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Vyas MV, Redditt V, Mohamed S, Abraha M, Sheth J, Shah BR, Ko DT, Ke C. Determinants, Prevention, and Incidence of Cardiovascular Disease Among Immigrant and Refugee Populations. Can J Cardiol 2024; 40:1077-1087. [PMID: 38387721 DOI: 10.1016/j.cjca.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/15/2024] [Accepted: 02/18/2024] [Indexed: 02/24/2024] Open
Abstract
Immigration policies shape the composition, socioeconomic characteristics, and health of migrant populations. The health of migrants is also influenced by a confluence of social, economic, environmental, and political factors. Immigrants and refugees often face various barriers to accessing health care because of factors such as lack of familiarity with navigating the health care system, language barriers, systemic racism, and gaps in health insurance. Social determinants of health and access to primary care health services likely influence the burden of cardiovascular risk factors among immigrants. The relatively low burden of many cardiovascular risk factors in many immigrant populations likely contributes to the generally lower incidence rates of acute myocardial infarction, heart failure, and stroke in immigrants compared with nonimmigrants, although cardiovascular disease incidence rates vary substantially by country of origin. The "healthy immigrant effect" is the hypothesis that immigrants to high-income countries, such as Canada, are healthier than nonimmigrants in the host population. However, this effect may not apply universally across all immigrants, including recent refugees, immigrants without formal education, and unmarried immigrants. As unfolding sociopolitical events generate new waves of global migration, policymakers and health care providers need to focus on addressing social and structural determinants of health to better manage cardiovascular risk factors and prevent cardiovascular disease, especially among the most marginalized immigrants and refugees.
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Affiliation(s)
- Manav V Vyas
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Division of Neurology, Li Ka Shing Knowledge Institute, St. Michael's Hospital-Unity Health, Toronto, Ontario, Canada
| | - Vanessa Redditt
- Crossroads Clinic, Women's College Hospital, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sebat Mohamed
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mosana Abraha
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Javal Sheth
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Baiju R Shah
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Department of Medicine, Sunnybrook Hospital, Toronto, Ontario, Canada
| | - Dennis T Ko
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Department of Medicine, Schulich Heart Centre, Sunnybrook Hospital, Toronto, Ontario, Canada
| | - Calvin Ke
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
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JOKAR MOZHGAN, ZANDI MITRA, EBADI ABBAS, MOMENAN AMIRABBAS, MARTINI MARIANO, BEHZADIFAR MASOUD. Adults' perceived health promotion needs in the prediabetes stage: a meta-synthesis study. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2023; 64:E411-E428. [PMID: 38379738 PMCID: PMC10876036 DOI: 10.15167/2421-4248/jpmh2023.64.4.3152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 01/11/2024] [Indexed: 02/22/2024]
Abstract
Introduction One of the methods to promote pre-diabetic patients' adherence to preventive behaviors and improving their lifestyle is to pay attention to their needs in the designed educational programs. Therefore, this study was conducted with the aim of identifying the needs of individuals with prediabetes. Methodology Three databases, including ISI/Web of Sciences, PubMed, Scopus were searched without time limitation until August 2022. The quality of the included studies was assessed using the Critical Appraisal Skills Programme tool. This study was reported according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research guidelines and to achieve the research goal, Sandelowski and Barroso's seven-step meta-synthesis method (2007) was used. Thematic synthesis was used to analyses the data. Results Out of the 1934 studies obtained, 34 studies were finally examined and 805 codes were recorded based on the extracted data. Through synthesizing and analyzing the primary studies, 8 main themes were extracted regarding individuals' needs in the prediabetes stage: Information needs, Cultural needs, psychological needs, Social support needs, Education needs, Financial needs, Service needs and Skill needs. Discussion and Conclusions The perceived needs and their types in each of the dimensions in detail can be a proper guide for designing educational programs and various interventions to control the prediabetes condition, leading to a reduction in the prevalence of type 2 diabetes in the society.
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Affiliation(s)
- MOZHGAN JOKAR
- School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - MITRA ZANDI
- School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - ABBAS EBADI
- Behavioral Sciences Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Research Center for Life & Health Sciences & Biotechnology of the Police, Direction of Health, Rescue & Treatment, Police Headquarter, Tehran, Iran
| | - AMIR ABBAS MOMENAN
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- TLGS Unit Manager, Tehran, Iran
| | - MARIANO MARTINI
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - MASOUD BEHZADIFAR
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
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Wanigaratne S, Rayner J, Glazier RH, Stukel TA, Lu H, Gandhi S, Saunders NR, Hynie M, Kilibarda A, Guttmann A. Primary health care utilization in the first year after arrival by refugee sponsorship model in Ontario, Canada: A population-based cohort study. PLoS One 2023; 18:e0287437. [PMID: 37494409 PMCID: PMC10370760 DOI: 10.1371/journal.pone.0287437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 06/06/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Canada's approach to refugee resettlement includes government sponsorship, a pioneering private sponsorship model and a third blended approach. Refugees are selected and supported differently in each approach including healthcare navigation. Little is known about how well private sponsors facilitate primary care navigation and whether this changed during the large-scale 2015 Syrian resettlement initiative characterized by civic and healthcare systems engagement. METHODS AND FINDINGS Population-based cohort study of resettled refugees arriving in Ontario between April 1, 2008 and March 31, 2017, with one-year follow-up, using linked health and demographic administrative databases. We evaluated associations of resettlement model (GARs, Privately Sponsored Refugees [PSRs], and Blended-Visa Office Referred [BVORs]) by era of arrival (pre-Syrian and Syrian era) and by country cohort, on measures of primary care (PC) navigation using adjusted Cox proportional hazards and logistic regression. There were 34,591 (pre-Syrian) and 24,757 (Syrian era) resettled refugees, approximately half of whom were GARs. Compared with the reference group pre-Syrian era PSRs, Syrian PSRs had slightly earlier PC visits (mean = 116 days [SD = 90]) (adjusted hazard ratios [aHR] = 1.19, 95% CI 1.14-1.23). Syrian GARs (mean = 72 days [SD = 65]) and BVORs (mean = 73 days [SD = 76]) had their first PC visit sooner than pre-Syrian era PSRs (mean = 149 days [SD = 86]), with respective aHRs 2.27, 95% CI 2.19-2.35 and 1.89, 95% CI 1.79-1.99. Compared to pre-Syrian PSRs, Syrian GARs and BVORs had much greater odds of a CHC visit (adjusted odds ratios 14.69, 95% CI 12.98-16.63 and 14.08, 95% 12.05-16.44 respectively) and Syrian PSRs had twice the odds of a CHC visit. CONCLUSIONS Less timely primary care and lower odds of a CHC visit among PSRs in the first year may be attributed to selection factors and gaps in sponsors' knowledge of healthcare navigation. Improved primary care navigation outcomes in the Syrian era suggests successful health systems engagement.
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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
| | - Jennifer Rayner
- Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Canada
- Alliance for Healthier Communities, Toronto, Canada
| | - Richard H Glazier
- ICES, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada
| | - Therese A Stukel
- 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
| | | | | | - Natasha R 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
- 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
| | - Michaela Hynie
- Department of Psychology/Centre for Refugee Studies, York University, Toronto, Canada
| | - Anja Kilibarda
- Columbia University Department of Political Science, New York City, New York, United States of America
| | - 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
- 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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Bai L, Benmarhnia T, Chen C, Kwong JC, Burnett RT, van Donkelaar A, Martin RV, Kim J, Kaufman JS, Chen H. Chronic Exposure to Fine Particulate Matter Increases Mortality Through Pathways of Metabolic and Cardiovascular Disease: Insights From a Large Mediation Analysis. J Am Heart Assoc 2022; 11:e026660. [PMID: 36346052 PMCID: PMC9750078 DOI: 10.1161/jaha.122.026660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/29/2022] [Indexed: 11/11/2022]
Abstract
Background Long-term exposure to outdoor fine particulate matter (PM2.5) is the leading environmental risk factor for premature mortality worldwide. Characterizing important pathways through which PM2.5 increases individuals' mortality risk can clarify the PM2.5-mortality relationship and identify possible points of interventions. Recent evidence has linked PM2.5 to the onset of diabetes and cardiovascular disease, but to what extent these associations contribute to the effect of PM2.5 on mortality remains poorly understood. Methods and Results We conducted a population-based cohort study to investigate how the effect of PM2.5 on nonaccidental mortality is mediated by its impacts on incident diabetes, acute myocardial infarction, and stroke. Our study population comprised ≈200 000 individuals aged 20 to 90 years who participated in population-based health surveys in Ontario, Canada, from 1996 to 2014. Follow-up extended until December 2017. Using causal mediation analyses with Aalen additive hazards models, we decomposed the total effect of PM2.5 on mortality into a direct effect and several path-specific indirect effects mediated by diabetes, each cardiovascular event, or both combined. A series of sensitivity analyses were also conducted. After adjusting for various individual- and neighborhood-level covariates, we estimated that for every 1000 adults, each 10 μg/m3 increase in PM2.5 was associated with ≈2 incident cases of diabetes, ≈1 major cardiovascular event (acute myocardial infarction and stroke combined), and ≈2 deaths annually. Among PM2.5-related deaths, 31.7% (95% CI, 17.2%-53.2%) were attributable to diabetes and major cardiovascular events in relation to PM2.5. Specifically, 4.5% were explained by PM2.5-induced diabetes, 22.8% by PM2.5-induced major cardiovascular events, and 4.5% through their interaction. Conclusions This study suggests that a significant portion of the estimated effect of long-term exposure to PM2.5 on deaths can be attributed to its effect on diabetes and cardiovascular diseases, highlighting the significance of PM2.5 on deteriorating cardiovascular health. Our findings should raise awareness among professionals that improving metabolic and cardiovascular health may reduce mortality burden in areas with higher exposure to air pollution.
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Affiliation(s)
| | - Tarik Benmarhnia
- Scripps Institution of OceanographyUniversity of CaliforniaSan Diego, La JollaCA
- Department of Family Medicine and Public HealthUniversity of CaliforniaSan Diego, La JollaCA
| | - Chen Chen
- Scripps Institution of OceanographyUniversity of CaliforniaSan Diego, La JollaCA
| | - Jeffrey C. Kwong
- ICESTorontoOntarioCanada
- Public Health OntarioTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoOntarioCanada
- Department of Family and Community MedicineUniversity of TorontoOntarioCanada
| | - Richard T. Burnett
- Environmental Health Science and Research BureauHealth CanadaOttawaOntarioCanada
| | - Aaron van Donkelaar
- Department of Energy, Environment and Chemical EngineeringWashington UniversitySt LouisMOUSA
| | - Randall V. Martin
- Department of Energy, Environment and Chemical EngineeringWashington UniversitySt LouisMOUSA
| | - JinHee Kim
- Public Health OntarioTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoOntarioCanada
| | - Jay S. Kaufman
- Department of Epidemiology and BiostatisticsMcGill UniversityMontrealQuebecCanada
- Institute for Health and Social PolicyMcGill UniversityMontrealQuebecCanada
| | - Hong Chen
- ICESTorontoOntarioCanada
- Public Health OntarioTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoOntarioCanada
- Environmental Health Science and Research BureauHealth CanadaOttawaOntarioCanada
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Balla S, Dogba MJ, Kastner M. Research Partnerships with Patients Living with Type 2 Diabetes: Practices and Challenges in Quebec Among People New to Canada. Glob Qual Nurs Res 2022; 9:23333936221129836. [PMID: 36341139 PMCID: PMC9629550 DOI: 10.1177/23333936221129836] [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: 11/14/2021] [Revised: 08/17/2022] [Accepted: 08/24/2022] [Indexed: 11/17/2022] Open
Abstract
Patients are increasingly encouraged to participate in health research programs as partners, with the aim to ensure that studies address their priorities. In response, the Strategy for Patient-Oriented Research (SPOR) has been created in Canada to transform the patient's role in research from a passive beneficiary to a more proactive partner of change within the healthcare system. This research investigates what people new to Canada living with type 2 diabetes think about participating in research partnerships. Using an ethnographic approach, 31 people new to Canada with a diagnosis of type 2 diabetes were interviewed. Findings indicated that few people new to Canada were represented among the Diabetes Action Canada (DAC) Network's Circles of Patient Partners in Quebec. Barriers to engagement in research were: lack of information; competing priorities; language barrier and privacy concerns; preconceptions about being a patient partner; prejudices on research engagement as something demanding and binding; and the matter of religious and gender differences. Some participants questioned the extent to which involvement in research can really meet their expectations considering institutional control over research, funding requirements that often dictate priorities and the biomedical approach which still, in many respects, dominates health research. Implications for achieving equity, diversity, and inclusion of patient partners in research are discussed.
