Hospitalization related to chronic hepatitis B and C in recent immigrants in Canada: An immigration administrative
Edward Ng1, Jacklyn Quinlan2, George Giovinazzo2
1Health Analysis Division, Statistics Canada.
Insights
Canadian immigrants face higher hospitalization rates for hepatitis B virus (HBV) and hepatitis C virus (HCV) compared to long-term residents. Targeted screening for HBV and HCV in immigrants is recommended to address this health disparity.
Area of Science:
- Hepatology
- Infectious Diseases
- Public Health
Background:
- Immigrants from endemic regions may have elevated risks for hepatitis B virus (HBV) and hepatitis C virus (HCV) related liver disease.
- This study investigates HBV and HCV hospitalization burdens in Canadian immigrants versus long-term residents.
Purpose of the Study:
- To compare HBV and HCV-related hospitalizations between recent Canadian immigrants and long-term residents.
- To describe the disease burden, including hospitalizations, lengths of stay, comorbidities, and sequelae, in these populations.
Main Methods:
- A descriptive, cross-sectional study utilizing linked administrative databases (Discharge Abstract Database and Longitudinal Immigration Database).
- Inclusion of 5,854,949 immigrants arriving between 1980 and 2013, with an 85% linkage rate.
- Analysis of HBV- and HCV-related hospitalizations, comorbidities, and sequelae, stratified by immigration status and country of origin risk level.
Main Results:
- Immigrants accounted for 37% of HBV and 9% of HCV hospitalizations, despite being 16% of the population.
- Hospitalization ratios relative to population share were 2.3 for HBV and 0.5 for HCV.
- Hepatitis-related hospitalization ratios were significantly higher in immigrant seniors.
Conclusions:
- Immigrants, particularly for HBV, experience a disproportionate burden of hepatitis-related hospitalizations in Canada.
- Findings support the need for tailored health screening strategies for HBV and HCV within the Canadian immigration framework.
Background:
Canadian immigrants from countries where the hepatitis B virus (HBV) and hepatitis C virus (HCV) are endemic may be at higher risk of liver-related disease than Canadian-born residents. This study compared HBV- and HCV-related hospitalizations in Canadian immigrants (arriving from 1980 to 2013) and long-term residents (Canadian-born population and pre-1980 immigrants) and aimed to describe the burden of disease in both groups.
Methods:
Based on the 2004/2005-to-2013/2014 hospital Discharge Abstract Database linked to the 1980-to-2013 Longitudinal Immigration Database, this descriptive cross-sectional study examined the distribution of HBV- and HCV-related hospitalizations, lengths of stay, comorbidities, and sequelae incurred by immigrants and long-term residents in Canada. With a linkage rate of 85%, 5,854,949 immigrants were included in the study. Proportions of HBV- and HCV-related hospitalizations attributable to immigrants were calculated.
Results:
By birth country risk level, 22% of HBV-related hospital events among recent immigrants, and 20% of those related to HCV, were among people from high-risk countries. Proportionally, fewer immigrants had comorbidities than long-term residents. The top two hospital-related sequelae in both groups were cirrhosis and ascites, and liver cancer. While immigrants made up 16% of the Canadian population, they incurred 37% of HBV-related hospitalizations and 9% of HCV-related hospitalizations, giving ratios of hepatitis-related hospitalizations relative to the population share of 2.3 (95% confidence interval [CI]: 2.2 to 2.5) and 0.5 (95% CI: 0.5 to 0.6) respectively. These ratios were higher among seniors, at 4.4 (95% CI: 3.9 to 4.9) and 2.3 (95% CI: 1.9 to 2.6), respectively.
Interpretation:
Immigrants can require hospitalization for hepatitis in Canada, especially for HBV. These results may inform health screening for HBV or HCV in the Canadian immigration context.
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