1. 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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Inner City Health Research Unit

2. Inner City Health Research Unit
Immigration to Canada
Recent immigration*
1990’s (174, ,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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3. Inner City Health Research Unit
Urban Phenomenon
2001 immigrants
17 CMAs  91.5%
3 CMAs  %
Toronto, Montreal, Vancouver
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4. 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.
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5. 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)
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8. 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
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9. Highest Recent Immigration Neighbourhoods
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10. Inner City Health Research Unit
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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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Inner City Health Research Unit

12. Inner City Health Research Unit
Research Question
Do patterns of hospitalization differ according to immigration in Toronto’s inner city?
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13. 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)
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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 = , p < 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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19. 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.
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20. 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
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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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Inner City Health Research Unit

22. 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
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Inner City Health Research Unit