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Affiliation(s)
- Séraphin Balla
- Université Laval, Québec, QC, Canada,Séraphin Balla, Université Laval, 110 Rue du Temple, Quebec, QC G1E 5A5, Canada.
| | - Maman Joyce Dogba
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada
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Chu A, Shah BR, Rashid M, Booth GL, Fazli GS, Tu K, Sun LY, Abdel-Qadir H, Yu CH, Shin S, Connelly KA, Tobe S, Liu PP, Lee DS. Trends in glucose testing among individuals without diabetes in Ontario between 2010 and 2017: a population-based cohort study. CMAJ Open 2022; 10:E772-E780. [PMID: 35998927 PMCID: PMC9402266 DOI: 10.9778/cmajo.20210195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Early identification of people with diabetes or prediabetes enables greater opportunities for glycemic control and management strategies to prevent related complications. To identify gaps in screening for these conditions, we examined population trends in receipt of timely glucose testing overall and in specific clinical subgroups. METHODS Using linked administrative databases, we conducted a retrospective cohort study of people aged 40 years and older without diabetes at baseline. Our primary outcome was up-to-date glucose testing, defined as having received testing at least once in the 3 years before each index year from 2010 to 2017, using linked administrative databases of people residing in Ontario, Canada. We calculated rates of up-to-date testing by age group, sex, ethnicity (South Asian, Chinese, general population) and comorbidities (hypertension, hyperlipidemia, cardiovascular disease). RESULTS Over the 8-year study period, up-to-date glucose testing rates were stable at 67% for men and 77% for women (both relative risk 1.00 per year; 95% confidence interval 1.00-1.00). Testing rates were significantly lower in men than in women (all age groups p < 0.001) and lower in younger than older age groups (except those aged ≥ 80 yr). South Asian people had the highest testing rates, although among people aged 70 years or older, testing was highest in the general population (p < 0.001). Among people with hypertension, hyperlipidemia and cardiovascular disease, annual testing rates were also stable, but only 58% overall among people with hypertension. INTERPRETATION We found lower glucose testing rates in younger men and people with hypertension. Our findings reinforce the need for initiatives to increase awareness of glycemic testing.
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Affiliation(s)
- Anna Chu
- ICES Central (Chu, Shah, Rashid, Booth, Sun, Abdel-Qadir, Tobe, Lee); University of Toronto (Chu, Shah, Booth, Fazli, Tu, Abdel-Qadir, Yu, Connelly, Tobe, Lee); Sunnybrook Health Sciences Centre (Shah, Tobe); Unity Health Toronto (Booth, Fazli, Yu, Connelly); University Health Network (Tu, Abdel-Qadir, Lee); North York General Hospital (Tu), Toronto, Ont.; University of Ottawa Heart Institute (Sun, Liu); University of Ottawa (Sun, Shin), Ottawa, Ont.; Woman's College Hospital (Abdel-Qadir); Keenan Research Centre (Connelly), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Baiju R Shah
- ICES Central (Chu, Shah, Rashid, Booth, Sun, Abdel-Qadir, Tobe, Lee); University of Toronto (Chu, Shah, Booth, Fazli, Tu, Abdel-Qadir, Yu, Connelly, Tobe, Lee); Sunnybrook Health Sciences Centre (Shah, Tobe); Unity Health Toronto (Booth, Fazli, Yu, Connelly); University Health Network (Tu, Abdel-Qadir, Lee); North York General Hospital (Tu), Toronto, Ont.; University of Ottawa Heart Institute (Sun, Liu); University of Ottawa (Sun, Shin), Ottawa, Ont.; Woman's College Hospital (Abdel-Qadir); Keenan Research Centre (Connelly), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Mohammed Rashid
- ICES Central (Chu, Shah, Rashid, Booth, Sun, Abdel-Qadir, Tobe, Lee); University of Toronto (Chu, Shah, Booth, Fazli, Tu, Abdel-Qadir, Yu, Connelly, Tobe, Lee); Sunnybrook Health Sciences Centre (Shah, Tobe); Unity Health Toronto (Booth, Fazli, Yu, Connelly); University Health Network (Tu, Abdel-Qadir, Lee); North York General Hospital (Tu), Toronto, Ont.; University of Ottawa Heart Institute (Sun, Liu); University of Ottawa (Sun, Shin), Ottawa, Ont.; Woman's College Hospital (Abdel-Qadir); Keenan Research Centre (Connelly), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Gillian L Booth
- ICES Central (Chu, Shah, Rashid, Booth, Sun, Abdel-Qadir, Tobe, Lee); University of Toronto (Chu, Shah, Booth, Fazli, Tu, Abdel-Qadir, Yu, Connelly, Tobe, Lee); Sunnybrook Health Sciences Centre (Shah, Tobe); Unity Health Toronto (Booth, Fazli, Yu, Connelly); University Health Network (Tu, Abdel-Qadir, Lee); North York General Hospital (Tu), Toronto, Ont.; University of Ottawa Heart Institute (Sun, Liu); University of Ottawa (Sun, Shin), Ottawa, Ont.; Woman's College Hospital (Abdel-Qadir); Keenan Research Centre (Connelly), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Ghazal S Fazli
- ICES Central (Chu, Shah, Rashid, Booth, Sun, Abdel-Qadir, Tobe, Lee); University of Toronto (Chu, Shah, Booth, Fazli, Tu, Abdel-Qadir, Yu, Connelly, Tobe, Lee); Sunnybrook Health Sciences Centre (Shah, Tobe); Unity Health Toronto (Booth, Fazli, Yu, Connelly); University Health Network (Tu, Abdel-Qadir, Lee); North York General Hospital (Tu), Toronto, Ont.; University of Ottawa Heart Institute (Sun, Liu); University of Ottawa (Sun, Shin), Ottawa, Ont.; Woman's College Hospital (Abdel-Qadir); Keenan Research Centre (Connelly), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Karen Tu
- ICES Central (Chu, Shah, Rashid, Booth, Sun, Abdel-Qadir, Tobe, Lee); University of Toronto (Chu, Shah, Booth, Fazli, Tu, Abdel-Qadir, Yu, Connelly, Tobe, Lee); Sunnybrook Health Sciences Centre (Shah, Tobe); Unity Health Toronto (Booth, Fazli, Yu, Connelly); University Health Network (Tu, Abdel-Qadir, Lee); North York General Hospital (Tu), Toronto, Ont.; University of Ottawa Heart Institute (Sun, Liu); University of Ottawa (Sun, Shin), Ottawa, Ont.; Woman's College Hospital (Abdel-Qadir); Keenan Research Centre (Connelly), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Louise Y Sun
- ICES Central (Chu, Shah, Rashid, Booth, Sun, Abdel-Qadir, Tobe, Lee); University of Toronto (Chu, Shah, Booth, Fazli, Tu, Abdel-Qadir, Yu, Connelly, Tobe, Lee); Sunnybrook Health Sciences Centre (Shah, Tobe); Unity Health Toronto (Booth, Fazli, Yu, Connelly); University Health Network (Tu, Abdel-Qadir, Lee); North York General Hospital (Tu), Toronto, Ont.; University of Ottawa Heart Institute (Sun, Liu); University of Ottawa (Sun, Shin), Ottawa, Ont.; Woman's College Hospital (Abdel-Qadir); Keenan Research Centre (Connelly), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Husam Abdel-Qadir
- ICES Central (Chu, Shah, Rashid, Booth, Sun, Abdel-Qadir, Tobe, Lee); University of Toronto (Chu, Shah, Booth, Fazli, Tu, Abdel-Qadir, Yu, Connelly, Tobe, Lee); Sunnybrook Health Sciences Centre (Shah, Tobe); Unity Health Toronto (Booth, Fazli, Yu, Connelly); University Health Network (Tu, Abdel-Qadir, Lee); North York General Hospital (Tu), Toronto, Ont.; University of Ottawa Heart Institute (Sun, Liu); University of Ottawa (Sun, Shin), Ottawa, Ont.; Woman's College Hospital (Abdel-Qadir); Keenan Research Centre (Connelly), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Catherine H Yu
- ICES Central (Chu, Shah, Rashid, Booth, Sun, Abdel-Qadir, Tobe, Lee); University of Toronto (Chu, Shah, Booth, Fazli, Tu, Abdel-Qadir, Yu, Connelly, Tobe, Lee); Sunnybrook Health Sciences Centre (Shah, Tobe); Unity Health Toronto (Booth, Fazli, Yu, Connelly); University Health Network (Tu, Abdel-Qadir, Lee); North York General Hospital (Tu), Toronto, Ont.; University of Ottawa Heart Institute (Sun, Liu); University of Ottawa (Sun, Shin), Ottawa, Ont.; Woman's College Hospital (Abdel-Qadir); Keenan Research Centre (Connelly), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Sheojung Shin
- ICES Central (Chu, Shah, Rashid, Booth, Sun, Abdel-Qadir, Tobe, Lee); University of Toronto (Chu, Shah, Booth, Fazli, Tu, Abdel-Qadir, Yu, Connelly, Tobe, Lee); Sunnybrook Health Sciences Centre (Shah, Tobe); Unity Health Toronto (Booth, Fazli, Yu, Connelly); University Health Network (Tu, Abdel-Qadir, Lee); North York General Hospital (Tu), Toronto, Ont.; University of Ottawa Heart Institute (Sun, Liu); University of Ottawa (Sun, Shin), Ottawa, Ont.; Woman's College Hospital (Abdel-Qadir); Keenan Research Centre (Connelly), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Kim A Connelly
- ICES Central (Chu, Shah, Rashid, Booth, Sun, Abdel-Qadir, Tobe, Lee); University of Toronto (Chu, Shah, Booth, Fazli, Tu, Abdel-Qadir, Yu, Connelly, Tobe, Lee); Sunnybrook Health Sciences Centre (Shah, Tobe); Unity Health Toronto (Booth, Fazli, Yu, Connelly); University Health Network (Tu, Abdel-Qadir, Lee); North York General Hospital (Tu), Toronto, Ont.; University of Ottawa Heart Institute (Sun, Liu); University of Ottawa (Sun, Shin), Ottawa, Ont.; Woman's College Hospital (Abdel-Qadir); Keenan Research Centre (Connelly), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Sheldon Tobe
- ICES Central (Chu, Shah, Rashid, Booth, Sun, Abdel-Qadir, Tobe, Lee); University of Toronto (Chu, Shah, Booth, Fazli, Tu, Abdel-Qadir, Yu, Connelly, Tobe, Lee); Sunnybrook Health Sciences Centre (Shah, Tobe); Unity Health Toronto (Booth, Fazli, Yu, Connelly); University Health Network (Tu, Abdel-Qadir, Lee); North York General Hospital (Tu), Toronto, Ont.; University of Ottawa Heart Institute (Sun, Liu); University of Ottawa (Sun, Shin), Ottawa, Ont.; Woman's College Hospital (Abdel-Qadir); Keenan Research Centre (Connelly), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Peter P Liu
- ICES Central (Chu, Shah, Rashid, Booth, Sun, Abdel-Qadir, Tobe, Lee); University of Toronto (Chu, Shah, Booth, Fazli, Tu, Abdel-Qadir, Yu, Connelly, Tobe, Lee); Sunnybrook Health Sciences Centre (Shah, Tobe); Unity Health Toronto (Booth, Fazli, Yu, Connelly); University Health Network (Tu, Abdel-Qadir, Lee); North York General Hospital (Tu), Toronto, Ont.; University of Ottawa Heart Institute (Sun, Liu); University of Ottawa (Sun, Shin), Ottawa, Ont.; Woman's College Hospital (Abdel-Qadir); Keenan Research Centre (Connelly), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Douglas S Lee
- ICES Central (Chu, Shah, Rashid, Booth, Sun, Abdel-Qadir, Tobe, Lee); University of Toronto (Chu, Shah, Booth, Fazli, Tu, Abdel-Qadir, Yu, Connelly, Tobe, Lee); Sunnybrook Health Sciences Centre (Shah, Tobe); Unity Health Toronto (Booth, Fazli, Yu, Connelly); University Health Network (Tu, Abdel-Qadir, Lee); North York General Hospital (Tu), Toronto, Ont.; University of Ottawa Heart Institute (Sun, Liu); University of Ottawa (Sun, Shin), Ottawa, Ont.; Woman's College Hospital (Abdel-Qadir); Keenan Research Centre (Connelly), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont.
