All-cause and circulatory disease-related hospitalization, by generation status: Evidence from linked data.
BACKGROUND
Immigrants tend to have better health than the Canadian-born. However, the "healthy immigrant" effect diminishes over time and varies by source country. This study examines whether lower hospitalization rates persist from the first (G1) to the second generation (G2) of immigrants, compared with other Canadians (G3+). All-cause and circulatory disease-related hospitalization rates were examined by generation, with special attention to people of Chinese and South Asian descent.


METHODS
Data from the 2006 Census-hospitalization linkage database (which excludes Quebec) were analysed using logistic regression. Age-standardized all-cause (excluding pregnancy) and circulatory disease-related hospitalization rates were derived for the urban population aged 30 or older for the 2006/2007 to 2008/2009 fiscal years.


RESULTS
Over the generations, immigrants' all-cause and circulatory disease-related hospitalization rates converged with those of the Canadian population overall. Compared with G3+, the age-adjusted odds of all-cause hospitalization among men were 0.49 (CI = 0.48-0.51) for recent G1 immigrants, 0.78 (CI = 0.77-0.79) for long-term G1 immigrants, and 0.95 (CI = 0.94-0.97) for G2. Adjustments for socioeconomic status reduced the difference, especially between G2 and G3+. For South Asians, rates converged for circulatory disease, notably among men. Hospitalization rates for people of Chinese descent rose across generations, but remained significantly below rates for G3+.


CONCLUSIONS
The lower circulatory disease-related hospitalization risk experienced by G1 is maintained in G2 among people of Chinese descent, but not among South Asians.
Health Analysis Division, Statistics Canada, Ottawa, Ontario.
Edward
E
Ng
Health Analysis Division, Statistics Canada, Ottawa, Ontario.
Claudia
C
Sanmartin
Institute for Clinical Evaluative Studies and the University of Toronto, Toronto, Ontario.
Jack V
JV
Tu
Health Analysis Division, Statistics Canada, Ottawa Health Research Institute and the University of Ottawa, Ottawa, Ontario.
Douglas G
DG
Manuel
D000328:Adult; D000368:Aged; D001210:Asia, Southeastern / Q000208:ethnology; D002170:Canada / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000208:ethnology*; D019352:Censuses; D002681:China / Q000208:ethnology; D054242:Emigrants and Immigrants; D005191:Family Characteristics / Q000208:ethnology*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016247:Information Storage and Retrieval / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011634:Public Health; D012923:Social Class
Cardiovascular diseases; Chinese; South Asian; census; data linkage; hospital records; immigrant health; medical records; socioeconomic status