Disparities in Mortality Patterns Among Canadian Immigrants and Refugees, 1980–1998: Results of a National Cohort Study

This study examines mortality patterns among Canadian immigrants, including both refugees and non-refugees, 1980–1998. Records of a stratified random sample of Canadian immigrants landing between 1980–1990 (N = 369,936) were probabilistically linked to mortality data (1980–1998). Mortality rates among immigrants were compared to those of the general Canadian population, stratifying by age, sex, immigration category, region of birth and time in Canada. Multivariate analysis examined mortality risks for various immigrant subgroups. Although immigrants presented lower all-cause mortality than the general Canadian population (SMR between 0.34 and 0.58), some cause-specific mortality rates were elevated among immigrants, including mortality from stroke, diabetes, infectious diseases (AIDS and hepatitis among certain subgroups), and certain cancers (liver and nasopharynx). Mortality rates differed by region of birth, and were higher among refugees than other immigrants. These results support the need to consider the heterogeneity of immigrant populations and vulnerable subgroups when developing targeted interventions.     

Ethnicity and Postmigration Health Trajectory in New Immigrants to Canada

Objectives. In this prospective cohort study, we examined the trajectory of general health during the first 4 years after new immigrants’ arrival in Canada. We focused on the change in self-rated health trajectories and their gender and ethnic disparities.Methods. Data were derived from the Longitudinal Survey of Immigrants to Canada and were collected between April 2001 and November 2005 by Statistics Canada. We used weighted samples of 3309 men and 3351 women aged between 20 and 59 years.Results. At arrival, only 3.5% of new immigrants rated their general health as poor. Significant and steady increases in poor health were revealed during the following 4 years, especially among ethnic minorities and women. Specifically, we found a higher risk of poor health among West Asian and Chinese men and among South Asian and Chinese women than among their European counterparts.Conclusions. Newly arrived immigrants are extremely healthy, but the health advantage dissipates rapidly during the initial years of settlement in Canada. Women and minority ethnic groups may be more vulnerable to social changes and postmigration settlement.Over the past 4 decades, immigrant health research has exposed 2 major contradictions to the classic models of assimilation, which have traditionally focused on the stressful process of migration and postmigration settlement and acculturation.1–3 The assimilation models make 2 major immigrant health claims: (1) arriving immigrants are at risk for physical and mental illness and are thus likely to burden the receiving nation with extra health care costs, and (2) immigrant health improves over time and across generations, following the increasing degree of acculturation. Although these claims may initially appear to be intuitive and have been supported by early immigrant research,3 research over the past few decades has refuted the major health premises of assimilation models. One major finding is the healthy immigrant effect, wherein newly arrived immigrants, at least in Australia and North America, show health advantages over native-born populations on most core indicators of health, including mortality, morbidity, disability, and mental disorders.4–10 The current literature on immigrant health has shown that the immigrant health advantage dissipates over years and across generations, although core settlement indicators such as language, cultural traits, and education increase among both the immigrant groups and their children.4–6,11–13 These results not only contradict the health trajectory proposed by assimilation models but also raise serious concerns regarding equity in national health care policies.A plethora of scientific literature on immigrant health has suggested significant variations in postmigration health across immigrant groups from a variety of backgrounds. Furthermore, reported declines in health over years of residence in Canada and across generations may be found only among racial/ethnic minority immigrants.14,15 Some studies have found that immigrants appear to report significantly higher rates of poor self-rated health than native-born, nonimmigrant populations,9,14,16 which is contrary to research findings on chronic health conditions, life expectancy, and disability.15,17,18 With regard to self-rated health, research findings have also shown complex variations in immigrant health across ethnicity or place of origin. Some studies have observed that in comparison with Canadian-born individuals, non-European immigrants were twice as likely and European immigrants were less likely to report poor health.8,19,20 Kobayashi et al.21 found that Black and French immigrants had better self-rated health than native-born Canadians, and South Asian and Chinese immigrants had poorer health. Other researchers found no health differences between immigrants and the Canadian-born population22–24 and no ethnic health variation.25,26 It is possible that these studies contradict the assumption of healthy immigrant status because they included immigrants who had been settled longer and had experienced a decline in health over the years. Although understanding the health trajectory is a foundation for effectively addressing how ethnic health disparities are shaped, current research has been limited when attempting to fully account for the complexity of the immigrant health trajectory, especially self-rated health, over time.18,19,27 In Canada, the observations of the healthy immigrant effect and its decline phenomenon have been widely accepted in self-rated health18,19,27,28; however, research on the self-rated health trajectory of immigrants has been far more limited, especially in findings from longitudinal studies and in the area of gender and ethnic health disparities.A few existing longitudinal studies from Germany and Australia have confirmed the healthy immigrant effect and its decline toward native-born levels within 5 years after arrival.29,30 However, 1 US longitudinal study did not find this effect among relatively recent elderly immigrants; in addition, the health decline was not significantly different from that of nonimmigrants.31 Although a Canadian longitudinal immigrant study also did not demonstrate any meaningful differences in decline in health for immigrants according to country of origin,32 most studies have suggested that recent non-European immigrants (visible minorities and refugees) were more likely than Canadian-born individuals to experience declines in self-rated health over time.6,8,13,19,26 Immigrant literature has proposed that although remarkable declines in immigrants’ health advantage occurred over a relatively short period of time after arriving in Canada,5,13,19 the estimated duration of the healthy immigrant effect’s diminishment to the point of convergence with the health level of the Canadian-born population was more than 10 years after arrival.9,18,33 However, whether the healthy immigrant effect could apply uniformly to both genders and all ethnic groups and how the onset of declining health begins and engenders ethnic disparities after immigration is still unclear.Research has identified gender as an important anchor for the diminishing healthy immigrant effect and ethnic health disparities.14,15,34–36 Generally, female immigrants are considered to be more vulnerable to social changes than their male counterparts.37 Corresponding to this proposition, female immigrants have been found to experience a greater risk of deteriorating physical and mental health than male immigrants, especially among South Asian and African immigrants9,19,38,39; however, a lack of evidence concerning changes in self-rated health is a major limitation to a full understanding of the gender effect on ethnic disparities.33 Moreover, most empirical analyses of associations among immigrant status, acculturation, and health were based on cross-sectional data in which changes in health over years of residence or acculturation in the host society were inappropriately evaluated by comparing migration cohorts (or samples) who arrived over different periods of years or decades. Thus, to accurately assess the healthy immigrant effect, it is important to examine longitudinal cohort studies of how health changes from the point of arrival and across years of residence in the host country.     

