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That immigration is a determinant of health and that immigration systems themselves contribute to structural disadvantage remains under-addressed within healthcare in Canada. This article offers context for how immigration shapes health, and recommendations for how health systems can be better prepared to respond to the diverse needs of immigrants and migrants (together referred to as im/migrants), based on a community-based research project in British Columbia. Findings call attention to the varied and intersecting ways in which immigration status, access to health insurance, language, experiences of trauma and discrimination, lack of support for health system limits access to healthcare, and the roles community-based organizations play in supporting access. Recommendations are intended to help make sure that all health services are accessible to everyone, and move beyond a homogenizing category of "newcomers" into practical, meaningful strategies that attend to diverse and intersecting community needs., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: We investigated the relationship between neighbourhood income quintile and mental health service use by immigration experience among youth and explored changes during the COVID-19 pandemic., Method: We used administrative data to examine mental health service use among youth aged 10 to 24 in British Columbia, Canada, between April 1, 2019, and March 31, 2022. We compared rates of community-based mental health service use, emergency department visits, and hospitalizations and the proportion of involuntary admissions by neighbourhood income quintile and immigration. We used models stratified by immigration to estimate the relationship with income., Results: Non-immigrant youth used substantially more services than immigrant youth. Service use increased following the pandemic's start and peaked between January and March 2021. We observed a clear income gradient for community-based service use among both immigrant and non-immigrant youth, but the direction of the gradient was reversed. Service use was highest among non-immigrant youth in lower-income neighbourhoods and lowest for immigrant youth in lower-income neighbourhoods. We observed similar patterns of income gradient for non-immigrant youth for emergency department visits and hospitalization. The proportion of involuntary admissions was higher for immigrant youth., Conclusions: Mental health service use was substantially lower among immigrant youth than non-immigrant youth, but higher proportions of immigrant youth were hospitalized involuntarily. The reverse income gradient patterns observed for community-mental health service use are noteworthy and suggest significant barriers to accessing preventable care among immigrant youth, particularly those living in lower-income neighbourhoods., Competing Interests: Declarations. Ethics approval and consent to participate: We received ethical approval from Simon Fraser University (SFU) and University of British Columbia (UBC) harmonized ethics review boards (REB number: H20-02303). Competing interest: The authors declare no competing interests., (© 2024. The Author(s).)

Background: The onset of the COVID-19 pandemic drove a rapid and widespread shift to virtual care, followed by a gradual return to in-person visits. Virtual visits may offer more convenient access to care for some, but others may experience challenges accessing care virtually, and some medical needs must be met in-person. Experiences of the shift to virtual care and benefits of in-person care may vary by immigration experience (immigration status and duration), official language level, and age. We examined use of virtual care and return to in-person visits in the Canadian province of British Columbia (BC), comparing patterns by age and across immigration groups, including length of time in Canada and language level (official languages English and French) at time of arrival., Methods: We used linked administrative health and immigration data to examine total primary care visits (virtual or in-person) and return to in-person visits during the COVID-19 pandemic (2019/20-2021/2) in BC. We examined the proportion of people with any primary care visits and with any in-person visits within each year as measures of access to primary care. We estimated the odds of any primary care visits and any in-person visits by immigration group and official language level assessed prior to arrival: non-immigrants, long-term immigrants, recent immigrants (< 5 years) with high assessed official language level and recent immigrants (< 5 years) with low assessed official language level (assessed prior to arrival), stratified by age., Results: In general, changes in access to primary care (odds of any visits and odds of any in-person visits) were similar across immigration groups over the study period. However, we observed substantial disparities in access to primary care by immigration group among people aged 60 + , particularly in recent immigrants with low official language level (0.42, 0.40-0.45). These disparities grew wider over the course of the pandemic., Conclusion: Though among younger adults changes in access to primary care between 2019-2021 were similar across immigration groups, we observed significant and growing inequities among older adults, with particularly limited access among adults who immigrated recently and with low assessed official language level. Targeted interventions to ensure acceptable, accessible care for older immigrants are needed., (© 2024. The Author(s).)

Objectives: Having temporary immigration status affords limited rights, workplace protections, and access to services. There is not yet research data on impacts of the COVID-19 pandemic for people with temporary immigration status in Canada., Methods: We use linked administrative data to describe SARS-CoV-2 testing, positive tests, and COVID-19 primary care service use in British Columbia from January 1, 2020 to July 31, 2021, stratified by immigration status (citizen, permanent resident, temporary resident). We plot the rates of people tested and confirmed positive for COVID-19 by week from April 19, 2020 to July 31, 2021 across immigration groups. We use logistic regression to estimate adjusted odds ratios of a positive SARS-CoV-2 test, access to testing, and primary care among people with temporary status or permanent residency, compared with people who hold citizenship., Results: A total of 4,146,593 people with citizenship, 914,089 people with permanent residency, and 212,215 people with temporary status were included. Among people with temporary status, 52.1% had "male" administrative sex and 74.4% were ages 20-39, compared with 50.1% and 24.4% respectively among those with citizenship. Of people with temporary status, 4.9% tested positive for SARS-CoV-2 over this period, compared with 4.0% among people with permanent residency and 2.1% among people with citizenship. Adjusted odds of a positive SARS-CoV-2 test among people with temporary status were almost 50% higher (aOR 1.42, 95% CI 1.39, 1.45), despite having half the odds of access to testing (aOR 0.53, 95% CI 0.53, 0.54) and primary care (aOR 0.50, 95% CI 0.49, 0.52)., Conclusion: Interwoven immigration, health, and occupational policies place people with temporary status in circumstances of precarity and higher health risk. Reducing precarity accompanying temporary status, including regularization pathways, and decoupling access to health care from immigration status can address health inequities., (© 2023. The Author(s).)

This qualitative study aimed to understand how migration experiences shape im/migrant women's needs, desire for, and expectations of healthcare in the British Columbia (BC), Canada context. Interviews with 33 im/migrant women (December 2018-January 2020) highlighted that traumatic experiences across migration increased healthcare needs; insufficient prior health system information contributed to poor experiences; and comparative healthcare experiences across places shaped future healthcare expectations. We use the BC setting to demonstrate the need to abide by global commitments to protect people during migration, train providers in trauma-informed care, develop health assessments that center migration journeys, and appropriately fund im/migrant-serving community organizations., Competing Interests: Declaration of competing interest None., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)