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Raza MA, Aziz S, Iftikhar D, Anjum I, Fialova D. Addressing quality medication use among migrant patients: Establishment of an organization to provide culturally competent medication care. Saudi Pharm J 2024; 32:101922. [PMID: 38318317 PMCID: PMC10840353 DOI: 10.1016/j.jsps.2023.101922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 12/12/2023] [Indexed: 02/07/2024] Open
Abstract
As the global landscape continues to witness an increase in migration, the healthcare community faces an evolving challenge: the provision of quality medication care to migrant patients. Language barriers, cultural differences, and a lack of understanding of the local healthcare system can often impede the effective management of medications and access to healthcare services among migrant populations. Pharmacists, as medication experts, are dignified to make a substantial impact in bridging the gap between migrants and quality healthcare. Their expertise in medication management, accessibility, and counseling positions them as critical healthcare providers for this patient population. Pharmacies and pharmacists can serve as trusted hubs where migrants receive not only essential medications but also culturally sensitive support in navigating the healthcare system. This commentary article highlights the critical importance of culturally competent medication care for migrant patients and the central role that pharmacists can play in this endeavor. By establishing organization dedicated to this cause lead by pharmacists, we can not only address an urgent healthcare concern but also set a precedent for a healthcare system that values inclusivity, cultural competence, and equitable access to quality medication care for all, regardless of their cultural background.
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Affiliation(s)
- Muhammad Ahmer Raza
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University in Prague, Czech Republic
| | - Shireen Aziz
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University in Prague, Czech Republic
| | | | - Irfan Anjum
- Department of Basic Medical Sciences, Shifa College of Pharmaceutical Sciences, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Daniela Fialova
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University in Prague, Czech Republic
- Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
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Bawatneh A, Darwish A, Eideh H, Darwish HM. Identification of gene mutations associated with type 1 diabetes by next-generation sequencing in affected Palestinian families. Front Genet 2024; 14:1292073. [PMID: 38274107 PMCID: PMC10808782 DOI: 10.3389/fgene.2023.1292073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 12/04/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction: Diabetes Mellitus is a group of metabolic disorders characterized by hyperglycemia secondary to insulin resistance or deficiency. It is considered a major health problem worldwide. T1DM is a result of a combination of genetics, epigenetics, and environmental factors. Several genes have been associated with T1DM, including HLA, INS, CTLA4, and PTPN22. However, none of these findings have been based on linkage analysis because it is rare to find families with several diabetic individuals. Two Palestinian families with several afflicted members with variations in the mode of inheritance were identified and selected for this study. This study aimed to identify the putative causative gene(s) responsible for T1DM development in these families to improve our understanding of the molecular genetics of the disease. Methods: One afflicted member from each family was selected for Whole-Exome Sequencing. Data were mapped to the reference of the human genome, and the resulting VCF file data were filtered. The variants with the highest phenotype correlation score were checked by Sanger sequencing for all family members. The confirmed variants were analyzed in silico by bioinformatics tools. Results: In one family, the IGF1R p.V579F variant, which follows autosomal dominant inheritance, was confirmed and segregated in the family. In another family, the NEUROD1 p.P197H variant, which follows autosomal recessive inheritance, was positively confirmed and segregated. Conclusion: IGF1R p.V579F and NEUROD1 p.P197H variants were associated with T1DM development in the two inflicted families. Further analysis and functional assays will be performed, including the generation of mutant model cell systems, to unravel their specific molecular mechanism in the disease development.