Recent research on immigrant health from statistics Canada's population surveys

This paper reviews recent research using Statistics Canada data to compare immigrant health with that of the Canadian-born. A number of Statistics Canada studies have been used for such comparisons, including the National Population Health Survey and the Canadian Community Health Survey. Across the range of indicators studied, compared to the Canadian-born, immigrants are generally in as good or better health, have similar or better health behaviours, and similar or less frequent health service use (the "healthy immigrant effect"). These indications appear to be strongest among recent and non-European immigrants. These studies have established baseline patterns and identified that important distinctions exist among immigrant subgroups. Future research on more detailed subgroups that uses longitudinal data and cross-culturally validated instruments is needed.     

Migrant Selectivity or Cultural Buffering? Investigating the Black Immigrant Health Advantage in Low Birth Weight

Prior studies on population health have reported an “immigrant health advantage” in which immigrants tend to show better health outcomes compared to their native-born racial/ethnic counterparts. Migrant selectivity and cultural buffering have been proposed as explanations for this relative advantage, predominantly in studies that focus on Latino immigrants’ health in the US. This study adds to the relatively scant literature on black immigrant health advantage by comparing the two hypotheses (migrant selectivity and cultural buffering) as related to black immigrant health. The effect of nativity on infant low birth weight is tested using data from the US Fragile Families and Child Wellbeing Study. Results indicate that immigrant black mothers do have relatively better health outcomes that may result from cultural buffering, which reduces their risky health behaviors.     

Are immigrants healthier than native-born Canadians? A systematic review of the healthy immigrant effect in Canada

Objectives: Immigrants are typically healthier than the native-born population in the receiving country and also tend to be healthier than non-migrants in the countries of origin. This foreign-born health advantage has been referred to as the healthy immigrant effect (HIE). We examined evidence for the HIE in Canada.

Design: We employed a systematic search of the literature on immigration and health and identified 78 eligible studies. We used a narrative method to synthesize the HIE across different stages of the life-course and different health outcomes within each stage. We also examined the empirical evidence for positive selection and duration effects – two common explanations of migrants’ health advantage and deterioration, respectively.

