Cancer mortality among immigrant populations in Ontario, 1969 through 1973.

Ontario is home to a sizeable, recently established immigrant population whose cancer mortality has until now remained unexamined. The province''s six largest immigrant groups (British, Italian, German, Dutch, Polish and Soviet) were investigated to compare their cancer mortality experience with that prevailing in Ontario and in their countries of birth for the period 1969 through 1973. Standardized mortality ratios (SMRs) were computed from data from Statistics Canada and the World Health Organization (for 1971) for five sites of cancer. The rates of death from stomach cancer were significantly higher for the immigrant groups (except the Germans) than for the Canadian-born (SMRs 158.6 to 256.1) and were significantly lower for the immigrants (except the Dutch) than for the populations of their countries of birth (SMRs 26.5 to 72.9). The rates of death from colorectal cancer and cancer of the breast tended to be lower among the immigrants. Most male immigrants had high rates of death from lung cancer relative to the Canadian-born, whereas their female counterparts had relatively low rates. For most of the immigrant groups the rates of death from prostate cancer closely resembled those prevailing in the country of birth. Displacement of cancer mortality experience towards that in Ontario was most evident for Polish immigrants. It may have been too soon to see trends among the more recent immigrants (Italian, German and Dutch), who, for the most part, had not yet reached the age of highest cancer risk. Ontario should provide a valuable resource for further studies of lifestyle and environmental determinants of cancer.     

Sex differences in life expectancy in Canada: immigrant and native-born populations

A growing body of research often indicates that immigrant populations in Western countries enjoy a lower level of mortality in relation to their native-born host populations. In this literature, sex differences in mortality are often reported but substantive analyses of the differences are generally lacking. The present investigation looks at sex differences in life expectancy with specific reference to immigrant and Canadian-born populations in Canada during 1971 and 2001. For these two populations, sex differences in expectation of life at birth are decomposed into cause-of-death components. Immigrants in Canada have a higher life expectancy than their Canadian-born counterparts. In absolute terms, immigrant females enjoy the highest life expectancy. In relative terms, however, immigrant men show a larger longevity advantage, as their expectation of life at birth exceeds that of Canadian-born men by a wider margin than do foreign-born females in relation to Canadian-born females. It is also found that immigrants have a smaller sex differential in life expectancy as compared with the Canadian born. Decomposition analysis shows this is a function of immigrants having smaller sex differences in death rates from heart disease and cancer. Factors thought to underlie these differentials between immigrants and the Canadian born are discussed and suggestions for further research are given.     

Effect of changing mortality on the working life of American men and women, 1970–1990

Abstract

The mortality patterns of men and women of working age, in terms of the major causes of death, have changed over the past three decades. This study assesses the extent to which mortality among persons of working age represents an economic loss to society. This economic loss is measured by the per capita loss of productive working life, defined as the number of years, on the average, a person can expect to be an active member of the labor force. Causes of death affecting primarily older Americans (heart disease, cancer, stroke) had a relatively small and declining impact on the working lives of men and women. Major causes of death affecting the young (motor vehicle accidents, homicide, AIDS), although accounting for fewer deaths, were responsible for many more years of lost productivity. Gender and socioeconomic differentials in mortality suggest that different strategies are necessary for future reductions in lost work‐years.     

Mortality from unintentional injuries in California, 1985.

In 1985 unintentional injuries were the fourth leading cause of death among California residents, causing 10,380 deaths. They were the leading cause of potential life lost, accounting for 278,109 years lost. This was more than twice the number of years lost due to heart disease and 1 1/2 times the number lost due to cancer. Motor vehicle traffic accidents were the leading cause of unintentional injury deaths, accounting for half (5,158) the deaths. The next two leading causes were poisoning (especially for men aged 25 to 44 years) and falls (especially among persons aged 75 and older). Drowning was second to motor vehicle accidents as a cause of death in children aged 1 to 14 years. California''s age-adjusted injury mortality rates in 1985 were lower in coastal and urban counties than in inland and rural counties, and these rates were generally lower in counties having organized systems of trauma care.     