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Affiliation(s)
- Abrar Bawatneh
- Molecular Genetics and Genetics Toxicology Program, Faculty of Graduate Studies, Arab American University, Jenin, Palestine
| | - Alaa Darwish
- Faculty of Health Professions, AlQuds University, Jerusalem, Palestine
| | | | - Hisham M. Darwish
- Molecular Genetics and Genetics Toxicology Program, Faculty of Graduate Studies, Arab American University, Jenin, Palestine
- Faculty of Allied Medical Sciences, Arab American University, Jenin, Palestine
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Tremblay J, Hamet P. Environmental and genetic contributions to diabetes. Metabolism 2019; 100S:153952. [PMID: 31610851 DOI: 10.1016/j.metabol.2019.153952] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 07/18/2019] [Accepted: 07/18/2019] [Indexed: 01/18/2023]
Abstract
Diabetes mellitus (DM) is a heterogeneous group of disorders characterized by persistent hyperglycemia. Its two most common forms are type 1 diabetes (T1D) and type 2 diabetes (T2D), for which genetic and environmental risk factors act in synergy. Because it occurs in children and involves infectious, autoimmune or toxic destruction of the insulin-secreting pancreatic beta-cells, type 1 diabetes has been called juvenile or insulin-deficient diabetes. In type 2, patients can still secrete some insulin but its effectiveness may be attenuated by 'insulin resistance.' There is also a group of rare forms of diabetes in the young which are inherited as monogenetic diseases. Whether one calls the underlying process 'genes vs. environment' or 'nature vs nurture', diabetes occurs at the interface of the two domains. Together with our genetic background we are born tabula rasa-a blank slate upon which the story of life, with all its environmental inputs will be written. There is one proviso: the influence of epigenetic inheritance must also be considered. Thus, in the creation of databases that include "big data" originating from genomic as well as exposome (defined as: the totality of environmental exposure from conception to death), a broad perspective is crucial as these factors act in concert in such chronic illnesses as diabetes that, for example, are likely to require adoption of an appropriate lifestyle change. Also, it is becoming increasingly evident that epigenetic factors can modulate the interplay between genes and environment. Consequently, throughout the life of an individual nature and nurture interact in a complex manner in the development of diabetes. This review addresses the question of the contribution of gene and environment and their interactions in the development of diabetes.
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Affiliation(s)
- Johanne Tremblay
- CRCHUM Research Center, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Pavel Hamet
- CRCHUM Research Center, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
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Immigration factors and potentially avoidable hospitalizations in Canada. SSM Popul Health 2018; 7:100336. [PMID: 30581968 PMCID: PMC6299159 DOI: 10.1016/j.ssmph.2018.100336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 12/03/2018] [Accepted: 12/06/2018] [Indexed: 11/22/2022] Open
Abstract
Objective Estimate the effect of immigration characteristics on the risk of a hospitalization for an ambulatory care sensitive condition (ACSC). Research design We analyzed data on the Canadian resident adult population aged 18 to 74 years who responded to the 2006 long form Census. The Census data were linked to the Canadian Institute for Health Information (CIHI)’s Discharge Abstract Database (DAD) for fiscal years 2006–2007, 2007–2008, and 2008–2009. We conducted a logistic regression on the binary variable we created for an ACSC admission. Measures The CIHI definition of ACSC hospitalizations was used to identify potentially avoidable hospitalizations in the DAD. Immigration factors analyzed included years in Canada, ethnic origin, and ability to speak one of the official languages. Results There were 3,342,450 respondents aged between 18 and 74. Using the Canadian at birth as our reference population, recent immigrants (up to five years in Canada) had lower odds of an ACSC hospitalization, regardless of their ethnic origins, with the exception of immigrants from Oceania and from other North American countries for whom the effect was not significant. The protective effect was still present in children of immigrants (AOR=0.89). Immigrants from the Caribbean, from Southern, Eastern, and Western Europe, as well as those from East Asia had lower odds across categories of time spent in Canada. The protective effect was stronger in immigrants from East Asia and lower in those of Oceanic and other North American countries. Conclusions Our results suggest that the healthy immigrant effect dissipates with time in Canada but remains even in children of immigrants. The protective effect differs depending on the ethnic origin of the immigrant. Immigrants generally arrive in a country with a higher health status than that of the local population. Immigrants and children of immigrants have lower odds of having an ACSC hospitalization are lower than Canadians at birth. Odds of an ACSC hospitalization vary depending on immigration characteristics such as the ethnic origin and the time lived in Canada.
