Healthy Immigrant Effect Research Articles

Eating disorders among international migrants: a systematic review and meta-analysis.

Migrants may have elevated exposure to stressors, which can affect their physical and mental well-being. However, migrants often experience a healthy immigrant effect, the applicability of this phenomena to eating disorders is unknown. We aimed to synthesize the available literature and estimate a summary measure of prevalence odds ratio for eating disorders in migrant populations compared to local populations. A literature search was conducted using MEDLINE, Embase, PsycINFO, and Web of Science with keywords on migration and eating disorders. Inclusion criteria involved using a validated eating disorder scale and having a comparator group. Two independent reviewers performed study screening and data extraction. The NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess risk of bias. Random-effects models of meta-analysis were applied to compare eating disorder prevalence between migrants and local populations. There were 10 studies included in our review (meta-analysis = 6, narrative synthesis = 4). Studies provided prevalence estimates for: any eating disorder, binge eating disorder, anorexia nervosa, and bulimia nervosa. Among studies with a diagnostic instrument, the pooled prevalence odds ratio (POR) between migrants and local populations for any eating disorder was 0.45 (95%CI: 0.35-0.59). However, a subgroup analysis of eating disorder instruments among studies using risk assessment tools demonstrated inconsistent findings, with both increases and decreases in prevalence. Migrants were found to have a lower prevalence of eating disorders compared to local populations, supporting the healthy immigrant hypothesis. However, this effect differs between diagnostic and risk assessment tools.

Cancer mortality in Germany-born Americans and Germans

IntroductionComparing cancer mortality and associated risk factors among immigrant populations in a host country to those in their country of origin reveals disparities in cancer risk, access to care, diagnosis, and disease management. This study compares cancer mortality between the German resident population and Germany-born individuals who migrated to the US. MethodsCancer mortality data from 2008–2018 were derived for Germans from the World Health Organization database and for Germany-born Americans resident in four states (California, Florida, Massachusetts, and New York) from respective Departments of Vital Statistics. We calculated age-standardized mortality rates (ASMRs) using the European standard population and standardized mortality ratios (SMR) compared to the German resident population along with 95% confidence intervals (CIs). ResultsGermany-born American males had lower ASMRs (253.8 per 100,000) than German resident population (325.6 per 100,000). The difference in females was modest, with ASMRs of 200.7 and 203.7 per 100,000, respectively. For all cancers, Germany-born American males had an SMR of 0.72 (95% CI: 0.70–0.74) and females 0.98 (95% CI: 0.95–1.00). Male SMRs among Germany-born Americans were significantly below one for oral cavity, stomach, colorectal, liver, lung, prostate, and kidney cancer. Among females, SMRs were below one for oral cavity, stomach, colorectal, gallbladder, breast, cervix uteri, and kidney cancer. For both sexes, SMRs were over one for bladder cancer (1.14 for males, 1.21 for females). Mortality was higher for lung cancer (SMR: 1.68), non-Hodgkin’s lymphoma (1.18) and uterine cancer (1.22) among Germany-born American females compared to the German resident population. ConclusionGermany-born American males but not females showed lower cancer mortality than German resident population. Disparities may stem from variations in risk factors (e.g., smoking and alcohol use) as well as differences in screening practices and participation, cancer treatment, besides some residual potential "healthy immigrant effect".

Assessing the Impact of Marginalization on Survival for Patients Undergoing Autologous Stem Cell Transplant in Ontario, Canada