Patterns and determinants of immigrants’ sense of belonging to Canada and their source country

This study examines the relative distribution of immigrants who have: strong sense of belonging to both Canada and the source country; strong sense of belonging to Canada only; strong sense of belonging to the source country only; and weak sense of belonging to Canada and the source country. It further examines four sets of determinants of these acculturation profiles, including source-country socio-economic and cultural characteristics, immigrant entry status, post-migration experience, and demographic characteristics. Using a large national representative sample of 7,000 immigrants in Canada from over 100 countries, this study finds that the overwhelming majority of immigrants have a strong sense of belonging to Canada with or without a strong sense of belonging to their source country. Source-country attributes are as important as immigrant entry status and post-migration experience in affecting immigrants’ sense of belonging to Canada and their source country.     

Canadian Indian mortality during the 1980s

This study concerns itself with an investigation of general and cause-specific mortality differentials between Canadian Registered Indians (a subset of all aboriginals) and the larger Canadian population over two points in time, 1981 and 1991. Multivariate analyses are executed separately across four segments of the life cycle: adulthood, infancy, early childhood and late childhood. With respect to adults, Indians share relatively high rates of suicide, homicide and accidental causes of death; over time, their conditional risks of death due to cancer and circulatory afflictions have gone up significantly. Mortality disadvantages for the Indians are also pronounced in infancy, early childhood (ages 1-4) and late childhood (ages 5-14). Suicide, accidents, and violence constitute serious problems among 5-14 year olds, while infectious/parasitic, respiratory and circulatory complications, plus accidents and violence, are principle killers in infancy. For children aged 1-4, respiratory problems and accidents/violence are prime causes of premature death. This less-than-optimal mortality profile is reflective of persistent problems associated with prolonged socioeconomic marginalization. The temporal pattern of change in chronic/degenerative disease mortality among adult Indians suggests a movement of this population toward a mature stage of epidemiological transition.     

Sociocultural stress and the american native in Alaska: An analysis of changing patterns of psychiatric illness and alcohol abuse among Alaska natives

This paper presents selected morbidity and mortality statistics to outline developing trends and the current status of psychiatric illness and alcohol abuse among the Aleut, Athabascan, Yupik, Inupiat, Tlingit, Haida and Tsimpshian people of Alaska. Analysis of the records of the Indian Health Service, the Community Mental Health Centers and the Alaska Psychiatric Institute, the providers of care for Alaska Natives, shows that the number of individuals treated as inpatients and outpatients for psychiatric illness and alcohol abuse has been rising steadily. Accidental injury and suicidal behavior are common. The treated prevalence rates for these diagnoses exceed recorded rates for other American Native and non-Native groups. For each category of violent death, suicide, homicide, accidents and alcohol, rates for Alaska Natives are higher than rates for Alaska non-Natives, American Indians and the U.S. (all races) and are rising. The data suggest a public health problem in which the primary elements are behavioral disturbance and violent death.     

Heterosis and outbreeding depression in descendants of natural immigrants to an inbred population of song sparrows (Melospiza melodia)

We studied heterosis and outbreeding depression among immigrants and their descendants in a population of song sparrows on Mandarte Island, Canada. Using data spanning 19 generations, we compared survival, seasonal reproductive success, and lifetime reproductive success of immigrants, natives (birds with resident-hatched parents and grandparents), and their offspring (F1s, birds with an immigrant and a native parent, and F2s, birds with an immigrant grandparent and resident-hatched grandparent in each of their maternal and paternal lines). Lifetime reproductive success of immigrants was no worse than that of natives, but other measures of performance differed in several ways. Immigrant females laid later and showed a tendency to lay fewer clutches, but had relatively high success raising offspring per egg produced. The few immigrant males survived well but were less likely to breed than native males of the same age that were alive in the same year. Female F1s laid earlier than expected based on the average for immigrant and native females, and adult male F1s were more likely to breed than expected based on the average for immigrant and native males. The performance differences between immigrant and native females and between F1s and the average of immigrants and natives are consistent with the hypothesis that immigrants were disadvantaged by a lack of site experience and that immigrant offspring benefited from heterosis. However, we could not exclude the possibility that immigrants had a different strategy for optimizing reproductive success or that they experienced ecological compensation for life-history parameters. For example, the offspring of immigrants may have survived well because immigrants laid later and produced fewer clutches, thereby raising offspring during a period of milder climatic conditions. Although sample sizes were small, we found large performance differences between F1s and F2s, which suggested that either heterosis was associated with epistasis in F1s, that F2s experienced outbreeding depression, or that both phenomena occurred. These findings indicate that the performance of dispersers may be affected more by fine-scale genetic differentiation than previously assumed in this and comparable systems.     

