The Immigrant Mortality Advantage in Canada, 2001 and 2011

Abstract

This study examines differential mortality between immigrant and native-born populations in Canada with respect to eighteen causes of death categories encompassing chronic and external types of mortality over two census periods, 2001 and 2011. The following interrelated questions are addressed: (1) what is the magnitude of the immigrant mortality advantage relative to native-born Canadians? (2) How does it change over time? (3) Is the migrant advantage uniform across all causes of death? (4) Does the advantage for immigrants prevail across all age groups? (5) Are immigrant men and women equally advantaged across causes of death? These queries are explored with multivariate analysis guided by a conceptual framework that specifies differential mortality as a function of nativity factors, health selection, and acculturation effects. It is shown that nativity status exerts a strong independent effect, and that over time, migrants experienced larger reductions in risk than did native-born Canadians. Further analysis revealed support for both health selection and acculturative explanations. Sex differences are found, with male immigrants enjoying a small but significant relative mortality advantage compared to immigrant females. The paper discusses these findings and closes with suggestions for further study.

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Notes

  1. 1.

    A similar phenomenon, described as an “epidemiological paradox,” has been observed for Hispanics in the USA (see for example, Turra and Elo 2008a; Abraido-Lanza et al. 1999).

  2. 2.

    Recent representative international works include those of Wallace (2016), Ikram et al. (2016), and Boulogne et al. (2012).

  3. 3.

    The periods of observation are 2000–2002 and 2010–2012, and 2001 and 2011 are corresponding central years.

  4. 4.

    Perez (2002) also reported that smoking and heavy drinking differed between immigrant and Canadian-born and varied with immigrants’ length of residence in Canada.

  5. 5.

    Phrases such as “unhealthy assimilation,” “pathogenic process,” and “negative assimilation” have been used to describe health change in immigrants (Antecol and Bedard 2006; De Maio 2010; Moran et al. 2017).

  6. 6.

    Perez (2002) also noted that with respect to diabetes, high blood pressure, heart disease in women, and cancer in men, immigrant and non-immigrant health were comparable, and there was no clear gradient of worsening health with time since immigration.

  7. 7.

    As pointed out by one of the anonymous reviewers for this journal, additional layers to this hypothesis may be considered. First, if new arrivals in the 2001–2011 periods are younger than non-immigrants, then mortality of immigrants in 2011 will improve relative to 2001. Second, if the added immigrants of a certain age are in better health than non-immigrants of the same age, this will improve mortality for the immigrant population as a whole. And if an immigrant of a certain age arriving after 2001 is in better health than an immigrant of the same age that arrived earlier, then mortality in the overall immigrant population should also improve. This last proposition can only be tested directly with longitudinal data on immigrant cohorts by period of arrival, followed accordingly over time.

  8. 8.

    In 2001, the population of Canada was just over 31 million, growing to nearly 33.5 million by 2011. Over these two periods, the proportion foreign-born rose from 20 to 22%.

  9. 9.

    Two data concerns are worth noting. First, while census and NHS exclude the institutional population, the death database does not. Second, over recent years, Canada has been accepting a sizable number of non-permanent residents, which includes temporary foreign workers, and these cases are not identifiable in the vital statistics and census data. The extent to which these features may introduce bias in the statistical results is not possible to verify.

  10. 10.

    The log-rate model is the additive version of Poisson regression, which assumes the probability of a given number of deaths in a fixed interval of time occur with a constant rate independently of the time since the last event (Laird and Olivier 1981; Larson 1984).

  11. 11.

    Age was derived as current year—year of birth and the variable was then grouped into 5-year age categories.

  12. 12.

    The immigrant population is considerably older than the Canadian-born population. In 2001 and 2011, calculated average age of the immigrant population was 45.7 and 46.7 years, respectively whereas for the Canadian-born, the corresponding figures were 35.3 and 37.9.

  13. 13.

    Out of 264,333 deaths in 2015 in Canada, ischemic heart disease claimed 34,104 lives, and an additional 13,910 were due to cerebrovascular diseases (Statistics Canada CANSIM 2017a).

  14. 14.

    In 2015, Canada recorded 78,580 cancer deaths of which over 20,000 were due to lung cancer (Statistics Canada, CANSIM 2017b).

  15. 15.

    There were over 17,500 deaths in Canada in 2015 due to accidents, poisonings, and violence (Statistics Canada, CANSIM 2018).

  16. 16.

    I am grateful to one of the anonymous reviewers for this journal for pointing out this important policy change and its possible ramifications for the healthy immigrant effect.

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Acknowledgements

The analysis presented in this paper was conducted at the Canada Research Data Centre at the University of Alberta which is part of the Canadian Research Data Centre Network (CRDCN).

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The services and activities provided by the Research Data Center are made possible by the financial or in-kind support of the SSHRC, the CIHR, the CFI, Statistics Canada, and the University of Alberta.

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Correspondence to Frank Trovato.

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Appendix

Appendix

Table 5 Cause of death categories used in this study and associated ICD-10 codes

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Trovato, F. The Immigrant Mortality Advantage in Canada, 2001 and 2011. Int. Migration & Integration 21, 351–379 (2020). https://doi.org/10.1007/s12134-019-00655-2

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Keywords

  • Immigrants
  • Native-born
  • Canada
  • Mortality
  • Causes of death
  • Log-rate model