Urban Health Care and Research Priorities in Immigrant Health National Symposium on Immigrant Health Ottawa, March 25, 2003 Dr. Rick Glazier 23/11/2018 Inner City Health Research Unit

Inner City Health Research Unit Immigration to Canada Recent immigration* 1990’s (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 23/11/2018 Inner City Health Research Unit

Inner City Health Research Unit Urban Phenomenon 2001 immigrants 17 CMAs  91.5% 3 CMAs  76.5% Toronto, Montreal, Vancouver 23/11/2018 Inner City Health Research Unit

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 >1000 people 37% visible minorities half of residents born outside Canada 1 in 8 residents recent immigrants < 5 years. 23/11/2018 Inner City Health Research Unit

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 2002:13(Suppl) 23/11/2018 Inner City Health Research Unit

Inner City Health Research Unit Inner City Toronto Population 780,000 in 1996 Former City of Toronto, York, East York 62 neighbourhoods 1136 enumeration areas 23/11/2018 Inner City Health Research Unit

Highest Recent Immigration Neighbourhoods 23/11/2018 Inner City Health Research Unit

Inner City Health Research Unit 23/11/2018 Inner City Health Research Unit

Inner City Health Research Unit 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 23/11/2018 Inner City Health Research Unit

Inner City Health Research Unit Research Question Do patterns of hospitalization differ according to immigration in Toronto’s inner city? 23/11/2018 Inner City Health Research Unit

Inner City Health Research Unit 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) 23/11/2018 Inner City Health Research Unit

Inner City Health Research Unit 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) 23/11/2018 Inner City Health Research Unit

Inner City Health Research Unit Odds Ratios for Women by Recent Immigration Quintile (After Adjustment for Income) 23/11/2018 Inner City Health Research Unit

Inner City Health Research Unit Odds Ratios for Men by Recent Immigration Quintile (After Adjusting for Income) 23/11/2018 Inner City Health Research Unit

Inner City Health Research Unit 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 < 0.05) Not true for obstetrical and mental health admissions (ORs = 1.15, 1.06 & 0.69), p = NS 23/11/2018 Inner City Health Research Unit

Inner City Health Research Unit 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 23/11/2018 Inner City Health Research Unit

Potential Explanations Toronto’s 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. 2000;37, -59. 23/11/2018 Inner City Health Research Unit

Inner City Health Research Unit 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 23/11/2018 Inner City Health Research Unit

Inner City Health Research Unit 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 23/11/2018 Inner City Health Research Unit

Inner City Health Research Unit Acknowledgements Toronto Inner City Time Trends Working Group: Mohammad M. Agha (St. Michael’s Hospital Inner City Health Research) Robin Badgley (Centre for Research in Women’s Health, Toronto) Elizabeth M. Badley (Public Health Sciences, University of Toronto) Jocalyn Clark (Centre for Research in Women’s Health, Toronto) Maria I. Creatore (St. Michael’s Hospital Inner City Health Research) Richard H. Glazier (St. Michael’s Hospital Inner City Health Research Unit) Peter Gozdyra (Department of Geography, University of Toronto) Stephen Hwang (St. Michael’s Hospital Inner City Health Research Unit) Flora Matheson (St. Michael’s Hospital Inner City Health Research Unit) Dianne Patychuk (Toronto Public Health) Lorraine Purdon (Southeast Toronto Project) Anne Rhodes (St. Michael’s Hospital Inner City Health Research Unit) Leah Steele (St. Michael’s Hospital Inner City Health Research Unit) Support: CIHR, CERIS, St. Michael’s Hospital, ICES 23/11/2018 Inner City Health Research Unit