Accidents involving off-road motor vehicles in a northern community.

The increasing number of accidents associated with off-road motor vehicles used for recreational purposes prompted this prospective study. During 1985 the records of victims of all motor vehicle accidents who were seen at the Hudson Bay Union Hospital, Hudson Bay, Sask., were studied; patients involved in on-road vehicle accidents were included for comparison. Emphasis was placed on age, vehicle type, mechanism of accident, injury severity and the use of safety features. Almost half of the victims of off-road vehicle accidents were under 16 years of age. The poor adherence to government legislation and manufacturer recommendations was evident in the number of people who did not wear helmets or use headlights.     

Birth Outcomes of Latin Americans in Two Countries with Contrasting Immigration Admission Policies: Canada and Spain

Background

We delved into the selective migration hypothesis on health by comparing birth outcomes of Latin American immigrants giving birth in two receiving countries with dissimilar immigration admission policies: Canada and Spain. We hypothesized that a stronger immigrant selection in Canada will reflect more favourable outcomes among Latin Americans giving birth in Canada than among their counterparts giving birth in Spain.

Materials and Methods

We conducted a cross-sectional bi-national comparative study. We analyzed birth data of singleton infants born in Canada (2000–2005) (N = 31,767) and Spain (1998–2007) (N = 150,405) to mothers born in Spanish-speaking Latin American countries. We compared mean birthweight at 37–41 weeks gestation, and low birthweight and preterm birth rates between Latin American immigrants to Canada vs. Spain. Regression analysis for aggregate data was used to obtain Odds Ratios and Mean birthweight differences adjusted for infant sex, maternal age, parity, marital status, and father born in same source country.

Results

Latin American women in Canada had heavier newborns than their same-country counterparts giving birth in Spain, overall [adjusted mean birthweight difference: 101 grams; 95% confidence interval (CI): 98, 104], and within each maternal country of origin. Latin American women in Canada had fewer low birthweight and preterm infants than those giving birth in Spain [adjusted Odds Ratio: 0.88; 95% CI: 0.82, 0.94 for low birthweight, and 0.88; 95% CI: 0.84, 0.93 for preterm birth, respectively].

Conclusion

Latin American immigrant women had better birth outcomes in Canada than in Spain, suggesting a more selective migration in Canada than in Spain.     

Canadian Indian mortality during the 1980s

Abstract

This study concerns itself with an investigation of general and cause‐specific mortality differentials between Canadian Registered Indians (a subset of all aboriginals) and the larger Canadian population over two points in time, 1981 and 1991. Multivariate analyses are executed separately across four segments of the life cycle: adulthood, infancy, early childhood and late childhood. With respect to adults, Indians share relatively high rates of suicide, homicide and accidental causes of death; over time, their conditional risks of death due to cancer and circulatory afflictions have gone up significantly. Mortality disadvantages for the Indians are also pronounced in infancy, early childhood (ages 1–4) and late childhood (ages 5–14). Suicide, accidents, and violence constitute serious problems among 5–14 year olds, while infectious/parasitic, respiratory and circulatory complications, plus accidents and violence, are principle killers in infancy. For children aged 1–4, respiratory problems and accidents/violence are prime causes of premature death. This less‐than‐optimal mortality profile is reflective of persistent problems associated with prolonged socioeconomic marginalization. The temporal pattern of change in chronic/degenerative disease mortality among adult Indians suggests a movement of this population toward a mature stage of epidemiological transition.     

Breast cancer incidence by country of birth among immigrant women in British Columbia,Canada

IntroductionBreast cancer rates vary internationally and between immigrant and non-immigrant populations. We describe breast cancer incidence by birth region and country in British Columbia, Canada.MethodsWe linked population-based health and immigration databases for a population with >1.29 million immigrants to assess breast cancer incidence among immigrant and non-immigrant women. We report age-standardized incidence ratios (SIRs) by birth region and country using non-immigrant women as the standard.ResultsSIRs varied widely by both birth country and region. Low rates were found for South (SIR = 0.52, 95% CI: 0.47,0.59) and East Asian (SIR = 0.75, 95% CI: 0.72,0.79) women and a higher rate for Western Europeans (SIR = 1.15, 95% CI: 1.01,1.30).ConclusionThere is considerable variation in SIRs across some of British Columbia’s largest immigrant populations and several demonstrate significantly different risk profiles compared to non-immigrants. These findings provide unique data to support breast cancer prevention and control.     