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Farid D, Li P, Da Costa D, Afif W, Szabo J, Dasgupta K, Rahme E. Depression, diabetes and immigration status: a retrospective cohort study using the Canadian Longitudinal Study on Aging. CMAJ Open 2022; 10:E508-E518. [PMID: 35700994 PMCID: PMC9343120 DOI: 10.9778/cmajo.20210019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND A bidirectional association between depression and diabetes exists, but has not been evaluated in the context of immigrant status. Given that social determinants of health differ between immigrants and nonimmigrants, we evaluated the association between diabetes and depression incidence, depression and diabetes incidence, and whether immigrant status modified this association, among immigrants and nonimmigrants in Canada. METHODS We employed a retrospective cohort design using data from the Canadian Longitudinal Study on Aging Comprehensive cohort (baseline [2012-2015] and 3-year follow-up [2015-2018]). We defined participants as having diabetes if they self-reported it or if their glycated hemoglobin A1c level was 7% or more; we defined participants as having depression if their Center for Epidemiological Studies Depression score was 10 or higher or if they were currently undergoing depression treatment. We excluded those with baseline depression (Cohort 1) and baseline diabetes (Cohort 2) to evaluate the associations between diabetes and depression incidence, and between depression and diabetes incidence, respectively. We constructed logistic regression models with interaction by immigrant status. RESULTS Cohort 1 (n = 20 723; mean age 62.7 yr, standard deviation [SD] 10.1 yr; 47.6% female) included 3766 (18.2%) immigrants. Among immigrants, 16.4% had diabetes, compared with 15.6% among nonimmigrants. Diabetes was associated with an increased risk of depression in nonimmigrants (adjusted odds ratio [OR] 1.27, 95% confidence interval [CI] 1.08-1.49), but not in immigrants (adjusted OR 1.12, 95% CI 0.80-1.56). Younger age, female sex, weight change, poor sleep quality and pain increased depression risk. Cohort 2 (n = 22 054; mean age 62.1 yr, SD 10.1 yr; 52.2% female) included 3913 (17.7%) immigrants. Depression was associated with an increased risk of diabetes in both nonimmigrants (adjusted OR 1.39, 95% CI 1.16-1.68) and immigrants (adjusted OR 1.60, 95% CI 1.08-2.37). Younger age, male sex, waist circumference, weight change, hypertension and heart disease increased diabetes risk. INTERPRETATION We found an overall bidirectional association between diabetes and depression that was not significantly modified by immigrant status. Screening for diabetes for people with depression and screening for depression for those with diabetes should be considered.
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Affiliation(s)
- Doaa Farid
- Department of Family Medicine (Farid, Szabo), McGill University; Centre for Outcomes Research and Evaluation (Farid, Li, Da Costa, Dasgupta, Rahme), Research Institute of the McGill University Health Centre; Department of Pediatrics (Li), and Division of Clinical Epidemiology (Da Costa, Rahme), Department of Medicine, McGill University; Division of Gastroenterology (Afif), Department of Medicine, and Chronic Viral Illnesses Service (Szabo), McGill University Health Centre; Division of General Internal Medicine (Dasgupta), Department of Medicine, McGill University, Montréal, Que
| | - Patricia Li
- Department of Family Medicine (Farid, Szabo), McGill University; Centre for Outcomes Research and Evaluation (Farid, Li, Da Costa, Dasgupta, Rahme), Research Institute of the McGill University Health Centre; Department of Pediatrics (Li), and Division of Clinical Epidemiology (Da Costa, Rahme), Department of Medicine, McGill University; Division of Gastroenterology (Afif), Department of Medicine, and Chronic Viral Illnesses Service (Szabo), McGill University Health Centre; Division of General Internal Medicine (Dasgupta), Department of Medicine, McGill University, Montréal, Que
| | - Deborah Da Costa
- Department of Family Medicine (Farid, Szabo), McGill University; Centre for Outcomes Research and Evaluation (Farid, Li, Da Costa, Dasgupta, Rahme), Research Institute of the McGill University Health Centre; Department of Pediatrics (Li), and Division of Clinical Epidemiology (Da Costa, Rahme), Department of Medicine, McGill University; Division of Gastroenterology (Afif), Department of Medicine, and Chronic Viral Illnesses Service (Szabo), McGill University Health Centre; Division of General Internal Medicine (Dasgupta), Department of Medicine, McGill University, Montréal, Que
| | - Waqqas Afif
- Department of Family Medicine (Farid, Szabo), McGill University; Centre for Outcomes Research and Evaluation (Farid, Li, Da Costa, Dasgupta, Rahme), Research Institute of the McGill University Health Centre; Department of Pediatrics (Li), and Division of Clinical Epidemiology (Da Costa, Rahme), Department of Medicine, McGill University; Division of Gastroenterology (Afif), Department of Medicine, and Chronic Viral Illnesses Service (Szabo), McGill University Health Centre; Division of General Internal Medicine (Dasgupta), Department of Medicine, McGill University, Montréal, Que
| | - Jason Szabo
- Department of Family Medicine (Farid, Szabo), McGill University; Centre for Outcomes Research and Evaluation (Farid, Li, Da Costa, Dasgupta, Rahme), Research Institute of the McGill University Health Centre; Department of Pediatrics (Li), and Division of Clinical Epidemiology (Da Costa, Rahme), Department of Medicine, McGill University; Division of Gastroenterology (Afif), Department of Medicine, and Chronic Viral Illnesses Service (Szabo), McGill University Health Centre; Division of General Internal Medicine (Dasgupta), Department of Medicine, McGill University, Montréal, Que
| | - Kaberi Dasgupta
- Department of Family Medicine (Farid, Szabo), McGill University; Centre for Outcomes Research and Evaluation (Farid, Li, Da Costa, Dasgupta, Rahme), Research Institute of the McGill University Health Centre; Department of Pediatrics (Li), and Division of Clinical Epidemiology (Da Costa, Rahme), Department of Medicine, McGill University; Division of Gastroenterology (Afif), Department of Medicine, and Chronic Viral Illnesses Service (Szabo), McGill University Health Centre; Division of General Internal Medicine (Dasgupta), Department of Medicine, McGill University, Montréal, Que
| | - Elham Rahme
- Department of Family Medicine (Farid, Szabo), McGill University; Centre for Outcomes Research and Evaluation (Farid, Li, Da Costa, Dasgupta, Rahme), Research Institute of the McGill University Health Centre; Department of Pediatrics (Li), and Division of Clinical Epidemiology (Da Costa, Rahme), Department of Medicine, McGill University; Division of Gastroenterology (Afif), Department of Medicine, and Chronic Viral Illnesses Service (Szabo), McGill University Health Centre; Division of General Internal Medicine (Dasgupta), Department of Medicine, McGill University, Montréal, Que.
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Ogungbe O, Turkson-Ocran RA, Koirala B, Byiringiro S, Liu X, Elias S, Mensah D, Turkson-Ocran E, Nkimbeng M, Cudjoe J, Baptiste D, Commodore-Mensah Y. Acculturation and Cardiovascular Risk Screening among African Immigrants: The African Immigrant Health Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2556. [PMID: 35270252 PMCID: PMC8909198 DOI: 10.3390/ijerph19052556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/11/2022] [Accepted: 02/17/2022] [Indexed: 01/12/2023]
Abstract
Acculturation and immigration-related factors may impact preventive, routine cardiovascular risk (CV) screening among African immigrants. We examined the associations between length of stay, percent of life spent in the U.S. (proxy for acculturation), and CV screening. Outcomes were recent screening for hypertension, diabetes, and dyslipidemia. Multivariable logistic regression analyses were used to examine these relationships. Among 437 African immigrants, 60% were males, mean age was 47 years, 61% had lived in the U.S. for ≥10 years, mean length of stay was 15 years, and 81% were employed. Only 67% were insured. In the 12 months prior, 85% had screened for hypertension, 45% for diabetes, and 63% for dyslipidemia. African immigrants with a ≥10-year length of U.S. stay had 2.20 (95%Confidence Intervals: 1.31−3.67), and those with >25% years of life spent in the U.S. had 3.62 (95%CI: 1.96−6.68) higher odds of dyslipidemia screening compared to those with a <10-year length of stay and ≤25% years of life spent in the U.S., respectively. Overall, screening for CV risk higher in African immigrants who have lived longer (≥10 years) in the U.S. Recent African immigrants may experience challenges in accessing healthcare. Health policies targeting recent and uninsured African immigrants may improve access to CV screening services.
