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

Abstract

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.

Migration and health in Canada: health in the global village

“…6 This review (2001-2007) identified and described 12 national population studies on health status. 5,[10][11][12][13][14][15][16][17][18] Our updating search identified eight additional national population studies describing health status of immigrants and refugees to Canada [19][20][21][22][23][24][25][26] (Figure 1). Health and demographic data on nonstatus people (illegal aliens) in Canada was very limited.…”

“…44 After migration, several of these beneficial health indicators become less pronounced with increased duration of residence. 22,44 Age-standardized all-cause mortality is lower for immigrant and refugee populations than for the Canadianborn population (standardized mortality ratio 0.34-0.58); 14 however, subgroups of immigrants are at increased risk of mortality 23 14 Further, McDonald and Kennedy report that the incidence of type 2 diabetes increases among nonrecent immigrants when examining two periods of cross-sectional data. 15 Other illnesses, mental illnesses 13 and arthritis 25 are less common in immigrant populations.…”

“…45 This is often seen in regard to infectious diseases that continue to be common in developing countries. 14,46 The risk of infectious disease in some migrant populations continues after arrival, as those who make return visits to their homeland might re-expose themselves and their children to threats not present in Canada. Migrants travelling to visit friends and relatives 47 are an increasingly important aspect of modern travel medicine.…”

Evidence-based clinical guidelines for immigrants and refugees

“…5 In addition, compared with the Canadian-born population, subgroups of immigrants are at increased risk of disease-specific mortality; for example, Southeast Asians from stroke (odds ratio [OR] 1.46, 95% confidence interval [CI] 1.00-1.91), 9 Caribbeans from diabetes mellitus (OR 1.67, 95% CI 1.03-2.32) and infectious diseases (e.g., for AIDS, OR 4.23, 95% CI 2.72-5.74), and immigrant men from liver cancer (OR 4.89, 95% CI 3.29-6.49). 10 The health needs of newly arriving immigrants and refugees often differ from those of Canadian-born men, women and children. The prevalence of diseases differs with exposure to disease, migration trajectories, living conditions and genetic predispositions.…”

“…11 Additionally, patients may present with conditions or concerns that are unfamiliar to practitioners. 5,10 Many source countries have limited resources and differing health care systems, and these differences may also contribute to health inequalities among migrants. 12 In these guidelines, we refer to low-and middle-income countries as "developing.…”