Risk of fatal accidents occurring other than at sea among Icelandic seamen.

OBJECTIVE--To study mortality among seamen, particularly from fatal accidents that occurred other than at sea. DESIGN--Cohort study. SETTING--Iceland. SUBJECTS--27,884 seamen, both fishermen and sailors from the merchant fleet, who had been members of a pension fund from 1958 to 1986. MAIN OUTCOME MEASURES--Cause of death (ICD seventh revision), standardised mortality ratio. RESULTS--Most standardised mortality ratios were greater than 1, being 1.26 for all causes and 1.83 for all external causes. There was no healthy worker effect. The excess of deaths from all external causes included all subcategories of death from accidents, poisonings, and violence and not just accidents at sea (water transport accidents, ICD codes E850-E858). A significant trend was found for length of employment and mortality from all accidents at sea, drowning at sea, accidental poisoning, other accidents, and accidental drowning; correlation coefficients for all causes, all accidents, suicide, and injuries undetermined whether accidentally or purposely inflicted were 0.7-0.8. Compared with seamen who started work during 1968-77, those who started work in 1978 or later had higher mortality from all causes, road traffic accidents, poisoning, other accidents, homicide, and injuries unknown whether accidentally or purposely inflicted, but not from all accidents at sea and accidental drowning. CONCLUSION--Seamen seem to be a special group with a high risk of fatal accidents occurring not only at sea. The association between fatal accidents other than at sea and length of employment as seamen indicates that seamen are modified by their occupation towards hazardous behaviour or a risky lifestyle.     

Mortality in Adult Offspring of Immigrants: A Swedish National Cohort Study

BackgroundHigher risks of psychiatric disorders and lower-than-average subjective health in adulthood have been demonstrated in offspring of immigrants in Sweden compared with offspring of native Swedes, and linked to relative socioeconomic disadvantage. The present study investigated mortality rates in relation to this inequity from a gender perspective.MethodsWe used data from national registers covering the entire Swedish population aged 18-65 years. Offspring of foreign-born parents who were either Swedish born or had received residency in Sweden before school age (<7 years) were defined as “offspring of immigrants.” We used Cox regression models to examine the association between parental country of birth and mortality between 1990 and 2008, with adjustment for education, income, age and family type.ResultsMale offspring of immigrants from the Middle East (HR:2.00, CI:1.66-2.26), other non-European countries (HR:1.80, CI:1.36-2.36) and Finland (HR:1.56, CI:1.48-1.65) showed an age-adjusted excess mortality risk from all causes of death when compared to offspring with Swedish-born parents. Income, but not education, greatly attenuated these increased mortality risks. No excess mortality rates were found among female offspring of immigrants, with the exception of external cause of death among offspring of Finnish immigrants.ConclusionThe study demonstrates high mortality rates in male offspring of immigrants from Finland and non-European countries that are associated with economic, but not educational, disadvantage. No increased mortality rates were found among female offspring of immigrants. Future studies are needed to explain this gender differential and why income, but not education, predicts mortality in male offspring of immigrants.     

Migration and health in Canada: health in the global village

Background:

Immigration has been and remains an important force shaping Canadian demography and identity. Health characteristics associated with the movement of large numbers of people have current and future implications for migrants, health practitioners and health systems. We aimed to identify demographics and health status data for migrant populations in Canada.

Methods:

We systematically searched Ovid MEDLINE (1996–2009) and other relevant web-based databases to examine immigrant selection processes, demographic statistics, health status from population studies and health service implications associated with migration to Canada. Studies and data were selected based on relevance, use of recent data and quality.

Results:

Currently, immigration represents two-thirds of Canada’s population growth, and immigrants make up more than 20% of the nation’s population. Both of these metrics are expected to increase. In general, newly arriving immigrants are healthier than the Canadian population, but over time there is a decline in this healthy immigrant effect. Immigrants and children born to new immigrants represent growing cohorts; in some metropolitan regions of Canada, they represent the majority of the patient population. Access to health services and health conditions of some migrant populations differ from patterns among Canadian-born patients, and these disparities have implications for preventive care and provision of health services.

