Search

Background: Most studies of disparities in birth and postnatal outcomes by parental birthplace combine all immigrants into a single group. We sought to evaluate heterogeneity among immigrants in Canada by comparing birth and postnatal outcomes across different immigration categories. Methods: We conducted a population-based retrospective study using Statistics Canada data on live births and stillbirths (1993–2017) and infant deaths (1993–2018), linked to parental immigration data (1960–2017). We classified birthing parents as born in Canada, economic-class immigrants, family-class immigrants, or refugees, and evaluated differences in preterm births, small-for-gestational-age (SGA) and large-for-gestational-age (LGA) births, stillbirths, and infant deaths among singleton births by group. Results: Among 7 980 650 births, 1 715 050 (21.5%) were to immigrants, including 632 760 (36.9%) in the economic class, 853 540 (49.8%) in the family class, and 228 740 (13.4%) refugees. Compared with infants of Canadian-born birthing parents, infants of each of the 3 immigrant groups had higher risk of preterm birth, SGA birth, and stillbirth, but lower risk of LGA birth and neonatal death. Compared with infants of economic-class immigrants, infants of refugees had higher risk of early preterm birth (0.9% v. 0.8%, adjusted risk ratio [RR] 1.08, 95% confidence interval [CI] 1.01–1.15) and LGA birth (9.2% v. 7.5%, adjusted RR 1.12, 95% CI 1.10–1.15), but lower risk of SGA birth (10.2% v. 11.0%, adjusted RR 0.92, 95% CI 0.90–0.94), while infants of family-class immigrants had higher risk of SGA birth (12.2% v. 11.0%, adjusted RR 1.01, 95% CI 1.00–1.02). Risk of stillbirth, neonatal death, and overall infant death did not differ significantly among immigrant groups. Interpretation: Heterogeneity exists in outcomes of infants born to immigrants to Canada across immigration categories. These results highlight the importance of disaggregating immigrant populations in studies of health disparities. [ABSTRACT FROM AUTHOR]

Background The COVID-19 pandemic has highlighted several issues among health care workers in Canada's long-term care and seniors' (LTCS) homes, including labour shortages, staff retention difficulties, overcrowding, and precarious working conditions. There is currently a lack of information on the health, well-being and working conditions of health care workers in LTCS homes--many of them immigrants--and a limited understanding of the relationship between them. This paper examines differences between immigrant and non-immigrant workers' health outcomes and precarious working conditions during the pandemic. Data and methods The data were from the 2021 Survey on Health Care Workers' Experiences During the Pandemic, which collected information on LTCS home health care workers' (n=2,051) health, employment or work experiences, and working environment during the COVID-19 pandemic. Summary statistics and multivariable logistic regressions were conducted to examine the association between precarious work and workers' health (life stress, mental health and general health), stratified by immigrant status. Selected working characteristics were included in the regression models as covariates, namely occupation, number of locations worked, facility ownership status and number of years worked. Results Immigrant health care workers were more likely than non-immigrant health care workers to experience precarious work in LTCS homes. Precarious work--characterized by income loss, reduced hours of work, and unpaid leave--was associated with stress and poor general health among immigrant and nonimmigrant workers in the sector. Employment precarity was also associated with poor mental health for immigrant workers, but there was no association for non-immigrant workers. Interpretation Employment precarity and the health and well-being of health care workers warrants further attention, in particular among immigrants employed in the LTCS residential care sector. [ABSTRACT FROM AUTHOR]

Background At the onset of the COVID-19 pandemic, there was an overrepresentation of males in COVID-19 deaths worldwide, with Canada reporting more female COVID-19 deaths. This paper examines the overrepresentation of female COVID-19 deaths in Canada, with an immigration lens. Data and methods Data were extracted from the COVID-19 Sex-Disaggregated Data Tracker to compare the sex distribution of COVID-19 deaths in Canada with that of other countries. A linkage of deaths to the Longitudinal Immigration Database (IMDB) allows for the comparison of sex-specific COVID-19 death rates by immigrant status for age and geography, as well as by major employment sector among immigrants, using the tax data from the IMDB. Results While there were proportionately more female than male COVID-19 deaths in Canada in the early months of the pandemic, this trend was mainly a phenomenon among non-immigrants aged 85 and older. In addition, COVID-19-specific death rates for males were higher than those for females across age groups by immigrant status, except for those aged 85 and older among the non-immigrant population. Among immigrants, the death rate among health care and social assistance workers was higher among males than among females (10.7 vs. 2.9 per 100,000 population). The initially observed overrepresentation of female COVID-19 deaths to male COVID-19 deaths in Canada evened out in the summer of 2021. Interpretation The higher proportion of female COVID-19 deaths was likely related to the high concentration of COVID-19 deaths in long-term care facilities, where a lower institutionalization rate for immigrants had been observed. Since the implementation of vaccination targeting long-term care facility residents in Canada, the overrepresentation of female COVID-19 deaths ceased. [ABSTRACT FROM AUTHOR]

Background: Immigrants, a fast-growing population in Canada, score below the national average in health literacy, but the reasons behind the low scores are largely unknown. Also, there is a need to understand the long-term impact of immigration by examining health literacy by generational status. Objective: To examine health literacy differentials in Canada, comparing immigrants and non-immigrants; as well as immigrant sub-groups by their region of origin, recency of arrival and generational status. Methods: A cross-sectional multi-stage representative sample of 22,818 respondents from the Canadian component of the 2003 International Adult Literacy and Skills survey. Data were collected in the home of each respondent. We used descriptive statistics and logistic regression in this study. Results: Fewer immigrants (24%) than non-immigrants (44%) had the requisite health literacy level. After controlling for selected factors, health literacy was still significantly lower for immigrants compared to non-immigrants (OR = 0.51; 95% CI = 0.37-0.70). For the immigrant sub-groups and by generations, initial differences that were observed, disappeared after controlling for selected factors. Overall, health literacy was associated with economic, education, and literacy-related factors, but the association with literacy practices at home and at work was stronger for the immigrants than the non-immigrants. Conclusion: Education and literacy practices at home and at work are important determinants of the population's health literacy; however, education is more likely to be associated with acquisition, while literacy practices are more likely associated with maintenance of health literacy. This adds to our understanding of the factors associated with health literacy, by immigrant and generational status, and shows how different segments of the population in Canada process health information.

