Intentional injuries in newcomers to Alberta, 2016-2023.

BACKGROUND: Violence and intentional self-harm are major contributors to morbidity and mortality in Canada. Newcomers may face unique vulnerabilities shaped by pre-migration trauma, settlement stressors, and structural barriers, yet population-based evidence on intentional injuries among immigrants in Alberta remains limited. The objective of the current study was to identify associations between immigrant status, and immigrant admission type, and intentional injuries experienced by Albertans. METHODS: We conducted a longitudinal retrospective cohort study of Albertans using the 2016 data from census records linked to emergency department (ED) data from 2016 to 2023. Outcomes were ED visits for intentional injuries, defined using International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Canada (ICD-10-CA) codes for assault and self-harm. The primary exposure was immigrant status (recent immigrant vs. non-immigrant), and the secondary exposure was immigration by admission category (compared to long-term immigrants). Cox proportional hazards models were used to evaluate the association between immigrant status, immigration admission type, and intentional injury outcomes. RESULTS: Our baseline sample was representative of over 300,000 immigrants and 2.4 million non-immigrants living in Alberta in 2016. Injury rates were highest among non-immigrant (237.57 per 100,000 person-months) populations (vs. 168.73 per 100,000 person-months). Immigrant status was associated with a lower hazard of intentional injury compared with non-immigrants (HR 0.71, 95% CI 0.60-0.84). Among immigrants, refugees experienced a higher hazard of intentional injury (HR 1.46, 95% CI 1.04-2.06) and, specifically, assault (HR 1.76, 95% CI 1.20-2.59) compared with economic immigrants, while no significant differences were observed for self-harm. CONCLUSIONS: While immigrant status appears protective overall, refugees face elevated risks of assault-related injuries. These findings underscore the need for targeted, trauma-informed and culturally safe violence prevention strategies for refugee populations and other high-risk newcomer groups in Alberta.