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Building Social Capital Through a Peer-Led Community Health Workshop: A Pilot with the Bhutanese Refugee Community. J Community Health 2018; 41:509-17. [PMID: 26578350 DOI: 10.1007/s10900-015-0124-z] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Despite the high health and mental health care needs, resettled refugees often face cultural and linguistic challenges that hinder the access to appropriate and timely interventions and services. Additionally, such concepts as preventive health or mental health treatment are foreign to this population, which creates additional burdens to the refugee community that already have difficulty navigating a complex health care system in the U.S. To address multiple and complex gaps in health and mental health support for the refugee community, requested is an innovative approach that can convey culturally responsive and effective interventions for health promotion, such as peer-based health education. Few studies have been conducted on the effectiveness of peer-led community health interventions with refugee populations in the U.S. resettlement context. However, peer-led interventions have been shown to be effective when working with cultural minorities and interventions in an international context. Adopting a social capital framework, the current study conducted qualitative evaluation on the impact of a pilot peer-led community health workshop (CHW) in the Bhutanese refugee community. A hybrid thematic analysis of focus group discussion data revealed the improvement in health promotion outcomes and health practice, as well as perceived emotional health. The results also showed that the peer-led CHW provided a platform of community building and participation, while increasing a sense of community, sense of belonging and unity. The findings posit that a peer-led intervention model provides culturally responsive and effective tools for building social capital and promoting community health in the refugee community.
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Okrainec K, Booth GL, Hollands S, Bell CM. Language Barriers Among the Foreign-Born in Canada: Agreement of Self-Reported Measures and Persistence Over Time. J Immigr Minor Health 2017; 19:50-56. [PMID: 26395900 DOI: 10.1007/s10903-015-0279-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Persistent language barriers are associated with poor health outcomes. The agreement between reporting a language barrier at time of immigration and in the 2007-2008 Canadian Community Health Survey (CCHS) was calculated using kappa scores among foreign-born individuals who arrived to Ontario, Canada between 1985 and 2005. A total of 2323 immigrants were included, with a mean (± SD) time of 10.2 ± 6.4 years between immigration and completing the CCHS. Only 6 % of immigrants reported a persistent language barrier, resulting in a low agreement between the two sources (kappa = 0.06, 95 % CI 0.042-0.086). Though immigrants were less likely to report a persistent language barrier the longer they had been in Canada, only 13 % of immigrants who had arrived <2 years ago reported one. Self-reported language barriers at time of immigration are poor indicators of persistent language barriers. There is a need for a better measure of language barriers among Canadian immigrants.
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Affiliation(s)
- Karen Okrainec
- Toronto Western Hospital, University Health Network, 399 Bathurst Street, 8EW-432E, Toronto, ON, M5T 2S8, Canada. .,Samuel Lunenfeld Research Institute of Mount Sinai Hospital, Toronto, ON, Canada.
| | - Gillian L Booth
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Simon Hollands
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Chaim M Bell
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Samuel Lunenfeld Research Institute of Mount Sinai Hospital, Toronto, ON, Canada
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Beig J, Khanolkar M, Cundy T. Type 2 diabetes in young adults in Central Auckland: demography and complications. Intern Med J 2017; 48:67-73. [PMID: 28967170 DOI: 10.1111/imj.13623] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 09/18/2017] [Accepted: 09/21/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Type 2 diabetes (T2D) in young adults is associated with a high risk of diabetes complications. AIMS To investigated the demography and the emergence of complications of young adults with T2D in the central Auckland region where there has been substantial immigration. METHODS In total, 310 young adults with T2D (<40 years) were registered with the Auckland Diabetes Centre in 2015. We documented demographic, anthropometric and metabolic variables and prevalence and the emergence of complications. RESULTS Three demographic groups accounted for 243 participants (78%): 135 (44%) were migrants of Asian or Pacific Island origin, diagnosed a median 9 years after migration at a mean age of 28 ± 6 years; 88 (29%) were New Zealand-born Pāsifika descent, with a high prevalence of morbid obesity and 37 (12%) had major mental illness or intellectual disability. At diagnosis, the median HbA1c was 80 mmol/mol, and in 28%, it was ≥100 mmol/mol. A median 6 years after diagnosis, 56% had some degree of retinopathy, with the prevalence related both to the duration of diabetes and glycaemic control (P = 0.001). Forty-four percent of subjects had abnormal albuminuria at diagnosis (12% with macroalbuminuria). Increased albuminuria was strongly associated with obesity (P = 0.002). The development of CKD stages 4-5 was related both to the severity of retinopathy and degree of albuminuria at diagnosis (P = 0.0001). Major cardiovascular events were related to the severity of retinopathy at diagnosis (P = 0.0001). CONCLUSIONS New migrants, New Zealand-born Pāsifika and patients with mental illness or an intellectual disability comprise the bulk of young onset T2D. The disease is aggressive, and by the age of 40, patients are already developing advanced complications.