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Affiliation(s)
- Oluwabunmi Ogungbe
- Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA; (B.K.); (S.B.); (X.L.); (S.E.); (D.B.); (Y.C.-M.)
| | - Ruth-Alma Turkson-Ocran
- Beth Israel Deaconess Medical Center, Division of General Medicine, Section for Research, Boston, MA 02215, USA;
| | - Binu Koirala
- Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA; (B.K.); (S.B.); (X.L.); (S.E.); (D.B.); (Y.C.-M.)
| | - Samuel Byiringiro
- Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA; (B.K.); (S.B.); (X.L.); (S.E.); (D.B.); (Y.C.-M.)
| | - Xiaoyue Liu
- Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA; (B.K.); (S.B.); (X.L.); (S.E.); (D.B.); (Y.C.-M.)
| | - Sabrina Elias
- Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA; (B.K.); (S.B.); (X.L.); (S.E.); (D.B.); (Y.C.-M.)
| | - Danielle Mensah
- Drexel University College of Medicine, Philadelphia, PA 19129, USA;
| | | | - Manka Nkimbeng
- School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA;
| | | | - Diana Baptiste
- Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA; (B.K.); (S.B.); (X.L.); (S.E.); (D.B.); (Y.C.-M.)
| | - Yvonne Commodore-Mensah
- Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA; (B.K.); (S.B.); (X.L.); (S.E.); (D.B.); (Y.C.-M.)
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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9
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Ke C, Luk AO, Chan JCN, Wei X, Shah BR. Migration and diabetes incidence among Chinese adults in Canada, China, Hong Kong, and Taiwan: An international population-based comparative study from 2000 to 2017. Diabetes Res Clin Pract 2021; 180:109062. [PMID: 34543705 DOI: 10.1016/j.diabres.2021.109062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/27/2021] [Accepted: 09/14/2021] [Indexed: 10/20/2022]
Abstract
AIMS We conducted an international population-based study comparing the incidence of young- (age 20-39 years) and usual- (age ≥ 40 years) onset diabetes among Chinese-Canadian immigrants; their source populations (mainland China, Hong Kong, Taiwan); and other Canadians. METHODS Using population-based data (2000-17; n = 3.4 million cases), we calculated incidence rates and incidence rate ratios comparing the average incidence for each cohort. RESULTS The average incidence of young-onset diabetes (YOD) among immigrants from China, Hong Kong, and Taiwan was 165.5, 121.0, and 78.4 per 100,000 person-years respectively. Immigrants from China and Hong Kong had higher YOD incidence than their source populations (RR China: 2.59, 2.44-2.74; Hong Kong: 1.64, 1.49-1.81), while immigrants from Taiwan had lower rates versus Taiwan (RR 0.63, 0.45-0.86). YOD incidence among immigrants from China increased sharply by 8.3% (3.3-13.6%) per year from 2011 onward-over twice the annual increase among non-Chinese Canadians. The average incidence rates of usual-onset diabetes among immigrants from China, Hong Kong, and Taiwan were higher than (RR 1.77, 1.73-1.81), similar to (0.98, 0.96-1.01), and lower than (0.36, 0.32-0.40) those in each source population respectively. CONCLUSIONS Diabetes incidence among Chinese migrants is unexpectedly heterogeneous, varying according age at migration, territory of origin, and the occurrence of diabetes in the source population.
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Affiliation(s)
- Calvin Ke
- Department of Medicine, University of Toronto, Toronto, Canada; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region; ICES, Toronto, Canada.
| | - Andrea O Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region; Asia Diabetes Foundation, Metropole Square, Shatin, Hong Kong Special Administrative Region; Hong Kong Institute of Diabetes and Obesity and Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region; Asia Diabetes Foundation, Metropole Square, Shatin, Hong Kong Special Administrative Region; Hong Kong Institute of Diabetes and Obesity and Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Baiju R Shah
- Department of Medicine, University of Toronto, Toronto, Canada; ICES, Toronto, Canada; Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
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10
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Wang G, Vance DE, Li W. A Cross-Sectional Analysis of APOE Gene Polymorphism and the Risk of Cognitive Impairments in the Alzheimer's Disease Neuroimaging Initiative Study. JAR LIFE 2021; 10:26-31. [PMID: 36923510 PMCID: PMC10002875 DOI: 10.14283/jarlife.2021.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/12/2021] [Indexed: 03/18/2023]
Abstract
Background It is inconclusive on how apolipoprotein epsilon (APOE) gene polymorphism is associated with the risk of having mild cognitive impairment (MCI) or Alzheimer's disease (AD). Objectives To investigate how APOE genotype is associated with the risk of MCI or AD using the data collected from the Alzheimer's Disease Neuroimaging Initiative (ADNI) participants. Methods A cross-sectional design was used to analyze the baseline data collected from the 1,720 ADNI participants. APOE gene polymorphism was analyzed on how they are related to the risk of cognitive impairments of either MCI or AD using a percent yield (PY) method. Then cognitive functions were compared among six different APOE genotypes using a two-way ANCOVA by controlling possible confounding factors. Results The prevalence of six APOE genotypes in 1,720 participants is as following: e2/e2 (0.3%), e2/e3 (7.4%), e3/e3 (45.4%), e2/e4 (2%), e3/e4 (35%) and e4/e4 (9.9%). The e2/e2 and e4/e4 genotypes were associated with the lowest and the highest risk respectively for cognitive impairments of either MCI or AD. Further, a worse cognitive diagnosis was associated with an increasing number of APOE e4 allele in a dose dependent manner. Participants with genotype e3/e3 had a better memory measure than those with the genotype of e3/e4. Conclusions APOE gene polymorphism is associated with different level of risks for cognitive impairments. The heterozygous genotype e3/e4 is associated with a worse memory function compared to the genotype of e3/e3. Further investigations are needed to intervene the cognitive deteriorations in those with at risk APOE genotypes.
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Affiliation(s)
- G Wang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - D E Vance
- Office of Research and Scholarship, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - W Li
- Physician Assistant Studies, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama
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11
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Payton C, Kimball S, Ahrenholz NC, Wieland ML. Preventive Care and Management of Chronic Diseases in Immigrant Adults. Prim Care 2020; 48:83-97. [PMID: 33516426 DOI: 10.1016/j.pop.2020.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Immigrants may have variable access to chronic disease screening and treatment in their countries of origin and host country, often limited by their immigration status. Immigrants face barriers to chronic disease management and preventive care, including health insurance access, linguistic challenges, lack of culturally sensitive care, limited records, and acculturation. Health care providers should prioritize chronic disease screening and follow up regularly to encourage preventive care and self-management of chronic disease.
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Affiliation(s)
- Colleen Payton
- School of Nursing and Public Health, Moravian College, 1200 Main Street, Bethlehem, PA 18018, USA.
| | - Sarah Kimball
- Immigrant & Refugee Health Center, Boston Medical Center, 725 Albany Street, 43 Suite 5b, Boston, MA 02118, USA; Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, USA
| | - Nicole Chow Ahrenholz
- International Medicine Clinic, Harborview Medicine Center, 325 9th Avenue Box 359895, Seattle, WA 98104, USA; University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Mark L Wieland
- Community Internal Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
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12
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Fazli GS, Moineddin R, Chu A, Bierman AS, Booth GL. Neighborhood walkability and pre-diabetes incidence in a multiethnic population. BMJ Open Diabetes Res Care 2020; 8:e000908. [PMID: 32601153 PMCID: PMC7326269 DOI: 10.1136/bmjdrc-2019-000908] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 04/16/2020] [Accepted: 04/23/2020] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION We examined whether adults living in highly walkable areas are less likely to develop pre-diabetes and if so, whether this association is consistent according to immigration status and ethnicity. RESEARCH DESIGN AND METHODS Population-level health, immigration, and administrative databases were used to identify adults aged 20-64 (n=1 128 181) who had normoglycemia between January 2011 and December 2011 and lived in one of 15 cities in Southern Ontario, Canada. Individuals were assigned to one of ten deciles (D) of neighborhood walkability (from lowest (D1) to highest (D10)) and followed until December 2013 for the development of pre-diabetes. RESULTS Overall, 220 225 individuals in our sample developed pre-diabetes during a median follow-up of 8.4 years. Pre-diabetes incidence was 20% higher among immigrants living in the least (D1) (adjusted HR 1.20, 95% CI 1.15 to 1.25, p<0.0001) versus most (D10, referent) walkable neighborhoods after accounting for age, sex, and area income. Findings were similar among long-term residents and across sexes. However, susceptibility to walkability varied by ethnicity where D1 versus D10 adjusted HRs ranged from 1.17 (95% CI 1.02 to 1.35, p=0.03) among West Asian and Arab immigrants to 1.32 (95% CI 1.19 to 1.47, p<0.0001) in Southeast Asians. Ethnic variation in pre-diabetes incidence was more marked in low walkability settings. Relative to Western Europeans, the adjusted HR for pre-diabetes incidence was 2.11 (95% CI 1.81 to 2.46, p<0.0001) and 1.50 (95% CI 1.27 to 1.77, p<0.0001) among Sub-Saharan African and the Carribean and Latin American immigrants, respectively, living in the least walkable (D1) neighborhoods, but only 1.24 (95% CI 1.08 to 1.42, p=0.002) and 1.00 (95% CI 0.87 to 1.15, p=0.99) for these same groups living in the most walkable (D10) neighborhoods. CONCLUSIONS Pre-diabetes incidence was reduced in highly walkable areas for most groups living in Southern Ontario cities. These findings suggest a potential role for walkable urban design in diabetes prevention.
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Affiliation(s)
- Ghazal S Fazli
- MAP-Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Rahim Moineddin
- Departmen of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Arlene S Bierman
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Gillian L Booth
- MAP-Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Keenan Research Centre & Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
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Creatore MI, Booth GL, Manuel DG, Moineddin R, Glazier RH. A Population-Based Study of Diabetes Incidence by Ethnicity and Age: Support for the Development of Ethnic-Specific Prevention Strategies. Can J Diabetes 2020; 44:394-400. [PMID: 32241753 DOI: 10.1016/j.jcjd.2019.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 11/30/2019] [Accepted: 12/19/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Although national guidelines advocate for earlier diabetes screening in high-risk ethnic groups, little evidence exists to guide clinicians on the age at which screening should commence. The purpose of this study was to determine age equivalency thresholds for diabetes risk across a broad range of ethnic populations. METHODS This population-based, retrospective cohort study used linked administrative health and immigration records for 592,376 individuals in Ontario, Canada. Adjusted incidence rates by ethnicity, sex and age were used to derive ethnic-specific age thresholds for risk. RESULTS Diabetes incidence rates in South Asians reached an equivalent risk as that experienced by a 40-year-old Western European man (3.7 per 1,000 person-years) by 25 years of age. For all other non-European ethnic groups, the equivalent risk was experienced between 30 and 35 years of age. These risk differentials persisted despite controlling for covariates. CONCLUSIONS We found a 15-year difference in age equivalency of risk across ethnic groups.
