Healthcare Access for Immigrants With MS in Ontario ‘Reassuring,’ Study Finds

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by Forest Ray PhD |

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Immigrants with multiple sclerosis (MS) in Ontario use public health services as much as long-term residents, but are more likely to be hospitalized during the year in which they are diagnosed, according to a recent study.

While reasons for that year’s higher hospitalization rates are not clear, evidence supports that immigrants to Ontario “are not systematically disadvantaged” in accessing its free health care, the researchers wrote.

The study, “Health service utilization in immigrants with multiple sclerosis,” was published in the journal PLOS One.

Factors like sex, race, immigration status, and income can affect a person’s access to healthcare services in general. Disease like MS can be a complication, as they often require early treatment and specialized neurological care to promote better long-term  outcomes.

Little is currently known regarding  socioeconomic factors that most influence health service utilization among people with MS. In particular, no previous study has measured the effect that being an immigrant on such use.

Researchers in Canada studied health services use in Ontario — a province with universal healthcare services without user fees, and with one of the largest and most diverse immigrant populations globally.

They reviewed medical records of immigrants and long-term residents with MS between the ages of 20 and 65, focusing on health service utilization during the year prior to a diagnosis and for two years afterward.

Records from 2003 to 2014 showed 13,028 cases of MS in Ontario, with 1,070 (8.2%) diagnosed in people who were immigrants.

Compared with long-term residents, immigrants visited a hospital’s emergency department slightly less throughout the year prior to diagnosis and for the two years post-diagnosis. Visits that were specific to MS, however, were similar across both groups.

Immigrants showed higher hospitalization rates both in total and for MS-specific reasons during the year in which they received their diagnosis. However, during the first year after diagnosis, they had fewer hospitalizations than long-term residents. Hospitalizations did not differ significantly between these groups at two years post-diagnosis.

Outside of emergency services, immigrants sought fewer primary care visits — both in general and for MS-specific reasons — in the year prior to and over the two years following diagnosis.

Immigrants also had fewer neurology outpatient visits than long-term residents over the year prior to diagnosis, but these became more frequent over the following two years.

Overall, immigrants appeared more likely to use other specialist outpatient services in the year before MS diagnosis, the year of diagnosis, and over the first year post-diagnosis.

MS-specific outpatient visits also tended to be more common among immigrants during the year of their MS diagnosis and over the two years following it, but researchers did not consider this observation statistically significant.

According to the team, while the study reports generally positive findings — suggesting that immigrants with MS in Ontario make adequate use of available healthcare and “are not systematically disadvantaged in their access to health services” — the higher rate of hospitalization during the year in which immigrants are diagnosed with MS provides some cause for concern.

Reasons for this higher rate are unclear, but the researchers suggested that immigrants could experience more severe or sudden presentations of neurological symptoms. Some previous research, they noted, observed more severe early demyelinating attacks among non-white MS patients.

Immigrants may also be less familiar with local health services and other social support systems available to help with the consequences of illness. But, they noted, several other lines of research show conflicting evidence on this point.

“Overall, our findings were reassuring concerning health services access for immigrants with MS in Ontario, a publicly funded health care system. However, immigrants were more likely to be hospitalized despite greater use of outpatient neurology care in the year of MS diagnosis,” the researchers wrote.

“Reasons for this may include more severe disease presentation or lack of social support among immigrants and warrant further investigation,” the team added.