Background Autologous hematopoietic stem cell transplants (ASCT) are potentially life-saving interventions used to treat hematologic disorders. However, it is unclear if socioeconomic disparities impact the patient benefit from ASCT. Recent evidence suggests lower rates of ASCT for patients living in rural settings and for ethnic minority groups. Few population-based studies have assessed comprehensive indices of marginalization as predictors of outcomes after ASCT. In a publicly funded healthcare setting, it is crucial to understand if various aspects of marginalization interact to ultimately impact survival for patients undergoing ASCT. Methods We performed a retrospective population-based study using administrative healthcare databases from Ontario, Canada. Patients were included if they had undergone auto-SCT for lymphoma or myeloma between 2010 and 2022. The Ontario Marginalization Index (ON-Marg), created using Canadian census data, explores four key aspects of marginalization: residential instability (referring to housing instability), material deprivation (referring to individual and community abilities to access basic material needs), dependency (referring to lack of income from employment), and ethnic concentration (referring to individuals who are recent immigrants or belonging to a visible minority group). The primary outcome was 2-year overall survival (OS) from time of transplant to death or end of the study period stratified by ON-Marg quintiles. Multivariable Cox regression analyses were used to identify baseline characteristics associated with OS. Results A total of 1886 patients underwent ASCT for lymphoma and 2842 patients underwent ASCT for myeloma. The median age of patients undergoing ASCT for lymphoma was 56 years (IQR 44-63) and 64% of patients were male. 22% of patients had high aggregated diagnosis group (ADG) comorbidity scores and 15% had a prior history of cancer. 2-year OS for patients in the fifth quintile of marginalization of the ethnic concentration index was 80.4% (95% CI 75.9-84.1%), compared to 72.3% (95% CI 67.5-76.5%) in the first quintile ( Figure 1A). This survival advantage (HR 0.71, 95% CI 0.52-0.99) persisted after adjusting for age, comorbidity burden, and distance to hospital ( Table 1). Patients who lived 150-200 km from the transplant center had a lower risk of death compared to patients who lived within 50km of the hospital (HR 0.53, 95% CI 0.30-0.94). 2-year OS was not significantly different for patients in quintile 5 of marginalization of the dependency index compared to quintile 1 (HR 1.25, 95% CI 0.93-1.67), with similarly no significant difference across residential instability or material deprivation. The median age of patients undergoing ASCT for myeloma was 61 years (IQ 55-66), and 25% of patients had high ADG comorbidity scores. OS was not significantly different across all domains of marginalization, with a 2-year OS of 88.8% (95% CI 85.8-91.2%) in quintile 1 of ethnic deprivation and 87.5% (95% CI 84.7-89.8%) in quintile 5 ( Figure 1B). Higher comorbidity scores were associated with an increased risk of death compared to lower comorbidity scores (HR 2.17, 95% CI 1.58-2.98), as shown in Table 1. Living 150-200 km from the transplant center was associated with worse OS (HR 1.74, 95% CI 1.24-2.45). Conclusion This is one of the first studies to examine the effect of marginalization on outcomes after ASCT in a publicly-funded healthcare system. For patients undergoing ASCT for lymphoma, patients in quintile 5 of ethnic concentration had improved 2-year OS compared to patients in quintile 1. One possible explanation is the healthy immigrant effect, whereby immigrant patients are healthier than their Canadian-born counterparts. Cultural factors may also have a protective role. Patients undergoing ASCT for lymphoma who lived farther from the transplant center had a lower risk of death; these patients may be more highly selected based on fitness and disease biology to be referred for transplant compared to patients who live within close proximity. For patients undergoing ASCT for myeloma, 2-year OS was not affected by ethnic concentration quintile. The decision for referral for ASCT for myeloma is not as subjective, with ASCT commonly used in the first-line setting for eligible patients regardless of distance, which likely accounts for this difference. Further work is needed to ensure that all eligible patients receive ASCT.