Background Canadian immigrants from countries where the hepatitis B virus (HBV) and hepatitis C virus (HCV) are endemic may be at higher risk of liver-related disease than Canadian-born residents. This study compared HBV- and HCV-related hospitalizations in Canadian immigrants (arriving from 1980 to 2013) and longterm residents (Canadian-born population and pre-1980 immigrants) and aimed to describe the burden of disease in both groups. Methods Based on the 2004/2005-to-2013/2014 hospital Discharge Abstract Database linked to the 1980-to-2013 Longitudinal Immigration Database, this descriptive cross-sectional study examined the distribution of HBV- and HCV-related hospitalizations, lengths of stay, comorbidities, and sequelae incurred by immigrants and long-term residents in Canada. With a linkage rate of 85%, 5,854,949 immigrants were included in the study. Proportions of HBV- and HCV-related hospitalizations attributable to immigrants were calculated. Results By birth country risk level, 22% of HBV-related hospital events among recent immigrants, and 20% of those related to HCV, were among people from high-risk countries. Proportionally, fewer immigrants had comorbidities than long-term residents. The top two hospital-related sequelae in both groups were cirrhosis and ascites, and liver cancer. While immigrants made up 16% of the Canadian population, they incurred 37% of HBV-related hospitalizations and 9% of HCVrelated hospitalizations, giving ratios of hepatitis-related hospitalizations relative to the population share of 2.3 (95% confidence interval [CI]: 2.2 to 2.5) and 0.5 (95% CI: 0.5 to 0.6) respectively. These ratios were higher among seniors, at 4.4 (95% CI: 3.9 to 4.9) and 2.3 (95% CI: 1.9 to 2.6), respectively. Interpretation Immigrants can require hospitalization for hepatitis in Canada, especially for HBV. These results may inform health screening for HBV or HCV in the Canadian immigration context. [ABSTRACT FROM AUTHOR]

Background Few quantitative studies have used national-level data to examine access to mental health consultation (MHC) by immigrants in Canada, and even fewer studies investigate MHCs using the following variables: immigrant admission category, duration in Canada since landing and world source regions. This study examines MHCs by immigrants and refugees--compared with those of Canadian-born respondents--while controlling for self-reported mental health (SRMH) and immigrant characteristics, using a population-based survey linked to immigrant landing information. This study, which is based on a linked database, allows for much richer insight into immigrant populations than most previous studies. Data and methods Based on data from four cycles (2011 to 2014) of the Canadian Community Health Survey linked to data from the Longitudinal Immigration Database, the odds ratios of having had MHCs are compared between the Canadian-born population and immigrants by immigration dimensions, while controlling for SRMH. Results are hierarchically adjusted for age, sex, socioeconomic factors and sense of belonging. Results After the above-mentioned factors were controlled for, immigrants were much less likely than Canadian-born respondents to access MHCs. Specifically, compared with the Canadian-born population that had high levels of SRMH, immigrants with high levels of SRMH were statistically less likely to have had an MHC (odds ratio [OR]=0.5, 95% confidence interval [CI] from 0.4 to 0.5), while those with low SRMH levels were more likely to report an MHC (OR=4.8, 95% CI from 4.5 to 5.1, for the Canadian-born population but OR=1.8, 95% CI from 1.5 to 2.1, for immigrants). Most Asian immigrants with low SRMH levels were only as likely to report MHCs as Canadian-born respondents with high SRMH levels. Refugees with low SRMH levels also had only a slightly elevated MHC level (OR=1.6, 95% CI from 1.1 to 2.3) compared with Canadian-born individuals with high SRMH levels. Overall, refugees were not more likely than immigrants of other admission categories to report having had an MHC, even though previous findings have shown that refugees report low levels of SRMH. Interpretation This study provides new evidence on the differences in access to MHC between Canadian-born individuals and immigrants by various characteristics, while controlling for SRMH. Results probably reflect the structural or cultural barriers to MHC and point to a possible pathway to either maintain or improve mental health among immigrants. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Studies in Population is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: In 2003, Ontario introduced a patient enrolment system as part of health care reforms, aimed at enhancing primary health care services, but it is unclear whether immigrants have benefited from this health care reform. Therefore, we studied whether this reform changed the extent of immigrants' enrolment in primary care services in Ontario between 2003 and 2012.Methods: This is a population-based retrospective cohort study, in which a closed cohort of 9231840 Ontario residents between 1985 and 2003 was created, using linked health administrative and immigration databases. Levels of enrolment for traditional and more comprehensive capitation-based practice between 2003 and 2012 were compared by immigrant status. Logistic regression modelling was used to assess the odds of enrolment on primary care practices.Results: Overall enrolment in primary care practices increased gradually after 2004, until 2012, when two-thirds of the cohort (67%) were enrolled. The immigrants' enrolment level remained consistently lower than that of long-term residents over the study period. By 2012, enrolment of immigrants in capitation-based models was significantly lower (17.3% versus 25.4%). In particular, enrolment in Family Health Teams, considered the most comprehensive care model, was considerably lower in immigrants compared with long-term residents (5.6% versus 18.0%; OR = 0.40, 95% CI: 0.40 to 0.41).Conclusions: Immigrant enrolment rates in new comprehensive primary care models were consistently lower than among long-term residents. This has implication on equitable primary care access for immigrant populations. [ABSTRACT FROM AUTHOR]