Results: We find that the HIE appears to be strongest during adulthood but less so during childhood/adolescence and late life. A foreign-born health advantage is also more robust for mortality but less so for morbidity. The HIE is also stronger for more recent immigrants but further research is needed to determine the critical threshold for when migrants’ advantage disappears. Positive selection as an explanation for the HIE remains underdeveloped.

Conclusions: There is an absence of a uniform foreign-born health advantage across different life-course stages and health outcomes in Canada. Nonetheless, it remains the case that the HIE characterizes the majority of contemporary migrants since Canada’s foreign-born population consists mostly of core working age adults.     

Cancer Incidence Among Canadian Immigrants, 1980–1998: Results from a National Cohort Study

Canadian immigrants have lower overall cancer risk than the Canadian-born population. Less is known about risks for immigrant subgroups and site-specific cancers. Linked administrative data sets were used to compare cancer incidence between subgroups of immigrants to Canada and the general Canadian population. The study involved 128,962 refugees and 241,010 non-refugees. Standardized incidence ratios (SIRs) were calculated for all-site and site-specific cancers by immigration categories and regions of birth. Relative to the general Canadian population, incidence of all-site cancer was lower among immigrants overall, by sex and refugee status (non-refugee SIRs 0.25: men, 0.24: women; refugee SIRs 0.31: both). Significantly higher SIRs resulted for liver, nasopharyngeal and cervical cancers, including liver cancer among South-East Asian and North-East Asian immigrants, and nasopharyngeal cancer among North-East Asian non-refugees. Hypothesized explanations for variation in cancer incidence include earlier viral infection in the country of origin.     

The Oral Health Status of Recent Immigrants and Refugees in Nova Scotia, Canada

There are no published reports on the oral health status of adult immigrants and refugees in Canada. An oral health interview and clinical oral examination were conducted on 45 recent immigrants and 41 recent Bhutanese refugees, aged 18–67, in Nova Scotia, Canada. Over half (53 %) of the immigrants and 85 % of the refugees had untreated decay. Most (89 % of immigrants; 98 % of refugees) had moderate to severe gingivitis and the majority (73 % of immigrants; 85 % of refugees) had moderate to severe periodontitis. Despite these, 64 % of immigrants and 49 % of refugees rated their oral health as good, very good or excellent, and most believed they did not need fillings or periodontal treatment. Oral disease among the study sample was higher than the Canadian average and there was a striking discrepancy between self-reported and clinically determined need for dental care.     

Providing Social Support for Immigrants and Refugees in Canada: Challenges and Directions

In this article we report research findings from a qualitative study of social support for immigrants and refugees in Canada. We focus on challenges from the perspectives of 137 service providers and policymakers in health and immigrant settlement who participated in in-depth interviews and focus groups in three Canadian cities. Results show that social support is perceived to play an important role in immigrant settlement and to have a positive impact on immigrant health, although immigrants face many systemic challenges. Systemic issues—limited resources, lack of integration of policies and programs and narrow service mandates—also limit service providers’ abilities to meet newcomer’s needs. This research suggests that changes in public discourse about immigrants’ contributions, improved governance and service coordination, and a holistic, long-term perspective are important to more effectively support immigrant settlement and to promote immigrant health and well being.     

International migration to Canada: The post-birth health of mothers and infants by immigration class

There are over 214 million international migrants worldwide, half of whom are women, and all of them assigned by the receiving country to an immigration class. Immigration classes are associated with certain health risks and regulatory restrictions related to eligibility for health care. Prior to this study, reports of international migrant post-birth health had not been compared between immigration classes, with the exception of our earlier, smaller study in which we found asylum-seekers to be at greatest risk for health concerns. In order to determine whether refugee or asylum-seeking women or their infants experience a greater number or a different distribution of professionally-identified health concerns after birth than immigrant or Canadian-born women, we recruited 1127 migrant (and in Canada <5 years) women–infant pairs, defined by immigration class (refugee, asylum-seeker, immigrant, or Canadian-born). Between February 2006 and May 2009, we followed them from childbirth (in one of eleven birthing centres in Montreal or Toronto) to four months and found that at one week postpartum, asylum-seeking and immigrant women had greater rates of professionally-identified health concerns than Canadian-born women; and at four months, all three migrant groups had greater rates of professionally-identified concerns. Further, international migrants were at greater risk of not having these concerns addressed by the Canadian health care system. The current study supports our earlier findings and highlights the need for case-finding and services for international migrant women, particularly for psychosocial difficulties. Policy and program mechanisms to address migrants' needs would best be developed within the various immigration classes.     

