sponsorship, a pioneering private sponsorship model and a third blended approach. Refugees are selected and supported differently in each approach including healthcare navigation. Little is known about how well private sponsors facilitate primary care navigation and whether this changed during the large-scale 2015 Syrian resettlement initiative characterized by civic and healthcare systems engagement.

METHODS AND FINDINGS

Population-based cohort study of resettled refugees arriving in Ontario between April 1, 2008 and March 31, 2017, with one-year follow-up, using linked health and demographic administrative databases. We evaluated associations of resettlement model (GARs, Privately Sponsored Refugees [PSRs], and Blended-Visa Office Referred [BVORs]) by era of arrival (pre-Syrian and Syrian era) and by country cohort, on measures of primary care (PC) navigation using adjusted Cox proportional hazards and logistic regression. There were 34,591 (pre-Syrian) and 24,757 (Syrian era) resettled refugees, approximately half of whom were GARs. Compared with the reference group pre-Syrian era PSRs, Syrian PSRs had slightly earlier PC visits (mean = 116 days [SD = 90]) (adjusted hazard ratios [aHR] = 1.19, 95% CI 1.14-1.23). Syrian GARs (mean = 72 days [SD = 65]) and BVORs (mean = 73 days [SD = 76]) had their first PC visit sooner than pre-Syrian era PSRs (mean = 149 days [SD = 86]), with respective aHRs 2.27, 95% CI 2.19-2.35 and 1.89, 95% CI 1.79-1.99. Compared to pre-Syrian PSRs, Syrian GARs and BVORs had much greater odds of a CHC visit (adjusted odds ratios 14.69, 95% CI 12.98-16.63 and 14.08, 95% 12.05-16.44 respectively) and Syrian PSRs had twice the odds of a CHC visit.

CONCLUSIONS

Less timely primary care and lower odds of a CHC visit among PSRs in the first year may be attributed to selection factors and gaps in sponsors' knowledge of healthcare navigation. Improved primary care navigation outcomes in the Syrian era suggests successful health systems engagement.

Health Care Use and System Costs Among Pediatric Refugees in Canada

BACKGROUND

Resettled refugees land in Canada through 3 sponsorship models with similar health insurance and financial supports but differences in how resettlement is facilitated. We examined whether health system utilization, costs, and aggregate 1-year morbidity differed by resettlement model.

METHODS

Population-based matched cohort study in Ontario, 2008 to 2018, including pediatric (0-17 years) resettled refugees and matched Ontario-born peers and categorized refugees by resettlement model: (1) private sponsorship (PSRs), (2) Blended Visa Office-Referred program (BVORs), and (3) government-assisted refugee (GAR). Primary outcomes were health system utilization and costs in year 1 in Canada. Multivariable logistic regression was used to test the associations between sponsorship model and major illnesses.

RESULTS

We included 23 287 resettled refugees (13 360 GARs, 1544 BVORs, 8383 PSRs) and 93 148 matched Ontario-born. Primary care visits were highest among GARs and lowest in PSRs (median visits [interquartile range], GARs 4[2-6]; BVORs 3[2-5]; PSRs 3[2-5]; P <.001). Emergency department visits and hospitalizations were more common among GARs and BVORs versus PSRs (emergency department: GARs 19.2%; BVORs 23.4%; PSRs 13.8%; hospitalizations: GARs 2.5%; BVORs 3.2%; PSRs 1.1%, P <.001). Mean 1-year health system costs were highest among GARs (mean [standard deviation] $1278 [$7475]) and lowest among PSRs ($555 [$2799]; Ontario-born $851 [9226]). Compared with PSRs, GARs (adjusted odds ratio 1.63, 95% confidence interval 1.47-1.81) and BVORs (adjusted odds ratio 1.52, 95% confidence interval 1.26-1.84) were more likely to have major illnesses.

CONCLUSIONS

Health care use and morbidity of PSRs suggests they are healthier and less costly than GARs and BVOR model refugees. Despite a greater intensity of health care utilization than Ontario-born, overall excess demand on the health system for all resettled refugee children is low.

Adult newcomers' perceptions of access to care and differences in health systems after relocation from Syria

Background

In Canada, approximately 13% of the population lives with multiple chronic conditions. Newcomers, including refugees, have the same or higher risk of developing chronic diseases as their host population. In 2015–2016, Canada welcomed almost 40, 000 newcomers from Syria. This study aimed to (1) understand adult newcomer health needs for self-management of non-infectious chronic conditions; and (2) identify strategies to improve access to health care services to meet these needs.

Methods

This study used a qualitative descriptive design. Interviews and focus groups were conducted with consenting newcomers, service providers and community agency administrators. Interview guides were developed with input from community partners and snowball sampling was used.

Results

Participants included 22 Syrian newcomers and 8 service providers/administrators. Findings revealed the initial year of arrival as one of multiple adjustments, often rendering chronic disease management to a lower priority. Self-care and self-management were not routinely incorporated into newcomer lives though community health agencies were proactive in creating opportunities to learn self-management practices. Gaps in access to care were prevalent, including mental health services which typically were not well developed for trauma and post-traumatic stress disorder (PTSD), particularly for men. Newcomers expressed frustration with lengthy wait times and not being able to access specialists directly. Youth frequently played a key role in translation and disseminating information about services to their families.

