Urban Health Care and Research Priorities in Immigrant Health

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Urban Health Care and Research Priorities in
Immigrant Health

• National Symposium on Immigrant Health
• Ottawa, March 25, 2003
• Dr. Rick Glazier

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Immigration to Canada

• Recent immigration
• 1990s (174,000-257,000 annually)
• 2001 had 250,346 landings
• 67,644 family (26.6), 152,939 economic (58.7),
  2,828 other (1.4), 27,894 refugees (11.1)
• Asia/Pacific 53.0, Africa/Middle East 19.2,
  Europe/UK 17.3, South/Central America 8.0
• Facts and Figures 2001 Citizenship and
  Immigration Canada

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Urban Phenomenon

• 2001 immigrants
• 17 CMAs ? 91.5
• 3 CMAs ? 76.5
• Toronto, Montreal, Vancouver

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Immigration to Toronto

• Toronto had 125,061 (50.0) immigrants in 2001
• changes over time
• 1961
• 90 of immigrants from Europe
• 3 visible minorities
• 1996
• 106 countries represented by gt1000 people
• 37 visible minorities
• half of residents born outside Canada
• 1 in 8 residents recent immigrants lt 5 years.

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Potential Impact on Health

• Selection of younger, healthier people
• Fewer chronic conditions, lower rates of
  depression and alcohol dependence
• Recent immigrants
• Asia, Africa, Caribbean
• language and acculturation issues
• refugees
• acute stress, PTSD, family social network
  disruption
• less health screening
• Health Reports 200213(Suppl)

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Inner City Toronto

• Population 780,000 in 1996
• Former City of Toronto, York, East York
• 62 neighbourhoods
• 1136 enumeration areas

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Highest Recent Immigration Neighbourhoods
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Hospitalization

• Includes serious health conditions
• Can group by type
• medical, surgical, obstetrical, mental health,
  ambulatory care sensitive (eg diabetes, asthma)
• Expect hospital admissions to be lower among
  healthier groups

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Research Question

• Do patterns of hospitalization differ according
  to immigration in Torontos inner city?

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Data Sources

• Hospitalization
• Separation abstracts
• Canadian Institute for Health Information (CIHI)
  1997
• Ambulatory care sensitive, medical, surgical,
  mental health, obstetrical admissions
• Denominators
• 1996 Canada census, custom cross-tabs
• Postal Code Conversion File (Statistics Canada)

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Analysis

• Unit of analysis
• 1136 enumeration areas (EAs), pop 600
• Control for age, sex, income differences
• Poisson regression
• results reported as adjusted odds ratios (ORs)

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Odds Ratios for Women by Recent Immigration
Quintile (After Adjustment for Income)
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Odds Ratios for Men by Recent Immigration
Quintile (After Adjusting for Income)
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Findings

• Ambulatory care sensitive, medical, surgical,
  admissions 50 higher in high recent immigration
  EAs than low EAs, after accounting for income
• (ORs for Q5 1.35-1.95, p lt 0.05)
• Not true for obstetrical and mental health
  admissions (ORs 1.15, 1.06 0.69), p NS

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Interpretation

• Limitations
• Ecological analyses apply to areas, not
  individuals
• Recent immigrant areas often also lower SES
• difficult to separate out SES effects
• Key finding
• Recent immigration areas have higher hospital
  needs
• Seems incongruent with healthy migrant effect

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Potential Explanations

• Torontos inner city has areas of concentrated
  urban disadvantage
• recent immigration, visible minority, low income
• increasing concentration over time
• ? refugee health issues
• Non-immigrants responsible?
• Fong, E, Shibuya, K. Demography. 200037, -59.

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Research Priorities

• Individual-level data extremely useful eg LIDS
• immigration-SES relationships complex
• neighbourhood context likely to be important
• hierarchical models, GIS methods ideal
• Added value from further examining
• main countries of origin
• immigration class
• period of migration
• neighbourhood settlement patterns
• services available
• variety of health status, utilization measures
• other urban settings

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Policy Implications

• Subgroups of recent immigrants may have
• increased health needs
• low prevention rates
• access barriers
• Identify and address needs of at-risk groups
• screening policies, discrimination, follow-up
• disadvantaged urban neighbourhoods an important
  contextual issue for immigration

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Acknowledgements

• Toronto Inner City Time Trends Working Group
• Mohammad M. Agha (St. Michaels Hospital Inner
  City Health Research)
• Robin Badgley (Centre for Research in Womens
  Health, Toronto)
• Elizabeth M. Badley (Public Health Sciences,
  University of Toronto)
• Jocalyn Clark (Centre for Research in Womens
  Health, Toronto)
• Maria I. Creatore (St. Michaels Hospital Inner
  City Health Research)
• Richard H. Glazier (St. Michaels Hospital Inner
  City Health Research Unit)
• Peter Gozdyra (Department of Geography,
  University of Toronto)
• Stephen Hwang (St. Michaels Hospital Inner City
  Health Research Unit)
• Flora Matheson (St. Michaels Hospital Inner City
  Health Research Unit)
• Dianne Patychuk (Toronto Public Health)
• Lorraine Purdon (Southeast Toronto Project)
• Anne Rhodes (St. Michaels Hospital Inner City
  Health Research Unit)
• Leah Steele (St. Michaels Hospital Inner City
  Health Research Unit)
• Support CIHR, CERIS, St. Michaels Hospital,
  ICES