The deterioration of health status among immigrants to Canada

Abstract

A growing body of literature suggests that immigrants to Canada experience deterioration in their health status after settling in the country. While self-selection processes and Canadian immigration policy ensure that, at the time of arrival, immigrants are healthier than the Canadian-born population, this health advantage does not persist over time. This study uses new data from the Longitudinal Survey of Immigrants to Canada (N=7720) to examine how health transitions vary among immigrants. Logistic regression analyses indicate that visible minorities and immigrants who experienced discrimination or unfair treatment are most likely to experience a decline in self-reported health status. The results also confirm a clear inverse socioeconomic gradient with respect to increasing levels of feelings of sadness, depression and loneliness. These findings reflect important dimensions driving population health patterns in Canada, a country with a highly lauded health care system based on the principles of universality and comprehensiveness. Our findings suggest that discrimination and inequality partly drive the health transitions of immigrants. These factors, which largely operate outside of the formal health care system, need to be understood and addressed if health inequities are to be reduced.     

加拿大亚洲移民健康状况及影响因素研究

目的 评估加拿大亚洲移民的健康状况及相关影响因素.方法 采用横断面研究,利用加拿大统计局提供的2003年加拿大人群健康状况调查数据进行分析.采用描述性分析比较不同人群中健康影响因素分布差异.通过对患病率进行年龄标化,比较亚洲移民、非移民及其他移民的慢性病患病情况差异.利用多因素logistic回归分析控制可能影响因素,比较不同人群中选定的6种慢性病指标的0R值及95%CI.结果 经年龄标化后,亚洲移民患有1～5种慢性病患病率与非移民无明显差异,患有5种以上慢性病的患病率为3.56%,明显低于非移民慢性病患病率5.31%.亚洲移民患有至少一种慢性病的风险(0R=0.49,95%CI:0.46-0.51)明显低于非移民患病风险(0R=1.00).新移民患病风险(0R=0.34,95%CI:0.31～0.37)低于老移民的患病风险(0R=0.62,95%CI:0.58～0.66).调整社会经济特征和生活方式等冈素后,亚洲移民4种常见病的患病风险仅有微小改变,除心脏病的患病风险变化明显.结论 亚洲移民总体慢性病的患病率及患病风险低于非移民,但这种健康优势随着在加拿大的居住年限的推移逐渐消失.社会经济特征和生活方式的不同不能完全解释亚洲移民和非移民的健康状况差异.     

Identifying health insurance predictors and the main reported reasons for being uninsured among US immigrants by legal authorization status

This study identifies differences in health insurance predictors and investigates the main reported reasons for lacking health insurance coverage between short‐stayed (≤10 years) and long‐stayed (>10 years) US immigrant adults to parse the possible consequences of the Affordable Care Act among immigrants by length of stay and documentation status. Foreign‐born adults (18‐64 years of age) from the 2009 California Health Interview Survey are the study population. Health insurance coverage predictors and the main reasons for being uninsured are compared across cohorts and by documentation status. A logistic‐regression two‐part multivariate model is used to adjust for confounding factors. The analyses determine that legal status is a strong health insurance predictor, particularly among long‐stayed undocumented immigrants. Immigration status is the main reported reason for lacking health insurance. Although long‐stayed documented immigrants are likely to benefit from the Affordable Care Act implementation, undocumented immigrants and short‐stayed documented immigrants may encounter difficulties getting health insurance coverage. Copyright © 2013 John Wiley & Sons, Ltd.     