Migration Circumstances,Psychological Distress,and Self-Rated Physical Health for Latino Immigrants in the United States

Objectives. We determined the impact of premigration circumstances on postmigration psychological distress and self-rated physical health among Latino immigrants.Methods. We estimated ordinary least squares and logistic regression models for Latino immigrants in the 2002–2003 National Latino and Asian American Study (n = 1603).Results. Mean psychological distress scores (range = 10–50) were 14.8 for women and 12.7 for men; 35% of women and 27% of men reported fair or poor physical health. A third of the sample reported having to migrate; up to 46% reported unplanned migration. In multivariate analyses, immigration-related stress was significantly associated with psychological distress, but not with self-rated health, for both Latino men and women. Having to migrate was associated with increased psychological distress for Puerto Rican and Cuban women respondents and with poorer physical health for Puerto Rican migrant men. Unplanned migration was significantly associated with poorer physical health for all Latina women respondents.Conclusions. The context of both pre- and postmigration has an impact on immigrant health. Those involved in public health research, policy, and practice should consider variation in immigrant health by migration circumstances, including the context of exit and other immigration-related stressors.Theories of acculturation, defined as “the acquisition of the cultural elements of the dominant society,”1^(p369) dominate Latino immigrant health research.2–4 Acculturation studies highlight important aspects of how individuals make meaning of their life experiences, including health experiences, through language, cultural norms, and values.5 In addition, studies of Latino mental health have demonstrated the influence of cultural change within immigrant families; uneven levels of acculturation within families can lead to family cultural conflict, which may have adverse mental health impacts.6,7Nevertheless, the focus on cultural determinants of health (i.e., acculturation) often comes at the expense of other factors related to migration, including social, political, and economic adversity in both places of origin and the United States.8–12 A particularly understudied set of influences on Latino immigrant health relates to the circumstances of departure, including whether individuals had to migrate because of political conflict, dire economic conditions, or other pressures.13 Exposure to such conditions in one’s place of origin may have lingering affects on mental health.14,15 The degree to which migration is planned might also have a long-term impact on health; unplanned migration may lead to a more sudden rupture of the social networks that support both psychological and physical well-being.16–19 Acculturation-focused studies typically do not consider the influence of migration or country-of-origin context on immigrant health, given that the frame of reference for acculturation is US society.11Stressors related to the conditions of migration include a set of social and structural inequities that immigrants may experience upon arriving and settling in the United States. These include unfair treatment attributable to legal status, nativity status, and accent, as well as unequal access to social benefits, such as health care.20–24 These forms of discrimination are often subsumed in the immigrant health literature within the construct of “acculturative stress,”25 suggesting erroneously that they can be attributed to an individual’s level of acculturation. More accurately, however, these stressors relate to the diverse social, political, and economic climates in receiving communities and not necessarily to whether immigrants have “acculturated.”8 For example, immigrants who are proficient in English may continue to experience discrimination based on their legal status.26 We therefore prefer the more expansive term “immigration-related stress” instead of “acculturative stress,” which is conceptually limited to the challenges involved with cultural change, including language learning and retention.27 Immigration-related stressors may comprise discrimination, including legal status discrimination, and may also refer to the challenges of familial cross-border separation, which does not necessarily relate to level of acculturation.28 Immigration-related stress has been shown to be associated with adverse health outcomes for specific Latino subgroups,3,29 but it has received less attention in national studies.We tested the relationship of migration circumstances to both psychological distress and self-rated physical health for a national sample of Latino immigrants in the United States. We hypothesized that stressful conditions leading to migration, as well as adverse experiences of arrival and settlement, would be associated with higher levels of psychological distress and poorer overall physical health. We expected that the relationships between premigration circumstances and health outcomes would be moderated by Latino subgroup, given that migration experiences vary greatly among Latino groups, which include peoples from distinct social, cultural, political, and economic contexts.30,31 For example, Puerto Rican–born migrants are US citizens and therefore have different conditions of migration than those migrating without legal documents or who have to navigate the immigration system for legal entry.32 In addition, some Latin American immigrants have faced distinct migration circumstances because of the political context in both their countries of origin and the United States. For example, early waves of Cuban migrants received refugee status and resettlement assistance,18 whereas the majority of those fleeing civil wars in Central America were never granted refugee status, limiting their access to benefits.30,33,34 For some Latino subgroups, such as Cubans and many Central and South Americans, unplanned or involuntary migration might refer more to political reasons for migration, or a combination of political and economic motivations,18 whereas for other groups (e.g., Puerto Ricans or Mexicans), identifying migration as involuntary or unplanned might refer more to dire economic circumstances or family obligations that motivated migration.32 We therefore hypothesized that circumstances of migration would be more strongly associated with poor health outcomes for Cubans and many other Latinos, given that many of these groups were motivated to migrate, at least in part, by political circumstances such as civil war or political persecution.We also hypothesized that migration circumstances would be related to psychological distress and physical health above and beyond measures of individual- and family-level acculturation. This reflects our argument that structural contexts can cause stress for Latino immigrants in both places of origin and of settlement.Finally, we expected to find different patterns in the association between migration circumstances and health outcomes by gender. In part, we expected that women would report higher levels of psychological distress than men, although there may be fewer differences in physical health outcomes. Men and women experience different migration circumstances, with significant variation by ethno-national subgroup.32–35 For example, Mexican women have historically been more likely to join family members already settled in the United States, although they are increasingly initiating migration; many Mexican men established migration networks in the 20th century through labor projects directly targeting male workers.36,37 Puerto Rican men were similarly recruited in the early and mid-20th century to work on the US mainland. Women became increasingly incorporated into circular labor migration patterns over the second half of the 20th century, often fulfilling familial and economic obligations in both Puerto Rico and the mainland.32,38 Central American and Dominican women were historically more likely to initiate migration in their family networks, taking jobs in factories or as domestic workers and facilitating men’s migration later on.33,34 Political refugees, including Cubans and some South Americans, were more likely to migrate as families.38 Given these differences, the meaning of migration planning and decision-making might vary qualitatively for men and women. This suggests the need for an analysis stratified by gender, although we expected that reporting unplanned migration or having to migrate (vs wanting to migrate) would be associated with poorer health for both men and women.Researchers have also documented gendered experiences of settlement for immigrants, including lesser access to legal and occupation-related resources for women compared with men,38,39 and greater continued attachment of women to countries of origin,40,41 with women more likely to maintain family caregiving roles both in places of settlement and abroad. These additional disadvantages resulting from stressful migration circumstances may lead to poorer health outcomes for female migrants than for male migrants, and they provide additional rationale for stratified analyses by gender, although we expected that immigration-related stressors would be negatively associated with psychological and physical health for both men and women.     

