Abstract
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Background
Keywords
Findings
Authors
What is already known on this subject?
What does this study add?
Background
Immigrants tend to have better health than the Canadian-born. However, the “healthy immigrant” effect diminishes over time and varies by source country. This study examines whether lower hospitalization rates persist from the first (G1) to the second generation (G2) of immigrants, compared with other Canadians (G3+). All-cause and circulatory disease-related hospitalization rates were examined by generation, with special attention to people of Chinese and South Asian descent.
Data and methods
Data from the 2006 Census-hospitalization linkage database (which excludes Quebec) were analysed using logistic regression. 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.
Results
Over the generations, immigrants’ all-cause and circulatory disease-related hospitalization rates converged with those of the Canadian population overall. Compared with G3+, the age-adjusted odds of all-cause hospitalization among men were 0.49 (CI = 0.48-0.51) for recent G1 immigrants, 0.78 (CI = 0.77-0.79) for long-term G1 immigrants, and 0.95 (CI = 0.94-0.97) for G2. Adjustments for socioeconomic status reduced the difference, especially between G2 and G3+. For South Asians, rates converged for circulatory disease, notably among men. Hospitalization rates for people of Chinese descent rose across generations, but remained significantly below rates for G3+.
Interpretation
The lower circulatory disease-related hospitalization risk experienced by G1 is maintained in G2 among people of Chinese descent, but not among South Asians.
Keywords
Cardiovascular diseases, census, Chinese, data linkage, hospital records, immigrant health, medical records, socioeconomic status, South Asian
Findings
Since the 1970s, the origins of immigrants to Canada have shifted toward non-European sources, such as India and China. As a result, 8% of the total population self-identify as South Asian or Chinese, a percentage that is projected to reach about 15% by 2031. Canada’s changing ethnic make-up and its long-run impact on subsequent generations can have implications for health care. [Full Text]
Authors
Edward Ng (edward.ng@statcan.gc.ca), Claudia Sanmartin and Doug G. Manuel are with the Health Analysis Division at Statistics Canada, Ottawa, Ontario. Doug G. Manuel is also with the Ottawa Health Research Institute and the University of Ottawa. Jack V. Tu is with the Institute for Clinical Evaluative Studies and the University of Toronto, Toronto, Ontario.
What is already known on this subject?
- Canadian studies of immigrant integration have explored economic outcomes for the second generation, but patterns of health and health care use by generation status have received little attention thus far.
- South Asian immigrants have a circulatory disease mortality risk similar to the Canadian-born population, but higher than other immigrant groups such as the Chinese.
- There is a need to determine if the relatively high circulatory disease mortality risk among South Asians is reflected in hospitalization, and if the health risks affect subsequent generations.
What does this study add?
- Using linked census-hospital data, this study examined all-cause (excluding pregnancy) and circulatory disease-related hospitalizations among first- and second-generation of immigrants, particularly, South Asians and Chinese.
- Based on age-standardized hospitalization rates, South Asian immigrants’ health advantage in circulatory disease is lost by the second generation.
- Among the Chinese, all-cause and circulatory disease-related hospitalization risk generally increased across generations, but remained significantly lower than for Canadians overall.
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