Assessing the “healthy immigrant effect” in mental health: Intra- and inter-cohort trends in mood and/or anxiety disorders

BackgroundThe healthy immigrant effect implies that, at the time of immigration, new immigrants are typically healthier than the Canadian-born population. Furthermore, this health advantage fades the longer cohorts of immigrants remain in the host country. MethodsMost studies assessing the healthy immigrant effect rely on strong, untestable assumptions to extract unique effects for length of stay (LOS) (i.e., how long an immigrant has been in a host country), period (i.e., year of observation), and cohort (i.e., year of immigration). Rather than attempting to parse out separate effects for LOS, period, and cohort, we adopt a descriptive, cohort-centric approach to study immigrant mental health, which examines intra- and inter-cohort trends, that is, joint LOS-period and cohort-period parameters, respectively. While intra-cohort trends show how immigrants’ mental health change with LOS across periods, inter-cohort trends reveal how the mental health of successive cohorts of immigrants differ across time periods. To provide a thorough assessment of the healthy immigrant effect, we use both survey and administrative data on cohorts of Canadian immigrants from 2003 to 2013. ResultsThe survey data reveal that mental health declines steeply (i.e., there is an increase in mood and/or anxiety disorders) within and across immigrant cohorts, while the administrative data show little overall change in mental health care utilization within and across cohorts. The divergent results may reflect issues related to barriers in access to mental health services because the administrative data, which are based on health care utilization, do not the capture the increase in mental disorders seen in the survey data. ConclusionThis study highlights the benefit of a cohort-based approach to assess the healthy immigrant effect as it pertains to mental health as well as the importance of using different types of data, which may be measuring different aspects of immigrant mental health and health care utilization.

Abstract 13306: Substantial Variation in the Rate of Coronary Artery Disease Among Ontario Immigrants

Immigrants constitute a substantial proportion of the population in Western Europe and North America. Although prior studies have suggested that a "healthy immigrant effect" exists, little is known about the extent and variation of stable obstructive coronary artery disease (CAD) among immigrants. We evaluated the association of country of origin and the rates of stable CAD among immigrants. We assembled a cohort of immigrants and non-immigrants who received elective cardiac catheterization in Ontario, Canada, between April 1, 2012 and March 31, 2021. Immigrants were categorized by their country of origin into 7 regions: Africa, Caribbean, Latin America, Western Countries, East Asia, South Asia, and Middle East. Our main outcome was the rate of obstructive CAD (left main stenosis ≥50% or major epicardial vessel stenosis ≥70%). Multivariable logistic regression analyses adjusting for age, cardiac risk factors, and socioeconomic status was used to study the association of country of birth with presence of CAD. The study included 208,363 non-immigrants and 36,139 immigrants: 13,503 from South Asia, 6,839 from Western Countries, 5,036 from East Asia, 4,374 from the Middle East, 2,481 from Latin America, 2,320 from Caribbean, and 1,586 from Africa. Obstructive CAD was found in 47.1% of immigrants and 47.4% of non-immigrants. Immigrants from South Asia had the highest rate of obstructive CAD at 53.7% and those from the Caribbean had the lowest rate at 32.5%. South Asian men and women had the highest odds of obstructive CAD compared to non-immigrants (Figure). Despite the conventional belief that immigrants have better health status, we found that immigrants in Canada had higher odds of obstructive CAD than non-immigrants. In addition, significant variation exists among patients by country of origin even after accounting for the traditional cardiac risk factors.

Unhealthy sleep assimilation

Abstract Migrant health advantages, the ‘healthy immigrant effect’, erode over time, leading to what is known as unhealthy assimilation. Health-related behaviours are central to unhealthy assimilation, and here we focus on an understudied and central part of our daily time: sleep. Building on diverse streams of literature, we conceptualize and empirically study the sleep assimilation patterns of immigrants. With data from Germany, we demonstrate that immigrants sleep significantly more than natives upon arrival, while their sleep ‘advantage’ dissipates with years spent in the host country. We also explore the heterogeneity of the sleep assimilation process by gender, education, wages, work schedules, and job physical intensity.

Naturalization and immigrants' health.

The "healthy immigrant effect" refers to the well-documented fact that immigrants are healthier than natives upon arrival, but their health level converges to that of natives over time. Unfortunately, we know little about whether environmental, institutional, or selective return migration mechanisms are behind the convergence. In this paper, I test whether immigrants' naturalization influences health convergence speed. Using restricted-access Spanish health data from the National and European Health Surveys, I estimate the impact of naturalization on health by exploiting that naturalization is possible after 2years of residence for immigrants from specific countries and after 10years for all other immigrants. I find that naturalization worsens immigrants' health and thus accelerates the speed of convergence to natives' health. Increases in employment are potential mechanisms behind this effect.