Interpretation:

Because the health characteristics of some migrant populations vary according to their origin and experience, improved understanding of the scope and nature of the immigration process will help practitioners who will be increasingly involved in the care of immigrant populations, including prevention, early detection of disease and treatment.Migration is an important component of globalization. International migration is estimated at 200 million people,¹ and the volume of migration continues to increase. Between 1990 and 2005, global migrants increased by some 33 million people, with the largest growth observed in the developed world. The movement of populations of this size has important implications for health practitioners, health systems² and the health of individuals.^3,4Health status is associated with quality of life and use of formal and informal health services.⁵ Overall, immigrants appear to be healthier than the Canadian-born population, by virtue of being capable, both physically and mentally, of successfully moving themselves, and often their families, from one country to another.⁶ However, over time, this healthy immigrant effect is lost.⁷Health status is not equivalent across all subgroups of immigrants. Certain migrant populations experience a higher risk of infectious diseases, cancer, diabetes and heart disease, which has clinical implications for those providing care to migrant communities.⁶ The health of migrants is a product of environmental, economic, genetic and socio-cultural factors related to when people migrated to Canada, where and how they lived in their original home country, and how and why they migrated. Their health is also influenced by postmigration factors involving integration into their new place of residence, employment, education and poverty, as well as the accessibility and responsiveness of health practitioners and responsiveness of the Canadian health care system to immigrants’ health needs.⁸Migration medicine is complicated by the use of similar terms, such as immigrant, refugee or migrant, for what are, in reality, different populations. This article will use standard Canadian immigration terminology. To help primary care practitioners interpret the clinical preventive recommendations of the Canadian Collaboration for Immigrant and Refugee Health, we aimed to identify demographics, health status reports, access to health care and health system implications of migrant populations in Canada.     

Common mental health problems in immigrants and refugees: general approach in primary care

Background:

Recognizing and appropriately treating mental health problems among new immigrants and refugees in primary care poses a challenge because of differences in language and culture and because of specific stressors associated with migration and resettlement. We aimed to identify risk factors and strategies in the approach to mental health assessment and to prevention and treatment of common mental health problems for immigrants in primary care.

Methods:

We searched and compiled literature on prevalence and risk factors for common mental health problems related to migration, the effect of cultural influences on health and illness, and clinical strategies to improve mental health care for immigrants and refugees. Publications were selected on the basis of relevance, use of recent data and quality in consultation with experts in immigrant and refugee mental health.

Results:

The migration trajectory can be divided into three components: premigration, migration and postmigration resettlement. Each phase is associated with specific risks and exposures. The prevalence of specific types of mental health problems is influenced by the nature of the migration experience, in terms of adversity experienced before, during and after resettlement. Specific challenges in migrant mental health include communication difficulties because of language and cultural differences; the effect of cultural shaping of symptoms and illness behaviour on diagnosis, coping and treatment; differences in family structure and process affecting adaptation, acculturation and intergenerational conflict; and aspects of acceptance by the receiving society that affect employment, social status and integration. These issues can be addressed through specific inquiry, the use of trained interpreters and culture brokers, meetings with families, and consultation with community organizations.

Interpretation:

Systematic inquiry into patients’ migration trajectory and subsequent follow-up on culturally appropriate indicators of social, vocational and family functioning over time will allow clinicians to recognize problems in adaptation and undertake mental health promotion, disease prevention or treatment interventions in a timely way.Changing patterns of migration to Canada pose new challenges to the delivery of mental health services in primary care. For the first 100 years of Canada’s existence, most immigrants came from Europe; since the 1960s, there has been a marked shift, with greater immigration from Asia, Africa, and Central and South America.¹ The mix differs across the provinces, although nearly all immigrants settle in Canada’s largest cities.² The task of preventing, recognizing and appropriately treating common mental health problems in primary care is complicated for immigrants and refugees because of differences in language, culture, patterns of seeking help and ways of coping.^3–6In consultation with experts in immigrant and refugee mental health, we reviewed the literature to determine associated risks and clinical considerations for primary care practitioners in the approach to common mental health problems among new immigrant or refugee patients.^7–10 In this paper, we review the effect of migration on mental health, use of health care and barriers to care. We outline basic clinical strategies for primary mental health care of migrants including the use of interpreters, family interaction and assessment, and working with community resources.     

