title: Describing the linkages of the immigration, refugees and citizenship Canada permanent resident data and vital statistics death registry to Ontario's administrative health database.
abstract: Ontario, the most populous province in Canada, has a universal healthcare system that routinely collects health administrative data on its 13 million legal residents that is used for health research. Record linkage has become a vital tool for this research by enriching this data with the Immigration, Refugees and Citizenship Canada Permanent Resident (IRCC-PR) database and the Office of the Registrar General's Vital Statistics-Death (ORG-VSD) registry. Our objectives were to estimate linkage rates and compare characteristics of individuals in the linked versus unlinked files.
  
  
  
  We used both deterministic and probabilistic linkage methods to link the IRCC-PR database (1985-2012) and ORG-VSD registry (1990-2012) to the Ontario's Registered Persons Database. Linkage rates were estimated and standardized differences were used to assess differences in socio-demographic and other characteristics between the linked and unlinked records.
  
  
  
  The overall linkage rates for the IRCC-PR database and ORG-VSD registry were 86.4 and 96.2 %, respectively. The majority (68.2 %) of the record linkages in IRCC-PR were achieved after three deterministic passes, 18.2 % were linked probabilistically, and 13.6 % were unlinked. Similarly the majority (79.8 %) of the record linkages in the ORG-VSD were linked using deterministic record linkage, 16.3 % were linked after probabilistic and manual review, and 3.9 % were unlinked. Unlinked and linked files were similar for most characteristics, such as age and marital status for IRCC-PR and sex and most causes of death for ORG-VSD. However, lower linkage rates were observed among people born in East Asia (78 %) in the IRCC-PR database and certain causes of death in the ORG-VSD registry, namely perinatal conditions (61.3 %) and congenital anomalies (81.3 %).
  
  
  
  The linkages of immigration and vital statistics data to existing population-based healthcare data in Ontario, Canada will enable many novel cross-sectional and longitudinal studies to be conducted. Analytic techniques to account for sub-optimal linkage rates may be required in studies of certain ethnic groups or certain causes of death among children and infants.
authors: Institute for Clinical Evaluative Sciences, G-106, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
authors: Maria
authors: M
authors: Chiu
authors: Institute for Clinical Evaluative Sciences, G-106, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
authors: Michael
authors: M
authors: Lebenbaum
authors: Canadian Institute For Health Information, 4110 Yonge Street, Suite 300, Toronto, ON, M2P 2B7, Canada.
authors: Kelvin
authors: K
authors: Lam
authors: Institute for Clinical Evaluative Sciences, G-106, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
authors: Nelson
authors: N
authors: Chong
authors: Institute for Clinical Evaluative Sciences, G-106, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
authors: Mahmoud
authors: M
authors: Azimaee
authors: College of Physicians & Surgeons of Ontario, 80 College Street, Toronto, ON, M5G 2E2, Canada.
authors: Karey
authors: K
authors: Iron
authors: Ottawa Hospital Research Institute, 725 Parkdale Ave, Ottawa, ON, K1Y 4E9, Canada.
authors: Doug
authors: D
authors: Manuel
authors: Institute for Clinical Evaluative Sciences, G-106, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada. astrid.guttmann@ices.on.ca.
authors: Astrid
authors: A
authors: Guttmann
mesh_terms: D002170:Canada; D002423:Cause of Death; D016208:Databases, Factual / Q000706:statistics & numerical data*; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D006801:Humans; D008498:Medical Record Linkage; D009864:Ontario; D012036:Refugees / Q000706:statistics & numerical data*; D012042:Registries / Q000706:statistics & numerical data*
keywords: Health Administrative Data; Immigrant and refugee data; Record linkage; Vital statistics death data