Immigrant, black and racialized people’s health

Immigrant, black and racialized people’s health Learn about the research of Dr. Bukola Salami, Professor at Cumming School of Medicine, University of Calgary, in this particular focus on Immigrant, Black, and Racialized People’s Health. Immigrants often arrive in Canada in better health than the Canadian-born population due to pre-arrival health screening. This phenomenon is called the healthy immigrant effect. However, the health of immigrants often declines after a period of time in Canada. Several factors contribute to this health decline, including poor socioeconomic outcomes, healthcare access barriers, and discrimination. Professor Salami’s research program focuses on policies and practices shaping migrant and Black people’s health. She has been involved in over 85 funded studies totaling over $230 million. She has led research projects on topics including African immigrant child health, immigrant mental health, access to healthcare for Black women, access to healthcare for immigrant children, Black youth mental health, the health of internally displaced children, the well-being of temporary foreign workers, COVID-19 vaccine hesitancy among Black Canadians, an environmental scan of equity-seeking organizations in Alberta, culturally appropriate practices for research with Black Canadians, international nurse migration, and parenting practices of African immigrants.

Population-Based Differences in Cancer Incidence between Immigrants and Non-Immigrants in Canada from 1992-2015

The purpose of this study was to investigate if there are differences in cancer incidence between immigrants and non-immigrants in Canada. We hypothesized that immigrants have lower cancer incidence compared to non-immigrants. In this retrospective study, a linked-database approach was employed using Statistics Canada data. The Canadian Cancer Registry and Canadian Vital Statistics Database were linked with the 1991 Census cohort and the cohort was followed from 1992-2015 for cancer incidence. Excluded persons included Census non-respondents, institutional residents, those living on reserves and those less than 25 years of age. Sampling and bootstrap weights were used to ensure the sample represented the Canadian population and for statistical analyses. Total unweighted and weighted sample was 2,585,160 and 17,002,560, respectively which provided adequate power to answer the research question. Multivariate logistic regression and cox regression models included age, sex, household income, marital status, highest degree of education, knowledge of Canada's official languages (English or French), immigrant status and region of birth. Subcategories of immigrants were created based on time spent in Canada (0-4, 5-9, 10-19, 20+ years). Raw data showed that 16.8% of immigrants and 15.9% of non-immigrants had cancer. After adjusting, logistic regression analyses showed that immigrants had lower odds of any cancer diagnoses in comparison with non-immigrants (OR = 0.92, 95% CI [0.92,0.93], p<.001), as well as lung (OR = 0.74, 95% CI [0.72-0.75], p<.001); breast (OR = 0.96, 95% CI [0.94-0.98], p = .001); colorectal (OR = 0.93, 95% CI [0.91-0.95], p<.001) and head and neck cancer (OR = 0.85, 95% CI [0.81-0.90], p<.001). However, immigrants had higher odds of stomach cancer and non-cervix gynecological cancers (OR = 1.39, 95% CI [1.32-1.46]; OR = 1.06, 95% CI [1.02-1.10]), respectively. Hazard ratios were lower for immigrants in comparison to the Canadian-born but increased based on time spent in Canada (0-4 years: 0.77, 95% CI [0.71-0.84], p<.001; 5-9 years: 0.82, 95% CI [0.75-0.89], p<.001; 10-19 years: 0.90, 95% CI [0.82-0.98], p = .011). This study demonstrates a significant difference in cancer incidence between immigrants and non-immigrants. These results support current research in the observation of a 'healthy immigrant effect' (HIE) which convey that immigrants have better health outcomes than their native-born counterparts, with the effect decreasing over time spent in the host country. Since we controlled for demographic and socio-economic factors, we propose other factors to be contributing to the HIE such as individual-level health behaviors including smoking, diet and access to screening services. While it points to a HIE, we propose this phenomenon to be more complex due to the possibility of under-reporting of cases or differences in health behaviors, warranting further studies in this area.

