title: Neighbourhood immigration, health care utilization and outcomes in patients with diabetes living in the Montreal metropolitan area (Canada): a population health perspective.
abstract: BACKGROUND
  Understanding health care utilization by neighbourhood is essential for optimal allocation of resources, but links between neighbourhood immigration and health have rarely been explored. Our objective was to understand how immigrant composition of neighbourhoods relates to health outcomes and health care utilization of individuals living with diabetes.
  
  
  METHODS
  This is a secondary analysis of administrative data using a retrospective cohort of 111,556 patients living with diabetes without previous cardiovascular diseases (CVD) and living in the metropolitan region of Montreal (Canada). A score for immigration was calculated at the neighbourhood level using a principal component analysis with six neighbourhood-level variables (% of people with maternal language other than French or English, % of people who do not speak French or English, % of immigrants with different times since immigration (<5 years, 5-10 years, 10-15 years, 15-25 years)). Dependent variables were all-cause death, all-cause hospitalization, CVD event (death or hospitalization), frequent use of emergency departments, frequent use of general practitioner care, frequent use of specialist care, and purchase of at least one antidiabetic drug. For each of these variables, adjusted odds ratios were estimated using a multilevel logistic regression.
  
  
  RESULTS
  Compared to patients with diabetes living in neighbourhoods with low immigration scores, those living in neighbourhoods with high immigration scores were less likely to die, to suffer a CVD event, to frequently visit general practitioners, but more likely to visit emergency departments or a specialist and to use an antidiabetic drug. These differences remained after controlling for patient-level variables such as age, sex, and comorbidities, as well as for neighbourhood attributes like material and social deprivation or living in the urban core.
  
  
  CONCLUSIONS
  In this study, patients with diabetes living in neighbourhoods with high immigration scores had different health outcomes and health care utilizations compared to those living in neighbourhoods with low immigration scores. Although we cannot disentangle the individual versus the area-based effect of immigration, these results may have an important impact for health care planning.
authors.affiliation: Département de médecine de famille et de médecine d'urgence, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 3001, 12th Avenue N, Sherbrooke, QC, J1H 5N4, Canada. alain.vanasse@usherbrooke.ca.|Groupe de recherche PRIMUS, Centre de recherche CHUS, Sherbrooke, QC, Canada. alain.vanasse@usherbrooke.ca.
authors.forename: Alain
authors.initials: A
authors.lastname: Vanasse
authors.affiliation: Groupe de recherche PRIMUS, Centre de recherche CHUS, Sherbrooke, QC, Canada. josiane.courteau@usherbrooke.ca.
authors.forename: Josiane
authors.initials: J
authors.lastname: Courteau
authors.affiliation: Groupe de recherche PRIMUS, Centre de recherche CHUS, Sherbrooke, QC, Canada. maria.gabriela.orzanco@usherbrooke.ca.
authors.forename: Maria Gabriela
authors.initials: MG
authors.lastname: Orzanco
authors.affiliation: Groupe de recherche PRIMUS, Centre de recherche CHUS, Sherbrooke, QC, Canada. patrick.bergeron@usherbrooke.ca.
authors.forename: Patrick
authors.initials: P
authors.lastname: Bergeron
authors.affiliation: Département de médecine de famille et de médecine d'urgence, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 3001, 12th Avenue N, Sherbrooke, QC, J1H 5N4, Canada. alan.cohen@usherbrooke.ca.|Groupe de recherche PRIMUS, Centre de recherche CHUS, Sherbrooke, QC, Canada. alan.cohen@usherbrooke.ca.
authors.forename: Alan A
authors.initials: AA
authors.lastname: Cohen
authors.affiliation: Spatial Epidemiology and Evaluation Research Group, Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia. Theo.Niyonsenga@unisa.edu.au.
authors.forename: Théophile
authors.initials: T
authors.lastname: Niyonsenga
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000628:therapy*; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D004641:Emigration and Immigration / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012959:Socioeconomic Factors
chemical_list: D007004:Hypoglycemic Agents