A 10-Year Comparison of Injury Patterns and Outcomes between Migrants and Residents in a high-income country setting.

IntroductionMigrants are drawn to high-income countries (HICs) for employment, often in sectors deemed difficult, risky, and low paying. However, they experience more injuries and deaths and face barriers to healthcare. The World Health Organization has highlighted migrant health as a priority. While Hargreaves et al. and others studied migrant occupational health, most did not compare with residents. Lau et al. and Pega et al. did, but with limitations: the former focused on deaths, the latter judged the evidence to be poor. Few large studies in HICs directly compare injury outcomes and barriers between migrants and residents. Singapore, with a sizeable migrant workforce in construction, marine, and process industries, provides a suitable setting. We hypothesised that migrants sustain more work- and commute-related injuries, and poorer outcomes. MethodsWe performed a 10-year retrospective analysis (2013-2022) of injured patients at a central tertiary hospital in Singapore using its trauma registry. Migrants and residents were identified by registration numbers. Outcomes included injury severity, mortality, access barriers, and mechanisms of injury. Logistic regression adjusted for confounders. ResultsAfter excluding cases with missing data (31,555), 281,847 patients remained; migrants comprised 66,719 (23.7%). Migrants were predominantly young, male, and Chinese or Indian. Adjusted analyses showed migrants had lower odds of significant injuries (OR 0.87, 95%CI 0.81-0.93) and mortality (OR 0.64, 95%CI 0.48-0.84), but higher odds of discharging Against Medical Advice (OR 1.42, 95%CI 1.31- 1.55) and higher ED discharge prevalence (PR 1.04, 95%CI 1.04-1.05). Falls and vehicular accidents were leading mechanisms in both groups. Migrants had more falls from height (74.9%) and vehicular injuries (35.8%), while residents had more ground-level falls (46.0%). ConclusionContrary to our hypothesis, migrants had lower odds of significant injuries and mortality. Protective mechanisms such as workplace safety policies may contribute. Yet, higher AMA and ED discharges suggest barriers to care. Findings highlight the need for prevention focused on falls from height and vehicular trauma, and continued efforts to reduce healthcare disparities in migrants.