Abstract
Immigrant populations continue to grow across Western countries. Such populations may face vulnerabilities that contribute to the risk of experiencing violent injury. Youths are at disproportionate risk compared with other age groups, and such violence may be preventable with appropriately targeted injury prevention strategies. To examine the association of immigrant or refugee status and immigration-related factors with the experience of assault. This population-based cohort study used linked health and administrative databases in Ontario, Canada, where health services are funded through a universal, single-payer health insurance plan. All youths and young adults aged 10 to 24 years (hereafter referred to as youths) residing in Ontario from January 1, 2008, to December 31, 2016, were eligible to participate. Data were analyzed from April 13, 2017, to January 6, 2020. The main exposure was immigrant status. Secondary exposures were immigration-related factors, including visa class, time since immigration, and region and country of origin. The main outcome consisted of violent injuries requiring acute care (emergency department visit or hospitalization) or causing death. Poisson regression models were used to estimate rate ratios for injuries. A total of 22 969 443 person-years were included in the analysis (51.3% male and 48.7% female participants). Compared with nonimmigrants, a greater proportion of immigrants lived in the lowest neighborhood income quintile (30.5% vs 18.2%) and urban areas (98.9% vs 87.7%). Among immigrants, 17.9% were refugees. Rates of violent injuries experienced were 549.0 (95% CI, 545.7-552.2) per 100 000 person-years in nonimmigrant youth, 225.0 (95% CI, 219.4-230.7) per 100 000 person-years in nonrefugee immigrant youth, and 525.4 (95% CI, 507.2-544.1) per 100 000 person-years in refugee immigrant youth. The rates of violent injury among nonrefugee and refugee immigrants were lower than among nonimmigrants (nonrefugee adjusted rate ratio [aRR], 0.41 [95% CI, 0.38-0.43]; refugee aRR, 0.82 [95% CI, 0.76-0.89]). Older age (oldest vs youngest aRR, 6.90 [95% CI, 6.53-7.29]), male sex (aRR, 2.60 [95% CI, 2.52-2.68]), and low neighborhood income (aRR, 2.42 [95% CI, 2.32-2.53]) were associated with violent injury risk. Rates of experiencing assault were lowest among South Asian (aRR, 0.33 [95% CI, 0.30-0.37]) and East Asian (aRR, 0.23 [95% CI, 0.19-0.26]) immigrants. Only Somali immigrants experienced higher assault rates (712.0 [95% CI, 639.3-805.3] per 100 000 person-years) compared with nonimmigrants. Most injuries (79.9%) were from being struck, followed by being cut (5.9%). The low rates of assault experienced by immigrants, including refugees, compared with nonimmigrants suggests that Canadian immigrant settlement supports and cultural factors may be protective against the risk of experiencing assault.
Highlights
Violence against youth is a global phenomenon and a leading cause of death in high-income countries.[1,2] Prevalence rates vary considerably depending on the country, culture, and socioeconomic climate
The rates of violent injury among nonrefugee and refugee immigrants were lower than among nonimmigrants
Older age, male sex, and low neighborhood income were associated with violent injury risk
Summary
Violence against youth is a global phenomenon and a leading cause of death in high-income countries.[1,2] Prevalence rates vary considerably depending on the country, culture, and socioeconomic climate. Understanding the distribution of youth who die due to or who experience and survive physical violence by sociodemographic factors, including immigration factors, can guide interventions and policies for violence prevention efforts. Foreign-born individuals constitute 21.9% of the Canadian population.[4] Immigrants to Canada come from more than 150 source countries for 1 of 3 main reasons: family reunification (ie, family class immigrants), humanitarian or compassionate needs (ie, refugees), and the ability to contribute economically and fill labor market needs (ie, economic class immigrants).[4] As the number of immigrants continues to rise in Canada and most high-income countries,[5] public concern has increased about racism, marginalization, poverty, use of public resources, criminal gang involvement, and violence among immigrant youth.[6,7,8,9] Increasing global migration with a simultaneous rise in urban violence has fueled anti-immigrant sentiment, and the role immigrants play in contributing to this violence has dominated discourse.[10,11,12] Given the lack of public crime statistics by immigrant status, conclusions cannot be drawn regarding causal relationships between immigration and violence
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