Newcomer children show lower rates of emergency department use for non‑urgent conditions, study finds

Institute for Clinical Evaluative Sciences

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Toronto, ON, February 27, 2026 — Refugee and immigrant children are less likely to visit the emergency department (ED) for minor illnesses (e.g., respiratory infections) compared to children born in Ontario, according to a new study from ICES and The Hospital for Sick Children (SickKids). 

The study followed 458,597 children (113,098 refugee and immigrant children for the first four years after arrival to Canada and 345,499 Ontarian-born within the same period). The researchers found that refugee and immigrant children had more primary care visits for minor illnesses and fewer non-urgent ED visits for similar conditions than their Ontario-born peers. One possible explanation for fewer ED visits for minor illnesses among resettled refugee families in particular, may be related to the healthcare-navigation support that these families receive during early settlement. However, after two years of arrival, primary care visits for minor conditions decreased while non-urgent ED visits increased among all resettled refugee children, which the authors suggest may be related to reduced resettlement financial support and the challenge these families may face accessing primary care during regular work hours. 

“This study contributes to the growing research that disproves the belief that newcomers misuse healthcare services,” says Dr. Susitha Wanigaratne, Senior Research Associate at the Edwin S.H. Leong Centre for Healthy Children and SickKids, a fellow at ICES, and an adjunct lecturer at the Dalla Lana School of Public Health. “In addition, some studies from comparable, high-income countries suggest that inclusive health care for migrants not only improves health outcomes but also reduces costs.” 

Key findings 

• Refugee and immigrant children who had at least one minor illness visit were less likely to visit the ED for non-urgent health problems in the first two years of arrival and more likely to have primary care visits for similar problems than children born in Ontario. 

• While resettled refugees were more likely to be affiliated with a community health centre than other immigrant groups, this did not help explain their more appropriate use of the healthcare system. 

• Ontario-born children who would typically be more familiar with the healthcare system were the most likely to visit the ED for non-urgent health problems and the least likely to have primary care visits for similar problems. 

“In Canada, government‑assisted and privately sponsored refugees have access to settlement workers and sponsors during their first year in the country,” says Dr. Astrid Guttmann, Co-Director of the Edwin S.H. Leong Centre for Healthy Children, and a senior scientist at ICES and SickKids. “While all refugee children had lower numbers of ED visits for minor problems, the effect was stronger in resettled refugee children, suggesting settlement services have a positive effect on healthcare navigation.” 

One limitation of the study is that it did not account for factors, including parental employment and education level, that may influence a caregiver’s decision to use the ED for non‑urgent conditions. 

The study “Emergency department visits for minor illnesses among recent refugee and immigrant children” is in the February issue of JAMA Network Open.  

  

ICES is an independent, not-for-profit research and analytics institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. ICES leads cutting-edge studies and analyses evaluating healthcare policy, delivery, and population outcomes. Our knowledge is highly regarded in Canada and abroad and is widely used by government, hospitals, planners, and practitioners to make decisions about healthcare delivery and to develop policy. For the latest ICES news, follow us on BlueSky and LinkedIn: @ICESOntario  

The Hospital for Sick Children (SickKids) is recognized as one of the world’s foremost paediatric health-care institutions and is Canada’s leading centre dedicated to advancing children’s health through the integration of patient care, research and education. Founded in 1875 and affiliated with the University of Toronto, SickKids is one of Canada’s most research-intensive hospitals and has generated discoveries that have helped children globally. Its mission is to provide the best in complex and specialized family-centred care; pioneer scientific and clinical advancements; share expertise; foster an academic environment that nurtures health-care professionals; and champion an accessible, comprehensive and sustainable child health system. SickKids is proud of its vision for Healthier Children. A Better World. Please visit sickkids.ca.  

 

  

FOR FURTHER INFORMATION PLEASE CONTACT:   

Charlotte Lam   
Communications Associate  
ICES    
media@ices.on.ca    
437-317-8804   

Sarah Warr 
Team Lead, External Communications & Public Affairs 
SickKids 
media.line@sickkids.ca 

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Journal

JAMA Network Open

DOI

10.1001/jamanetworkopen.2025.60070 

Method of Research

Observational study

Subject of Research

People

Article Title

Emergency department visits for minor illnesses among recent refugee and immigrant children

Article Publication Date

27-Feb-2026

 

Stress-testing the Cascadia Subduction Zone reveals variability that could impact how earthquakes spread

University of Washington

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image: 

This map models locking at the Cascadia Subduction Zone, with red showing where the plates are tightly locked and orange/yellow indicating less locking. The study sites are marked with small red squares and the small blue lines along the edge depict other faults, the proposed fluid conduits in this study. The cross section shows fluid migration in more detail.

