PT  - JOURNAL ARTICLE
AU  - Wanigaratne, Susitha
AU  - Stukel, Therese
AU  - Lu, Hong
AU  - Guan, Jun
AU  - Hynie, Michaela
AU  - Saunders, Natasha Ruth
AU  - Guttmann, Astrid
TI  - Morbidity among resettled refugees at arrival in Ontario, Canada (1994–2017): a controlled interrupted time series study examining the effect of the Immigration Refugee Protection Act, 2002
AID  - 10.1136/jech-2024-222947
DP  - 2025 Apr 01
TA  - Journal of Epidemiology and Community Health
PG  - 249--256
VI  - 79
IP  - 4
4099  - http://jech.bmj.com/content/79/4/249.short
4100  - http://jech.bmj.com/content/79/4/249.full
SO  - J Epidemiol Community Health2025 Apr 01; 79
AB  - Background Immigration inadmissibility on medical grounds is common among high-income countries. In Canada, the Immigrant and Refugee Protection Act (IRPA) became law in 2002. With humanitarian protection as a priority, IRPA removed medical inadmissibility based on exceeding a cost threshold for the projected use of health and social services for resettled refugees. Our objective was to determine whether resettled refugees arriving in Ontario after IRPA became law (2004–2017) were more likely to exceed the cost threshold than those who arrived before (1994–2002).Methods We linked population-based immigration (1994–2017) and healthcare data (1994–2019) in Ontario, Canada and conducted interrupted and controlled interrupted time series (ITS and CITS, respectively) analyses using segmented regression. We examined morbidity prevalence (a proxy for exceeding the cost threshold), in the pre-IRPA and post-IRPA periods among resettled refugees and three control groups—successful asylum seekers, economic immigrants and other Ontario residents. Morbidity prevalence levels and slopes across years were estimated comparing the post-IRPA to pre-IRPA period within resettled refugees and each control group (ITS), and for resettled refugees relative to each control group comparing the same periods (CITS).Results Morbidity prevalence levels and slopes did not increase significantly within resettled refugees arriving after compared with before IRPA, nor when compared with control groups. Increasing morbidity prevalence among all immigrant groups post-IRPA suggested that subsequent policy changes linked to excessive demand policies may have impacted morbidity.Conclusion Evolving medical inadmissibility policies suggest the need to provide a fulsome evaluation, balancing possible implications with the documented contributions immigrants make to Canada.Data may be obtained from a third party and are not publicly available. The dataset from this study is held securely in coded form at ICES. While legal data sharing agreements between ICES and data providers (eg, healthcare organisations and government) prohibit ICES from making the dataset publicly available, access may be granted to those who meet prespecified criteria for confidential access, available at https://www.ices.on.ca/DAS (email: das@ices.on.ca). The full dataset creation plan and underlying analytical code are available from the authors on request, understanding that the computer programmes may rely on coding templates or macros that are unique to ICES and are therefore either inaccessible or may require modification.