Neighbourhood context and abuse among immigrant and non-immigrant women in Canada: findings from the Maternity Experiences Survey

Objectives

To examine the relationship between neighbourhood deprivation and concentration of immigrants, and abuse among immigrant women versus non-immigrant women.

Methods

Using data from the Canadian Maternity Experiences Survey (un-weighted sample N?=?5,679 and weighted sample N?=?68,719) linked to the neighbourhoods Census data, we performed contextual analysis to compare abuse prevalence among: immigrants ≤5?years, immigrants >5?years and Canadian-born. We identified two level effect modifiers: living in high (≤15?% of households at or below low-income cut-off- [LICO]) versus low-income (>15?% below LICO) neighbourhoods and living in high (≥25?%) versus low immigrant (<25?%) neighbourhoods. Individual socioeconomic position (SEP), family variables and neighbourhood SEP or percentage of immigrants were considered in different logistic regression models.

Results

Immigrant women were less likely to experience abuse even upon adjustment for individual SEP, family variables and neighbourhood characteristics. The protective effect of the neighborhood was stronger among immigrant women living in low-income and high immigrant neighborhoods, irrespective of length of stay in Canada.

Conclusion

Policies and interventions to reduce abuse among immigrant women need to consider neighbourhood’s SEP and concentration of immigrants.     

Early onset of type 2 diabetes among visible minority and immigrant populations in Canada

Objectives: Type 2 diabetes is a chronic condition that affects nearly over three million Canadians, including immigrants. The timing of the first onset of diabetes has been linked to several other severe diseases. Yet, there is a dearth of empirical studies that examine the timing of the first onset of diabetes among Canadians, in general, and among immigrants and ethnic minority populations within Canada, in particular.

Design: Applying event history techniques to the 2013 Canadian Community and Health Survey, we address this research void by examining factors that contribute to the first onset of diabetes among immigrant and visible minority populations in Canada (N?=?8905). Given the gendered patterns in the epidemiology of diseases and the differences in risk factors for men and women, gender-specific models were estimated.