城市新移民自评健康状况及其影响因素分析

目的 了解城市新移民自评健康状况及其影响因素,为提高城市新移民的健康状况提供依据。方法 采用χ²检验比较不同自评健康状况城市新移民之间人口学特征、生活方式和健康状况之间的差异,采用有序Logistic回归得出城市新移民自评健康的影响因素。结果 城市新移民自评健康好、一般、差的人数分别为3 247例（71.8%）、1 092例（24.2%）和181例（4.0%）。多因素分析显示,在城市新移民中18~岁、30~岁和60~岁年龄段人群和70岁及以上年龄段人群相比自评健康更好;初中学历者和高中及以上学历者相比,自评健康状况更好;无工作或者退休者相比有工作者,自评健康状况更差;无两周患病、无慢性病、无一年住院和无抑郁者自评健康状况更好;不喝酒和偶尔喝酒的人群相比于经常喝酒的人群,自评健康状况更差;睡眠时间<6 h者相比与睡眠时间 ≥ 9 h者,自评健康状况更差。结论 应该加强老年人、无业或退休人群、高文化水平等重点人群的健康管理,从而促进相应人群的健康水平。     

Culture,but more than culture: an exploratory study of the HIV vulnerability of Indian immigrants in Canada

Explanations of immigrant health that ascribe to culture a fundamental causal role neglect the broader structural and contextual factors with which culture intersects. Based on a qualitative study of Indian immigrants’ vulnerability to HIV in Canada, this paper presents a contextualised understanding of these individuals’ understanding of, perceptions about, and responses to the HIV risk in their post-immigration lives. The study reveals that although culture – both traditional values and the norms of the diaspora community – appears to have constrained Indian immigrants’ capacities to respond to the risk, this effect can be properly understood only by situating such constraint in the context of the settlement process that has shaped participants’ living conditions, including their relationship with the diasporic community in Canada. We argue that HIV vulnerability should be conceptualised as a health inequality associated with broader systems of power relations (eg socio-economic marginalisation, gender inequality, discrimination, and racism). This more holistic conceptualisation of the intersection of culture, integration, and HIV vulnerability will facilitate exploration of HIV prevention strategies, through which interconnected inequalities of gender, race, and access to knowledge and resources can be challenged.     

Immigrant health,place effect and regional disparities in Canada

The paper addresses a critically important area in Canadian immigration and health from both a social and a spatial perspective. It employs multilevel and contextual approaches to examine the social determinants of immigrant health as well as the place effects on self-reported health at a regional and neighborhood scale. The data come from the raw microdata file of the 2005-10 Canadian Community Health Survey (a random national health survey) and the publicly available Canadian Marginalization index based on the 2006 Census. Three populations are compared: Canadian-born, overall foreign-born, and Chinese immigrants. The results suggest various degrees of association between self-reported health, individual and lifestyle behavioral characteristics, and neighborhood material deprivation and ethnic concentration in census tracts. These factors contribute differently to the reported health of Chinese immigrants, Canada's largest recent immigrant group. A healthy immigrant effect is partially evident in the overall foreign-born population, but appears to be relatively weak in Chinese immigrants. For all groups, neighborhood deprivation moderately increases the likelihood of reporting poor health. Ethnic concentration negatively affects self-rated health, with the exception of the slight protective effect of Chinese-specific ethnic density in census tracts. The multilevel models reveal significant area inequalities across Census Metropolitan Areas/Census Agglomerations in risk of reporting unhealthy status, with greater magnitude in the foreign-born population. The vast regional variations in health among Chinese immigrants should be interpreted carefully due to the group's heavy concentration in large cities. The study contributes to the literature on ethnicity and health by systematically incorporating neighborhood contextual effects in modeling the social determinants of immigrant health status. It fills a gap in the literature on neighborhoods and health by focusing on ethnically disparate groups rather than on the general population. By revealing regional disparities in health, the paper adds a spatial perspective to the work on immigrant health.     

