Migration and Diabetes in British Columbia and Quebec: Prevalence and Health Service Utilization

Abstract

he number of people with type 2 diabetes is increasing and has become a global health priority. It is estimated that the prevalence of diabetes for all age groups worldwide will increase from 2.8% in 2000 to 4.4% in 2030. 1 Diabetes can lead to complications such as blindness, renal disease, cardiovascular diseases, amputations, and premature death. It is a significant economic burden in both developing and developed countries. 2 Studies from several countries have shown that immigrants have higher rates of diabetes compared to residents in their host countries. [3][4][5] The important contributory and interactive factors with regard to this phenomenon are genetic predisposition, changes in nutrition and lifestyle behaviours, stress related to migration and settlement, and greater acculturation and stronger integration within the host country. 3.4,6 Furthermore, available literature suggests that immigrants experience more barriers to health care due to lack of culturally adapted programs, lack of provider awareness of cultural health preferences, and language barriers. [7][8][9] These findings emphasize the need to identify those immigrant populations most vulnerable to diabetes and to better understand the gaps in health care access experienced by immigrants.Immigrants account for a large and increasing proportion of the population in Canada. In recent years, approximately 250,000 immigrants arrived in Canada annually. In 2006, the proportion of Canada's population who were born outside the country reached its highest level in 75 years and represented approximately 20% of the total population. 10 Research exploring diabetes prevalence and health service utilization among Canadian immigrants is limited. 11 BC and QC are two provinces that receive large numbers of immigrants. French is the dominant language in QC, thus attracting more immigrants with ability to speak this language. BC, where English is the dominant language, attracts far fewer Frenchspeaking immigrants.The present study examines the prevalence of diabetes among immigrants as well as physician service utilization by diabetics in the immigrant population in general, and in specific immigrant population subgroups in British Columbia (BC) and Quebec (QC). The objective is to identify excess diabetes risk and vulnerability in health service utilization among diabetic immigrants.

Study methodology and diabetes control in patients from the non‐English diabetes management project (NEDMP)

“…Although they reported differences in socio‐demographic risks factors, such as older age and less educational attainment in those with language barriers, they found no differences in the rates of diabetes complications. The similarity in the rates of diabetes related complications between English and non‐English speaking individuals can be explained by; 1) non‐English speaking adults readily access primary care services; 2) improved communication with family members and hospital based interpreter services; 3) translated educational materials and the increase in community support groups …”

“…The similarity in the rates of diabetes related complications between English and non-English speaking individuals can be explained by; 1) non-English speaking adults readily access primary care services; 2) improved communication with family members and hospital based interpreter services; 3) translated educational materials and the increase in community support groups. [12][13][14] We found that more than two-thirds of patients with DR had poor diabetes control in both the EDMP and NEDMP. Similar findings from our work also reflect these unsatisfactory levels of diabetes control in English speaking adults.…”

Immigration, ethnicity, and avoidable mortality in Canada, 1991–2006

“…The effect of measures of socioeconomic status like income and education on health-care access and utilization could apply to all ethnic groups and to both immigrants and nonimmigrants. However, in Canada, factors like unemployment and low occupational status, and language proficiency could be more relevant to immigrants (Dean and Wilson 2009;Wang et al 2012;Wu et al 2005). Low official language proficiency is especially applicable for immigrants from countries where neither English nor French are used widely.…”

Type 2 diabetes in young adults in Central Auckland: demography and complications

“…The Tokelau Island Migrant study was among the first to demonstrate that the incidence of T2D was higher in migrants to New Zealand than in those remaining in their homeland . Studies from many parts of the world have since shown that the prevalence of diabetes is high in migrants . Migration involves losses, disruption to usual life habits, exposure to new experiences and challenges that can impact adiposity and T2D through nutrition transition to high‐caloric diets, physical inactivity, stress and neighbourhood deprivation .…”

“…16 Studies from many parts of the world have since shown that the prevalence of diabetes is high in migrants. [17][18][19][20] Migration involves losses, disruption to usual life habits, exposure to new experiences and challenges that can impact adiposity and T2D through nutrition transition to high-caloric diets, physical inactivity, stress and neighbourhood deprivation. 21,22 Pacific people (40%), M aori (27%) and Asian (20%) people are more likely to reside in the poorest areas (NZ Dep 13 Quintile 5 areas) than people of European descent.…”