Race, immigrant status, and inequality in physical activity: An intersectional and life course approach.

Physical activity improves health and well-being, but not everyone can be equally active. Previous research has suggested that racial minorities are less active than their white counterparts and immigrants are less active than their native-born counterparts. In this article, we adopt an intersectional and life course approach to consider how race and immigrant status may intersect to affect physical activity across the life span. This new approach also allows us to test the long-standing habitual versus structural debate in physical activity. Analysing data from two recent cycles of the Canadian Community Health Survey (CCHS, 2015-2016 & 2017-2018), we find that physical activity is only lower among immigrants who are also racial minorities and that the gap is most significant during adulthood, but rather insignificant during adolescence and late life. The findings that inequality in physical activity is more apparent among the most disadvantaged racialised immigrants and among working-age adults when structural influences are greater suggest that inequality in physical activity is rooted in structural inequalities, rather than habitual differences. Finally, we demonstrate that the widely observed 'healthy (racialised) immigrant effect' can be underestimated if inequality in physical activity is not considered.

Healthy Immigrant Effect or Under-Detection? Examining Undiagnosed and Unrecognized Late-Life Depression for Racialized Immigrants and Nonimmigrants in Canada.

Immigrants to Canada tend to have a lower incidence of diagnosed depression than nonimmigrants. One theory suggests that this "healthy immigrant effect (HIE)" is due to positive selection. Another school of thought argues that the medical underuse of immigrants may be the underlying reason. This unclear "immigrant paradox" is further confounded by the intersecting race-migration nexus. This population-based study analyzed data of participants (n = 28,951, age ≥45) from the Canadian Community Health Survey (2015-2018). Multivariable logistic regression was employed to examine associations between race-migration nexus and mental health outcomes, including depressive symptoms (Patient Health Questionnaire [PHQ-9] score ≥10). Compared to Canadian-born (CB) Whites, immigrants, regardless of race, were less likely to receive a mood/anxiety disorder diagnosis (M/A-Dx) by health providers in their lifetime. Racialized immigrants were mentally disadvantaged with increased odds of undiagnosed depression (Adjusted odds ratio [AOR] = 1.76, 99% Confidence interval [CI]:1.30-2.37), whereas White immigrants were mentally healthier with decreased odds of PHQ depression (AOR=0.75, 99%CI: 0.58, 0.96) and poor self-rated mental health (AOR=0.56, 99% CI=0.33, 0.95). Among the subpopulation without a previous M/A-Dx (N = 25,203), racialized immigrants had increased odds of PHQ depression (AOR = 1.45, 99% CI: 1.15-1.82) and unrecognized depression (AOR = 1.47, 99% CI: 1.08-2.00) than CB Whites. Other risk factors for undiagnosed depression include the lack of regular care providers, emergency room as the usual source of care, and being home renters. Despite Canadian universal health coverage, the burden of undiagnosed depression disproportionately affects racialized (but not White) immigrants in mid to late life. Contingent on race-migration nexus, the HIE in mental health may be mainly driven by the healthier profile of White immigrants and partly attributable to the under-detection (by health professionals) and under-recognition of mental health conditions among racialized immigrants. A paradigm shift is needed to estimate late-life depression for medically underserved populations.