Socioeconomic status and health status: A study of males in the Canada health survey

The relationships between education/occupation/income and health status have been well documented in the international epidemiological and sociological literature for many years, however, specific studies on the subject are scarce in Canada. Even when relationships have been demonstrated, the reasons for these relationships are much debated. This study presents an analysis of the relationship between socioeconomic status (SES) and health status. The study is based on analysis of data from a sample of nearly 2000 male principal income earners from the 1978 Canada Health Survey. Firstly, is there a relationship between an individual's SES and health status in Canada? Secondly, what aspects of SES--education, occupational status, and/or income--are most important? Thirdly, what are the possible explanations of the observed relationship? That is, is it possible to disaggregate the relationship and thereby infer possible causal mechanisms? The findings indicated a direct positive relationship between SES and health status, i.e. the higher an individual's SES, the better that person's health. The major exception to this was the SES/fitness relationship. In this instance, the higher the SES, the lower the level of fitness. Though age was an important control variable as SES, fitness and illness are age related, the findings relating SES to the health measures remained even when age was controlled for. Of the three SES measures, income was consistently the best correlate of health status. Occupational status showed the most inconsistent relationships with health status. The findings supported both the social causation and social selection hypotheses. That is, social position can have an effect on health status (social causation), while health status can affect one's social position (social selection).     

中国大陆城市新移民健康公平的社会决定因素研究

目的 明确中国大陆城市新移民健康公平现状及其社会决定因素,为进一步改善当前现状提供理论依据。方法 以健康社会决定因素的分层模型为框架展开文献回顾并进行整理分析,梳理影响城市新移民健康公平的相关因素。结果 目前我国大陆城市新移民健康公平状况尚存在一些特殊问题,受到包括生存环境、社会经济地位、社会保障及其他相关政策因素的影响。结论 在城市新移民融入城市的进程中,政府应积极改善其生存环境,保障其合理收入以缩小贫富差距,同时落实各项保障政策,合理配置卫生资源,逐步实现健康公平,使其更好融入城市。     

Effects of length of stay and language proficiency on health care experiences among immigrants in Canada and the United States

This study sought to examine the influence of length of stay and language proficiency on immigrants' access to and utilization of care in Canada and the United States (U.S,). Data came from the 2007-2008 Canadian Community Health Survey and the National Health Interview Survey. Analyses were limited to foreign-born, non-elderly adults in each country (n = 12,870 in Canada and n = 7440 in the U.S.). Health care indicators included having a usual source of care; annual consultation with a health professional, dentist, and eye doctor; flu shot in the past year; and Pap test in the past 3 years. Logistic regression models were employed to estimate the relative odds of access or use of care, adjusting for need, demographic factors, socioeconomic status, and insurance coverage. In general, rates of health care access and utilization were higher in Canada than the U.S. among all immigrant groups. In both countries, adjusted analyses indicated that immigrants with shorter length of stay (less than 10 years) and limited language proficiency generally had lower rates of access/use compared with those with longer length of stay (10 years or more) and proficiency in each country's official language(s), respectively. There was one exception to this pattern in the U.S.: immigrants with limited English had higher odds of having a recent Pap test relative to English-proficient immigrants. The persistence of disparities in health care experiences based on length of stay and language proficiency in Canada suggests that universal health insurance coverage may not be sufficient for ensuring access to and utilization of primary and preventive care for this population.     

The association between health risk status and health care costs among the membership of an Australian health plan

Health promotion in Australia has developed into an accepted strategy for solving public health problems and promoting the health of its citizens. However, there are few evidence-based research studies in Australia that measure health risk status or track health changes over time with defined cost outcome measures. Those individuals with more high-risk lifestyle behaviors have been associated with higher costs compared with those with low-risk behaviors. Although intuitively it was believed that the health promotion programs had a positive impact on health behaviors and consequently on health care costs, the relationship between health risk status and health care costs had yet to be tested in the Australian population. Consequently, a verification study was initiated by the Australian Health Management Group (AHMG) to confirm that those relationships between health risks and medical costs that had been published would also hold in the Australian population using Australian private health care costs as the outcome measure. Eight health risks were defined using a Health Risk Appraisal (HRA) to determine the health risk status of participants. Consistent with previous studies, low-risk participants were associated with the lowest health care costs (377 Australian dollars) compared with medium- (484 Australian dollars) or high-risk (661 Australian dollars) participants and non-participants (438 Australian dollars). If the health care costs of those at low risk were considered as the baseline costs, excess health care costs associated with excess health risks in this population were calculated at 13.5% of total expenditures. Health risk reduction and low-risk maintenance can provide important strategies for improving/maintaining the health and well-being of the membership and for potential savings in health care costs.     

