1. 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 Immigrant Health Assessment – Profiling Health Diversity in Canada 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 of the health of immigrant populations in Canada that can inform multilevel policies & programs Objectives To determine whether disparities exist between immigrant 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 between immigrant 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) Immigrant subgroupDeaths (1980-98) Standardized Mortality Ratio (SMR) Non-Refugee Men37230.34 Non-Refugee Women35400.40 Refugee Men10760.48 Refugee Women6430.58 *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) Standardized Mortality Ratios (SMR) Non-refugeesRefugees MalesFemalesMalesFemales Infectious/ parasitic diseases0.800.910.72*1.97 Cancer0.380.400.590.62 Endocrine/ nutritional disorders 0.430.570.36- Circulatory diseases0.310.40 0.53 Respiratory diseases0.290.340.480.55 Digestive system disorders0.290.350.370.52 Injuries0.310.390.430.55 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) SexImmigration CategoryCases (1980-96) Standardized Incidence Ratio (SIR) MalesNon-Refugee Economic 587 0.25 Non-Refugee Family 1618 0.25 Refugees 703 0.31 FemalesNon-Refugee Economic 627 0.26 Non-Refugee Family 1576 0.23 Refugees6410.31 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 SMR = standardised mortality ratio Immigrants have a higher mortality risk for certain cancers (stomach, liver) Naso-pharyngeal cancer is also elevated

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) & First Physician Billing Claim for 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. 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 Discussion – Key findings

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