Abstract
Recent immigrants face unique cultural and logistical challenges that differ from those of long-standing residents, which may influence the type of care they receive at the end of life. To compare places of care among recent immigrants and long-standing residents in Canada in the last 90 days of life. This population-based retrospective cohort study used linked health administrative data on individuals from Ontario, Canada, who died between January 1, 2013, and December 31, 2016, extracted on February 26, 2020. Individuals were categorized by immigration status: recent immigrants (since 1985) and long-standing residents. Data were analyzed from December 27, 2019, to February 26, 2020. All decedents who immigrated to Canada between 1985 and 2016 were classified as recent immigrants. Subgroup analyses assessed the association of region of origin. The main outcome was place of care, including institutional and noninstitutional settings, in the last 90 days of life. Descriptive statistics were used to compare characteristics and health service utilization among recent immigrants and long-standing residents. Negative binomial regression models estimated the rate ratios (RR) of using acute care and long-term care in the last 90 days of life. A total of 376 617 deceased individuals (median [IQR] age, 80 [68-88] years; 187 439 [49.8%] women and 189 178 [50.2%] men) were identified, among whom 22 423 (6.0%) were recent immigrants; recent immigrants were younger than long-standing residents (median [IQR] age, 76 [60-85] years vs 81 [69-88] years; P < .001), more likely to be living in lower income neighborhoods (12 357 immigrants [55.1%] vs 166 017 long-standing residents [46.9%] in the lower 2 income quintiles; P < .001), and had a higher Charlson Index score (score ≥5, 6294 immigrants [28.1%] vs 74 809 long-standing residents [21.1%]; P < .001). In the last 90 days of life, recent immigrants spent more days in intensive care units than long-standing residents (mean [SD], 2.64 [8.73] days vs 1.47 [5.70] days; P < .001), while long-standing residents spent more days using long-term care than recent immigrants (mean [SD], 19.49 [35.81] days vs 10.45 [27.42] days; P < .001). Being a recent immigrant was associated with a greater likelihood of acute inpatient care use (RR, 1.21; 95% CI, 1.18-1.24) and lower likelihood of long-term care use (RR, 0.66; 95% CI, 0.63-0.70), after adjusting for covariates. These findings suggest that at the end of life, recent immigrants were significantly more likely to receive inpatient and intensive care unit services and die in acute care settings compared with long-standing residents. Further research is needed to examine differences in care preference and disparities for immigrant groups of different origins.
Highlights
In 2019, Canada welcomed more than 341 000 new permanent residents, where they represented 26% of the workforce and contributed more than 80% to population growth, and more than 50% had university degrees.[1]
Being a recent immigrant was associated with a greater likelihood of acute inpatient care use (RR, 1.21; 95% CI, 1.18-1.24) and lower likelihood of long-term care use (RR, 0.66; 95% CI, 0.63-0.70), after adjusting for covariates
Key Points Question Is recent immigration status associated with place of care at the end of life compared with long-standing residents?. In this cohort study of 376 617 deceased individuals in Ontario, Canada, recent immigrants who died were younger, had lower income and higher risk of mortality, and died more often in acute care settings compared with long-standing residents
Summary
In 2019, Canada welcomed more than 341 000 new permanent residents, where they represented 26% of the workforce and contributed more than 80% to population growth, and more than 50% had university degrees.[1] despite their contribution to a productive and skilled Canadian society, immigrants can experience restricted health care, as they often face challenges, such as poverty, language difficulties, or policies that enforce delays on immigrants before they can receive health insurance.[2,3,4,5] These barriers complicate the ability of immigrants to establish relationships with physicians, access prescriptions and medications, and seek appropriate health care. It is important to consider how health policies can be revised to provide patient-centric and culturally appropriate care that supports the increasing diversity of the population.[20,21,22]
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