The association between subjective social status and mental health among Asian immigrants: investigating the influence of age at immigration

This paper examines how age at immigration influences the association between adult subjective social status and mental health outcomes. The age when people immigrate shapes the capacity and efficiency at which they learn and use a new language, the opportunities to meet and socialize with a wide range of people, and respond to healthy or stressful environments. We hypothesize that adult subjective social status will be more predictive of health outcomes among immigrants who arrive in the US in mid- to late-adulthood compared with immigrants who arrive earlier. To investigate this hypothesis, data on immigrants are drawn from the US first national survey of mental health among Asian Americans (N=1451). Logistic regression is used to estimate the relationships between adult subjective social status and mood dysfunction, a composite of anxiety and affective disorder symptoms. As predicted, age at immigration moderated the relationship between adult subjective social status and mood dysfunction. Adult subjective social status was related to health among immigrants arriving when they were 25 years and older, but there was no association between subjective social status and mental health among immigrants arriving before the age of 25 years.     

Epistemological barriers to addressing the social determinants of health among public health professionals in Ontario,Canada: a qualitative inquiry

To date, Ontario public health units (PHUs) have generally neglected the social determinants of health (SDH) concept in favor of risk aversion and behaviorally oriented health promotion approaches. Addressing SDH and responding to the presence of health inequities is required under the Ontario Public Health Standards and is a component of provincial public health documents and reports. Nevertheless, units vary in their understanding and application of the SDH concept in their activities. The authors conducted 18 interviews with Medical Officers of Health and lead staff persons from nine Ontario PHUs, in order to better understand how these differences in addressing the SDH among health units come about. The findings suggest that differences in practice largely result from epistemological variations: conceptions of the SDH; the perceived role of public health in addressing them; and understandings concerning the validity of differing forms of evidence and expected outcomes. Drawing from Bachelard’s concept of epistemological barriers and Raphael’s seven discourses on the SDH, we examine the ways in which the participating units discuss and apply the SDH concepts. We argue that a substantial barrier to further action on the SDH is the internalization of discourses and traditions that treat health as individualized and depoliticized.     

三峡库区移民心理健康状况及影响因素分析

目的研究三峡库区外迁移民心理健康状况与影响因素。方法采用整群分层随机抽样,调查对象接受居民基本情况表、与团体用心理社会应激调查表（PSSG）、症状自评量表（SCL-90）、社会支持评定量表（SSRS）的测查。结果（1）移民组的SCL-90除敌对、恐怖和偏执3个因子外均高于当地居民组（P〈0.001）;（2）移民组的PSSG生活事件、消极情绪体验、消极应对方式和应激总分高于地当地居民组（P〈0.001）;而积极情绪体验、积极应对方式得分低于当地居民组（P〈0.001）;（3）移民组的SSRS支持得分均低于当地居民组（P〈0.001）;（4）多因素的Logistic回归分析显示：影响移民心理健康水平的因素有年龄、健康状况、与地政府的关系和社会支持。结论移民组与当地居民组心理健康状态有明显差异,应针对影响因素采取措施,进一步做好移民工作。     

South Asian-White health inequalities in Canada: intersections with gender and immigrant status

Objectives. We apply intersectionality theory to health inequalities in Canada by investigating whether South Asian-White health inequalities are conditioned by gender and immigrant status in a synergistic way.