Conclusion

Chronic disease management was a low priority for newcomers who were focussed on resettlement issues such as learning English or finding work. Provision of practical supports such as bus tickets, translation, and information about the healthcare system were identified as means of improving access to care.

Provincial variations in not having a regular medical doctor and having unmet healthcare needs among Canadians

BACKGROUND

Despite spending 11.0% of the total gross domestic product, the quality of healthcare services in Canada has received mixed reviews. We first separately examined provincial variations in not having a regular medical doctor and having unmet healthcare needs among Canadians. Second, we evaluated provincial variations in the impact of not having a regular medical doctor on having unmet healthcare needs among Canadians.

METHODS

We applied logistic regressions using data from the 2014 and 2017-2018 Canadian Community Health Surveys (CCHS). The total sample size for this study was 120,345 individuals aged 12 years and older: 61,240 from the 2014 CCHS and 59,105 from the 2017-2018 CCHS.

RESULTS

We found significant provincial variations in not having a regular medical doctor and having unmet healthcare needs among Canadians. People in Quebec and the Territories were more likely not to have a regular medical doctor than their peers in Alberta. People in Quebec and the Territories were also more likely to have unmet healthcare needs than their counterparts in Alberta. Not having a regular medical doctor impacted whether Canadians reported having unmet healthcare needs to varying degrees across provinces.

CONCLUSION

Findings from this study may contribute to designing province-specific policy interventions and inform efforts that seek to address barriers to having a regular medical doctor and reducing unmet healthcare needs among Canadians.

Physical Health of Older Canadians: Do Intersections Between Immigrant and Refugee Status, Racialized Status, and Socioeconomic Position Matter?

It is unclear whether racial or nativity health disparities exist among older Canadians and what social and economic disadvantages may contribute to these differences. Secondary analysis of data collected from respondents aged 55 and older in the Canadian General Social Survey 27 was performed. The outcome variable was self-reported physical health. Compared to racialized immigrants, white immigrant and Canadian-born respondents had approximately 35% higher odds of good health. Among racialized older adults, the odds of good health were better if they were younger than 75, more affluent, better educated, had a confidant, had not experienced discrimination in the past five years, and were more acculturated. Racialized immigrants are at a health disadvantage compared to white groups in Canada; however, greater acculturation, social support, and lower experiences of discrimination contribute to better health among racialized older adults.

Health determinants among refugees in Austria and Germany: A propensity-matched comparative study for Syrian, Afghan, and Iraqi refugees

In recent years, Germany and Austria have been among the leading European receiving countries for asylum seekers and refugees (AS&R). The two countries have cultural and economic similarities, but differ, for example, in their health care systems, with AS&R having unrestricted access to health services upon arrival in Austria, but not in Germany. This study investigates the determinants of health among refugees in Austria and Germany, and how these determinants differ between the two countries. We analyze comparable and harmonized survey data from both countries for Syrian, Afghan, and Iraqi nationals aged 18 to 59 years who had immigrated between 2013 and 2016 (Germany: n = 2,854; Austria: n = 374). The study adopts a cross-sectional design, and uses propensity score matching to examine comparable AS&R in the two receiving countries. The results reveal that the AS&R in Germany (72%) were significantly less likely to report being in (very) good health than their peers in Austria (89%). Age and education had large impacts on health, whereas the effects of length of stay and length of asylum process were smaller. Compositional differences in terms of age, sex, nationality, education, and partnership situation explained the country differences only in part. After applying propensity score matching to adjust for structural differences and to assess non-confounded country effects, the probability of reporting (very) good health was still 12 percentage points lower in Germany than in Austria. We conclude that many of the determinants of health among AS&R correspond to those in the non-migrant population, and thus call for the implementation of similar health policies. The health disadvantage found among the AS&R in Germany suggests that removing their initially restricted access to health care may improve their health.

Depression-level symptoms among Syrian refugees: findings from a Canadian longitudinal study

BACKGROUND

Canada launched the Syrian Refugee Resettlement Initiative in 2015 and resettled over 40,000 refugees.

AIM

To evaluate the prevalence of depression-level symptoms at baseline and one year post-resettlement and analyze its predictors.

METHODS

Data come from the Syrian Refugee Integration and Long-term Health Outcomes in Canada study (SyRIA.lth) involving 1924 Syrian refugees recruited through a variety of community-based strategies. Data were collected using structured interviews in 2017 and 2018. Depression symptoms were measured using Patient Health Questionnaire 9 (PHQ-9). Analysis for associated factors was executed using multinomial logistic regression.

RESULTS

Mean age was 38.5 years (SD 13.8). Sample included 49% males and 51% females settled in Ontario (48%), Quebec (36%) and British Columbia (16%). Over 74% always needed an interpreter, and only 23% were in employment. Prevalence of depression-level symptoms was 15% at baseline and 18% in year-2 (p < 0.001). Significant predictors of depression-level symptoms at year-2 were baseline depression, sponsorship program, province, poor language skills, lack of satisfaction with housing conditions and with health services, lower perceived control, lower perceived social support and longer stay in Canada.

CONCLUSION

Increase in depression-level symptoms deserves attention through focusing on identified predictors particularly baseline depression scores, social support, perceived control and language ability.