Abstract
An ongoing challenge of estimating the burden of infectious diseases known to disproportionately affect migrants (e.g. malaria, enteric fever) is that many health information systems, including reportable disease surveillance systems, do not systematically collect data on migrant status and related factors. We explored whether health administrative data linked to immigration records offered a viable alternative for accurately identifying cases of hepatitis A, malaria and enteric fever in Ontario, Canada. Using linked health care databases generated by Ontario’s universal health care program, we constructed a cohort of medically-attended individuals with presumed hepatitis A, malaria or enteric fever in Peel region using diagnostic codes. Immigrant status was ascertained using linked immigration data. The sensitivity and positive predictive value (PPV) of diagnostic codes was evaluated through probabilistic linkage of the cohort to Ontario’s reportable disease surveillance system (iPHIS) as the reference standard. Linkage was successful in 90.0% (289/321) of iPHIS cases. While sensitivity was high for hepatitis A and enteric fever (85.8% and 83.7%) and moderate for malaria (69.0%), PPV was poor for all diseases (0.3–41.3%). The accuracy of diagnostic codes did not vary by immigrant status. A dated coding system for outpatient physician claims and exclusion of new immigrants not yet eligible for health care were key challenges to using health administrative data to identify cases. Despite this, we show that linkages of health administrative and immigration records with reportable disease surveillance data are feasible and have the potential to bridge important gaps in estimating burden using either data source independently.
Highlights
As populations become more connected and diverse through travel and immigration, there is a growing interest in understanding the health needs of migrant populations to protect their health and that of the broader public [1]
In ethnoculturally diverse regions in Canada and around the world, VFR travellers account for the majority of hepatitis A, malaria, and enteric fever cases reported to public health [3]
We constructed a cohort of medically-attended individuals with presumed hepatitis A, malaria or enteric fever in Peel region through deterministic linkage of the Canadian Institutes for Health Information’s hospital discharge abstract (DAD) and same-day surgeries databases (SDS), National Ambulatory Care Reporting System (NACRS), and Ontario Health Insurance Plan (OHIP) physician claims
Summary
As populations become more connected and diverse through travel and immigration, there is a growing interest in understanding the health needs of migrant populations to protect their health and that of the broader public [1]. The European Centre for Disease Prevention and Control has called for better data to improve understanding of risk groups of imported malaria in Europe [12] Another important challenge with public health surveillance data is poor sensitivity as cases may not seek health care or be reported to public health (which varies by disease [13, 14]), or they may seek health care or die from their infection while travelling [15, 16]. These limitations may explain the lack of studies estimating burden of travel or migration-related infectious diseases, despite the value of this information to decision-makers [17]
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