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Although immigrants tend to be healthier than the Canadian-born population when they arrive, subgroups, notably different immigration categories, may differ in health and health care use. Data limitations have meant the research has seldom focused on category of immigrant―economic, family or refugee. A newly linked database has made it possible to study acute care hospitalization by immigration category and source region.

Data and Methods

The Immigrant Landing File―Hospital Discharge Abstract Linked Database (n = 2.6 million) was used to derive sex-specific crude and age-standardized hospitalization rates (ASHRs) per 10,000 population for all-cause and leading causes of hospitalization during the 2006/2007-to-2008/2009 period.


Economic class immigrants had lower all-cause ASHRs than did their family class or refugee counterparts. Male refugees had high ASHRs overall and for circulatory diseases, digestive diseases, injury, and cancer. Female differences by immigrant class were less pronounced. All-cause ASHRs (excluding pregnancy) rose with years since arrival in Canada for male and female immigrants. Immigrants from East Asia had the lowest ASHRs; those from the United States, the highest.


Although hospital use is an imperfect indicator of health status, this study supports an initial healthy immigrant effect and its subsequent decline. Marked differences emerged among immigrant subgroups with some, notably refugees and immigrants from the United States, having significantly higher hospitalization rates overall and for leading causes, compared with other groups.


Data linkage, health care utilization, hospital records, immigrant health, refugees


When they arrive in Canada, immigrants tend to be in better health than the Canadian-born population. However, the relationship between immigration and health is complex, and depends on a host of pre- and post-migration factors such as place of birth and reason for migration. Two 2011 studies found substantial heterogeneity in health outcomes by source region and period of immigration. Moreover, whether the health advantage prevails across immigration categories―refugee, economic, and family―is not known. [Full Text]


Edward Ng (edward.ng@canada.ca), Claudia Sanmartin and Douglas G. Manuel are with the Health Analysis Division at Statistics Canada, Ottawa, Ontario. Douglas G. Manuel is also with the Ottawa Health Research Institute and the Institute of Clinical Evaluative Sciences.

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What is already known on this subject?

  • While immigrants tend to have better health on entry to Canada, it is not clear if this health advantage is shared across source countries and by immigrant category (refugee, economic, family).
  • Immigrant information is lacking in provincial and territorial health data and at the national level.
  • Surveys include immigration variables, but sample sizes are usually not large enough for birthplace-specific analyses.
  • Linkage of census and health administrative information has created databases of sufficient size for the analysis of immigrant-related variables.

What does this study add?

  • Linkage of the Immigrant Landing File to the Discharge Abstract Database makes it possible to analyze immigrant hospitalization at the national level.
  • Initial results of this linkage generally corroborate other research on the health of immigrants, and provide additional insights by immigrant category.
  • Refugees of both sexes had high all-cause (excluding pregnancy) age-standardized hospitalization rates (ASHRs), compared with economic class immigrants. For males, this was also true for the four leading causes of hospitalization.
  • A high ASHR for cancer among female economic class principal applicants warrants further study.

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