Design. Our dataset comprised 10 cycles (2001–2013) of the Canadian Community Health Survey. Using binary logistic regression modeling, we examined South Asian-White inequalities in self-rated health, diabetes, hypertension and asthma before and after controlling for potentially explanatory factors. Models were calculated separately in subsamples of native-born women, native-born men, immigrant women and immigrant men.

Results. South Asian immigrants had higher odds of fair/poor self-rated health, diabetes and hypertension than White immigrants. Native-born South Asian men had higher odds of fair/poor self-rated health than native-born White men and native-born South Asian women had lower odds of hypertension than native-born White women. Education, household income, smoking, physical activity and body mass index did little to explain these associations. The three-way interaction between racial identity, gender and immigrant status approached statistical significance for hypertension but not for self-rated health and asthma.

Conclusion. Our findings provide modest support for the intersectionally inspired principle that combinations of identities derived from race, gender and nationality constitute sui generis categories in the manifestation of health outcomes.     

Examining spatial variations in the prevalence of mental health problems among 5-year-old children in Canada

The purpose of this study is to examine spatial variations in the prevalence rates of the three most common behaviour problems among 5-year-old children in Canada, to establish the data's suitability for potential spatial analyses of factors contributing to the prevalence of such problems. Data on kindergarten children's outcomes are routinely collected for populations of children in Canada using the Early Development Instrument (EDI), a population-level, teacher completed questionnaire. These data have been previously used to estimate prevalence rates of aggression, anxiety, and hyperactivity. The current study geographically analyzed these estimates to examine their consistency in relation to gender differences at larger provincial geographies and smaller Census Subdivision (CSD) geographies. Multilevel analyses were completed to examine the variation in prevalence at both levels of geography. Data for over 150,000 5-year-olds in three Canadian provinces and 410 Census Subdivisions were available for analyses. Prevalence rates of behaviour problems estimated with the EDI showed consistent gender relationships at both levels of aggregation. Controlling for individuals' age and sex, there was significant variation at the CSD level in risk of behavioural problems, and for anxiety and aggression, this was not explained by the distribution of CSDs in different provinces. This suggests local variation in these aspects of children's behaviour, within provinces. These findings open up the opportunity to further explore the utility and variability of EDI-based spatial variation in children's mental health.     

Social transfers and the health status of mothers in Norway and Canada

The unconditional health status of lone mothers is worse than that of married mothers in Canada but not in Norway. Even controlling for demographic characteristics and health behaviours in Canada, the health status of lone mothers is worse. Only after we control for income does the differential in health status between married and lone mothers in Canada disappear. An important difference between the countries is that lone mothers are much less likely to be poor in Norway because they receive more generous social transfers. A simulation which involves 'giving Canadian mothers Norwegian transfers,' illustrates the possibility of significant gains in socioeconomic status and health of poor mothers in Canada.     

新疆沙湾县哈萨克族居民营养健康状况调查

目的 了解新疆哈萨克族居民膳食营养与健康状况,为制定营养改善策略提供科学依据。方法 采用3 d 24 h膳食回顾法和称重法,对新疆沙湾地区牛圈子牧场1 628名≥18岁常住哈萨克族居民进行膳食调查和医学体检。结果 哈萨克族居民膳食构成以粮谷类为主,食盐摄入过多,蔬菜水果摄入不足,豆类、蛋类和鱼虾类等食物基本不吃;能量的日均摄入量为11 762.5 kJ,蛋白质为103.8 g,占供能的14.2%;脂肪为50.3 g,占供能的16.2%;碳水化合物为485.0 g,占供能的69%;膳食纤维和微量营养素低于参考摄入量;动物性食物提供的蛋白质占33.5%,提供的脂肪占54.2%;高血压患病率为39.7%,超重为26.2%,肥胖为27.7%。结论 膳食结构不合理、能量过剩、微量元素不足、高血压、超重和肥胖已成为影响哈萨克族居民健康的重要因素,应加强对居民的营养干预和健康教育,预防相关疾病的发生。