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Wanigaratne S, Shah B, Stukel TA, Lu H, Den Otter-Moore S, Shetty J, Saunders N, Gandhi S, Guttmann A. COVID-19 hospitalization, mortality and pre-mature mortality by a history of immigration in Ontario, Canada: a population-based cohort study. LANCET REGIONAL HEALTH. AMERICAS 2024; 34:100762. [PMID: 38779655 PMCID: PMC11109005 DOI: 10.1016/j.lana.2024.100762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 05/25/2024]
Abstract
Background Immigrants in high-income countries experienced inequities in COVID-19 severe outcomes. We examined hospitalization and death throughout the pandemic, and change during the vaccine era, in Ontario, Canada. Methods We conducted a population-based study using linked immigration and health data, following two cohorts for 20 months from January 1, 2020 (pre-vaccine) and September 1, 2021 (vaccine era). We used multivariable Poisson generalized estimating equation regression to estimate adjusted rate ratios (aRR) with 95% confidence intervals (CI), accounting for age, sex and co-morbidities. We calculated age-standardized years of life lost (ASYRs) rates by immigrant category. Findings Of 11,692,387 community-dwelling adults in the pre-vaccine era cohort and 11,878,304 community-dwelling adults in the vaccine era cohort, 21.6% and 21.4% of adults in each era respectively were immigrants. Females accounted for 57.9% and 57.8% of sponsored family, and 68.4% and 67.6% of economic caregivers, in each era respectively. Compared to other Ontarians in the pre-vaccine era cohort, hospitalization rates were highest for refugees (aRR [95% CI] 3.41 [3.39-3.44]) and caregivers (3.13 [3.07-3.18]), followed by sponsored family and other economic immigrants. Compared to other Ontarians, aRRs were highest for immigrants from Central America (5.00 [4.92-5.09]), parts of South Asia (3.95 [3.89-4.01]) and Jamaica (3.56 [3.51-3.61]) with East Asians having lower aRRs. Mortality aRRs were similar to hospitalization aRRs. In the vaccine era, all aRRs were attenuated and most were similar to or lower than other Ontarians, with refugees and a few regions maintaining higher rates. In the pre-vaccine era ASYRs were higher for all immigrant groups. ASYRs dropped in the vaccine era with only refugees continuing to have higher rates. Interpretation Immigrants, particularly refugees, experienced greater premature mortality. aRRs for most immigrant groups dropped substantially after high vaccine coverage was achieved. Vaccine outreach and improvements in the social determinants of health are needed. Funding Canadian Institutes of Health Research, Canada Research Chairs Program.
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Affiliation(s)
- Susitha Wanigaratne
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
| | - Baiju Shah
- ICES, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Therese A. Stukel
- ICES, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Canada
| | | | | | - Janavi Shetty
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
| | - Natasha Saunders
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | | | - Astrid Guttmann
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Niraula A, Ratti N, Colley M, Rosenberg M, Ghassemi E, Wilson K. Negotiating precarity: Recent immigrants' perceptions of waiting for public healthcare in Ontario, Canada. Health Policy 2023; 133:104843. [PMID: 37262964 DOI: 10.1016/j.healthpol.2023.104843] [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: 03/24/2022] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/03/2023]
Abstract
Canada is widely known for its universal publicly funded health care system. While its health care system is an important part of Canadian identity, recent immigrants living in some provinces and territories are not covered by the publicly funded healthcare system until they have met a minimum residency requirement. This article seeks to understand the multiple manifestations of financial and emotional precarity that recent immigrants face as they navigate a lack of access to health care during their first three months of arrival in Ontario. This paper draws on qualitative semi-structured interview data from 46 recent immigrants who came from 12 different countries and had been living in Ontario, Canada. We found that the wait period to obtain health care often added to the prohibitive costs associated with immigration and settlement. During the wait period, recent immigrants faced financial burdens and their inability to access publicly funded hospitals and medical services when needed which resulted in feelings of vulnerability, anxiety, and emotional hardship. Given the financial and emotional precarities faced by recent immigrants during the wait period, we argue that the Canadian 'universal' healthcare system excludes and creates barriers to timely and equitable access to healthcare services for recent immigrants. We recommend to permanently eliminate the wait period policy to ensure the health and wellbeing of recent immigrants.
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Affiliation(s)
- Ashika Niraula
- Canada Excellence Research Chair in Migration & Integration Program, Toronto Metropolitan University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada.
| | - Nicole Ratti
- York Region Transit, The Regional Municipality of York, 50 High Tech Rd, 4(th) Floor, Richmond Hill, ON L4B 4N7, Canada
| | - Michele Colley
- Dept. of Geography, Geomatics & Environment, University of Toronto, 3359 Mississauga Road, Mississauga, ON, L5L 1C6, Canada
| | - Mark Rosenberg
- Dept. of Geography and Planning, Queen's University, Kingston, Ontario, K7L 3N6, Canada
| | - Effat Ghassemi
- Newcomer Centre of Peel, 165 Dundas Street West, Suite 116, Mississauga, ON, L5B 2N6, Canada
| | - Kathi Wilson
- Dept. of Geography, Geomatics & Environment, University of Toronto, 3359 Mississauga Road, Mississauga, ON, L5L 1C6, Canada
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Lamb D, Banerjee R, Emanuel T. New Canadians Working amid a New Normal: Recent Immigrant Wage Penalties in Canada during the COVID-19 Pandemic. CANADIAN PUBLIC POLICY. ANALYSE DE POLITIQUES 2022; 48:60-78. [PMID: 38629967 PMCID: PMC10234262 DOI: 10.3138/cpp.2022-003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
The global coronavirus disease 2019 (COVID-19) pandemic has exposed and arguably intensified many existing inequalities. This analysis explores the relationship between recent immigrant earnings and the pandemic. Specifically, we attempt to empirically answer the question "Has the COVID-19 pandemic exacerbated (or mitigated) recent immigrant-non-immigrant employment and wage gaps?" We find that the pandemic did not change the labour force activity profile of recent or long-term immigrants. Moreover, the pandemic did not disproportionately disadvantage recent immigrants' earnings. In fact, recent immigrant men who were employed during the COVID-19 crisis experienced a small but statistically significant earnings premium. This was insufficient, however, to overcome the overall earnings discount associated with being a recent immigrant. In addition, we find that the recent immigrant COVID-19 earnings boost is observable only at and below the median of the earnings distribution. We also use Heckman selection correction to attempt to adjust for unobserved sample selection into employment during the pandemic. The fact that COVID-19 has not worsened recent immigrant earnings gaps should not overshadow the large, recent immigrant earnings disparities that existed before the pandemic and continue to exist regardless of the COVID-19 crisis.
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Affiliation(s)
- Danielle Lamb
- Ted Rogers School of Management, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Rupa Banerjee
- Ted Rogers School of Management, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Talia Emanuel
- Ted Rogers School of Management, Toronto Metropolitan University, Toronto, Ontario, Canada
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