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Affiliation(s)
- Maria I Creatore
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Gillian L Booth
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Douglas G Manuel
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Rahim Moineddin
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Richard H Glazier
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
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Fazli GS, Moineddin R, Bierman AS, Booth GL. Ethnic variation in the conversion of prediabetes to diabetes among immigrant populations relative to Canadian-born residents: a population-based cohort study. BMJ Open Diabetes Res Care 2020; 8:e000907. [PMID: 32071198 PMCID: PMC7039599 DOI: 10.1136/bmjdrc-2019-000907] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/21/2019] [Accepted: 12/20/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare absolute and relative rates of conversion from prediabetes to diabetes among non-European immigrants to Europeans and Canadian-born residents, overall, and by age and level of glycemia. RESEARCH DESIGN AND METHODS We conducted a retrospective cohort population-based study using administrative health databases from Ontario, Canada, to identify immigrants (n=23 465) and Canadian born (n=1 11 085) aged ≥20 years with prediabetes based on laboratory tests conducted between 2002 and 2011. Individuals were followed until 31 December 2013 for the development of diabetes using a validated algorithm. Immigration data was used to assign ethnicity based on country of origin, mother tongue, and surname. Fine and Gray's survival models were used to compare diabetes incidence across ethnic groups overall and by age and glucose category. RESULTS Over a median follow-up of 5.2 years, 8186 immigrants and 39 722 Canadian-born residents developed diabetes (7.1 vs 6.1 per 100 person-years, respectively). High-risk immigrant populations such as South Asians (HR: 1.72, 95% CI 1.55 to 1.99) and Southeast Asians (HR: 1.65, 95% CI 1.46 to 1.86) had highest risk of converting to diabetes compared with Western Europeans (referent). Among immigrants aged 20-34 years, the adjusted cumulative incidence ranged from 18.4% among Eastern Europeans to 52.3% among Southeast Asians. Conversion rates increased with age in all groups but were consistently high among South Asians, Southeast Asians and Sub-Saharan African/Caribbeans after the age of 35 years. On average, South Asians converted to diabetes 3.1-4.6 years earlier than Western Europeans and at an equivalent rate of conversion to Western Europeans who had a 0.5 mmol/L higher baseline fasting glucose value. CONCLUSIONS High-risk ethnic groups converted to diabetes more rapidly, at younger ages, and at lower fasting glucose values than European populations, leading to a shorter window for diabetes prevention.
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Affiliation(s)
- Ghazal S Fazli
- MAP- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Arlene S Bierman
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Gillian L Booth
- MAP- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Prevalence of Known Risk Factors for Type 2 Diabetes Mellitus in Multiethnic Urban Youth in Edmonton: Findings From the WHY ACT NOW Project. Can J Diabetes 2019; 43:207-214. [DOI: 10.1016/j.jcjd.2018.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/26/2018] [Accepted: 10/01/2018] [Indexed: 01/15/2023]
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Adherence to diabetes care process indicators in migrants as compared to non-migrants with diabetes: a retrospective cohort study. Int J Public Health 2019; 64:595-601. [DOI: 10.1007/s00038-019-01220-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/23/2019] [Accepted: 02/13/2019] [Indexed: 02/02/2023] Open
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Abstract
RÉSUMÉLe vieillissement et l’immigration ont significativement transformé la composition démographique au Canada, et les immigrants y représentent une proportion croissante de la population adulte plus âgée. L’accès adéquat aux services de santé est essentiel au bien-être et à l’inclusion sociale de cette population. Cet examen de la portée porte sur les connaissances actuelles concernant l’accès des immigrants d’âge avancé aux médecins omnipraticiens et à leur consultation, considérant que ces médecins jouent un rôle central dans la prestation de soins de première ligne, dans les soins préventifs et les soins de santé mentale. Le modèle en 5 étapes d’Arksey et O’Malley a été utilisé pour effectuer des recherches dans une grande variété de bases de données pour des articles publiés en anglais dans des revues avec comité de pairs concernant ce sujet dans le contexte canadien. Un total de 31 articles répondant aux critères d’inclusion ont été examinés en détail. Ces articles ont été classés en fonction de l’information disponible sur leurs auteurs, la population à l’étude, la méthodologie, le domaine de la santé et les obstacles mentionnés. Trois thèmes principaux ont émergé de cet examen de portée : l’accès et l’utilisation des soins de première ligne, la promotion de la santé et le dépistage du cancer, ainsi que l’utilisation des services de santé mentale. Les immigrants d’âge avancé font face à des obstacles en termes d’accès aux soins et ceux-ci seraient liés à la littératie en santé, à la langue, à la culture, aux croyances en matière de santé, aux inégalités spatiales et à des circonstances structurelles. L’examen de la portée présente de manière détaillée l’accès aux soins des personnes âgées immigrantes au Canada, et permet de dériver des implications sur les politiques qui permettraient de répondre à leurs besoins qui sont non comblés dans le domaine de la santé.
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Risk of Invasive Cervical Cancer Among Immigrants in Ontario, Canada. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:21-28. [DOI: 10.1016/j.jogc.2018.01.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/12/2018] [Indexed: 12/30/2022]
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Immigration and Adherence to Cervical Cancer Screening: A Provincewide Longitudinal Matched Cohort Study Using Multistate Transitional Models. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 41:813-823. [PMID: 31130182 DOI: 10.1016/j.jogc.2018.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 06/04/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Previous studies highlighting inequities in cancer screening between immigrants and non-immigrants have been methodologically limited. This longitudinal matched cohort study used a multistate modelling framework to examine associations between immigration status and cervical cancer screening adherence. METHODS A 1:1 matched cohort of women aged 25 and older from 1992-2014 who were residing in Ontario was examined. For each woman, the proportion of time spent being non-adherent was determined. Disparities in cervical screening adherence, and specifically the association between immigration status and the rate of becoming adherent, were investigated with a three-state transitional model. The model was adjusted for individual- and physician-level characteristics, which were updated annually and incorporated as time-varying covariates. RESULTS The matched cohort consisted of 1 156 720 immigrant and non-immigrant women. The median proportion of time spent non-adherent was 38.9% for immigrants and 24.7% for non-immigrants. The rate of becoming adherent among immigrants was lower than that among non-immigrants, after accounting for individual- and physician-level characteristics (relative rate 0.933; 95% CI 0.928-0.937). Other characteristics such as socioeconomic status, immigrant region of origin, presence of primary physician, and physician's sex were found to be significantly associated with cervical screening adherence. CONCLUSION This study assessed the association between immigration status and adherence to cervical cancer screening. The insights from this work can be used to target groups of women vulnerable to underscreening and to minimize their time spent non-adherent to cancer screening. The methodology serves as a useful framework for examining adherence to other types of cancer screening.
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Higher risk of gastric cancer among immigrants to Ontario: a population-based matched cohort study with over 2 million individuals. Gastric Cancer 2018; 21:588-597. [PMID: 29285629 DOI: 10.1007/s10120-017-0790-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 12/10/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND The risk of gastric carcinoma (GC) varies around the world and between females and males. We aimed to compare the risk of GC among immigrants to Ontario, Canada, to the risk of GC in its general population. METHODS This was a retrospective population-based matched cohort study from 1991 to 2014. We identified immigrants who were first eligible for the Ontario Health Insurance Plan at age 40 years or older, and matched 5 controls by year of birth and sex. We calculated crude rates and relative rates of GC stratified by sex. We modeled GC hazard using multivariable Cox proportional hazards regression, where a time-varying coefficient was incorporated to examine changes in the association of immigrant status with GC hazard over time. RESULTS Among females, 415 GC cases were identified among 209,843 immigrants and 1872 among 1,049,215 controls. Among males, 596 GC cases were identified among 191,792 immigrants and 2998 among 958,960 controls. Comparing immigrants from East Asia and Pacific with the controls, the crude relative rate of GC was 1.54 for females and 1.32 for males. The adjusted hazard ratio (HR) for GC among female immigrants was 1.29 [95% confidence interval (CI) 1.12, 1.48] within 10 years and 1.19 (1.01, 1.40) beyond 10 years; for males, the HR was 1.17 (1.04, 1.31) within 10 years and 1.00 (0.87, 1.15) beyond 10 years. CONCLUSION The risk of GC among immigrants is elevated. Although high-risk immigrant populations in Ontario have been identified, further knowledge is required before a program of GC prevention that is targeted to them can be planned.
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Perl J, McArthur E, Tan VS, Nash DM, Garg AX, Harel Z, Li AH, Sood MM, Ray JG, Wald R. ESRD among Immigrants to Ontario, Canada: A Population-Based Study. J Am Soc Nephrol 2018; 29:1948-1959. [PMID: 29720548 PMCID: PMC6050933 DOI: 10.1681/asn.2017101055] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 04/03/2018] [Indexed: 12/16/2022] Open
Abstract
Background The epidemiology of ESRD requiring maintenance dialysis (ESRD-D) in large, diverse immigrant populations is unclear.Methods We estimated ESRD-D prevalence and incidence among immigrants in Ontario, Canada. Adults residing in Ontario in 2014 were categorized as long-term Canadian residents or immigrants according to administrative health and immigration datasets. We determined ESRD-D prevalence among these adults and calculated age-adjusted prevalence ratios (PRs) comparing immigrants to long-term residents. Among those who immigrated to Ontario between 1991 and 2012, age-adjusted ESRD-D incidence was calculated by world region and country of birth, with immigrants from Western nations as the referent group.Results Among 1,902,394 immigrants and 8,860,283 long-term residents, 1700 (0.09%) and 8909 (0.10%), respectively, presented with ESRD-D. Age-adjusted ESRD-D prevalence was higher among immigrants from sub-Saharan Africa (PR, 2.17; 95% confidence interval [95% CI], 1.84 to 2.57), Latin America and the Caribbean (PR, 2.11; 95% CI, 1.90 to 2.34), South Asia (PR, 1.45; 95% CI, 1.32 to 1.59), and East Asia and the Pacific (PR, 1.34; 95% CI, 1.22 to 1.46). Immigrants from Somalia (PR, 4.18; 95% CI, 3.11 to 5.61), Trinidad and Tobago (PR, 2.88; 95% CI, 2.23 to 3.73), Jamaica (PR, 2.88; 95% CI, 2.40 to 3.44), Sudan (PR, 2.84; 95% CI, 1.53 to 5.27), and Guyana (PR, 2.69; 95% CI, 2.19 to 3.29) had the highest age-adjusted ESRD-D PRs relative to long-term residents. Immigrants from these countries also exhibited higher age-adjusted ESKD-D incidence relative to Western Nations immigrants.Conclusions Among immigrants in Canada, those from sub-Saharan Africa and the Caribbean have the highest ESRD-D risk. Tailored kidney-protective interventions should be developed for these susceptible populations.
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Affiliation(s)
- Jeffrey Perl
- Division of Nephrology, St. Michael's Hospital and the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada;
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Eric McArthur
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Vivian S Tan
- Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada
- Division of Nephrology, Department of Medicine and
| | - Danielle M Nash
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Amit X Garg
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada
- Division of Nephrology, Department of Medicine and
| | - Ziv Harel
- Division of Nephrology, St. Michael's Hospital and the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Alvin H Li
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; and
| | - Manish M Sood
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Joel G Ray
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Ron Wald
- Division of Nephrology, St. Michael's Hospital and the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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Weisman A, Fazli GS, Johns A, Booth GL. Evolving Trends in the Epidemiology, Risk Factors, and Prevention of Type 2 Diabetes: A Review. Can J Cardiol 2018; 34:552-564. [PMID: 29731019 DOI: 10.1016/j.cjca.2018.03.002] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 03/08/2018] [Accepted: 03/08/2018] [Indexed: 02/07/2023] Open
Abstract
Currently, the global prevalence of diabetes is 8.8%. This figure is expected to increase worldwide, with the largest changes projected to occur in low- and middle-income countries. The aging of the world's population and substantial increases in obesity have contributed to the rise in diabetes. Global shifts in lifestyles have led to the adoption of unhealthy behaviours such as physical inactivity and poorer-quality diets. Correspondingly, diabetes is a rapidly-increasing problem in higher- as well as lower-income countries. In Canada, the prevalence of diabetes increased approximately 70% in the past decade. Although diabetes-related mortality rates have decreased in Canada, the number of people affected by diabetes has continued to grow because of a surge in the number of new diabetes cases. Non-European ethnic groups and individuals of lower socioeconomic status have been disproportionately affected by diabetes and its risk factors. Clinical trials have proven efficacy in reducing the onset of diabetes in high-risk populations through diet and physical activity interventions. However, these findings have not been broadly implemented into the Canadian health care context. In this article we review the evolving epidemiology of type 2 diabetes, with regard to trends in occurrence rates and prevalence; the role of risk factors including those related to ethnicity, obesity, diet, physical activity, socioeconomic status, prediabetes, and pregnancy; and the identification of critical windows for lifestyle intervention. Identifying high-risk populations and addressing the upstream determinants and risk factors of diabetes might prove to be effective diabetes prevention strategies to curb the current diabetes epidemic.
