Multiple Morbidities Among Immigrant Populations in a Context of Universal Healthcare Coverage: Evidence from Canada.

The prevalence of type-2 diabetes, cardiovascular disease, and many other chronic non-communicable diseases is increasing rapidly worldwide. These diseases share many common risk factors, including their underlying socioeconomic determinants. In Canada, where essential medical and hospital services are covered under publicly funded health insurance for all residents, inequalities in chronic disease outcomes and in the factors influencing health persist across population groups. For example, prevalence of diabetes among persons 12 and older ranges from 4.4% for those in the highest income quintile, to 9.8% for those in the lowest. In other words, universal healthcare coverage alone is not sufficient to reduce inequalities and improve the health of disadvantaged groups. While recent immigrants may be less likely than the Canadian-born population to have chronic disease, studies suggest the healthy immigrant effect tends to dissipate over time. This research examines trends and tests hypothesized relationships between immigrant status (recent immigrant, longer-term immigrant, or non-immigrant), ethnic minority status, low income and material deprivation, and the occurrence of multiple chronic diseases. Using data from the 2016 Canadian Community Health Survey, we apply multinomial regression to examine the association between different individual- and community-level dimensions of marginalization and the risk of multiple morbidities. Preliminary findings from an earlier 2000-01 survey indicate 1.4% of recent immigrants (less than 10 years since immigration) had been diagnosed with diabetes, compared to 7.8% of longer-term immigrants (20 or more years since immigration). Meanwhile, 5.9% of recent immigrants were living with hypertension, versus 23.2% of longer-term immigrants. Drawing on the latest survey findings, we examine the trends to consider whether and how convergence in socioeconomic status and risk behaviours attenuates differentials in multimorbidity by immigrant status. The results are expected to enhance the evidence base on co-occurring chronic diseases among immigrant populations to inform health planning and promotion.