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Credit: Science Advances/Kidiwela et al.

The Cascadia Subduction Zone is unusually quiet for a megathrust fault. Spanning more than 600 miles from Canada to California, the fault marks the convergence of the Juan de Fuca and North American plates. While other subduction zones produce sporadic rumblings as the plates scrape past each other, Cascadia shows very little seismic activity, fueling assumptions that the plates are locked together by friction. 

The subduction zone — miles offshore and deep underwater — is difficult to observe. Most data collection is based onshore, which limits the breadth and quality of results. The lack of earthquakes further complicates efforts to understand its behavior and structure.

In a new study, the first to monitor strain offshore over an extended period of time, University of Washington researchers report that the plates may not be fully locked. Based on 13 years of ground motion data from sensors in different regions, the study shows the northern portion of the fault is locked and quiet, but the central region appears to be more active. There, researchers observed signs of a shallow, slow-motion earthquake and detected pulses of fluid flowing through subterranean channels, which may relieve pressure from the fault.

The findings, published Feb. 27 in Science Advances, may alter expectations of how this area will respond to a large earthquake. Similar features in other places have stopped a rupture that might have otherwise continued along the entire fault line.

“It’s preliminary, but we think that variable fluid pathways in Cascadia will change the behavior of large earthquakes on the fault,” said co-author Marine Denolle, a UW associate professor of Earth and space science. 

The Juan de Fuca plate is advancing toward the North American plate at a rate of approximately 4 centimeters a year. But because the plates are stuck together, that motion generates pressure. Eventually, the tension building at the boundary will exceed what the plates can tolerate. When they eventually slip free, an earthquake will spread along the boundary. 

Megathrust earthquakes, which occur at boundaries where one plate slides beneath another, rock the Pacific Northwest every 500 or so years. Researchers dated the last one to 1700, and estimates suggest a 10 to 15% chance that the entire fault will rupture, producing an earthquake that could exceed magnitude 9, within the next fifty years. The results from this study do not alter those odds, but the dynamics captured might influence the severity of the eventual earthquake.

A recent survey of the seafloor found that the fault can be separated into at least four geologically distinct segments. Each one may be insulated from a rupture in another region. In this study, the researchers took a closer look at two of the regions by analyzing data from three monitoring stations, one near Vancouver Island and two off the coast of Oregon. 

“We wanted to understand strain changes in different regions offshore,” said lead author Maleen Kidiwela, a UW doctoral student of oceanography. “We used the seismometers to measure how the seismic velocity varies underneath each station.”

Seismic velocity is a term used to describe the rate at which ambient noise travels through a material. Because the speed of sound depends on what it is moving through, tracking seismic velocity can give researchers a window into processes occurring beneath the ocean floor. 

“When you compact something, you can expect the sound waves to move through it faster,” said Kidiwela. 

The steady increase in seismic velocity observed at the northern site told the researchers the rock was compacting, which supports the theory that the two plates are locked in place.

The central region displayed a different pattern. For two months in 2016, seismic velocity decreased. The researchers attribute this drop to a slow-motion earthquake on the shallow edge of the oceanic plate that relieved some of the pressure at the fault. 

Other drops in seismic velocity, recorded between 2017 and 2022, were linked to fluid dynamics. Subduction squeezes liquid out of rocks and pushes it toward the surface. The study found that other faults, running perpendicular to the subduction zone, may act as pathways for letting trapped fluid out. 

“During a megathrust rupture, one of the ways that an earthquake propagates is through fluid pressure. If you have a way to release these fluids, it could help improve the stability of the fault, and potentially impact how the region behaves during a large earthquake,” Kidiwela said.

Pulling data from just three sites, the researchers observed complex dynamics that may have gone overlooked. Future work will greatly expand this effort. UW researchers received $10.6 million in 2023 to build an underwater observatory in the Cascadia Subduction Zone.

“Finding this link between fluids coming to the shallow subduction zone is pretty unique, as is the evidence that the fault is not completely locked,” said co-author William Wilcock, a UW professor of oceanography and one of the scientists involved with the observatory. “It suggests that we need more instruments there, because there may be more going on than people have been able to figure out before.” 

Additional co-authors include Kuan-Fu Feng from the University of Utah. 

This study was funded by the Jerome M. Paros Endowed Chair in Sensor Networks at the University of Washington and the National Science Foundation. 
For more information, contact Kidiwela at seismic@uw.edu.

