Health Reports, October 2015
All-cause and circulatory disease-related hospitalization, by generation status: Evidence from linked data
Immigrants tend to have better health than the Canadian-born. However, the "healthy immigrant" effect diminishes over time and varies by source country.
Over successive generations, immigrants' rates of hospitalization overall, and for circulatory diseases in particular, tended to rise and converge with those of the third-plus generation, according to an analysis of census data linked to hospital administrative records.
During the 2006/2007 to 2008/2009 period, all-cause hospitalization rates, standardized to account for differences in age distributions, were 609 per 10,000 population among first-generation immigrants. Among the second generation, the rate was 792 hospitalizations per 10,000, and for the third-plus generation, 839 hospitalizations per 10,000. The corresponding hospitalization rates for circulatory diseases were 119, 142 and 152, respectively, per 10,000.
Convergence in hospitalization rates over immigrant generations was apparent for both men and women. Recent (arrived 1996 to 2006) first-generation immigrants were the least likely to have had at least one hospitalization during the 2006/2007 to 2008/2009 period, followed by long-term (arrived before 1996) first-generation immigrants, and then, second-generation Canadians. All three groups were less likely to have been hospitalized compared with the third-plus generation.
Results varied by origin, with higher odds of circulatory disease-related hospitalization among people of South Asian descent, and lower odds among those of Chinese descent.
Adjustments for education and income reduced differences, especially between the second and third-plus generations. Based on age-standardized hospitalization rates, South Asian immigrants' health advantage in circulatory diseases was lost by the second generation. Among the Chinese, all-cause and circulatory disease-related hospitalization rates generally increased across generations, but remained significantly lower than for the third-plus generation.
Note to readers
This study used data from the 2006 Census of Population (long-form respondents) linked to administrative records to determine whether hospitalization patterns among first-generation immigrants persist in the second and third generations, and whether patterns differ between South Asians and Chinese subgroups.
Approximately 4.65 million census long-form respondents (excluding Quebec) were linked for the three fiscal years from 2006/2007 to 2008/2009. 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.
Generation status was defined based on immigrant status and parental place of birth. First-generation respondents are those who were, or had been, landed immigrants in Canada. Second-generation respondents are non-immigrants with at least one parent born outside Canada. Third-plus generation respondents are non-immigrants with both parents born in Canada. The study focuses on immigrants from China (including Hong Kong) and South Asia (Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka).
The primary outcome was at least one inpatient acute-care hospitalization between April 1, 2006 and March 31, 2009. Two types of hospitalization were considered: all-cause, excluding those related to pregnancy; and circulatory disease-related.
The article All-cause and circulatory disease-related hospitalization, by generation status: Evidence from linked data" is available in the October 2015 online issue of Health Reports, Vol. 26, no. 10 (82-003-X) from the Browse by key resource module of our website under Publications.
This issue of Health Reports also contains two other articles, "Linking 2006 Census and hospital data in Canada," and "Oral contraceptive use among women aged 15 to 49: Results from the Canadian Health Measures Survey."
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