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Neighbourhood immigrant concentration and hospitalization: A multilevel analysis of cardiovascular-related admissions in Ontario using linked data

  • Quantitative Research
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Abstract

Objective

To assess the influence of neighbourhood immigrant concentration on cardiovascular-disease-related hospitalizations in Canada (CVDH), while adjusting for individual-level immigrant status and socio-economic indicators at individual and neighbourhood levels.

Methods

Data were from the 2006 Canadian Census linked to the hospital Discharge Abstract Data (DAD) for the province of Ontario. Adults (n=1,459,950) aged >-18 years at baseline and grouped by place of birth (Canada, China, South Asia, Europe, and other) were followed between Census Day May 16, 2006 and March 31, 2008. Information on CVDH was obtained from the DAD, while that on immigration and socio-economic indicators was obtained from the Census. The analysis used multilevel logistic regression.

Results

Unadjusted results showed that CVDH was significantly lower among people living in neighbourhoods with medium and high immigrant concentration. Neighbourhood immigrant concentration tended to have no independent effect on CVDH after adjustment for individual-level immigrant status. Immigrants were less likely to experience CVDH irrespective of their country of birth. However, cross-level interaction showed that neighbourhood immigrant concentration provided additional protection to individual-level immigrant status against CVDH for most female immigrant groups, but only for South Asian males.

Conclusion

This study resulted from the first-ever linkage of census data to hospitalization data in Canada. It is also the first Canadian study to report on neighbourhood variation and the effect of immigrant concentration on CVDH. The study shows that understanding immigrant health requires both individual and neighbourhood approaches, and a consideration of country of origin.

Résumé

Objectif

Évaluer l’influence de la concentration d’immigrants au niveau des quartiers sur les hospitalisations liées aux maladies cardiovasculaires (HLMCV) au Canada, tout en tenant compte du statut d’immigrant au niveau individuel et des indicateurs socioéconomiques aux niveaux individuel et du quartier.

Méthode

Les données du Recensement du Canada 2006 ont été liées à celles du registre des sorties des hôpitaux (RSH) de la province de l’Ontario. Les adultes (n=1 459 950) de >-1 8 ans au départ, regroupés selon leur lieu de naissance (Canada, Chine, Asie du Sud, Europe et autre), ont été suivis entre le jour du recensement (le 16 mai 2006) et le 31 mars 2008. L’information sur les HLMCV provient du RSH, tandis que celle sur l’immigration et les indicateurs socioéconomiques provient du Recensement. Les données ont été analysées par régression logistique multiniveau.

Résultats

Les résultats avant ajustement montrent que les HLMCV étaient significativement plus faibles chez les personnes vivant dans des quartiers à concentrations moyennes et élevées d’immigrants. La concentration d’immigrants dans les quartiers avait tendance à n’avoir aucun effet indépendant sur les HLMCV une fois pris en compte le statut d’immigrant individuel. Les immigrants étaient moins susceptibles de subir des HLMCV, peu importe leur pays de naissance. Toutefois, l’interaction transversale a montré que la concentration d’immigrants dans les quartiers offrait une protection supplémentaire contre les HLMCV à la plupart des groupes de femmes immigrantes, mais chez les hommes, seulement aux immigrants d’Asie du Sud.

Conclusion

Cette étude est le résultat du tout premier maillage entre les données du Recensement et des données sur les hospitalisations au Canada. C’est aussi la première étude canadienne à aborder les écarts par quartier et l’effet de la concentration d’immigrants sur les HLMCV. L’étude montre que pour comprendre la santé des immigrants, il faut allier l’approche individuelle et l’approche par quartier et tenir compte du pays d’origine.

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Author information

Authors and Affiliations

  1. Health Analysis Division, Statistics Canada, 100 Tunney’s Pasture Driveway, R.H. Coats Building 24B, Ottawa, ON, K1A0T6, Canada

    D. Walter Rasugu Omariba PhD & Claudia Sanmartin PhD

  2. Department of Geography, McGill University, Montreal, QC, Canada

    Nancy A. Ross PhD

  3. Institute of Clinical Evaluative Sciences, Toronto, ON, Canada

    Jack V. Tu PhD

Authors
  1. D. Walter Rasugu Omariba PhD
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  2. Nancy A. Ross PhD
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  3. Claudia Sanmartin PhD
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  4. Jack V. Tu PhD
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Corresponding author

Correspondence to D. Walter Rasugu Omariba PhD.

Additional information

Acknowledgements: We are grateful to Julie Bernie, Rochelle Garner, Feng Hou and Claude Nadeau for helpful feedback on earlier versions of the paper.

Conflict of Interest: None to declare.

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Omariba, D.W.R., Ross, N.A., Sanmartin, C. et al. Neighbourhood immigrant concentration and hospitalization: A multilevel analysis of cardiovascular-related admissions in Ontario using linked data. Can J Public Health 105, e404–e411 (2014). https://doi.org/10.17269/cjph.105.4616

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  • DOI: https://doi.org/10.17269/cjph.105.4616

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