Tuberculosis-related hospital use among recent immigrants to Canada: an IMDBhospital

Transcription

1 Tuberculosis-related hospital use among recent immigrants to Canada: an IMDBhospital data linkage study Edward Ng 1, Dominique Elien-Massenat 2, George Giovinazzo 2 David Ponka 3, and Claudia Sanmartin 1 1 Health Analysis Division, Statistics Canada 2 Migration Health Branch, Immigration, Refugees and Citizenship Canada 3 Department of Family Medicine uottawa CRDCN 2018 National Conference Oct 18 & 19, 2018 Hamilton, Ontario

2 Purpose Highlight new data development and research in response to new migration trends with Tuberculosis as an example. 2

3 Mandate Health Analytics Division at Statistics Canada Research and new data development for policy decision making 3

4 Data inventory (1) Health care administrative data (2) Vital statistics (3) Population health surveys (4) Census of Population* / NHS (5) Immigrant Landing File (ILF) Health Yes Yes Yes No No Determinants No No Yes Some - SES Some-SES Immigration variables No No Yes Yes Yes Type Census Census Sample Sample Census 4 *Long form

5 Record linkage The process of matching records across or within datasets that refer to the same entity, such as a person Linkage conducted using unique identifying information - name, date of birth, postal code, personal health number 5

6 Social Data Linkage Environment (SDLE) SDLE facilitates the creation of linked administrative and survey data files for social analysis. 6

7 What is SDLE? Secure virtual linkage environment that stores only personal identifiers in a protected depository that is used to generate linkage keys across data sources. Keys are stored apart. SDLE is NOT a large integrated data base of survey information about individuals. Strong governance, adherence to policy and privacy requirements. Suite of services, tools and support for analysts and external researchers conducting record linkage activities within the social domain. 7

8 SDLE Record Linkage Approach for the TB project Immigrant Landing File (ILF) ( ) Record depository (linkage key) Discharge Abstract Database (DAD) ( ) IMDB-DAD linked data 8

9 Majority of active TB cases in 2015 from foreign-born population in Canada Source: PHAC Surveillance Report

10 10 Number and proportion of foreign-born population in Canada, 1871 to 2036

11 Source: Statistics Canada 2016 Census 11

12 Recent immigrants with TB-related hospitalization tend to be young adults or seniors, males and from high-burden TB countries, as well as from family and refugee categories Table linked cohort characteristics of recent immigrants to Canada and distribution of TB-related acute-care hospitalization, Canada Age group Sex 0 to to to to to and over Males Females Country of birth level of TB risk Low High (WHO+IRCC) Immigrant category WHO IRCC Economic - principal applicants Economic - spouse / children Family Refugee others/unknown/missing; Recent immigrant cohort (n=2,730,390) Recent immigrants with TB-related hospitalization Source: IMDB-DAD linked database (Quebec and the Territories excluded) 12

13 About 10% of TB-related hospitalization happened before landing, while close to 50% of first event occurred between 13 to 60 months after landing (n=1,120) Table 2. Distribution of first acute care TB-related hospitalization by duration since immigration landing (%) Before landing 0 to 12 months 13 to 60 months More than 60 months Source: IMDB-DAD linked database (Quebec and the Territories excluded)

14 About 5 recent immigrants per 100,000 person-years were hospitalized for TB post-landing, but the incidence varied by characteristics Table 3. Incidence of first acute-care TB related hospitalization among recent immigrants post-landing per 100,000 person-years at risk 14 Source: IMDB-DAD linked database (Quebec and the Territories excluded)

15 Refugee and family class immigrants were more likely to have TB-related hospitalization. Table 3. (cont.) Incidence of first acute-care TB related hospitalization among recent immigrants post-landing per 100,000 person-years at risk 15 Source: IMDB-DAD linked database (Quebec and the Territories excluded)

16 Recent immigrants (7% of the population) represented some 17% of TB-related hospitalization. The proportions varied by age, sex, and province. Table 4. Percentage of total TB-related acute care hospital events from 2001/ /14 occurred to recent immigrants relative to population share Overall Age at hospitalization 0 to 17 Recent immigrants aged (8% of the population) had 37% of the TB-related hospitalization 18 to to to to and over Sex Males Females Region Atlantic Ontario Prairie BC Estimated precentage of new immigrant population from 2011 National Household Survey Percentage of total TB hospital events occurring to new immigrants Source: IMDB-DAD linked database (Quebec and the Territories excluded) 16

17 Limitations Exclusion of Manitoba before April, 2004 and Quebec. Exclusion of TB-related cases proven postdischarge. Pre-landing data is an underestimation if there were issues related to ability to pay for hospitalization 17

18 Summary Top countries of TB cases are from the top 3 source countries of immigrants coming to Canada Ethiopia and Somalia among the top countries with post-landing TB hospitalization rates based on person years. About 10% of our study cohort had pre-landing TB hospitalization in Canada Immigrants arriving to Canada from 2000 to 2013, while 7% of the overall population, incurred 17% of all TB-related hospital discharges occurring during this time period. 18

19 Conclusion First study addressing TB-related hospitalizations among new immigrants to Canada on a national scale (outside of Quebec) Data linkage approach provides a new and innovative data source on TB among immigrants nation-wide that complements national surveillance data 19

20 Thank You for Your Interest For more info, contact Edward Ng at (Statistics Canada) 20