Background: Although immigrants tend to be healthier than the Canadian-born population when they arrive, subgroups, notably different immigration categories, may differ in health and health care use. Data limitations have meant the research has seldom focused on category of immigrant-economic, family or refugee. A newly linked database has made it possible to study acute care hospitalization by immigration category and source region. Data and methods: The Immigrant Landing File-Hospital Discharge A bstract Linked Database ( n = 2.6 m illion) was used to derive s ex-specific crude and age-standardized hospitalization rates (ASHRs) per 10,000 population for all-cause and leading causes of hospitalization during the 2006/2007-to-2008/2009 period. Results: Economic class immigrants had lower all-cause ASHRs than did their family class or refugee counterparts. Male refugees had high ASHRs overall and for circulatory diseases, digestive diseases, injury, and cancer. Female differences by immigrant category were less pronounced. All-cause ASHRs (excluding pregnancy) rose with years in Canada for male and female immigrants. Immigrants from East Asia had the lowest ASHRs; those from the United States, the highest. Interpretation: Although hospital use is an imperfect indicator of health status, this study supports an initial healthy immigrant effect and its subsequent decline. Marked differences emerged among immigrant subgroups with some, notably refugees and immigrants from the United States, having significantly higher hospitalization rates overall and for leading causes, compared with other groups.

Immigrant health Data linkage Hospital records Health care utilization Refugees

hospitalization human epidemiology middle aged statistics and numerical data acute disease Aged Humans migrant Adolescent Infant, Newborn Canada male preschool child Emigrants and Immigrants Infant risk factor Risk Factors Child, Preschool medical record Medical Record Linkage newborn female population research adult Censuses Child