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Affiliation(s)
- Junaid Beig
- Auckland Diabetes Centre, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | - Manish Khanolkar
- Auckland Diabetes Centre, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | - Tim Cundy
- Auckland Diabetes Centre, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
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Dirani M, Dang TM, Xie J, Gnanasekaran S, Nicolaou T, Rees G, Fenwick E, Lamoureux EL. Study methodology and diabetes control in patients from the non-English diabetes management project (NEDMP). Clin Exp Ophthalmol 2016; 45:160-167. [PMID: 27455413 DOI: 10.1111/ceo.12807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/23/2016] [Accepted: 07/19/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND To describe the clinical characteristics of non-English speaking patients from the Diabetes Management Project (NEDMP), and compare their diabetes management and severity of diabetic retinopathy (DR) with the English-speaking DMP sample (EDMP). DESIGN A prospective study was conducted on non-English speaking adults with diabetes who attended the Royal Victorian Eye and Ear Hospital. PARTICIPANTS 136 (90.1%) non-English speaking adults were assessed, with a mean age of 72.2 years (range: 50-88 years); 74 (54.4%) were male. METHODS Participants completed interviewer-administered questionnaires and underwent visual acuity, fundus photography, optical coherence tomography, biochemistry and anthropometric measurements. The EDMP assessed 609 patients in 2009 using a similar protocol. MAIN OUTCOME MEASURES Type and duration of diabetes, diabetes control and diabetic retinopathy. RESULTS A total of 127 (93.4%) and 8 (5.9%) participants reported having type 2 and type 1 diabetes, respectively, with a median (IQR) duration of 17 (14) years. The proportion of patients with poor diabetes control (HbA1c ≥ 7%) in the NEDMP was similar to the EDMP (64.0% and 68.2%, respectively; P = 0.411). A significantly higher proportion of patients with DR in the NEDMP were found to have poor diabetes control (HbA1c ≥ 7%) compared to those without DR (80.9% vs. 50.0%, P = 0.003). Almost two-thirds of NEDMP patients (74/118) had DR and 23% (27/115) had diabetic macular edema. The prevalence of DR was similar between the NEDMP and EDMP studies, ranging from 25-30% and 28-29%. CONCLUSIONS The clinical characteristics, diabetes control, and DR severity of English and non-English-speaking patients were similar. The high proportion of poor diabetes management in non-English speaking patients with DR suggests educational and behavioural interventions to improve glycaemic control are warranted.