Background: Medical screening plays a role in explaining the healthy immigrant effect (HIE) among immigrants newly landed in Canada. The 2002 Immigration and Refugee Protection Act (IRPA) modernized immigration selection by exempting certain immigrant categories (e.g., refugees and certain family-class immigrants) from inadmissibility on health grounds. This study examines the HIE in the IRPA era by sex, with a focus on those categories affected by the IRPA. Data and methods: The linked Canadian Community Health Survey (CCHS)-Longitudinal Immigration Database (IMDB) was used to compare sex-specific age-standardized proportions of four health measures between Canadian-born and immigrants aged 20 to 65, overall and by duration since landing. Immigrants who landed within three years of the surveys from 2007 to 2014 were examined by sex and immigrant category. Logistic regression was used to further compare the HIE in the same immigrant sub-groups to the Canadian-born, controlling for age and selected confounders. Results: This study found the HIE in most selected measures for immigrants overall, as well as for those recent immigrants arriving under the IRPA, including the family class. Among refugees, the HIE was observed only in less severe chronic conditions; this was especially the case among females. As expected, a strong HIE was observed among economic-class principal applicants. These health advantages persisted even after adjustment for socioeconomic and health factors. For self-rated health, the advantage existed for some groups only after full adjustment. Interpretation: This study is a first look at the healthy immigrant effect under the 2002 Immigration and Refugee Protection Act by immigration category. Results corroborate the existing literature on the presence of the HIE among immigrants: the HIE was found to be much weaker among refugees. [ABSTRACT FROM AUTHOR]

Background: While the incidence of active tuberculosis (TB) in Canada is among the lowest in the world, the rates of TB among immigrants and Indigenous people remain high. In fact, the majority of new active TB cases are disproportionately found among immigrants. This study profiles TB-related acute care hospitalizations among new immigrants to Canada by selected characteristics. Data and methods: This study is based on the 2000-to-2013 Longitudinal Immigration Database (IMDB) linked to the Canadian Institute for Health Information's Discharge Abstract Database (DAD) from 2001/2002 to 2013/2014. It examines the timing of first TB-related acute care hospitalization occurring from the fiscal year 2001/2002 to the fiscal year 2013/2014 among immigrants who landed in Canada from 2000 to 2013 outside of Quebec and the territories. Mean and median hospital days and the percentage of total TB hospitalizations incurred by these new immigrants are calculated to measure the burden of hospital care among recent immigrants. Results: From 2001/2002 to 2013/2014, 1,120 out of 2.7 million immigrants arriving between 2000 and 2013 were found to have, in total, 1,340 TB-related hospital discharges. The majority of cases (97%) were among immigrants from the Immigration, Refugees and Citizenship Canada (IRCC) designated country list for TB, in which about three quarters of the cases were from the World Health Organization (WHO) list of high TB-burden countries. Approximately half (45%) of immigrants hospitalized for TB were aged 18 to 34 at the time of hospitalization. Around 10% of all TB patients had been hospitalized before formally landing as immigrants. Mean and median length of hospital stay were 17 days and 11 days, respectively (22 days and 14 days, respectively, for the overall population in Canada). While new immigrants who landed between 2000 and 2013 represent 7% of the overall population of Canada, they incurred 17% of all TB-related hospital discharges occurring during this period. Interpretation: This paper demonstrates the value of linked administrative data to understanding immigrant health and is important for future work in this area. Current immigration protocols surrounding TB involve screening for active pulmonary TB and identifying some migrants with latent TB. Results of this study, linking TB-related hospitalizations to immigrant landing files, provide unique information that can inform public health action, as well as migration policy and program development to contribute to the efforts to eliminate TB. [ABSTRACT FROM AUTHOR]

Discussions about potential long-term health consequences of the COVID-19 pandemic on immigrant health and the healthy immigrant effect (HIE) remain unaddressed. Drawing on Canada as a case study, we summarize the primary and secondary impacts of COVID-19 on immigrants. We find that recent and female immigrants as well refugees have fared far worse than either their more established and male counterparts or the Canadian-born population. We then discuss how COVID-19 might influence (or weaken) immigrants' previously documented health advantage. We highlight two structural conditions induced by the pandemic that may alter the health profile of immigrants; namely, immigration policy and delayed medical treatments. Reflections on the requisite data for monitoring and tracking the overall impact of COVID-19 on immigrants' health are included. Finally, we conclude with a discussion of the Canadian patterns and its potential relevance to immigrants and the HIE in the United States. • Immigrants' health in Canada has been worsened by the COVID-19 pandemic. • COVID-19 related mortality is higher for immigrants than for native-born Canadians. • Secondary effects of the pandemic can have long-term impacts for immigrant health. • Future work should examine COVID-19 impacts on the healthy immigrant effect. [ABSTRACT FROM AUTHOR]

Background: Economic immigrants generally, and economic class principal applicants (ECPAs) specifically, tend to have better health than other immigrants, as well as the Canadian-born population. However, health outcomes vary among subcategories within this group, especially by sex. Methods: This study examines hospitalization rates among ECPAs aged 25 to 74 who arrived in Canada between 1980 and 2006 as skilled workers, business immigrants, or live-in caregivers. The analysis used two linked databases to estimate age-standardized hospitalization rates (ASHRs) overall and for leading causes by sex. ASHRs of ECPA subcategories were compared with each other and with those of the Canadian-born population. Logistic regression was used to derive odds ratios for hospitalization among ECPAs, by sex. Results: Male and female ECPAs aged 25 to 74 had significantly lower all-cause ASHRs than did the Canadian-born population in the same age range. This pattern prevailed for each ECPA subcategory and for each disease examined. Compared with skilled workers, business immigrants had lower odds of hospitalization; live-in caregivers who arrived after 1992 had higher odds. Adjustment for education, official language proficiency, and world region reduced the strength of or eliminated these associations. Interpretation: Compared with the Canadian-born population, ECPAs generally had lower hospitalization rates. Differences were apparent among ECPA subcategories. [ABSTRACT FROM AUTHOR]

Background: Refugees arrive in Canada with settlement challenges different from those faced by other immigrants, including a higher risk of poor health. This study reports hospitalization rates for the three fiscal years from 2006/2007 through 2008/2009 for immigrants who arrived during the 1980-to-2006 period, with a focus on three refugee groups. Methods: Information from two linked databases was used to estimate age-standardized hospitalization rates (ASHRs) per 10,000 population aged 30 or older for all causes (excluding pregnancy) and for leading causes, by immigrant category and by refugee subcategory. The analysis focused on refugees from Poland, Vietnam and the Middle East, whose hospitalization rates were compared with those of the Canadian-born population and/or economic class immigrants from the same source areas. Results: Immigrants aged 30 or older, including refugees, had significantly lower all-cause ASHRs than did the Canadian-born population. All-cause ASHRs were 470 per 10,000 for immigrants overall and 494 for refugees, compared with 891 for the Canadian-born. Of the three source areas, immigrants and refugees from Vietnam had lower ASHRs. The circulatory disease-specific ASHR for government-assisted refugees from the Middle East was similar to that of the Canadian-born population (142 and 158, respectively). Except for those from Poland, refugees typically had higher ASHRs than did their economic class counterparts. Interpretation: Refugees, like other immigrants, generally had lower hospitalization rates than did the Canadian-born population, but some subgroups were particularly susceptible to hospitalization for specific chronic diseases. [ABSTRACT FROM AUTHOR]