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Journal

Science Advances

DOI

10.1126/sciadv.aea3684 

Method of Research

Data/statistical analysis

Article Title

Active protothrusts and fluid highways: Seismic noise reveals hidden subduction dynamics in Cascadia

Article Publication Date

27-Feb-2026

We may be underestimating the true carbon cost of northern wildfires

A study led by a UC Berkeley researcher reconstructed emissions from Swedish wildfires and found that current climate estimates are failing to fully account for carbon released from smoldering organic soils.

University of California - Berkeley

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image: 

A controlled burn executed by the group Life2Taiga in 2024 in a boreal forest in Småland, Sweden. 

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Credit: Johan Eckdahl/UC Berkeley

Wildfires in the northern boreal forests of Alaska, Canada, Scandinavia and Russia may be more damaging to the climate than previously thought, a new UC Berkeley-led study suggests.

That’s because these fires don’t just burn through trees; they can also penetrate deep into the carbon-rich layers of soil underneath many boreal forests, releasing carbon that has been accumulating for hundreds or even thousands of years. These carbon-rich soils, also known as peat, are primarily found in the far north, where the cold, wet climate prevents vegetation from fully decomposing and leads to a buildup of partially decayed organic matter over time.

The study found that major models of wildfire carbon emissions — which are largely based on data from fires at lower latitudes, and use satellite images of visible flames to guide their estimates — are not properly accounting for the impact of fire on these underground carbon stores. 

“Many of the fires that matter most for the climate don’t look dramatic from space,” said study lead author Johan Eckdahl, a postdoctoral scholar in Berkeley’s Energy and Resources Group. “Peatlands and organic soils can smolder for weeks to years, releasing enormous amounts of ancient carbon.”

In the study, published today in the journal Science Advances, Eckdahl and his co-authors reconstructed the carbon emissions from 324 wildfires that burned in Sweden in 2018. By combining detailed national forest datasets with field measurements, they were able to create a high-resolution “map” of wildfire emissions, showing how variations in local climate and ground conditions can impact the amount of carbon that is stored in a forest and released by wildfire.

When they compared their detailed reconstructions with six of the most widely used global fire emissions models, the researchers found striking inaccuracies. Some regions showed large overestimates, while emissions from deep belowground carbon stores were dramatically underestimated.

For example, the models overestimated carbon emissions in the county of Gävleborg, a region that experienced large, high-intensity wildfires in drier forests that were clearly visible by satellite.

However, in the neighboring county of Dalarna, where low-intensity fires that were less noticeable by satellite burned into thick soil layers, the models underestimated carbon emissions by up to a factor of 14. 

“Sweden is a very large country, but it’s quite small compared to Siberia and Canada,” Eckdahl said. “We may be severely underestimating the impact of the recent extreme fire seasons in these regions.”

To measure the impact of wildfire on soil carbon, the team collected data at 50 of the sites that burned in 2018, 19 from high-intensity fires and 31 from low-intensity fires. At each site, they measured the depth of the organic-rich soil layer — which can vary from a few inches to many feet — and collected soil samples. By comparing the carbon content of the burned soil with soil from unburned forest land, they could calculate the amount of carbon released by the fire.

"Once you're out there, it's a simple task — just dig some holes — but the hard part is getting to the sites," Eckdahl said. "Sweden has a good network of forest roads, but in Siberia, I hear it's a real trek, which is one reason why we're severely missing measurements from that region."

As part of the Western Fire & Forest Collaborative, Eckdahl is now working with colleagues at UC Berkeley and across the nation to adapt these approaches to fire-prone forests in the Western U.S. While these forests may not have the same carbon-rich soil layers as boreal forests of the far north, there are still a variety of factors — including the local climate, the types of trees and vegetation present and the soil quality — that can have a dramatic impact on the wildfire emissions. Eckdahl’s focus will be on studying bacteria and fungi in the soil, and how they can help a forest recover after a wildfire.

“Forests in the Lower 48 and those far up north may look very different, but they share the common currency of carbon,” said Eckdahl. “By improving our understanding of how this element flows between the land and the atmosphere, we can better anticipate the impact of future fire regimes in a warming world and design smarter strategies to reduce climate risks on society.”

Lars Nieradzik of Lund University and Louise Rütting of the Brandenburg University of Technology are co-authors of the paper. 

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Journal

Science Advances

DOI

10.1126/sciadv.adw5226 

Method of Research

Experimental study

Subject of Research

Not applicable

Article Title

Reassessing boreal wildfire drivers enables high-resolution mapping of emissions for climate adaptation

Article Publication Date

27-Feb-2026