Neighbourhood Recent Immigration and Hospitalization in Toronto, Canada

Article excerpt

ABSTRACT

Recent immigrants to Canada tend to initially settle in low-income urban core areas. The relationships among immigration, neighbourhood effects and health are poorly understood. This study explored the risk of hospitalization in high recent-immigration areas in Toronto compared to other Toronto neighbourhoods. The study used 1996 hospitalization and census data. Regression was used to examine the effects of recent immigration on neighbourhood hospitalization rates. Most hospitalization categories showed significantly higher rates of admission as the proportion of recent immigrants increased. Income was also significantly associated with all categories of hospitalization except surgical admissions. Average household income was almost 60% lower ($36,122) in the highest versus the lowest immigration areas ($82,641) suggesting that, at the neighbourhood level, the effects of immigration and income may be difficult to disentangle. These findings have important implications for health care planning, delivery, and policy.

Half of all new immigrants to Canada, i.e., approximately 100,000-125,000 annually, settle in or near Toronto, Ontario.1,2 One in eight of Toronto's residents are recent immigrants, having arrived in Canada in the last five years. Recent immigrants can face unique hardships associated with emigration, adjustment, and integration into society. Socio-economic factors likely play a major role, but other aspects of migration may have an impact on newcomers' health and create special needs for health services as well as barriers to accessing health care. The impact that immigration has on health and the use of health services by both individuals and areas experiencing high levels of recent immigration is not fully understood.

Canadian studies have shown varying results regarding the health services utilization of recent immigrants. Depending on the type of service used, circumstances of migration, country of origin, sex and socio-economic status, studies have shown both similar utilization as well as lower utilization by recent immigrants as compared to Canadian-born populations. 3-13 Most earlier studies, however, did not satisfactorily differentiate between recent and nonrecent immigrants, and thus may not have captured the immediate health effects of recent immigration and resettlement. As well, many previous studies used selfreported use of the health care system, which often makes use of proxy respondents.9,10 Only one study, conducted in British Columbia and Manitoba, looked at hospital utilization among recent immigrants.11 This study found that in general, hospitalization rates for both sexes were significantly lower than tor the Canadianborn population. Hospitalization data are able to give an objective measure of health care use that is independent of self-report.

Despite evidence that immigrants to Canada may experience a "healthy immigrant effect", there have been few studies looking at the area-level health characteristics of high-immigration neighbourhoods. Increasingly, studies have shown that the "contextual" neighbourhood effects of poverty may influence the health and health behaviours of individuals.14-18 Some studies, particularly in the US, have looked at neighbourhood effects by race.14,19 Little attention has been paid, however, to the contextual effects of immigration on neighbourhood health and health behaviours. One American study found that women living in areas with a high proportion of recent immigrants were less likely to have had clinical breast exams and Pap smears.20

The purpose of this study is to examine the use of hospital inpatient services in high recent-immigration areas in Toronto, to more fully understand the health care needs of these areas. The results are interpreted in the context of the socioclemographic characteristics of those neighbourhoods that may most influence health and health care utilization.

AREA OF RESEARCH

Setting

The geographic area covered by this study consists of the central southern portion of the amalgamated city of Toronto, Ontario, including the city's downtown core. …