Cohort progress toward household formation and homeownership: young immigrant cohorts in Los Angeles and Toronto compared

As immigrants adapt to their new country, they experience both increased access to homeownership and an increase in independent household formation. This paper examines residential assimilation, as measured by homeownership and household formation, among five young immigrant cohorts in Los Angeles and Toronto over a five-year period in the early 2000s. Results show that while differences between groups are evident already at the beginning of the study period, residential assimilation occurs for all groups over time, relative to the native-born. This assimilation, however, seems to occur differently by group; the Chinese, for example, attain high homeownership rates by creating relatively few households, whereas black immigrants form many more households but much lower homeownership rates, over time. Comparing across countries, immigrants consistently have lower rates of household formation and mostly higher homeownership levels in Toronto than they do in Los Angeles.     

Canadian-Trained Basic Medical Scientists, 1946-47—1963-64

The number of master''s and doctoral degree holders who obtained their degree in a basic medical science under the supervision of a Canadian medical faculty between 1946-47 and 1963-64 was obtained from the medical schools. Of the total degree holders, 69% are currently residing in Canada, 23% in the U.S.A., and the remaining 8% in overseas countries.Questionnaire returns from doctoral degree holders revealed that citizenship status at the time of graduation is positively related to migration; migration rates were lowest for Canadian-born and highest for landed immigrants and foreign students. Geographic mobility during training was also found to be a significant factor which increased the propensity to migrate. One-half of those who took further postdoctorate training in the United States are currently living in the United States, compared to 15% of those who received all their training in Canada. Information on current type of employment revealed that only a quarter of the Ph.D. respondents are in a basic science teaching position in Canada.     

Patterns of Mortality and Factors Influencing Survival of a Recently Restored Elk Population in Ontario,Canada

This study examined patterns of mortality and determinants of survival among elk recently restored to four sites in Ontario, Canada (1998–2005). We predicted that: (1) elk located in release sites closer to the core of their historic range would have higher survival; (2) survival would increase as an animal's time and experience on the landscape increased; and (3) survival rates would decline as animals moved farther away from the release site. During the study, 443 elk were radiocollared and released; 218 mortalities were documented. Predation by wolves was the most important proximate cause of mortality, followed by death due to injuries from translocation and/or capture myopathy, accidents, emaciation, poaching, and Parelaphostrongylus tenuis infection. Overall, annual survival of elk across Ontario ranged from 0.45 (0.37–0.53) to 0.81 (0.66–0.90), with rates being lowest in the years immediately following release and highest in the final years of the study; this pattern was due to high initial mortality from translocation injuries and/or capture myopathy and possibly lack of familiarity with novel habitat. Model‐averaged hazards further support this finding, as the most important factor influencing elk survival was the length of holding period, with elk released after limited holding being less likely to survive than those held for longer periods. Our results suggest that mortalities caused by capture myopathy and transportation‐related injuries are important sources of risk for translocated elk. The method of introduction to the novel landscape and behavior in the first year should be accommodated via soft‐release and appropriate release areas.     

Replacement dolphins? Social restructuring of a resident pod of Atlantic bottlenose dolphins,Tursiops truncatus,after two major hurricanes

Environmental variations can influence the structure of ecological communities that in turn alter the grouping and association patterns of social communities. This study compares the social structure of bottlenose dolphins in the Bahamas before and after two major hurricanes. Approximately 30% of regularly seen individuals disappeared after the hurricanes, with an equal number of immigrants arriving afterwards. The primary goal of this study was to quantitatively describe social structure changes occurring after this large‐scale emigration (or death) and subsequent immigration of individuals using the social analysis program, SOCPROG 2.3. The pre‐hurricane results revealed one community with association patterns that were consistent with previous work on this population as well as other well‐documented populations. Post‐hurricane associations revealed that the community split into two distinct units, whose members associated highly within, but rarely between units. Association patterns varied between units. Immigrants assimilated well into the population, especially males. Over half of the post‐hurricane associations involved immigrants, the majority between residents and immigrants, and primarily involving immigrant males. The costs/benefits of choosing to associate with an immigrant individual differ between males and females and may have been the driving force for the changes in social structure that occurred.