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Affiliation(s)
- Mohamed Dirani
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye & Ear Hospital, East Melbourne, Victoria, Australia
| | - Trung M Dang
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye & Ear Hospital, East Melbourne, Victoria, Australia
| | - Jing Xie
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye & Ear Hospital, East Melbourne, Victoria, Australia
| | - Sivashanth Gnanasekaran
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye & Ear Hospital, East Melbourne, Victoria, Australia
| | - Theona Nicolaou
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye & Ear Hospital, East Melbourne, Victoria, Australia
| | - Gwyneth Rees
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye & Ear Hospital, East Melbourne, Victoria, Australia
| | - Eva Fenwick
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye & Ear Hospital, East Melbourne, Victoria, Australia.,Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Duke-NUS Medical School, Singapore
| | - Ecosse L Lamoureux
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye & Ear Hospital, East Melbourne, Victoria, Australia.,Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Department of Ophthalmology, National University of Singapore and National University Health System, Singapore.,Duke-NUS Medical School, Singapore
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Merry L, Semenic S, Gyorkos TW, Fraser W, Small R, Gagnon AJ. International migration as a determinant of emergency caesarean. Women Birth 2016; 29:e89-e98. [PMID: 27150314 DOI: 10.1016/j.wombi.2016.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 11/20/2015] [Accepted: 04/01/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND High caesarean rates are of concern given associated risks. International migrant women (women born abroad) represent a substantial proportion of women giving birth in high-income countries (HICs) and face social conditions that may exacerbate childbearing health risks. Among migrant women, emergency rather than planned caesareans, tend to be more prevalent. This method of delivery can be stressful, physically harmful and result in an overall negative birth experience. Research establishing evidence of risk factors for emergency caesareans in migrants is insufficient. AIMS (1) Describe potential pathways (with a focus on modifiable factors) by which migration, using internationally recommended migration indicators: country of birth, length of time in country, fluency in receiving-country language, migration classification and ethnicity, may lead to emergency caesarean; and (2) propose a framework to guide future research for understanding "potentially preventable" emergency caesareans in migrant women living in HICs. DISCUSSION "Potentially preventable" emergency caesareans in migrant women are likely due to several modifiable, interrelated factors pre-pregnancy, during pregnancy and during labour. Migration itself is a determinant and also shapes other determinants. Complications and ineffective labour progress and/or foetal distress and ultimately the decision to perform an emergency caesarean may be the result of poor health (i.e., physiological effects), lack of support and disempowerment (i.e., psychological effects) and sub-optimal care. CONCLUSION Understanding the direct and indirect effects of migration on emergency caesarean is crucial so that targeted strategies can be developed and implemented for reducing unnecessary caesareans in this vulnerable population.
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Affiliation(s)
- Lisa Merry
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada.
| | - Sonia Semenic
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada; Women's Health Mission, McGill University Health Centre (MUHC), Montreal, Quebec, Canada
| | - Theresa W Gyorkos
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada; Division of Clinical Epidemiology, McGill University Health Centre (MUHC), Montreal, Quebec, Canada
| | - William Fraser
- Centre hospitalier universitaire de Sherbrooke (CHUS) Research Centre, Sherbrooke, Quebec, Canada; Department of Obstetrics and Gynecology, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Rhonda Small
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Anita J Gagnon
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada; The Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Quebec, Canada
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Okrainec K, Booth GL, Hollands S, Bell CM. Impact of language barriers on complications and mortality among immigrants with diabetes: a population-based cohort study. Diabetes Care 2015; 38:189-96. [PMID: 25028526 DOI: 10.2337/dc14-0801] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Our objective was to examine the effect of language barriers on the risk of acute and chronic complications of diabetes and on mortality among immigrants. RESEARCH DESIGN AND METHODS Linked health and immigration databases were used to identify 87,707 adults with diabetes who immigrated to Ontario, Canada, between 1985 and 2005. These individuals were included in our cohort and stratified by language ability at the time of their immigration application. Primary end points included: one or more emergency department visit or hospitalization for 1) hypo- or hyperglycemia, skin and soft tissue infection, or foot ulcer and 2) a cardiovascular event or death between April 1, 2005, and February 29, 2012. RESULTS Our cohort was followed up for a median of 6.9 person-years. Immigrants with language barriers were older (mean age, 49 ± 15 vs. 42 ± 13 years; P < 0.001), more likely to have immigrated for family reunification (66% vs. 38%, P < 0.001), had less education (secondary school or less and no education, 82% vs. 53%; P < 0.001), and a higher use of health care (mean visits, 8.6 ± 12.1 vs. 7.8 ± 11.2; P < 0.001). Immigrants with language barriers were not found to have higher adjusted rates of diabetes complications (acute complications: hazard ratio [HR] 0.99, 95% CI 0.93-1.05; cardiovascular events or death: HR 0.95, 95% CI 0.91-0.99). Significant predictors included older age, being unmarried, living in a rural neighborhood, and having less education. Immigrants who were older (≥65 years) and who had arrived through family reunification had a lower risk of cardiovascular events or death (HR 0.88, 95% CI 0.81-0.96). CONCLUSIONS In a heterogenous immigrant population with universal insurance, language barriers were not found to increase the risk of diabetes complications. However, their effect may vary based on age at time of landing, education level, marital status, and neighborhood of settlement.