While immigrants tend to be healthier especially when they first arrived, this healthy immigrant effect may not apply to vaccine-preventable diseases (VPD) especially among immigrants from countries without vaccination programs. There is therefore an important information gap regarding differential health outcome and hospitalization usage by immigrant status, landing cohort, world region and immigrant category. This study focused on acute-care hospitalization, and used two recently linked population-based databases in Canada, namely, the 2006 Census linked to the Hospital Discharge Abstract (DAD), and the Immigrant Landing File linked to the DAD (ILF-DAD) to estimate crude and age-standardized VPD-related hospitalization rates (ASHR) by the above-mentioned immigrant characteristics to be compared with that for overall Canadian-born reference population. Based on the 2006 Census-DAD linked database, VPD-specific ASHR for overall immigrants was significantly higher than that for the Canadian-born population (1.6, 95% CI, 1.5, 1.6 vs 1.2, 95% CI, 1.1, 1.2, respectively). VPD-specific ASHRs by landing cohorts also increased with years in Canada (e.g. 1.4, 95% CI, 1.3, 1.5 for the 1990–2006 cohort, and 1.6, 95% CI, 1.5, 1.7 for the pre-1980 cohort). Based on the 1980–2006 ILF-DAD, the VPD-specific ASHRs were highest among Southeast and East Asians (e.g. 2.1, 95% CI, 1.9, 2.3 for East Asia). Compared with the Canadian-born, economic class immigrants overall had significantly lower ASHR (1.4, 95% CI 1.2, 1.6), but the low rate was mainly due to the dependants (spouse or children) within this class (0.8, 95% CI 0.6, 1.1). Both family and refugee categories had significantly higher ASHRs (1.3, 95% CI, 1.2, 1.5 and 1.7, 95% CI, 1.4, 2.1, respectively), especially among those refugees assisted by government (2.0, 95% CI, 1.4, 2.6). With increasing immigration, changing source countries and emerging needs for refugee settlements in Canada, these newly linked datasets help to monitor VPD-related hospitalization pattern among Canadian immigrants. [ABSTRACT FROM AUTHOR]

Background: Although immigrants tend to be healthier than the Canadian-born population when they arrive, subgroups, notably different immigration categories, may differ in health and health care use. Data limitations have meant the research has seldom focused on category of immigrant-economic, family or refugee. A newly linked database has made it possible to study acute care hospitalization by immigration category and source region. Data and methods: The Immigrant Landing File-Hospital Discharge Abstract Linked Database (n = 2.6 million) was used to derive sex-specific crude and age-standardized hospitalization rates (ASHRs) per 10,000 population for all-cause and leading causes of hospitalization during the 2006/2007-to-2008/2009 period. Results: Economic class immigrants had lower all-cause ASHRs than did their family class or refugee counterparts. Male refugees had high ASHRs overall and for circulatory diseases, digestive diseases, injury, and cancer. Female differences by immigrant class were less pronounced. All-cause ASHRs (excluding pregnancy) rose with years since arrival in Canada for male and female immigrants. Immigrants from East Asia had the lowest ASHRs; those from the United States, the highest. Interpretation: Although hospital use is an imperfect indicator of health status, this study supports an initial healthy immigrant effect and its subsequent decline. Marked differences emerged among immigrant subgroups with some, notably refugees and immigrants from the United States, having significantly higher hospitalization rates overall and for leading causes, compared with other groups. [ABSTRACT FROM AUTHOR]

Background The Canadian Health Measures Survey (CHMS) fills important health information gaps, but the feasibility of using it for immigrant research is unknown. Data and methods Weighted estimates of socio-demographic variables by immigrant status from the combined cycles 1 and 2 of the CHMS (2007 to 2009 and 2009 to 2011) were compared with distributions from the 2006 Census and the 2011 National Household Survey (NHS). Weighted CHMS estimates of selected self-reported health indicators among immigrants were compared with corresponding data from the 2009/2010 Canadian Community Health Survey (CCHS) by age group, sex, broad world region of origin, and period of arrival. Z-scores were used to detect statistical significance between the CHMS and CCHS estimates. Results The CHMS immigrant sample is generally similar to the average of 2006 Census/2011 NHS samples, but it contains higher percentages of recent immigrants, 30- to 49-year-olds, and immigrants from South/Central America. Estimates of selected self-reported health and health behaviour variables from the CHMS and the CCHS were similar overall, with minor differences at subgroup levels, and some inconclusive results due to high variability. Interpretation The combined CHMS immigrant sample can be used for health research. However, it is necessary to ensure that variables of interest meet sample size and prevalence requirements, especially at the subgroup level. [ABSTRACT FROM AUTHOR]

We used data from the 1991–2006 Canadian Census Mortality and Cancer Follow-up Study to compare all-cause mortality for immigrants with that of the Canadian-born population. The study addressed two related questions. First, do immigrants have a mortality advantage over the Canadian-born? Second, if immigrants have a mortality advantage, does it persist as their duration of residence increases? The analysis fitted sex-stratified hazard regression models for the overall sample and for selected countries of birth (UK, China, India, Philippines, and the Caribbean). Predictors were assessed at baseline. Mortality was lower among immigrants than the Canadian-born even after adjusting for a selected group of socio-demographic and socio-economic factors. The mortality differences persisted even after long residence in Canada, but appeared to be dependent on the age of the individual and the country of origin. Interpreted in light of known explanations of immigrant mortality advantage, the results mostly reflect selection effects. [ABSTRACT FROM PUBLISHER]

This article presents a review of recent studies based on Statistics Canada's health surveys to examine the mental health of immigrants and its changes over time, and documents factors found to influence mental health. The article concludes with a discussion on recent developments in data collection at Statistics Canada and how the data can shed light on immigrant mental health. [ABSTRACT FROM AUTHOR]

