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Journal of Immigrant and Minority Health

, Volume 7, Issue 4, pp 221–232 | Cite as

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

  • Marie DesMeules
  • Jenny Gold
  • Sarah McDermott
  • Zhenyuan Cao
  • Jennifer Payne
  • Bryan Lafrance
  • Bilkis Vissandjée
  • Erich Kliewer
  • Yang Mao
Article

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.

Keywords

mortality immigration refugees longitudinal record linkage 

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References

  1. 1.
    Statistics Canada: 2001 Census: Analysis Series, Canada’s Ethnocultural Portrait–-The Changing Mosaic. Ottawa: Statistics Canada; 2003Google Scholar
  2. 2.
    Statistics Canada [Online]. 2003 [cited 2003 Aug 5]; Available from URL: http://www.statcan.ca/english/Pgdb/
  3. 3.
    Hyman I: Immigration and Health. Ottawa: Health Canada; 2001Google Scholar
  4. 4.
    Kinnon D: Canadian research on immigration and health. Ottawa: Health Canada; 1999Google Scholar
  5. 5.
    Wilkins K: Tuberculosis, 1994. Health Rep 1996; 8:33–39PubMedGoogle Scholar
  6. 6.
    Gushulak BD, Williams LS: National immigration health policy: existing policy, changing needs, and future directions. Can J Public Health 2004; 95(3): I27–I29PubMedGoogle Scholar
  7. 7.
    Citizenship and Immigration Canada: Immigration and Refugee Protection Act, Fact Sheet 20, Medical Testing and Surveillance. [Online]. 2002 [cited 2003 Aug]. Available from http://www.cic.gc.ca/english/irpa/fs-medical.html
  8. 8.
    Chen J, Wilkins R, Ng E: Health expectancy by immigrant status, 1986 and 1991. Health Rep 1996; 8:29–38Google Scholar
  9. 9.
    Gold J, DesMeules M, Manuel D, Kazanjian A, Vissandjée B, Mao Y: Proceedings of the National Symposium on Immigrant Health in Canada. Can J Public Health 2004; 95(3): I1–I39Google Scholar
  10. 10.
    Parakulam G, Krishnan V, Odynak D: Health status of Canadian-born and foreign-born residents. Can J Public Health 1992; 83:311–314PubMedGoogle Scholar
  11. 11.
    Perez CE: Health status and health behavior among immigrants. Health Rep 2002; 13:S1–S12Google Scholar
  12. 12.
    Sharma R, Michallowski M, Verma R: Mortality differentials among immigrant populations in Canada. Int Migration 1990; 28:443–450Google Scholar
  13. 13.
    Singh GK, Siahpush M: All-cause and cause-specific mortality of immigrants and native born in the United States. Am J Public Health 2001; 91:392–399PubMedGoogle Scholar
  14. 14.
    Trovato F, Clogg C: General and cause specific adult mortality among immigrants in Canada, 1971 and 1981. Canadian Studies in Population 1992; 19:47–80Google Scholar
  15. 15.
    McKay L, Macintyre S, Ellaway A: Migration and Health: A Review of the International Literature. London: Medical Research Council; 2003Google Scholar
  16. 16.
    Vissandjee B, et al. Integrating ethnicity and migration as determinants of Canadian women’s health. Biomed Central, Women’s Health (in press)Google Scholar
  17. 17.
    Hanley A, Choi B, Holowaty E: Cancer mortality among Chinese migrants: A review. Int J Epidemiol 1995; 24:255–265PubMedGoogle Scholar
  18. 18.
    Miller BA, Kolonel LN, Bernstein L, Young Jr JL, Swanson GM, West D, et al. (eds): Racial/Ethnic Patterns of Cancer in the United States 1988–1992 Bethesda: National Cancer Institute; 1996Google Scholar
  19. 19.
    Nair C, Nargundkar M, Johansen H, Strachan J: Canadian cardiovascular disease mortality: first generation immigrants versus Canadian born. Health Rep 1990; 2:203–228PubMedGoogle Scholar
  20. 20.
    Travota F: Nativity, marital status and mortality in Canada. Sociological Abstracts 1998; 35:65–91Google Scholar
  21. 21.
    Sheth T, Nair C, Nargundkar M, Anand S, Yusuf S: Cardiovascular and cancer mortality among Canadians of European, South Asian and Chinese origin from 1979 to 1993: An analysis of 1.2 million deaths. CMAJ 1999; 161:132–138PubMedGoogle Scholar
  22. 22.
    Weioft G, Gullberg A, Hjern A, Rosen M: Mortality statistics in immigrant research: Method for adjusting underestimation of mortality. Int J Epidemiol 1999; 28:756–763CrossRefPubMedGoogle Scholar
  23. 23.
    Stern M, Wei M: Do Mexican Americans Really have low rates of cardiovascular disease? Prev Med 1999; 29:S90–S95CrossRefPubMedGoogle Scholar
  24. 24.
    Yang X: A sensitivity analysis of repeat migration attrition in the study of migrant adjustment: the case of Bangkok. Demography 1994; 31:585–592PubMedGoogle Scholar
  25. 25.
    Abraido-Lanza A, Dohrenwend B, Ng-Mak D, Turner J: The Latino mortality paradox: A test of the “salmon bias” and healthy migrant hypotheses. Am J Public Health 1999; 89:1543–1548PubMedGoogle Scholar