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Affiliation(s)
- Karen Okrainec
- University Health Network, Toronto, ON, Canada Mount Sinai Hospital and Samuel Lunenfeld Research Institute of Mount Sinai Hospital, Toronto, ON, Canada
| | - Gillian L Booth
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Simon Hollands
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Chaim M Bell
- Mount Sinai Hospital and Samuel Lunenfeld Research Institute of Mount Sinai Hospital, Toronto, ON, Canada Institute for Clinical Evaluative Sciences, Toronto, ON, Canada Department of Medicine, University of Toronto, Toronto, ON, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Abstract
OBJECTIVE Avoidable mortality is a well-recognized, but less studied indicator of the performance of the health system. First, the study seeks to establish whether immigrants overall and selected foreign-born ethnic groups (Western Europeans, South Asians, Chinese, and Filipinos) have an advantage over nonimmigrants in avoidable mortality. Second, it assesses the effect of sociodemographic and socioeconomic factors on any observed differences by duration of residence. DESIGN Deaths grouped by cause of death and by behavioral risk factors, namely smoking-related and alcohol-related, were derived from the 1991 Canadian Census Cohort: Mortality and Cancer Follow-up. The analysis estimated age-standardized mortality rates (ASMRs), rate ratios, and rate differences and also fitted hazard regression models for the overall Canadian-born population and for selected foreign-born ethnicities by sex. Predictors were assessed at baseline. RESULTS Compared to the Canadian-born persons, foreign-born men and women had lower ASMRs for overall avoidable mortality and also for selected causes of avoidable mortality. The only exception to this overall trend was for ischemic heart disease among South Asian women. Except for the order of prominence, the three leading causes of death for nonimmigrant and immigrant men and women overall were ischemic heart diseases, smoking-related diseases, and neoplasms. A similar pattern was observed among the ethnic groups, except for circulatory heart diseases replacing ischemic heart diseases and smoking-related diseases among Chinese and Filipino women, respectively. In the hazard regression analysis, the risk of avoidable mortality was lower for immigrants overall and selected ethnicities irrespective of the duration in Canada compared to nonimmigrants. These differences persisted even with adjustment for sociodemographic and socioeconomic factors. CONCLUSION Immigrants overall and the selected ethnicities enjoy an advantage over nonimmigrants in avoidable mortality. However, for certain causes of death especially ischemic heart disease mortality among South Asian women, immigrants appeared worse-off than nonimmigrants. The results suggest differential access to and use of health services, differences in protective health-related behavior, and the healthy immigrant effect.
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Omariba DWR, Ng E, Vissandjée B. Differences between immigrants at various durations of residence and host population in all-cause mortality, Canada 1991–2006. Population Studies 2014; 68:339-57. [DOI: 10.1080/00324728.2014.915050] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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13
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Self-reported use of diabetes healthcare services in a Quebec community-based sample: impact of depression status. Public Health 2014; 128:63-9. [DOI: 10.1016/j.puhe.2013.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 03/08/2013] [Accepted: 06/06/2013] [Indexed: 11/18/2022]
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14
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Patient barriers to insulin use in multi-ethnic populations. Can J Diabetes 2013; 37:202-4. [PMID: 24070844 DOI: 10.1016/j.jcjd.2013.02.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 01/23/2013] [Accepted: 02/14/2013] [Indexed: 01/18/2023]
Abstract
Insulin administration is often required in the management of type 2 diabetes mellitus for optimal glycemic control. Despite this, however, many patients are reluctant to initiate insulin treatment. In the general population, there are multiple factors leading to this reluctance including fear of hypoglycemia, needle phobia and weight gain. These barriers are also present in multi-ethnic populations. However, there are several patient barriers that are more prevalent in various ethnic backgrounds that need to be addressed. These barriers include language barriers, poor health literacy, social factors and religious implications. The awareness of these factors as well as potential strategies to help overcome them can lead to the improved management of patients with diabetes from multi-ethnic populations.
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