A population-based exploration of immigrants undergoing general surgery procedures in British Columbia: Do immigrants present for emergency surgeries more than non-immigrants?

Background: Canada's growing immigrant population faces language and cultural barriers that hinder timely access to healthcare. The balance between elective and emergency general surgery (EGS) reflects immigrant's access to healthcare since many EGS cases are avoidable through treatment as elective procedures.

Objective: This study examines whether immigrants are more likely to undergo EGS than non-immigrants and measures whether language proficiency or access to primary care plays a role in disparity in access to care.

Methods: All general surgery procedures performed in British Columbia, Canada between 2013 and 2021 were identified using a population-based longitudinal administrative data that linked immigration data with physician billing and hospital data. The primary outcome was whether patients' surgery was elective or EGS and the primary exposure was immigrant status. The odds of EGS between immigrants and non-immigrants was estimated adjusting for patient and system-level differences. The analysis compared immigrants with and without English proficiency on arrival to Canada.

Results: Of 237,054 general surgery procedures, 30.7 % were EGS and 15.2 % involved immigrants. Immigrants had slightly higher odds of undergoing emergency general surgery (EGS) than non-immigrants. Immigrants not fluent in English had 16 % higher odds of EGS (OR: 1.16, 95 %CI 1.03-1.32). Immigrants with fewer GP contacts were more likely to undergo EGS (45.5 % versus 42.2 %, p < 0.01).

Conclusions: Immigrants with language barriers and who accessed primary care less often were more likely to require EGS. These findings highlight the need for system-level interventions to reduce immigrants' reliance on emergency surgical care.