Immigrant Health Assessment – Profiling Health Diversity in Canada

1. Immigrant Health Assessment –Profiling Health Diversity in Canada M DesMeules, J Gold, B Vissandjée, D Manuel, A Kazanjian, J Payne, Y Mao Health Canada, Ottawa; University of Montreal, Montreal; Institute for Evaluative Sciences, Toronto; University of British Columbia, Vancouver Supported by the Canadian Population Health Initiative (CIHI) & Health Canada

2. Introduction – Immigrant Population Health in Canada • 18% of population (2001 Census) • Increasing ethno-cultural diversity and evidence that years of residence in Canada since migration is associated with measures of health status • Lack of comprehensive research/surveillance on their health and use of health services

3. Introduction – Immigrant Population Health in Canada…continued • Information is especially lacking on socio-demographic subgroups (refugees, those from specific source countries, recent and well established immigrants,etc.) • Disparities may exist in terms of health status, health service use and determinants of health

4. Introduction – Purpose of Immigrant Health Assessment/ surveillance • To describe morbidity, mortality, health service use, & determinants of health • To monitor trends over time • To identify health risks & disparities among immigrants

5. Introduction – Goal & Objectives Goal • To produce a comprehensive picture ofthe health of immigrant populations in Canada that can inform multilevel policies & programs Objectives • To determine whether disparities exist betweenimmigrant subgroups & compared to Canada • To develop sensitive immigrant health surveillance methodologies and systems

6. Methods • Canada is ideal for this surveillance because of its many foreign born citizens and national data sources on immigrants and health • Surveillance tools on immigrant health in Canada were optimized by linking databases : • 20% of landed immigrants (1980-90) were linked to mortality & cancer databases and followed for up to 19-years • 80% of landed immigrants (1985-2001) were linked to hospital & physician databases • Rates were used to determine whether disparities exist betweenimmigrant subgroups & compared to Canada

7. Findings Highlights of Research Findings • Mortality/ death • Cancer • Preliminary Results on the Use of Health Care Services

8. Findings – Immigrant Deaths from All-Causes Compared to Canada (Ratios Adjusted for Age) *SMR <1 indicates that immigrants have low mortality rates compared to Canada

9. Findings –Non-Refugee Deaths from All-Causes Compared to Canada (Ratios Adjusted for Age, 1980-98) *SMR < 1 indicates that immigrants from the source country have low mortality rates compared to Canada ** The number of observed deaths among non-refugee females from both China and Portugal is <=15.

10. Findings – Death by Cause in Immigrants Compared to Canada (Ratios Adjusted for Age, 1980-98) SMR >1 indicates that this cause of death is elevated for immigrants. SMR <1 indicates that immigrants have low mortality rates compared to Canada.

11. Findings – Cancer in Immigrants Compared to Canada (Ratios Adjusted for Age) SIR < 1 indicates that immigrants have low cancer incidence rates compared to Canada.

12. Findings - Mortality Risk from Certain Cancers in Immigrants Compared to Canada (1980-98) SMR estimates • Immigrants have a higher mortality risk for certain cancers (stomach, liver) • Naso-pharyngeal cancer is also elevated SMR = standardised mortality ratio

13. Findings – Cancer in Immigrants by years of residence in Canada since migration (1980-96) *The RR of cancer incidence is adjusted for socio-demographic determinants of health

14. Findings –Immigrant Physician Visits in British Columbia (1995/96) Compared to the Provincial Population (Ratios Adjusted for Age) *Rate ratio of 1 indicates that immigrants visit physicians as often as Canadians in the province. Rate ratio < 1 indicates that immigrants visit physicians less often than Canadians in the province.

15. Findings –Time Between Landing (1992-2001) &FirstPhysicianBillingClaimfor Immigrants in Ontario

16. Discussion – Research Methods • Methodology optimized surveillance information on immigrant health • Provided essential data on determinants of health in immigrant subgroups, e.g., on birthplace, type of immigrant, etc • Provided information on immigrant health and the variation due to years of residence in Canada after migration

17. Discussion – Key findings • Overall health status and low physician use • Unique health patterns by cause and for subgroups • Socio-demographic determinants of health (type of immigrant, marital status, etc.) may be especially important in immigrant health surveillance • Policies such as health card eligibility may effect health patterns

18. Discussion – Future Research & Policy • Expand on surveillance in subgroups and collect contextual information about the migration trajectory • Consider other determinants of health at the individual (e.g. health behaviours) & community (e.g. availability of special health services for immigrants) levels • Inform health policies & programs on health disparities in immigrant subgroups