Results: Results showed that South Asian, Black and Filipino women developed diabetes earlier, compared to women from the UK. Similarly, South Asian, Chinese, Filipino, Black, South East Asian and Arab men developed diabetes earlier than men from the UK. A significant and important finding of this analysis was that the risks of developing diabetes vanished completely for Black and Filipino women, after accounting for lifestyle factors. For South Asian women, however, there was significant attenuation in their risks after accounting for lifestyle factors. The findings were strikingly different for immigrant men. Specifically, their risks of developing diabetes increased after accounting for lifestyle factors.

Conclusions: These results suggest the development of gender-specific and lifestyle interventions, targeted at specific immigrant groups with increased risks of developing diabetes earlier in the life course.     

Immigrant Generation,Race, and Socioeconomic Outcomes of Mothers in Urban Cities: Who Fares Better?

Immigrants living in the United States tend to exhibit racially stratified outcomes, with greater socioeconomic disadvantage experienced by immigrants of color. However, few comparative studies have examined this relationship among multiple generations of immigrant women. This study compared first-, second-, and third-plus-generation immigrant mothers on seven socioeconomic outcomes. Data came from the Fragile Families and Child Wellbeing Study. Our sample consisted of 4056 first-, second-, and third-plus-generation immigrant mothers living in U.S. urban cities. Logistic, ordinal logistic, and linear regression analyses were conducted to predict socioeconomic outcomes. Among immigrants of color, increased generation status was associated with worse socioeconomic outcomes. Among White immigrants, generation status was largely unassociated with socioeconomic outcomes. Results underscore the need for increasing support for immigrants and their posterity. Further research is warranted investigating mechanisms that lead to racially stratified disadvantages as immigrant generation increases.

     

Risk of mental disorders in family reunification migrants and native Danes: a register-based historically prospective cohort study

Objectives  

Although family reunification migrants form a large proportion of migrants, their prevalence of mental disorders is unknown because research has focused on mixed groups of first generation immigrants and refugees. Our aim was to investigate the risk of mental disorders among family reunification migrants compared with that among native Danes.     

Acculturation and Self-Rated Mental Health Among Latino and Asian Immigrants in the United States: A Latent Class Analysis

This study assesses variations in acculturation experiences by identifying distinct acculturation classes, and investigates the role of these acculturation classes for self-rated mental health among Latino and Asian immigrants in the United States. Using 2002–2003 the National Latino and Asian American Study, Latent Class Analysis is used to capture variations in immigrant classes (recent arrivals, separated, bicultural and assimilated), and OLS regressions are used to assess the link between acculturation classes and self-rated mental health. For both Latinos and Asians, bicultural immigrants reported the best mental health, and separated immigrants and recent arrivals reported the worst mental health. The findings also reveal group differences in acculturation classes, whereby Latino immigrants were more likely to be in the separated class and recent arrivals class relative to Asian immigrants. While there was not a significant group difference in self-rated mental health at the bivariate level, controlling for acculturation classes revealed that Latinos report better self-rated mental health than Asians. Thus, Latino immigrants would actually have better self-rated mental health than their Asian counterparts if they were not more likely to be represented in less acculturated classes (separated class and recent arrivals) and/or as likely to be in the bicultural class as their Asian counterparts. Together the findings underscore the nuanced and complex nature of the acculturation process, highlighting the importance of race differences in this process, and demonstrate the role of acculturation classes for immigrant group differences in self-rated mental health.     

Vaccine-preventable disease-related hospitalization among immigrants and refugees to Canada: Study of linked population-based databases

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.     

New approaches to immigrant health assessment

While immigrant subgroups may present vulnerabilities in terms of health status, health service use, and social determinants, comprehensive information on their health is lacking. To examine mortality (1980-1998) and health service utilization (1985-2002) patterns in Canadian immigrants, a record linkage pan-Canadian research initiative using immigration and health databases has been undertaken. Preliminary results indicate that overall mortality is low among Canadian immigrants as compared to the general population for most leading causes (thus supporting the notion of "healthy immigrant effect"), with cause-specific exceptions. Moreover, results from British Columbia show that overall physician visits are low for immigrants, but not for all subgroups. Results from Ontario demonstrate a sharp increase in physician claims approximately three months following landing. Future analyses will address the short- and long-term health outcomes of immigrant subgroups, including less common diseases. Results are pertinent to practitioners working with immigrants and can inform immigrant health policy.