Prevalence of intellectual and developmental disabilities among first generation adult newcomers, and the health and health service use of this group: A retrospective cohort study

Abstract

Background Attention to research and planning are increasingly being devoted to newcomer health, but the needs of newcomers with disabilities remain largely unknown. This information is difficult to determine since population-level data are rarely available on newcomers or on people with intellectual and developmental disabilities (IDD), although in Ontario, Canada these databases are accessible. This study compared the prevalence of IDD among first generation adult newcomers to adult non-newcomers in Ontario, and assessed how having IDD affected the health profile and health service use of newcomers. Methods This population-based retrospective cohort study of adults aged 19–65 in 2010 used linked health and social services administrative data. Prevalence of IDD among newcomers (n = 1,649,633) and non-newcomers (n = 6,880,196) was compared. Among newcomers, those with IDD (n = 2,830) and without IDD (n = 1,646,803) were compared in terms of health conditions, and community and hospital service use. Results Prevalence of IDD was lower in newcomers than non-newcomers (171.6 versus 898.3 per 100,000 adults, p<0.0001). Among newcomers, those with IDD were more likely than those without IDD to have comorbid physical health disorders, non-psychotic, psychotic and substance use disorders. Newcomers with IDD were also more likely to have psychiatry visits, and frequent emergency department visits and hospitalizations. Conclusion First generation adult newcomers have lower rates of IDD than non-newcomers. How much of this difference is attributable to admission policies that exclude people expected to be high health service users versus how much is attributable to our methodological approach is unknown. Finding more medical and psychiatric comorbidity, and more health service use among newcomers with IDD compared to newcomers without IDD is consistent with patterns observed in adults with IDD more generally. To inform polices that support newcomers with IDD future research should investigate reasons for the prevalence finding, barriers and facilitators to timely health care access, and pathways to care.

Health and service use of newcomers and other adults with intellectual and developmental disabilities: A population‐based study

“…The only other population-based study that used linked population data from health, social services and immigration found that newcomers with intellectual and developmental disabilities were less healthy and used more services than newcomers with no intellectual and developmental disabilities (Durbin et al, 2019).…”

“…Our prior work based on population data showed that newcomers with IDD have higher rates of health issues than non‐newcomers (Durbin et al, 2019). This only tells part of the story.…”

“…Information is also missing regarding how their disability was treated by healthcare providers either in their home country prior to immigration or in Ontario upon arrival. We were likely missing about 5% of newcomers in Ontario (Durbin et al, 2019) because newcomers could only be included in this study if they first declared an intention to settle in Ontario, then did settle in Ontario, and were covered by the province's universal health insurance. Finally, because the groups differed in some key variables (e.g.…”

“…This means we cannot estimate the scope of the issue or design health services to meet the needs of this unique group. The only quantitative population‐based study on this topic compared adult newcomers with intellectual and developmental disabilities to adult newcomers without intellectual and developmental disabilities (Durbin et al, 2019). It showed a higher prevalence of physical and mental health conditions and health service use by newcomers with intellectual and developmental disabilities relative to newcomers without intellectual and developmental disabilities.…”

“…It showed a higher prevalence of physical and mental health conditions and health service use by newcomers with intellectual and developmental disabilities relative to newcomers without intellectual and developmental disabilities. Given that people with intellectual and developmental disabilities have higher rates of health conditions and healthcare use than people in the general population, it is important to know whether the high rates reported in the Durbin et al (2019) study are unique to newcomers with intellectual and developmental disabilities or simply reflect the higher rate of healthcare issues in the population with intellectual and developmental disabilities more generally.…”