Cancer Incidence by Race and Immigration Status in Canada: Value of Enhanced Sociodemographic Data for Disease Surveillance

Abstract Metrics of cancer burden stratified by race can inform tailored prevention strategies. Examining how these metrics, such as incidence, vary by immigration status can provide insight into the drivers of differential cancer risk by race. The conduct of such analyses in Canada has historically been hindered by a lack of sociodemographic data in routine health data sources, including cancer registries. In their recent study, Malagón and colleagues overcome this challenge by using National Cancer Registry data linked to self-reported race and place of birth from the Canadian census. The study provides estimates of cancer incidence for 19 cancer sites across more than 10 racial groups. Compared with the total population, they found that cancer risk tended to be lower among persons belonging to non-White, non-Indigenous racial groups. Exceptions were stomach, liver, and thyroid cancers where incidence rates were higher in minority groups than in the White population. For some cancers and racial groups, incidence was lower irrespective of immigration status, suggesting the healthy immigrant effect may be sustained across generations or that other factors are also at play. The results highlight potential areas for deeper inquiry and underscore the value of sociodemographic data for disease surveillance. See related article by Malagón et al., p. 906

Common mental disorders in Peruvian immigrant in Chile: a comparison with the host population

BackgroundThe Inner Santiago Health Study (ISHS) aimed to (i) estimate the prevalence of common mental disorders (CMD; i.e. depressive and anxiety disorders) among immigrants of Peruvian origin in Chile; (ii) determine whether such immigrants are at higher risk of CMD when compared with the native-born geographically matched population (i.e. non-immigrants); and (iii) identify factors associated with higher risk of any CMD among this immigrant group. A secondary aim was to describe access to mental health services by Peruvian immigrants meeting criteria for any CMD.MethodsFindings are based on a population-based cross-sectional household mental health survey of 608 immigrant and 656 non-immigrant adults (18-64 years) residing in Santiago de Chile. Diagnoses of ICD-10 depressive and anxiety disorders and of any CMD were obtained using the Revised Clinical Interview Schedule. The relationships between demographic, economic, psychosocial, and migration-specific predictor variables, and risk of any CMD were analyzed with a series of stepwise multivariate logistic regression models.ResultsThe one-week prevalence of any CMD was 29.1% (95% CI: 25.2-33.1) among immigrants and 34.7% (95% CI: 30.7-38.7) among non-immigrants. Depending on the statistical model used in the pooled sample, we found the prevalence of any CMD among non-immigrants to be higher (OR=1.53; 95% CI: 1.05-2.25) or similar (OR=1.34; 95% CI: 0.94-19.2) when compared with immigrants. In the multivariate stepwise regression of any CMD in immigrants only, the prevalence was higher for females, those with primary compared to higher education, in debt and exposed to discrimination. Conversely, higher levels of functional social support, sense of comprehensibility, and manageability were associated with a lower risk of any CMD in immigrants. In addition, no differences were observed between immigrants and non-immigrants reporting any CMD in mental health service utilization.ConclusionOur results evidence high levels of current CMD in this immigrant group, particularly amongst women. However, lower adjusted prevalence of any CMD in immigrants compared to non-immigrants was limited to preliminary statistical models, thus failing to provide clear support for a “healthy immigrant effect”. The study sheds new light on differences in CMD prevalence by immigrant status in Latin America by examining differential exposure to risk factors in immigrant versus non-immigrant groups.

“Healthy immigrant effect” among individuals experiencing homelessness in Spain?: Foreign-born individuals had higher average age at death in 15-year retrospective cohort study

