Utilization of emergency departments by individuals with refugee status: a systematic review of studies using data...

As global efforts to support displaced persons grow, Canada has taken significant steps to accept and resettle refugees. However, refugees in Canada often experience greater health disparities and more barriers to accessing healthcare compared to non-refugees. Acknowledging how these challenges affect their healthcare utilization, this systematic review aimed to examine the current state of knowledge of emergency department (ED) presentation patterns among Canadian refugees compared to non-refugee patients.

A systematic review was conducted following PRISMA guidelines. Six databases were searched from inception until October 2024. Studies were included if they provided quantitative data comparing refugee and non-refugee ED presentations in Canada. Meta-analysis was not performed because of the limited number of studies and heterogeneity.

Eleven studies met the inclusion criteria, including data from Ontario, Quebec, and Alberta. Six studies focused on children or young adults (≤ 24 years old). ED presentations were categorized into general adult and pediatric presentations, mental health presentations for both groups, and pregnancy-related presentations. Unintentional injury was the most common presentation for both refugee and non-refugee patients, followed by respiratory and abdominal complaints. Refugees showed higher rates of certain ED visits, particularly for pregnancy-related issues and postpartum psychiatric concerns. They also demonstrated higher presentation rates for intentional self-harm compared to non-refugee immigrants. However, these findings derive from individual studies rather than pooled data.

Although comprehensive data on refugees' use of Canadian emergency departments remains limited, unintentional injuries were the most commonly reported reason for ED visits, with comparatively higher rates of pregnancy-related and mental health-related presentations also observed. These patterns may indicate barriers to accessing outpatient services, potentially due to limited knowledge of the healthcare system, underlying cultural stigma, or the need for upfront payments to access these services. Further interventions are recommended to improve access to outpatient healthcare for refugee populations.