  26. 26.
    Razum O, Zeeb H, Rohrmann S: The ‘healthy migrant effect’–-not merely a fallacy of inaccurate denominator figures (Letter). Int J Epidemiol 2000; 29:191–192CrossRefPubMedGoogle Scholar
  27. 27.
    Razum O, Zeeb H, Akgun H, Yilmaz S: Low overall mortality of Turkish residents in Germany persists and extends into a second generation: Merely a healthy migrant effect? Trop Med Int Health 1998; 3:297–303CrossRefPubMedGoogle Scholar
  28. 28.
    Reijneveld SA: The cross-cultural validity of self-reported use of health care: A comparison of survey and registration data. J Clin Epidemiol 2000; 53:267–72CrossRefPubMedGoogle Scholar
  29. 29.
    Langlois C, Doherty C: The Longitudinal Immigrant Database (IMDB): An Introduction. IMDB Technical Paper, 1997 [cited 2003 Aug 5]. Citizenship and Immigration Canada Ottawa, ON: Canada Online. Available from URL:http://www.cic.gc.ca/english/srr/pdf/res4bi.pdf
  30. 30.
    Probert A, Semenciw R, Mao Y: Analysis of immigration data: 1980-1994, Chapter 9. In: Record Linkage Techniques, Proceedings of an International Workshop and Exposition. Arlington, VA; March 20–21, 1997Google Scholar
  31. 31.
    Kobayahse A, Moore E, Rosenberg M: Healthy Immigrant Children: A Demographic and Geographical Analysis. Ottawa: Human Resources Development Canada; 1998Google Scholar
  32. 32.
    Yusuf S, Reddy S, Ounpuu S, Anand S: Global burden of cardiovascular disease, part II: variations in cardiovascular disease by specific ethnic groups and geographical regions and prevention strategies. Circulation 2001; 104:2855– 2864PubMedGoogle Scholar
  33. 33.
    Sheth T, Nair C, Nargundkar M, Anand S, Yusuf S: Cardiovascular and cancer mortality among Canadians of European, south Asian and Chinese origin from 1979 to 1993: An analysis of 1.2 million deaths. CMAJ 1999; 161:132–138PubMedGoogle Scholar
  34. 34.
    Whincup PH, Gilg JA, Papacosta O, Seymour C, Miller GJ, Alberti KGMM, Cook DG: Early evidence of ethnic differences in cardiovascular risk: Cross sectional comparison of British South Asian and white children. BMJ 2002; 324:635–641CrossRefPubMedGoogle Scholar
  35. 35.
    Khattar RS, Swales JD, Senior R, Lahiri A: Racial variation in cardiovascular morbidity and mortality in essential hypertension. Heart 2000; 83: 267–71CrossRefPubMedGoogle Scholar
  36. 36.
    Hennis A, Wu SY, Nemesure B, Li X, Leske MC: Diabetes in a Caribbean population: epidemiological profile and implications. Int J Epidemiol 2002; 31: 234–239CrossRefPubMedGoogle Scholar
  37. 37.
    Lee J, Parsons GF, Gentleman JF: Falling short of Pap test guidelines. Health Rep 1998; 10:9–19.Google Scholar
  38. 38.
    Her C: Nasopharyngeal cancer and the Southeast Asian patient. Am Fam Physician 2001; 63:1776–1782PubMedGoogle Scholar
  39. 39.
    Rosenblatt KA, Weiss NS, Schwartz SM: Liver cancer in Asian migrants to the United States and their descendants. Cancer Causes Control 1996; 7:345–350CrossRefPubMedGoogle Scholar
  40. 40.
    Haworth EA, Soni Raleigh V, Balarajan R: Cirrhosis and primary liver cancer amongst first generation migrants in England and Wales. Ethn Health 1999; 4:93–99CrossRefPubMedGoogle Scholar
  41. 41.
    Montalto G, Cervello M, Giannitrapani L, Dantona F, Terranova A, Castagnetta LA: Epidemiology, risk factors, and natural history of hepatocellular carcinoma. Ann N Y Acad Sci 2002; 963:13–20PubMedGoogle Scholar
  42. 42.
    Decosas J, Pedneault V: Women and AIDS in Africa: demographic implications for health promotion. Health Policy Plan 1992; 7:227–233Google Scholar
  43. 43.
    Singer SM, Willms DG, Adrien A, Baxter J, Brabazon C, Leaune V, Godin G, Maticka-Tyndale E, Cappon P: Many voices–-sociocultural results of the ethnocultural communities facing AIDS study in Canada. Can J Public Health 1996; 87:S26–32, S28–35Google Scholar

Copyright information

© Springer Science + Business Media, Inc. 2005

Authors and Affiliations

  • Marie DesMeules
    • 1
  • Jenny Gold
    • 1
  • Sarah McDermott
    • 1
  • Zhenyuan Cao
    • 1
  • Jennifer Payne
    • 1
  • Bryan Lafrance
    • 2
  • Bilkis Vissandjée
    • 3
  • Erich Kliewer
    • 4
  • Yang Mao
    • 1
  1. 1.Surveillance Risk Assessment Division, Centre for Chronic Disease Prevention and ControlPublic Health Agency of CanadaOttawaCanada
  2. 2.Health Statistics DivisionStatistics CanadaOttawaCanada
  3. 3.School of Nursing SciencesUniversity of MontrealMontrealCanada
  4. 4.Department of Epidemiology and Cancer Registry of Cancer Care ManitobaWinnipegCanada

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