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. 2015 Oct 20;132(16):1549–1559.
doi: 10.1161/CIRCULATIONAHA.115.015345. Epub 2015 Aug 31.

The Incidence of Major Cardiovascular Events in Immigrants to Ontario, Canada: The CANHEART Immigrant Study

Jack V Tu  1 , Anna Chu  2 , Mohammad R Rezai  3 , Helen Guo  3 , Laura C Maclagan  3 , Peter C Austin  2 , Gillian L Booth  4 , Douglas G Manuel  5 , Maria Chiu  3 , Dennis T Ko  6 , Douglas S Lee  7 , Baiju R Shah  8 , Linda R Donovan  3 , Qazi Zain Sohail  9 , David A Alter  10
Affiliations

The Incidence of Major Cardiovascular Events in Immigrants to Ontario, Canada: The CANHEART Immigrant Study

Jack V Tu et al. Circulation. .

Abstract

Background: Immigrants from ethnic minority groups represent an increasing proportion of the population in many high-income countries but little is known about the causes and amount of variation between various immigrant groups in the incidence of major cardiovascular events.

Methods and results: We conducted the Cardiovascular Health in Ambulatory Care Research Team (CANHEART) Immigrant study, a big data initiative, linking information from Citizenship and Immigration Canada's Permanent Resident database to nine population-based health databases. A cohort of 824 662 first-generation immigrants aged 30 to 74 as of January 2002 from eight major ethnic groups and 201 countries of birth who immigrated to Ontario, Canada between 1985 and 2000 were compared to a reference group of 5.2 million long-term residents. The overall 10-year age-standardized incidence of major cardiovascular events was 30% lower among immigrants compared with long-term residents. East Asian immigrants (predominantly ethnic Chinese) had the lowest incidence overall (2.4 in males, 1.1 in females per 1000 person-years) but this increased with greater duration of stay in Canada. South Asian immigrants, including those born in Guyana had the highest event rates (8.9 in males, 3.6 in females per 1000 person-years), along with immigrants born in Iraq and Afghanistan. Adjustment for traditional risk factors reduced but did not eliminate differences in cardiovascular risk between various ethnic groups and long-term residents.

Conclusions: Striking differences in the incidence of cardiovascular events exist among immigrants to Canada from different ethnic backgrounds. Traditional risk factors explain part but not all of these differences.

Keywords: cardiovascular disease risk factors; ethnicity; immigrants; myocardial infarction; stroke.

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Figures

Figure 1.
Figure 1.
Countries of birth of 824 662 immigrants to Ontario, Canada (1985–2000) in the CANHEART Immigrant Study cohort.
Figure 2.
Figure 2.
Age-standardized incidence of a major cardiovascular event by country and region of birth among 29 countries of birth with at least 5000 immigrants, 2002 to 2011. CI indicates confidence interval.
Figure 3.
Figure 3.
Age-standardized cardiac risk factor score versus incidence of a major cardiovascular event by ethnicity and country of birth, 2002 to 2011. Cardiac risk factor scores are a measure of the traditional cardiac risk factor burden in each group (see online-only Data Supplement for more details). Results by country of birth are among 29 countries with at least 5000 immigrants.
Figure 4.
Figure 4.
Relative risk of a major cardiovascular event using Cox proportional hazard modeling, 2002 to 2011. Independent variables were added sequentially from models A to E. The R2 for each model indicates the proportion of variation in outcomes explained by each model. BMI indicates body mass index; CI, confidence interval; DM, diabetes mellitus; HDL, high-density lipoprotein; HTN, hypertension; and TC, total cholesterol.
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