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Affiliation(s)
- Alanna Weisman
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; The Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Ghazal S Fazli
- The Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
| | - Ashley Johns
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
| | - Gillian L Booth
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; The Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada.
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Hu Sophia H, Fu Mei R, Liu S, Lin YK, Chang WY. CE: Original Research: Physical Activity Among Chinese American Immigrants with Prediabetes or Type 2 Diabetes. Am J Nurs 2018; 118:24-32. [PMID: 29329117 PMCID: PMC5785420 DOI: 10.1097/01.naj.0000530221.87469.86] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
: Background: Although the benefits of aerobic exercise and strength training for patients with type 2 diabetes have been studied extensively, research on physical activity among Chinese American immigrants diagnosed with prediabetes or type 2 diabetes has been limited. PURPOSE We sought to learn more about this population's knowledge of physical activity, the types and intensity levels performed, and the barriers to such activity. DESIGN AND METHODS A concurrent mixed-methods design was used. The short version of the International Physical Activity Questionnaire-Chinese was used to quantitatively measure participants' levels of exercise intensity. Semistructured face-to-face interviews were conducted to obtain qualitative information regarding participants' knowledge about physical activity, the types performed, and the barriers to such activity. RESULTS A total of 100 Chinese American immigrants were recruited for the study from January to July 2012 in New York City. On average, participants had lived with a diagnosis of prediabetes or type 2 diabetes for 3.3 years and had lived in the United States for 21.5 years. Energy expenditure was measured in metabolic equivalent of task (MET) units; intensity was measured in cumulative MET-minutes per week. The mean total intensity score was 2,744 MET-minutes per week. This was achieved mainly through walking. The mean intensity score for walking was 1,454 MET-minutes per week; the mean duration was 79 minutes per day. Vigorous physical activity was least common. The mean intensity score for vigorous physical activity was 399 MET-minutes per week, and the mean duration was 17 minutes per week. Regarding types of physical activity, the most common were housekeeping, walking up stairs, and taking walking or stretching breaks every hour during the workday. Based on the interviews, three themes emerged regarding barriers to moderate or vigorous physical activity: insufficient education about physical activity, health concerns about physical activity, and work-related barriers to physical activity. CONCLUSIONS The majority of Chinese American immigrants with prediabetes or type 2 diabetes do not engage in sufficient physical activity, performing at a rate significantly below that of the general U.S. POPULATION Increases in the intensity and duration of physical activity should be promoted as part of diabetes management for Chinese American immigrants.
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Affiliation(s)
- H Hu Sophia
- Sophia H. Hu is an assistant professor and Wen-Yin Chang is a professor in the School of Nursing at Taipei Medical University, Taipei, Taiwan. Mei R. Fu is an associate professor in the Rory Meyers College of Nursing at New York University (NYU), New York City. Shan Liu is an associate professor in the College of Nursing and Public Health at Adelphi University, Garden City, NY. Yen-Kuang Lin is an associate research fellow in the Biostatistics Center at Taipei Medical University. This research was supported by grants from NYU's Muriel and Virginia Pless Center for Nursing Research, the Association of Chinese American Physicians, and the National Institute of Minority Health and Health Disparities (NIMHD project No. P60 MD000538-03). Contact author: Sophia H. Hu, . The authors and planners have disclosed no potential conflicts of interest, financial or otherwise
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Paszat L, Sutradhar R, Liu Y, Baxter NN, Tinmouth J, Rabeneck L. Risk of colorectal cancer among immigrants to Ontario, Canada. BMC Gastroenterol 2017; 17:85. [PMID: 28683721 PMCID: PMC5500923 DOI: 10.1186/s12876-017-0642-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 06/29/2017] [Indexed: 02/07/2023] Open
Abstract
Background The risk of colorectal cancer (CRC) varies around the world and between females and males. We aimed to compare the risk of CRC among immigrants to Ontario, Canada, to its general population. Methods We used an exposure-control matched design. We identified persons in the Immigration, Refugees and Citizenship Canada Permanent Resident Database with first eligibility for the Ontario Health Insurance Plan between July 1, 1991 and June 30, 2008 at age 40 years or older, and matched five controls by year of birth and sex on the immigrant’s first eligibility date. We identified CRC from the Ontario Cancer Registry between the index date and December 31, 2014. All analyses were stratified by sex. We calculated crude and relative rates of CRC. We estimated risk of CRC over time by the Kaplan-Meier method and compared immigrants to controls in age and sex stratified strata using log-rank tests. We modeled the hazard of CRC using Cox proportional hazards regression, accounting for within-cluster correlation by a robust sandwich variance estimation approach, and assessed an interaction with time since eligibility. Results Among females, 1877 cases of CRC were observed among 209,843 immigrants, and 16,517 cases among 1,049,215 controls; the crude relative rate among female immigrants was 0.623. Among males, 1956 cases of CRC were observed among 191,792 immigrants and 18,329 cases among 958,960 controls; the crude relative rate among male immigrants was 0.582.. Comparing immigrants to controls in all age and sex stratified strata, the log rank test p < 0.0001 except for females aged > = 75 years at index, where p = 0.01. The age-adjusted hazard ratio (HR) for CRC among female immigrants was 0.63 (95% CI 0.59, 0.67) during the first 10 years, and 0.66 (95% CI 0.59, 0.74) thereafter. Among male immigrants the age-adjusted HR = 0.55 (95% CI 0.52, 0.59) during the first 10 years and increased to 0.63 (95% CI 0.57, 0.71) thereafter. The adjusted HR > = 1 only among immigrants born in Europe and Central Asia. Conclusions The risk of CRC among immigrants to Ontario relative to controls varies by origin and over time since immigration.
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Affiliation(s)
- Lawrence Paszat
- University of Toronto, Institute for Clinical Evaluative Sciences, G106 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada.
| | - Rinku Sutradhar
- University of Toronto, Institute for Clinical Evaluative Sciences, G106 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - Ying Liu
- University of Toronto, Institute for Clinical Evaluative Sciences, G106 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - Nancy N Baxter
- University of Toronto, St Michael's Hospital, 30 Bond Street, Toronto, ON, M5B1W8, Canada
| | - Jill Tinmouth
- University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada
| | - Linda Rabeneck
- University of Toronto, Prevention and Cancer Control, Cancer Care Ontario, 620 University Avenue, Toronto, ON, M4, Canada
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Lovshin JA, Shah BR. Inadequate screening for retinopathy among recent immigrants with type 2 diabetes despite universal health care: A population-based study. J Diabetes Complications 2017; 31:664-668. [PMID: 28143734 DOI: 10.1016/j.jdiacomp.2016.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 12/22/2016] [Accepted: 12/23/2016] [Indexed: 10/20/2022]
Abstract
AIMS To examine retinopathy screening and treatment rates for recent immigrants compared to non-immigrants in a universal health care system. METHODS Linked health care and immigration databases were used to identify all 771,564 adults diagnosed with diabetes between 1996 and 2007, in Ontario, Canada. The cohort was stratified by their immigration status and followed until 2013 for retinopathy screening and treatment visits. RESULTS Retinopathy screening rates were low, and recent immigrants were considerably less likely to receive screening than long-term residents (≥1 examination within 1year: 37.5% vs. 50.5%, adjusted OR 0.76 [95% CI, 0.75-0.77]; ≥3 examinations within 6years: 46.6% vs. 61.9%, adjusted OR 0.77 [95% Cl, 0.76-0.79]). Immigrants were also less likely to receive surgical treatment for retinopathy, but adjustment for the frequency of screening attenuated these differences. CONCLUSIONS Despite universal access to physician services, only half of all individuals with newly-diagnosed type 2 diabetes received retinopathy screening within the first year, and recent immigrants were markedly less likely to be screened. After adjusting for screening rates, gaps in surgical treatment for retinopathy were attenuated, suggesting that treatable retinopathy may be being missed among recent immigrants because of inadequate screening.
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Affiliation(s)
- Julie A Lovshin
- Division of Endocrinology and Metabolism, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Ontario, Canada
| | - Baiju R Shah
- Department of Medicine, University of Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
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Iqbal J, Ginsburg O, Fischer HD, Austin PC, Creatore MI, Narod SA, Rochon PA. A Population-Based Cross-Sectional Study Comparing Breast Cancer Stage at Diagnosis between Immigrant and Canadian-Born Women in Ontario. Breast J 2017; 23:525-536. [PMID: 28252245 DOI: 10.1111/tbj.12785] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
There is limited information on stage at breast cancer diagnosis in Canadian immigrant women. We compared stage at diagnosis between immigrant women and Canadian-born women, and determined whether ethnicity was an independent factor associated with stage. 41,213 women with invasive breast cancer from 2007 to 2012 were identified from the Ontario Cancer Registry. Women were classified as either immigrants or Canadian-born by linkage with the Immigration, Refugees, and Citizenship Canada's Permanent Resident database. Women's ethnicity was classified as Chinese, South Asian, or remaining women in Ontario. Logistic regression was performed to calculate the odds ratio (OR) of being diagnosed at stage I breast cancer (versus stage II-IV). 4,353 (10.6%) women were immigrants and 36,860 (89.4%) were Canadian-born women. The mean age at breast cancer diagnosis was 53.5 years for immigrants versus 62.3 years for Canadian-born women (p < 0.0001). Immigrant women were less likely than Canadian-born women to be diagnosed with stage I breast cancers (adjusted OR = 0.85; 95% CI: 0.79-0.91; p < 0.0001). The adjusted OR of being stage I was 1.28 (95% CI: 1.14-1.43; p < 0.0001) for women of Chinese ethnicity and was 0.82 (95% CI: 0.70-0.96; p = 0.01) for women of South Asian ethnicity, compared to the remaining women in Ontario. Canadian immigrant women were less likely than Canadian-born women to be diagnosed with early-stage breast cancers. Ethnicity was a greater contributor to the stage disparity than was immigrant status. South Asian women, regardless of immigration status, might benefit from increased breast cancer awareness programs.