Objectives This article describes an algorithm to classify respondents to cycle 1.1 (2000/2001) of the Canadian Community Health Survey (CCHS) according to whether they have type 1, type 2 or gestational diabetes. Data source The data are from the chronic disease module and the drug module of cycle 1.1 of the CCHS. Analytical techniques A total of 6,361 respondents to cycle 1.1 of the CCHS reported that a health care professional had diagnosed them as having diabetes. The Ng-Dasgupta-Johnson algorithm classifies this group according to whether they have type 1, type 2 or gestational diabetes, based on their answers to CCHS questions about diabetes during pregnancy, use of oral medications to control diabetes, use of insulin, timing of initiation of insulin treatment, and age at diagnosis. Main results Application of an earlier algorithm to CCHS cycle 1.1 results in a 10%-90% split for type 1 and type 2 diabetes. By contrast, the Ng-Dasgupta-Johnson algorithm yields a 5%-95% split. This is not unreasonable, given the rapid rise in obesity, a major risk factor for type 2 diabetes, in Canada. [ABSTRACT FROM AUTHOR]

Background: The reduction of socioeconomic inequalities in health is an explicit objective of health policy in Canada, yet rates of death from cervical cancer are known to be higher among women of low socioeconomic status than among those of higher socioeconomic status. To evaluate progress toward the World Health Organization's goal of "Health for All," we examined whether income-related differentials in cervical can-cer mortality diminished from 1971 to 1996. Methods: Death registration data for Canada's census metropoli-tan areas in 1971, 1986, 1991 and 1996 were assigned to census tracts through postal code, and the tracts were in turn assigned to income quintiles based on their proportion of the population below the Statistics Canada low-income cutoff val-ues. We compared age-standardized death rates (using the 1966 world population standard) in the female population (ex-cluding those in institutions) across the 5 income quintiles and calculated interquintile rate ratios (poorest over richest) and in-terquintile rate differences (poorest minus richest). Results: From 1971 to 1996, the overall age-standardized cervical cancer death rate per 100 000 women (and 95% confidence interval) declined from 5.0 (4.5--5.6) to 1.9 (1.7--2.1), the in-terquintile rate ratio diminished from 2.7 (1.8--4.2) to 1.7 (1.1-- 2.6), and the interquintile rate difference decreased from 4.6 (2.8--6.4) to 1.1 (0.2--1.9). Interpretation: The income-related disparity in rates of death from cervical cancer as measured by rate ratios and rate differ-ences diminished markedly in urban Canada from 1971 to 1996. Among the numerous factors that may have contributed to the decline (including decline in fertility and improvement in diet), one important factor was probably the implementa-tion of effective screening programs. [ABSTRACT FROM AUTHOR]

Objectives: This article describes changes in income-related differences in mortality in Canada from 1971 to 1996, including trends by specific causes of death. Data source: Death registration and population data for residents of census metropolitan areas (CMAs) were obtained from the Canadian Mortality Data Base and population censuses for 1971, 1986, 1991, and 1996. The death data were then coded to census tract (CT), and institutional residents were identified (for exclusion). Analytical techniques: Within each CMA, the non-institutional population and deaths were grouped into neighbourhood income quintiles on the basis of the CT percentage of population below Canada's low-income cut-offs. Life expectancy at birth, probability of survival to age 75, potential years of life lost (PYLL), and income-related excess PYLL before age 75 were calculated, as were age-specific mortality rates and age- standardized mortality rates (ASMRs) for major causes of death. Main results: From 1971 to 1996, differences in life expectancy between the richest and poorest income quintiles of urban Canada diminished by well over 1 year for each sex (from 6.3 to 5.0 years for males, and from 2.8 to 1.6 years for females). Inter-quintile differences in infant mortality declined by 7 per thousand (76%). The rate of income-related excess potential years of life lost (PYLL) before age 75 diminished by 35%. By 1996 the major causes of death contributing to excess PYLL were circulatory diseases, injuries, neoplasms, and infectious diseases. For most causes of death (notably ischemic heart disease, most injuries, cirrhosis of the liver, and perinatal conditions), socio-economic disparities in mortality diminished markedly over time. However, some causes of death (such as lung cancer, prostate cancer and suicide for males, and breast cancer for females) showed little change, while a few (lung cancer for females, and infectious diseases, mental disorders and diabetes for both sexes) showed cl... INSETS: Methods;Restrictions and coding to CT and quintile;Other studies on socio-economic differentials in circulatory . .;Differential vulnerability to lung cancer among smokers, and . . [ABSTRACT FROM AUTHOR]

Presents a study which examined fertility among women who immigrated to Canada and the disruption hypothesis. What previous studies show; Historical trend of fertility among these women; Results of the study; What prompted this study.

This article presents a summary report on the dynamics of immigrants' health from Canada during 1994-95 to 2002-03. When immigrants arrive in Canada, they are generally in better health than the Canadian-born population. Potential immigrants are screened on medical and other health-related criteria before they are admitted to the country. There is also a degree of self-selection in the originating country, with applicants likely to be individuals with the stamina and motivation to undertake the rigors that immigration entails. An earlier study found that 97% of new immigrants rated their health as good, very good or excellent six months after theft arrival, compared with 88% for the general population. However, as time passes, this so-called healthy immigrant effect' tends to diminish as their health status converges with that of the general population. Immigrants overall make up an increasing share of the total population and without sufficient immigration to compensate for below-replacement fertility, the Canadian population could start to decline in about 30 years. Moreover, immigrants from non-European countries constitute an increasingly important segment of Canadian society, as about three-quarters of recent immigrants come from non-European nations.

