The Incidence of Major Cardiovascular Events in Immigrants to Ontario, Canada: The CANHEART Immigrant Study.
Immigrants from ethnic minority groups represent an increasing proportion of the population in many high-income countries but little is known about the causes and amount of variation between various immigrant groups in the incidence of major cardiovascular events.



We conducted the Cardiovascular Health in Ambulatory Care Research Team (CANHEART) Immigrant study, a big data initiative, linking information from Citizenship and Immigration Canada's Permanent Resident database to nine population-based health databases. A cohort of 824 662 first-generation immigrants aged 30 to 74 as of January 2002 from eight major ethnic groups and 201 countries of birth who immigrated to Ontario, Canada between 1985 and 2000 were compared to a reference group of 5.2 million long-term residents. The overall 10-year age-standardized incidence of major cardiovascular events was 30% lower among immigrants compared with long-term residents. East Asian immigrants (predominantly ethnic Chinese) had the lowest incidence overall (2.4 in males, 1.1 in females per 1000 person-years) but this increased with greater duration of stay in Canada. South Asian immigrants, including those born in Guyana had the highest event rates (8.9 in males, 3.6 in females per 1000 person-years), along with immigrants born in Iraq and Afghanistan. Adjustment for traditional risk factors reduced but did not eliminate differences in cardiovascular risk between various ethnic groups and long-term residents.



Striking differences in the incidence of cardiovascular events exist among immigrants to Canada from different ethnic backgrounds. Traditional risk factors explain part but not all of these differences.
Institute for Clinical Evaluative Sciences; Schulich Heart Centre, Sunnybrook Health Sciences Centre; University of Toronto, Toronto, Ontario, Canada tu@ices.on.ca.
Jack V
JV
Tu
Institute for Clinical Evaluative Sciences & University of Toronto, Toronto, Ontario, Canada.
Anna
A
Chu
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Mohammad R
MR
Rezai
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Helen
H
Guo
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Laura C
LC
Maclagan
Institute for Clinical Evaluative Sciences & University of Toronto, Toronto, Ontario, Canada.
Peter C
PC
Austin
Institute for Clinical Evaluative Sciences; University of Toronto; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
Gillian L
GL
Booth
Institute for Clinical Evaluative Sciences, Toronto; University of Toronto, Toronto; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Douglas G
DG
Manuel
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Maria
M
Chiu
Institute for Clinical Evaluative Sciences; Schulich Heart Centre, Sunnybrook Health Sciences Centre; University of Toronto, Toronto, Ontario, Canada.
Dennis T
DT
Ko
Institute for Clinical Evaluative Sciences; University of Toronto; Peter Munk Cardiac Centre and Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada.
Douglas S
DS
Lee
Institute for Clinical Evaluative Sciences; University of Toronto; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Baiju R
BR
Shah
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Linda R
LR
Donovan
University of Toronto, Toronto, Ontario, Canada.
Qazi Zain
QZ
Sohail
Institute for Clinical Evaluative Sciences; University of Toronto; Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.
David A
DA
Alter
cardiovascular disease risk factors; ethnicity; immigrants; myocardial infarction; stroke