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Affiliation(s)
- Javaid Iqbal
- Women's College Research Institute/Women's College Hospital, Toronto, ON, Canada
| | - Ophira Ginsburg
- Women's College Research Institute/Women's College Hospital, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Hadas D Fischer
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Peter C Austin
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Faculty of Medicine, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | - Steven A Narod
- Women's College Research Institute/Women's College Hospital, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Paula A Rochon
- Women's College Research Institute/Women's College Hospital, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Faculty of Medicine, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Alabousi M, Abdullah P, Alter DA, Booth GL, Hogg W, Ko DT, Manuel DG, Farkouh ME, Tu JV, Udell JA. Cardiovascular Risk Factor Management Performance in Canada and the United States: A Systematic Review. Can J Cardiol 2017; 33:393-404. [DOI: 10.1016/j.cjca.2016.07.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 07/03/2016] [Accepted: 07/06/2016] [Indexed: 01/13/2023] Open
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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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Risk of Developing Diabetes Among Refugees and Immigrants: A Longitudinal Analysis. J Community Health 2016; 41:1274-1281. [DOI: 10.1007/s10900-016-0216-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Wilhelm AK, Jacobson DJ, Guzman-Corrales L, Fan C, Baker K, Njeru JW, Wieland ML, Boehm DH. Regional Variation in Diabetic Outcomes by Country-of-Origin and Language in an Urban Safety Net Hospital. J Community Health 2016; 41:798-804. [PMID: 26841899 DOI: 10.1007/s10900-016-0155-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Adherence to diabetic care guidelines among US immigrants remains low. This study assesses adherence to diabetic care guidelines by country-of-origin and language among a limited English-proficient (LEP) population. Timely completion of diabetic measures and acceptable levels of hemoglobin A1c (A1c), low density lipoprotein (LDL) cholesterol, and blood pressure (BP) were compared between LEP and English-proficient (EP) patients in this 2013 retrospective cohort study of adult diabetics. More LEP patients met BP targets (83 vs. 68 %, p < 0.0001) and obtained LDL targets (89 vs. 85 %, p = 0.0007); however, they had worse LDL control (57 vs. 62 %, p = 0.0011). Ethiopians and Somalians [adjusted OR (95 % CI) = 0.44 (0.30, 0.63)] were less likely than Latin Americans to meet BP goals. LEP patients outperformed EP peers on several diabetic outcomes measures with important variation between groups. These data highlight the success of a safety net hospital in improving diabetes management among diverse populations.
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Affiliation(s)
- April K Wilhelm
- United Family Medicine Residency Program, Saint Paul, MN, USA
| | - Debra J Jacobson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Laura Guzman-Corrales
- Minneapolis Medical Research Foundation, 701 Park Avenue South (P7), Minneapolis, MN, 55415, USA.
| | - Chun Fan
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Karen Baker
- Analytic Center of Excellence, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Jane W Njeru
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mark L Wieland
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Deborah H Boehm
- Minneapolis Medical Research Foundation, 701 Park Avenue South (P7), Minneapolis, MN, 55415, USA
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Fernandes KA, Sutradhar R, Borkhoff CM, Baxter N, Lofters A, Rabeneck L, Tinmouth J, Paszat L. Small-area variation in screening for cancer, glucose and cholesterol in Ontario: a cross-sectional study. CMAJ Open 2015; 3:E373-81. [PMID: 26835437 PMCID: PMC4705009 DOI: 10.9778/cmajo.20140069] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Screening for cervical, breast and colon cancers, and elevations of cholesterol and glucose, reduces premature cause-specific mortality from these cancers and circulatory diseases. Despite primary care reforms and incentives, and promotion of cancer-screening programs among individuals, participation is suboptimal. We aimed to examine participation as of Dec. 31, 2011, by factors of deprivation, demographics and primary care at the small-area level. METHODS From health care administrative databases, we identified people eligible for each screening test, and their participation, in each dissemination area (referred to as small areas, n = 18 950) in Ontario. We calculated rates for each test among small areas (overall and stratified by demographic, socioeconomic and primary care descriptors) and stratified by sex for all tests combined. We loaded all data into a geographic information system. Funnel plots were generated showing the percentage of eligible people who completed screening for all tests by small area, stratified by sex. Overall and stratified screening prevalence ratios were calculated among small areas. RESULTS Among small areas, the mean and SD for participation in all tests combined was 31.6% (SD 11.0%) for women and 41.2% (SD 12.0%) for men. Screening prevalence among small areas, for each test and for all tests combined, overall and stratified by sex, declined with decreasing percentage with high school completion, decreasing socioeconomic quintile, and decreasing percentage with an identifiable primary care physician. INTERPRETATION Our results show that the rate of participation in all eligible screening tests among small areas is much lower than the rate of participation in any one particular test. This finding has implications for the design and implementation of strategies to improve rates of screening.
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Affiliation(s)
- Kimberly A Fernandes
- Institute for Clinical Evaluative Sciences (Fernandes, Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Dalla Lana School of Public Health (Sutradhar, Borkhoff, Rabeneck, Paszat); St. Michael's Hospital (Baxter, Lofters); Institute of Health Policy, Management and Evaluation (Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); University of Toronto (Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Cancer Care Ontario (Rabeneck); Sunnybrook Health Sciences Centre (Tinmouth), Toronto, Ont
| | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences (Fernandes, Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Dalla Lana School of Public Health (Sutradhar, Borkhoff, Rabeneck, Paszat); St. Michael's Hospital (Baxter, Lofters); Institute of Health Policy, Management and Evaluation (Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); University of Toronto (Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Cancer Care Ontario (Rabeneck); Sunnybrook Health Sciences Centre (Tinmouth), Toronto, Ont
| | - Cornelia M Borkhoff
- Institute for Clinical Evaluative Sciences (Fernandes, Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Dalla Lana School of Public Health (Sutradhar, Borkhoff, Rabeneck, Paszat); St. Michael's Hospital (Baxter, Lofters); Institute of Health Policy, Management and Evaluation (Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); University of Toronto (Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Cancer Care Ontario (Rabeneck); Sunnybrook Health Sciences Centre (Tinmouth), Toronto, Ont
| | - Nancy Baxter
- Institute for Clinical Evaluative Sciences (Fernandes, Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Dalla Lana School of Public Health (Sutradhar, Borkhoff, Rabeneck, Paszat); St. Michael's Hospital (Baxter, Lofters); Institute of Health Policy, Management and Evaluation (Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); University of Toronto (Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Cancer Care Ontario (Rabeneck); Sunnybrook Health Sciences Centre (Tinmouth), Toronto, Ont
| | - Aisha Lofters
- Institute for Clinical Evaluative Sciences (Fernandes, Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Dalla Lana School of Public Health (Sutradhar, Borkhoff, Rabeneck, Paszat); St. Michael's Hospital (Baxter, Lofters); Institute of Health Policy, Management and Evaluation (Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); University of Toronto (Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Cancer Care Ontario (Rabeneck); Sunnybrook Health Sciences Centre (Tinmouth), Toronto, Ont
| | - Linda Rabeneck
- Institute for Clinical Evaluative Sciences (Fernandes, Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Dalla Lana School of Public Health (Sutradhar, Borkhoff, Rabeneck, Paszat); St. Michael's Hospital (Baxter, Lofters); Institute of Health Policy, Management and Evaluation (Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); University of Toronto (Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Cancer Care Ontario (Rabeneck); Sunnybrook Health Sciences Centre (Tinmouth), Toronto, Ont
| | - Jill Tinmouth
- Institute for Clinical Evaluative Sciences (Fernandes, Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Dalla Lana School of Public Health (Sutradhar, Borkhoff, Rabeneck, Paszat); St. Michael's Hospital (Baxter, Lofters); Institute of Health Policy, Management and Evaluation (Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); University of Toronto (Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Cancer Care Ontario (Rabeneck); Sunnybrook Health Sciences Centre (Tinmouth), Toronto, Ont
| | - Lawrence Paszat
- Institute for Clinical Evaluative Sciences (Fernandes, Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Dalla Lana School of Public Health (Sutradhar, Borkhoff, Rabeneck, Paszat); St. Michael's Hospital (Baxter, Lofters); Institute of Health Policy, Management and Evaluation (Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); University of Toronto (Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Cancer Care Ontario (Rabeneck); Sunnybrook Health Sciences Centre (Tinmouth), Toronto, Ont
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Durbin A, Moineddin R, Lin E, Steele LS, Glazier RH. Mental health service use by recent immigrants from different world regions and by non-immigrants in Ontario, Canada: a cross-sectional study. BMC Health Serv Res 2015; 15:336. [PMID: 26290068 PMCID: PMC4546085 DOI: 10.1186/s12913-015-0995-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 08/11/2015] [Indexed: 11/10/2022] Open
Abstract
Background Given that immigration has been linked to a variety of mental health stressors, understanding use of mental health services by immigrant groups is particularly important. However, very little research on immigrants’ use of mental health service in the host country considers source country. Newcomers from different source countries may have distinct experiences that influence service need and use after arrival. This population study examined rates of use of primary care and of specialty services for non-psychotic mental health disorders by immigrants to Ontario Canada during their first five years after arrival. Service use by recent immigrants in broad source region groups representing all world regions was compared to use by age-matched Canadian-born or long term immigrants (called long term residents). Method This matched population-based cross-sectional study assessed likelihood of any use and counts of visits for each of primary care, psychiatric care and hospital care (emergency department visits or inpatient admissions) for non-psychotic mental health disorders from 1993–2012. Adult immigrants living in urban Ontario (n = 912,114) were categorized based on their nine world regions of origin. Sex-stratified conditional logistic regression models and negative binomial models were used to compare service use by immigrant region groups to their age-matched long term residents. Results Immigrant were more or less likely to access primary mental health care compared to age-matched long term residents, depending on their world region of origin. Regarding specialty mental health care (psychiatry and hospital care), immigrants from all regions used less than long term residents. Across the three mental health services, estimates of use by immigrant region groups compared to long term residents were among the lowest for newcomers from East Asian and Pacific (range: 0.16–0.82) and among the highest for persons from Middle East and North Africa (range: 0.56–1.23). Conclusion This population-based study showed lower use of mental health services by recent immigrants than long-term immigrants or native born individuals, with variation in immigrants’ use linked to world region of origin and type of mental health care. Variation across source region groups underscores the importance of identifying underlying individual characteristics that affect service use to make services more responsive to newcomers. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0995-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna Durbin
- Canadian Mental Health Association (Toronto branch), Toronto, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada. .,Institute for Clinical Evaluative Sciences, Toronto, Canada.
| | - Elizabeth Lin
- Department of Psychiatry, University of Toronto, Toronto, Canada. .,Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, Canada.
| | - Leah S Steele
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada. .,Institute for Clinical Evaluative Sciences, Toronto, Canada. .,Keenan Research Centre in the Li Ka Shing Knowledge Institute at St. Michael's Hospital, Toronto, Canada.
| | - Richard H Glazier
- Institute for Clinical Evaluative Sciences, Toronto, Canada. .,Keenan Research Centre in the Li Ka Shing Knowledge Institute at St. Michael's Hospital, Toronto, Canada.
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Bennett NR, Francis DK, Ferguson TS, Hennis AJM, Wilks RJ, Harris EN, MacLeish MMY, Sullivan LW. Disparities in diabetes mellitus among Caribbean populations: a scoping review. Int J Equity Health 2015; 14:23. [PMID: 25889068 PMCID: PMC4347914 DOI: 10.1186/s12939-015-0149-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 01/27/2015] [Indexed: 12/13/2022] Open
Abstract
Background Despite the large body of research on racial/ethnic disparities in health, there are limited data on health disparities in Caribbean origin populations. This review aims to analyze and synthesize published literature on the disparities in diabetes mellitus (DM) and its complications among Afro-Caribbean populations. Methods A detailed protocol, including a comprehensive search strategy, was developed and used to identify potentially relevant studies. Identified studies were then screened for eligibility using pre-specified inclusion and exclusion criteria. An extraction form was developed to chart data and collate study characteristics including methods and main findings. Charted information was tagged by disparity indicators and thematic analysis performed. Disparity indicators evaluated include ethnicity, sex, age, socioeconomic status, disability and geographic location. Gaps in the literature were identified and extrapolated into a gap map. Results A total of 1009 diabetes related articles/manuscripts, published between 1972 and 2013, were identified and screened. Forty-three studies met inclusion criteria for detailed analysis. Most studies were conducted in the United Kingdom, Trinidad and Tobago and Jamaica, and used a cross-sectional study design. Overall, studies reported a higher prevalence of DM among Caribbean Blacks compared to West African Blacks and Caucasians but lower when compared to South Asian origin groups. Morbidity from diabetes-related complications was highest in persons with low socioeconomic status. Gap analysis showed limited research data reporting diabetes incidence by sex and socioeconomic status. No published literature was found on disability status or sexual orientation as it relates to diabetes burden or complications. Prevalence and morbidity were the most frequently reported outcomes. Conclusion Literature on diabetes health disparities in Caribbean origin populations is limited. Future research should address these knowledge gaps and develop approaches to reduce them.