Results from the Joint Canada/United States Survey of Health (2002-2003) reveal that health status is relatively similar in the two countries, but income-related health disparities exist. Americans in the poorest income quintile are more likely to have poor health than their Canadian counterparts; there were no differences between the rich. In general, Canadians were more like insured Americans regarding access to services, and Canadians experienced fewer unmet needs overall. Despite higher U.S. levels of spending on health care, residents in the two countries have similar health status and access to care, although there are higher levels of inequality in the United States. [ABSTRACT FROM AUTHOR]

Background: Most studies of disparities in birth and postnatal outcomes by parental birthplace combine all immigrants into a single group. We sought to evaluate heterogeneity among immigrants in Canada by comparing birth and postnatal outcomes across different immigration categories., Methods: We conducted a population-based retrospective study using Statistics Canada data on live births and stillbirths (1993-2017) and infant deaths (1993-2018), linked to parental immigration data (1960-2017). We classified birthing parents as born in Canada, economic-class immigrants, family-class immigrants, or refugees, and evaluated differences in preterm births, small-for-gestational-age (SGA) and large-for-gestational-age (LGA) births, stillbirths, and infant deaths among singleton births by group., Results: Among 7 980 650 births, 1 715 050 (21.5%) were to immigrants, including 632 760 (36.9%) in the economic class, 853 540 (49.8%) in the family class, and 228 740 (13.4%) refugees. Compared with infants of Canadian-born birthing parents, infants of each of the 3 immigrant groups had higher risk of preterm birth, SGA birth, and stillbirth, but lower risk of LGA birth and neonatal death. Compared with infants of economic-class immigrants, infants of refugees had higher risk of early preterm birth (0.9% v. 0.8%, adjusted risk ratio [RR] 1.08, 95% confidence interval [CI] 1.01-1.15) and LGA birth (9.2% v. 7.5%, adjusted RR 1.12, 95% CI 1.10-1.15), but lower risk of SGA birth (10.2% v. 11.0%, adjusted RR 0.92, 95% CI 0.90-0.94), while infants of family-class immigrants had higher risk of SGA birth (12.2% v. 11.0%, adjusted RR 1.01, 95% CI 1.00-1.02). Risk of stillbirth, neonatal death, and overall infant death did not differ significantly among immigrant groups., Interpretation: Heterogeneity exists in outcomes of infants born to immigrants to Canada across immigration categories. These results highlight the importance of disaggregating immigrant populations in studies of health disparities., Competing Interests: Competing interests:: None declared., (© 2024 CMA Impact Inc. or its licensors.)

Objectives: Mental health and neurocognitive conditions are important causes of hospitalization among immigrants, though patterns may vary by immigrant category, world region of origin, and time since arrival in Canada. This study uses linked administrative data to explore differences in mental health hospitalization rates between immigrants and individuals born in Canada., Methods: Hospital records from the Discharge Abstract Database and the Ontario Mental Health Reporting System for 2011 to 2017 were linked to the 2016 Longitudinal Immigrant Database and to Statistics Canada's 2011 Canadian Census Health and Environment Cohort. Age-standardized hospitalization rates for mental health-related conditions (ASHR-MHs) were derived for immigrants and the Canadian-born population. ASHR-MHs overall and for leading mental health conditions were compared between immigrants and the Canadian-born population, stratified by sex and selected immigration characteristics. Quebec hospitalization data were not available., Results: Overall, immigrants had lower ASHR-MHs compared to the Canadian-born population. Mood disorders were leading causes of mental health hospitalization for both cohorts. Psychotic, substance-related, and neurocognitive disorders were also leading causes of mental health hospitalization, although there was variation in their relative importance between subgroups. Among immigrants, ASHR-MHs were higher among refugees and lower among economic immigrants, those from East Asia, and those who arrived in Canada most recently., Conclusion: Differences in hospitalization rates among immigrants from various immigration streams and world regions, particularly for specific types of mental health conditions, highlight the importance of future research that incorporates both inpatient and outpatient mental health services to further understand these relationships., (© 2023. Crown.)

Background: Few studies of the healthy immigrant effect (HIE) have examined the mental health outcomes of Canadian-born individuals on a national scale compared with immigrants by admission category. This study fills this gap by examining the self-reported mental health (SRMH) of immigrants by admission category and other immigration dimensions (e.g., source world region and duration since landing) and making comparisons with Canadian-born respondents to a population-based survey., Data and Methods: Based on four cycles (2011 to 2014) of the Canadian Community Health Survey (CCHS) linked to the Longitudinal Immigration Database (IMDB), odds ratios of high (i.e., excellent or very good) SRMH among Canadian-born respondents and IMDB-linked immigrants are compared using logistic regression. Among the IMDB immigrant population, high SRMH was also examined according to the above-mentioned immigration dimensions. Adjusted results were hierarchically controlled for age, sex, social and economic factors, and sense of belonging., Results: Age-sex adjusted results show that immigrants, especially refugees, are less likely than the Canadian-born population to report high mental health levels, but these differences disappeared after full adjustment. The odds of immigrants having high SRMH differed more by source world region and duration since landing. For example, fully adjusted results show support for the HIE, with recent immigrants (interviewed within 10 years of landing) more likely to report high SRMH than either the Canadian-born population or established immigrants. Greater odds of high SRMH among recent immigrants also holds across admission classes and for selected world regions., Discussion: This study provides new evidence on differences in mental health between Canadian-born individuals and immigrants by various characteristics. Results support a deterioration of the HIE in SRMH and identify factors significantly associated with SRMH. This study can also serve as a baseline for further studies on the impact of COVID-19 on immigrants' mental health by immigrant category.

Background: Medical screening plays a role in explaining the healthy immigrant effect (HIE) among immigrants newly landed in Canada. The 2002 Immigration and Refugee Protection Act (IRPA) modernized immigration selection by exempting certain immigrant categories (e.g., refugees and certain family-class immigrants) from inadmissibility on health grounds. This study examines the HIE in the IRPA era by sex, with a focus on those categories affected by the IRPA., Data and Methods: The linked Canadian Community Health Survey (CCHS)-Longitudinal Immigration Database (IMDB) was used to compare sex-specific age-standardized proportions of four health measures between Canadian-born and immigrants aged 20 to 65, overall and by duration since landing. Immigrants who landed within three years of the surveys from 2007 to 2014 were examined by sex and immigrant category. Logistic regression was used to further compare the HIE in the same immigrant sub-groups to the Canadian-born, controlling for age and selected confounders., Results: This study found the HIE in most selected measures for immigrants overall, as well as for those recent immigrants arriving under the IRPA, including the family class. Among refugees, the HIE was observed only in less severe chronic conditions; this was especially the case among females. As expected, a strong HIE was observed among economic-class principal applicants. These health advantages persisted even after adjustment for socioeconomic and health factors. For self-rated health, the advantage existed for some groups only after full adjustment., Discussion: This study is a first look at the healthy immigrant effect under the 2002 Immigration and Refugee Protection Act by immigration category. Results corroborate the existing literature on the presence of the HIE among immigrants: the HIE was found to be much weaker among refugees.