BackgroundIndividuals experiencing homelessness (IEHs) suffer from severe health inequities. Place of origin is linked to health and mortality of IEHs. In the general population the “healthy immigrant effect” provides a health advantage to foreign-born people. This phenomenon has not been sufficiently studied among the IEH population. The objectives are to study morbidity, mortality, and age at death among IEHs in Spain, paying special attention to their origin (Spanish-born or foreign-born) and to examine correlates and predictors of age at death.MethodsRetrospective cohort study (observational study) of a 15-year period (2006–2020). We included 391 IEHs who had been attended at one of the city’s public mental health, substance use disorder, primary health, or specialized social services. Subsequently, we noted which subjects died during the study period and analyzed the variables related to their age at death. We compared the results based on origin (Spanish-born vs. foreign-born) and fitted a multiple linear regression model to the data to establish predictors of an earlier age at death.ResultsThe mean age at death was 52.38 years. Spanish-born IEHs died on average almost nine years younger. The leading causes of death overall were suicide and drug-related disorders (cirrhosis, overdose, and chronic obstructive pulmonary disease [COPD]). The results of the linear regression showed that earlier death was linked to COPD (b = − 0.348), being Spanish-born (b = 0.324), substance use disorder [cocaine (b =-0.169), opiates (b =.-243), and alcohol (b =-0.199)], cardiovascular diseases (b = − 0.223), tuberculosis (b = − 0.163), high blood pressure (b =-0.203), criminal record (b =-0.167), and hepatitis C (b =-0.129). When we separated the causes of death for Spanish-born and foreign-born subjects, we found that the main predictors of death among Spanish-born IEHs were opiate use disorder (b =-0.675), COPD (b =-0.479), cocaine use disorder (b =-0.208), high blood pressure (b =-0.358), multiple drug use disorder (b =-0.365), cardiovascular disease (b =-0.306), dual pathology (b =-0.286), female gender (b =-0.181), personality disorder (b =-0.201), obesity (b =-0.123), tuberculosis (b =-0.120) and having a criminal record (b =-0.153). In contrast, the predictors of death among foreign-born IEHs were psychotic disorder (b =-0.134), tuberculosis (b =-0.132), and opiate (b =-0.119) or alcohol use disorder (b =-0.098).ConclusionsIEHs die younger than the general population, often due to suicide and drug use. The healthy immigrant effect seems to hold in IEHs as well as in the general population.

A256 INCIDENCE OF CIRRHOSIS AMONG RECENT IMMIGRANTS AND REFUGEES TO ONTARIO, CANADA : A POPULATION-BASED COHORT STUDY

Abstract Background The burden of cirrhosis is increasing in North America where a significant proportion of the population (~20%) is comprised of recent immigrants and refugees. However, the incidence of cirrhosis among this population has not been described. Purpose The aim of this study was to describe the incidence of cirrhosis among recent immigrants and refugees to Ontario, Canada stratified by cirrhosis etiology and region of origin and compare incidence rates to those of Canadian-born and long-term residents. Method This is a population-based cohort study from Ontario, Canada from 2000-2017 using healthcare data housed at ICES. Individuals with incident cirrhosis using a 5-year lookback were identified along with cirrhosis etiology using validated algorithms. Recent immigrants and refugees to Ontario (since 1985) and their World Bank region of origin were defined based on linkage to the Immigration, Refugees, and Citizenship Canada’s Permanent Resident database. Adjusted incidence rates of cirrhosis by immigration status, etiology, and region of origin were calculated and differences in rates were compared between recent immigrants and refugees to long-term residents (born in Canada or arriving before 1985) using age and sex adjusted Poisson regression to calculate rate ratios (RR). Result(s) In total, n=25,054 recent immigrants/refugees with incident cirrhosis were identified. 59% were male, median age was 49 years (IQR 39-61), 99% resided in urban areas and 31% resided in neighbourhoods of the lowest income quintile. The most common regions of origin were East Asia and Pacific (n=8,121; 32%), South Asia (n=5,576; 22%), Europe and Central Asia (n=4,454; 18%) and Latin America/Caribbean (n=3,216; 13%). The majority had NAFLD cirrhosis (n=13,972; 55%), followed by HBV (n=4,648; 19%), ALD (n=2,957; 12%), and HCV (n=2,635; 11%). Cirrhosis incidence stratified by etiology varied by region of origin, with HBV highest among the East Asia and Pacific and Sub-Saharan Africa cohort (Figure 1b), HCV among Sub-Saharan Africa and South Asia (Figure 1c), ALD among European/Central Asia and South Asia (Figure 1d), and NAFLD among the Latin America/Caribbean, Middle East/North Africa, and South Asian populations (Figure 1e). When comparing age and sex adjusted incidence of cirrhosis by etiology and immigration status, rates were lower among recent immigrants/refugees for all causes compared to long-term residents (all RR &amp;lt;1.0; Figure 1a,c-f) with the exception of HBV where it was over 4-fold higher (Figure 1b). Image Conclusion(s) Rates of HBV cirrhosis are substantially higher among migrants to Ontario while rates of all other causes of cirrhosis are lower, likely explained by the healthy immigrant effect. NAFLD has emerged as the most common etiology of cirrhosis among migrants with rates approaching those of Canadian-born and long-term residents. These data add to our understanding of the evolving epidemiology of cirrhosis and the contribution of other etiologies outside of viral hepatitis among immigrants. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