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Affiliation(s)
- Nadia R Bennett
- Epidemiology Research Unit, Tropical Medicine Research Institute, The University of the West Indies, Kingston, West Indies, Jamaica.
| | - Damian K Francis
- Epidemiology Research Unit, Tropical Medicine Research Institute, The University of the West Indies, Kingston, West Indies, Jamaica.
| | - Trevor S Ferguson
- Epidemiology Research Unit, Tropical Medicine Research Institute, The University of the West Indies, Kingston, West Indies, Jamaica.
| | - Anselm J M Hennis
- Chronic Disease Research Centre, Tropical Medicine Research Institute, The University of the West Indies, Bridgetown, West Indies, Barbados.
| | - Rainford J Wilks
- Epidemiology Research Unit, Tropical Medicine Research Institute, The University of the West Indies, Kingston, West Indies, Jamaica.
| | - Eon Nigel Harris
- The University of the West Indies, Kingston, West Indies, Jamaica.
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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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Wang L, Kwak MJ. Immigration, barriers to healthcare and transnational ties: A case study of South Korean immigrants in Toronto, Canada. Soc Sci Med 2014; 133:340-8. [PMID: 25481040 DOI: 10.1016/j.socscimed.2014.11.039] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The paper analyzes the healthcare-seeking behavior of South Korean immigrants in Toronto, Canada, and how transnationalism shapes post-migration health and health-management strategies. Built upon largely separate research areas in ethnicity and health, health geography, and transnationalism, the paper conceptualizes immigrant health as influenced by individual characteristics, the migration and resettlement experience, and place effects at both a local and a transnational scale. A mixed-method approach is used to capture insights into health status and experiences in accessing local and transnational healthcare among South Korean immigrants - a fast growing visible minority group in Canada. Statistical analysis of data from the Canadian Community Health Survey discloses patterns and trends in health and healthcare use among the Korean Canadian, overall foreign-born, and native-born populations. Focus groups reveal in-depth information on the decline of Korean immigrants' health status and the array of sociocultural, economic and geographic barriers in accessing healthcare in Canada, which gave rise to their transnational use of health resources in the home country. The transnational strategies included traveling to South Korea for medical examinations or treatment, importing medications from South Korea to Canada, and consulting health resources in South Korea by phone or email. The results provide timely knowledge on how a recent immigrant group adapts to Canada in the domain of health and adds a transnational perspective to the literature on ethnicity and health.
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Affiliation(s)
- Lu Wang
- Ryerson University, Department of Geography, 305 Victoria Street, Toronto, Ontario M5B 2K3, Canada.
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Durbin A, Lin E, Moineddin R, Steele LS, Glazier RH. Use of mental health care for nonpsychotic conditions by immigrants in different admission classes and by refugees in Ontario, Canada. OPEN MEDICINE : A PEER-REVIEWED, INDEPENDENT, OPEN-ACCESS JOURNAL 2014; 8:e136-46. [PMID: 25426182 PMCID: PMC4242791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Most Canadian newcomers are admitted in the economic, family, or refugee class, each of which has its own selection criteria and experiences. Evidence has shown various risks for mental health disorders across admission classes, but the respective service-use patterns for people in these classes are unknown. In this study, we compared service use for nonpsychotic mental health disorders by newcomers in various admission classes with that of long-term residents (i.e., Canadian-born persons or immigrants before 1985) in urban Ontario. METHODS In this population-based matched cross-sectional study, we linked health service databases to the Ontario portion of the Citizenship and Immigration Canada database. Outcomes were mental health visits to primary care physicians, mental health visits to psychiatrists, and emergency department visits or hospital admissions. We measured service use for recent immigrants (those who arrived in Ontario between 2002 and 2007; n = 359 673). We compared service use by immigrants in each admission class during the first 5 years in Canada with use by age- and sex-matched long-term residents. We measured likelihood of access to each service and intensity of use of each service using conditional logistic regression and negative binomial models. RESULTS Economic and family class newcomers were less likely than long-term residents to use primary mental health care. The use of primary mental health care by female refugees did not differ from that of matched long-term residents, but use of such care by male refugees was higher (odds ratio 1.14, 95% confidence interval 1.09-1.19). Immigrants in all admission classes were less likely to use psychiatric services and hospital services for mental health care. Exceptions were men in the economic and family classes, whose intensity of hospital visits was similar to that of matched long-term residents. INTERPRETATION Immigrants in all admission classes generally used less care for nonpsychotic disorders than longterm residents, although male refugees used more primary care. Future research should examine how mental health needs align with service use, particularly for more vulnerable groups such as refugees.
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Affiliation(s)
- Anna Durbin
- Anna Durbin, MPH, is a PhD candidate in the Institute of Health Policy, Management and Evaluation at the University of Toronto, Toronto, Ontario
| | - Elizabeth Lin
- Elizabeth Lin, PhD, is an Associate Professor in the Department of Psychiatry, University of Toronto, and a Scientist in the Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, Ontario
| | - Rahim Moineddin
- Rahim Moineddin, PhD, is an Associate Professor in the Department of Family and Community Medicine, University of Toronto, and a Scientist with the Institute for Clinical Evaluative Sciences, Toronto, Ontario
| | - Leah S Steele
- Leah S. Steele, BA, MD, PhD, CCFP, is an Assistant Professor in the Department of Family and Community Medicine, University of Toronto; a Scientist in the Department of Family and Community Medicine and the Keenan Research Institute of the Li Ka Shing Knowledge Institute, St. Michael's Hospital; and an Adjunct Scientist with the Institute for Clinical Evaluative Sciences, Toronto, Ontario
| | - Richard H Glazier
- Richard H. Glazier, MD, MPH, is a Senior Scientist with the Institute for Clinical Evaluative Sciences; a Professor in the Department of Family and Community Medicine at the University of Toronto and St. Michael's Hospital; and a Scientist with the Centre for Research on Inner City Health in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario
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Mook-Kanamori MJ, El-Din Selim MM, Takiddin AH, Al-Mahmoud KAS, Al-Homsi H, McKeon C, Al Muftah WA, Kader SA, Mook-Kanamori DO, Suhre K. Elevated HbA1c levels in individuals not diagnosed with type 2 diabetes in Qatar: a pilot study. Qatar Med J 2014; 2014:106-13. [PMID: 25745600 PMCID: PMC4344984 DOI: 10.5339/qmj.2014.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 11/05/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The prevalence of type 2 diabetes (T2D) in Qatar and the Middle East is one of the highest in the world. It is estimated that about one quarter of the individuals with tbl2D are undiagnosed. Elevated HbA1c levels are an indicator of tbl2D or a pre-diabetic state. In this study we set out to examine which factors, such as anthropometric and socio-demographic risk factors, are associated with elevated HbA1c levels in a population without tbl2D. METHODS We examined 191 subjects with no record of tbl2D. Anthropometrics and HbA1c were measured. Socio-demographic (age, gender, ethnicity and educational level) and health information were assessed through questionnaires. Elevated HbA1c levels were defined as >6.0% (>42 mmol/mol). Individual risk factors were examined in relationship to having elevated HbA1c levels using logistic regression. RESULTS Thirty-eight (20%) study participants had elevated HbA1c levels. Participants from South Asian and Filipino descent were more likely to present with elevated HbA1c levels than Arab participants (adjusted odds ratios (OR): 13.30 (95% confidence interval (CI): 4.24, 41.79), p < 0.001 for South Asian and 4.54 (95% CI: 1.04, 19.83), p = 0.04 for Filipinos). A body mass index of above 30 kg/m(2) was associated with elevated HbA1c levels (adjusted OR: 2.90 (95% CI: 1.29, 6.51), p = 0.01). Neither gender nor educational level was associated with elevated HbA1c levels. CONCLUSIONS Elevated HbA1c levels in individuals not diagnosed with diabetes were most frequently found in the South Asian and Filipino immigrant population. Special attention should therefore be given to the early identification of tbl2D in these subjects.
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Affiliation(s)
| | | | | | | | - Hala Al-Homsi
- Dermatology Department, Hamad Medical Corporation, Doha, Qatar
| | - Cindy McKeon
- Department of Clinical Research, Weill Cornell Medical College - Qatar, Doha, Qatar
| | - Wadha A Al Muftah
- Department of Physiology and Biophysics, Weill Cornell Medical College - Qatar, Doha, Qatar
| | - Sara Abdul Kader
- Department of Physiology and Biophysics, Weill Cornell Medical College - Qatar, Doha, Qatar
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Borkhoff CM, Saskin R, Rabeneck L, Baxter NN, Liu Y, Tinmouth J, Paszat LF. Disparities in receipt of screening tests for cancer, diabetes and high cholesterol in Ontario, Canada: a population-based study using area-based methods. Canadian Journal of Public Health 2013; 104:e284-90. [PMID: 24044467 DOI: 10.17269/cjph.104.3699] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 07/09/2013] [Accepted: 05/26/2013] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Few have compared socio-economic disparities in screening tests for cancer with recommended tests for other chronic diseases. We examined whether receipt of testing for colorectal, cervical and breast cancer, as well as diabetes and high cholesterol, differs by neighbourhood-level socio-economic and recent immigrant status. METHODS We conducted a population-based retrospective cohort study of patients identified as screen-eligible in 2009 living in Ontario, Canada. Postal codes were used to assign residents to a dissemination area (DA). Using Canadian census data, DAs were stratified by income quintile and proportion of recent immigrants. Prevalence of screening for cancer (colorectal, cervical, breast), diabetes, and high cholesterol, using administrative data, and prevalence ratios (least/most advantaged) were calculated. RESULTS The cohort comprised 7,652,592 people. Receipt of screening for colorectal cancer (women 61.6%; men 55.1%) and breast cancer (59.9%) were the lowest and diabetes (women 72.9%; men 61.4%) and high cholesterol (women 82.4%; men 70.3%) were the highest. We found disparities in the receipt of all tests, with the lowest uptake and largest disparities for cancer screening among those living in both low-income and high-immigration DAs: colorectal - women 48.6%; RR 0.77; 95% CI (0.74-0.79) and men 40.6%; RR 0.71 (0.68-0.74); cervical - 52.0%; RR 0.80 (0.78-0.81) and breast - 45.7%; RR 0.74 (0.72-0.77). CONCLUSION People living in low-income and high-immigration DAs had the lowest screening participation for all tests, although disparities were highest for cancer. An organized integrated chronic disease screening strategy leveraging the higher diabetes and high cholesterol screening participation may increase screening for cancer and other chronic diseases in never- and underscreened populations.
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Affiliation(s)
- Cornelia M Borkhoff
- Women's College Research Institute, Women's College Hospital Room 728 - 790 Bay Street, Toronto, Ontario, Canada M5G 1N8.
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