Background: Immigrants tend to have better health than the Canadian-born. However, the "healthy immigrant" effect diminishes over time and varies by source country. This study examines whether lower hospitalization rates persist from the first (G1) to the second generation (G2) of immigrants, compared with other Canadians (G3+). All-cause and circulatory disease-related hospitalization rates were examined by generation, with special attention to people of Chinese and South Asian descent., Data and Methods: Data from the 2006 Census-hospitalization linkage database (which excludes Quebec) were analysed using logistic regression. Age-standardized all-cause (excluding pregnancy) and circulatory disease-related hospitalization rates were derived for the urban population aged 30 or older for the 2006/2007 to 2008/2009 fiscal years., Results: Over the generations, immigrants' all-cause and circulatory disease-related hospitalization rates converged with those of the Canadian population overall. Compared with G3+, the age-adjusted odds of all-cause hospitalization among men were 0.49 (CI = 0.48-0.51) for recent G1 immigrants, 0.78 (CI = 0.77-0.79) for long-term G1 immigrants, and 0.95 (CI = 0.94-0.97) for G2. Adjustments for socioeconomic status reduced the difference, especially between G2 and G3+. For South Asians, rates converged for circulatory disease, notably among men. Hospitalization rates for people of Chinese descent rose across generations, but remained significantly below rates for G3+., Interpretation: The lower circulatory disease-related hospitalization risk experienced by G1 is maintained in G2 among people of Chinese descent, but not among South Asians.

Objectives: To determine whether there are differences in disability by immigrant generation and region of origin and recency of arrival in Canada, and the role of health literacy in this relationship., Methods: A secondary analysis of the Canadian component of the 2003 International Adult Literacy and Skills Survey (IALSS) was undertaken., Results: Compared to the third-plus generation, first-generation immigrants were less likely to report disability; these differences remained even after adjustment for sociodemographic and socioeconomic factors. No differences in disability were observed between the second- and third-plus generations. Among first-generation immigrants, those not from Europe or USA were less likely to report disability regardless of their duration in Canada. Health literacy was negatively associated with disability only in the analysis comparing generations of Canadians. However, its effect was largely accounted for by education, employment status and income., Conclusions: First-generation immigrants were less likely to be disabled than the other generations. Education, employment and income provide important avenues through which individuals develop health literacy. Health literacy was not associated with disability among first-generation immigrants perhaps because health literacy is low in this group.

Objective: There are 2 major forms of diabetes mellitus: types 1 and 2. A major limitation of most current population-based diabetes surveillance systems is the classification of diabetes types. Our objective was to examine the concordance of self-reported diabetes type with a previously developed classification algorithm, using a nationally representative survey sample., Methods: Self-reported data were available from 2544 adults with self-reported diabetes, aged ≥20 years and older, who responded to the diabetes component of the 2011 Survey of Living with Chronic Diseases in Canada. We examined the concordance of self-reported diabetes type with an algorithm based on self-reported, but objective, respondent characteristics, such as age of diagnosis and treatment patterns. Concordance was measured using kappa coefficients. Sensitivity, specificity and positive and negative predictive values were calculated using the algorithm as the reference "standard.", Results: Approximately 11% of the estimated population did not self-report diabetes type; almost all of these respondents would be classified as having type 2 diabetes by the algorithm. Of those self-reporting diabetes type, we found moderate overall agreement between the algorithm and self-reported type (kappa, 0.52; 95% confidence interval [CI], 0.52 to 0.53). Perfect agreement was noted in the youngest age group (kappa, 1.0; 95% CI, 1.0-1.0) but agreement was poor for the oldest age group (kappa, 0.20; 95% CI, 0.19 to 0.20)., Conclusions: An algorithm based on self-reported, objective characteristics related to diabetes diagnosis and treatment patterns may have the potential to overcome limitations of simple self-report diabetes type for the classification of diabetes type in older adults., (Copyright © 2013 Canadian Diabetes Association. All rights reserved.)

Objectives: The aim of this study was to develop a decision support tool to assess the potential benefits and costs of new healthcare interventions., Methods: The Canadian Partnership Against Cancer (CPAC) commissioned the development of a Cancer Risk Management Model (CRMM)--a computer microsimulation model that simulates individual lives one at a time, from birth to death, taking account of Canadian demographic and labor force characteristics, risk factor exposures, and health histories. Information from all the simulated lives is combined to produce aggregate measures of health outcomes for the population or for particular subpopulations., Results: The CRMM can project the population health and economic impacts of cancer control programs in Canada and the impacts of major risk factors, cancer prevention, and screening programs and new cancer treatments on population health and costs to the healthcare system. It estimates both the direct costs of medical care, as well as lost earnings and impacts on tax revenues. The lung and colorectal modules are available through the CPAC Web site (www.cancerview.ca/cancerrriskmanagement) to registered users where structured scenarios can be explored for their projected impacts. Advanced users will be able to specify new scenarios or change existing modules by varying input parameters or by accessing open source code. Model development is now being extended to cervical and breast cancers.

Background: New immigrants to Canada initially report better health than does the Canadian-born population. With time, this "healthy immigrant effect" appears to diminish. Limited ability to speak English or French has been identified as a possible factor in poor health. This analysis explored the relationship between self-reported official language proficiency and transitions to poor self-reported health., Data and Methods: Statistics Canada's Longitudinal Survey of Immigrants to Canada tracked a sample of the 2001 immigrant cohort for four years (6, 24 and 48 months after arrival). Data from each of the three survey waves were available for 7,716 respondents. Bivariate and multivariate analysis were used to examine associations between official language proficiency and self-reported health, by sex, controlling for selected pre-migration and post-migration factors. The prevalence of poor health among immigrants was compared with rates among the Canadian-born population, based on data from the Canadian Community Health Survey., Results: Among a representative sample of recent immigrants, the prevalence of poor self-reported health had risen substantially, especially among women, after four years in Canada. Prolonged limited official language proficiency was strongly associated with a transition to poor health among male and female immigrants who had earlier reported good health. Other factors significantly associated with an increase in the prevalence of poor self-reported health differed by sex. Refugee status, self-reported discrimination, and living in Vancouver were significant for men. Age, health care access problems, and limited friendliness of neighbours were significant for women.

