Christopher J. Yarnell|Longdi Fu|Manuel Dujovny|Peter Tanuseputro|Thérèse A. Stukel|Ruxandra Pinto|Damon C. Scales|Andreas Laupacis|Robert Fowler
Association Between Immigrant Status and End-of-Life Care in Ontario, Canada
University of Toronto|Institute for Clinical Evaluative Sciences|University of Ottawa|Institute for Clinical Evaluative Sciences|Bruyère|Institute for Clinical Evaluative Sciences|University of Toronto|Sunnybrook Health Science Centre|Health Sciences Centre|Sunnybrook Health Science Centre|Institute for Clinical Evaluative Sciences|Health Sciences Centre|University of Toronto|Institute for Clinical Evaluative Sciences|St. Michael's Hospital|Health Sciences Centre|University of Toronto|Sunnybrook Health Science Centre|Sunnybrook Health Science Centre|Institute for Clinical Evaluative Sciences|Health Sciences Centre|University of Toronto
people immigrate face unique health literacy communication system navigation challenges may diverse preferences influence endoflife careto examine endoflife care provided immigrants canada last 6 months lifethis populationbased cohort study april 1 2004 march 31 2015 included 967 013 decedents ontario canada using validated linkages health immigration databases identify immigrant since 1985 longstanding resident cohortsall decedents immigrated canada 1985 2015 classified recent immigrants subgroup analyses assessing association time since immigration region birth endoflife carelocation death intensity care received last 6 months life analysis included modified poisson regression generalized estimating equations adjusting age sex socioeconomic position causes death urban rural residence preexisting comorbiditiesamong 967 013 decedents 47 514 5 immigrated since 1985 sex socioeconomic status urban vs rural residence causes death similar longstanding residents older immigrant decedents median interquartile range age 75 5884 vs 80 6887 years recent immigrant decedents overall likely die intensive care 156 vs 100 difference 56 95 ci 5259 adjusting differences age sex income geography cause death relative risk 130 95 ci 127132 last 6 months life recent immigrant decedents experienced intensive care admissions 249 vs 192 difference 57 95 ci 5361 hospital admissions 721 vs 682 difference 39 95 ci 3543 mechanical ventilation 215 vs 136 difference 79 95 ci 7583 dialysis 55 vs 34 difference 21 95 ci 1923 percutaneous feeding tube placement 55 vs 30 difference 25 95 ci 2328 tracheostomy 23 vs 11 difference 12 95 ci 1114 relative risk dying intensive care recent immigrants compared longstanding residents varied according recent immigrant region birth 084 95 ci 074095 among born northern western europe 196 95 ci 189205 among born south asiaamong decedents ontario canada recent immigrants significantly likely receive aggressive care die intensive care unit compared residents research needed understand mechanisms behind association