Disaggregating Racial and Ethnic Data: A Step Toward Diversity, Equity, and Inclusion

Disaggregating Racial and Ethnic Data: A Step Toward Diversity, Equity, and Inclusion

Incidence of Cirrhosis Among Recent Immigrants and Refugees to Ontario, Canada.

The epidemiology of cirrhosis among immigrants to North America has not been described. Using population-level data from Ontario, Canada, recent immigrant and refugees with incident cirrhosis were identified and stratified by World Bank region of origin and cirrhosis etiology. Incidence rates were described based on region of origin and etiology and compared with those in Canadian-born/long-term residents. A total of 25,054 immigrants/refugees were identified with rates of cirrhosis lower compared with those in Canadian-born/long-term residents for all etiologies except hepatitis B virus likely explained by the healthy immigrant effect. Nonalcoholic fatty liver disease was the most common etiology of cirrhosis among immigrants and refugees.

Unraveling the Hispanic Health Paradox

In 2019, Hispanics in the US had a life expectancy advantage of 3.0 years and 7.1 years over non-Hispanic Whites and non-Hispanic Blacks, respectively, despite having real-household income values 26 percentage points lower than Non-Hispanic White households. Hispanics appear to have equal or even better health outcomes relative to non-Hispanic Whites across various health measures. This is known as the Hispanic health paradox. This paper underscores the importance of disaggregating Hispanics by ancestry and age profile when discussing the paradox across key health outcomes. It also provides an overview of the leading explanations, such as the salmon bias and the healthy immigrant effect. Further, it highlights the role of healthcare access and usage in this discussion. Ignoring these sources of bias have important consequences for how morbidity and mortality among Hispanics are measured within widely used national datasets.

188 - English language proficiency on healthcare access at amarillo refugee health screening project – a major trigger of healthy immigrant effect

188 - English language proficiency on healthcare access at amarillo refugee health screening project – a major trigger of healthy immigrant effect

Associations between caregiving status, acculturation, and psychological distress in a diverse sample.

Increasingly diverse caregiver populations have prompted studies examining culture and caregiver outcomes. Still, little is known about the influence of sociocultural factors and how they interact with caregiving context variables to influence psychological health. We explored the role of caregiving and acculturation factors on psychological distress among a diverse sample of adults. Secondary data analysis of the California Health Interview Survey (CHIS). The 2009 CHIS surveyed 47,613 adults representative of the population of California. This study included Latino and Asian American Pacific Islander (AAPI) caregivers and non-caregivers (n = 13,161). Multivariate weighted regression analyses examined caregiver status and acculturation variables (generational status, language of interview, and English language proficiency) and their associations with psychological distress (Kessler-6 scale). Covariates included caregiving context (e.g., support and neighborhood factors) and demographic variables. First generation caregivers had more distress than first-generation non-caregivers (β=0.92, 95% CI: (0.18, 1.65)); the difference in distress between caregivers and non-caregivers was smaller in the third than first generation (β=-1.21, 95% CI: (-2.24, -0.17)). Among those who did not interview in English (β=1.17, 95% CI: (0.13, 2.22)) and with low English proficiency (β=2.60, 95% CI: (1.21, 3.98)), caregivers reported more distress than non-caregivers. Non-caregivers exhibited the "healthy immigrant effect," where less acculturated individuals reported less distress. In contrast, caregivers who were less acculturated reported more distress.