According to the 2006 Census, almost the Canadian population were foreign-born, a percentage that is projected to reach at least 25% by 2031. Studies based on age-standardized mortality rates (ASMR) have found a healthy immigrant effect, with lower overall rates among immigrants. A duration effect has also been observed-immigrants' mortality advantage lessened as their time in Canada increased. ASMRs based on the 1991 to 2001 census mortality follow-up study indicate a healthy immigrant effect and a duration effect at the national level for all-cause mortality for both sexes. However, at the national level, the mortality rate among women from the United States and from Sub-Saharan Africa was similar to that of Canadian-born women. For the three largest Census Metropolitan Areas (Toronto, Montreal and Vancouver), a healthy immigrant effect was not observed among women or among most men from the United States or Sub-Saharan Africa.

Objectives: The purpose of this study was to determine whether there are differences in self-rated health by immigration and generational status, and the role of health literacy in this relationship., Methods: Data were from the Canadian component of the 2003 International Adult Literacy and Skills Survey (IALSS) undertaken by Statistics Canada. The sample comprised a total of 22,818 persons, of whom 3,861 were immigrants and 18,957 non-immigrants. The study employed logistic regression to examine the relationship between health literacy and self-rated health. The analysis separately compared: immigrants and non-immigrants; immigrant groups defined by region of origin and recency of arrival in Canada; and the local-born defined by generation., Results: Logistic regression results indicated that immigrants compared to non-immigrants, and recent immigrants not from Europe or USA compared to established immigrants from Europe or USA, were more likely to report good self-rated health. On the other hand, compared to the third-plus generation, the second generation were less likely to report good self-rated health. Health literacy was positively associated with good self-rated health. However, its effect was largely accounted for by discordance between mother tongue and language of survey administration among immigrants, and by literacy practices at home, education, place of residence, and income among non-immigrants., Conclusion: Health literacy is important in the health of both immigrants and non-immigrants, but with different underlying mechanisms. For non-immigrants, engaging in literacy practices at home would benefit both health literacy and overall health, whereas for immigrants, it would be improving proficiency in either English or French.

Background: Using a health outcome research framework, the hospitalization risk for a type 2 diabetes (T2DM) cohort is evaluated. Diabetes is "ambulatory care sensitive"--a condition largely manageable with appropriate care in the community. Thus, hospitalization may represent a negative care outcome., Data and Methods: Analyses were conducted by linking data from the Canadian Community Health Survey (CCHS) cycle 1.1 to the Canadian Hospital Morbidity Database for respondents identified as having T2DM. Logistic regression was used to examine the association between the likelihood of all-cause hospitalization within two years of the survey date and patients' characteristics, care path, and health system characteristics., Results: When the effects of demographic, socio-economic and health status characteristics were taken into account, physical inactivity and former or current smoking were significantly associated with an increased likelihood of hospitalization for those with type 2 diabetes. Specialist visits were positively related to hospitalization (OR = 1.4), whereas the relationship with general practitioner visits was negative (OR = 0.7). Regional hospital use patterns were significantly associated with hospitalization (OR = 2.6)., Interpretation: Regional patterns of hospital use are important for hospitalization: T2DM residents of health regions with generally higher hospitalization rates were more likely to be hospitalized than were those living elsewhere. In terms of care path, GP consultations were associated with a lower risk of hospitalization. Specialist consultations, likely a marker of disease severity, had the reverse effect.

Background: Most immigrants to Canada now come from Asia, the Middle East, the Caribbean and Africa, where cultures and languages often differ significantly from the Canadian context. Subgroups of immigrants experience disparities in health. Inability to communicate in an official language in Canada may be a marker of risk for poor health due to both pre- and post-migration factors. We aimed to study the relationship between language proficiency and self-reported health., Methods: We conducted a cross-sectional analysis of the first two surveys of the Longitudinal Survey of Immigrants to Canada (2001, 2003), a population-based cohort study of new immigrants to Canada. Specifically, we used logistic regression analyses to examine the relationship between self-reported health and language proficiency by sex, controlling for a range of health determinants at 6 months (wave 1) and 2 years (wave 2) after arrival., Results: After controlling for covariates (age, sex, education, region of birth, immigrant class, job satisfaction, access to health care), analysis of the wave 1 survey showed that poor proficiency in English or French is significantly related to the self-reported poor health (OR=2.0, p<0.01). And this relationship was consistent in the wave 2 survey (OR=1.9, p<0.01). We also found that this statistically significant association between poor language proficiency and self-reported health holds only for women (wave 1 survey OR=2.6, p <0.01, wave 2 survey OR=2.2, p<0.01), not for men., Conclusion: The association between poor language proficiency and poor self-reported health, and particularly its significantly greater impact on women, has implications for language training, health care and social services, and health information.

Colorectal cancer is the second leading cause of cancer-related mortality among Canadians. We derived the direct health care costs associated with the lifetime management of an estimated 16,856 patients with a diagnosis of colon and rectal cancer in Canada in 2000. Information on diagnostic approaches, treatment algorithms, follow-up and care at disease progression was obtained from various databases and was integrated into Statistics Canada's Population Health Model (POHEM) to estimate lifetime costs. The average lifetime cost (in Canadian dollars) of managing patients with colorectal cancer ranged from $20,319 per case for TNM stage I colon cancer to $39,182 per case for stage III rectal cancer. The total lifetime treatment cost for the cohort of patients in 2000 was estimated to be over $333 million for colon and $187 million for rectal cancer. Hospitalization represented 65% and 61% of the lifetime costs of colon and rectal cancer respectively. Disease costing models can be important policy- relevant tools to assist in resource allocation. Our results highlight the importance of performing preoperative tests and staging in an ambulatory care setting, where possible, to achieve optimal cost efficiencies. Similarly, terminal care might be delivered more efficiently in the home environment or in palliative care units.