Dissertation (Doctoral) Demand for Health among Canadians: Roles of Immigration Status, Country of Origin and Year since Immigration

Author

Kednapa Thavorn

Abstract

This thesis investigates the effects of immigration status, country of origin, and duration in Canada on three main health outcomes, namely health care utilization, occurrences of hypertension and heart disease, and body mass index. The first two chapters are cross-sectional studies that utilize data derived from linked national health survey and Ontario databases, whereas the third chapter is a longitudinal study which draws data from the longitudinal National Population Health Survey (NPHS).

The first chapter examines the role of immigration status and country of origin in explaining the use of three types of health services: primary care physicians, specialists, and hospitals. The findings suggest that immigrants, especially those who are male and have low educational attainment, use more primary care physicians than comparable non-immigrants. However, immigrants are found to use fewer expensive health services, i.e. specialist and hospital care, compared to Canadian-born residents. Likewise, immigrants from non-traditional source countries make even fewer visits to specialists than do those who came from traditional source countries.

The second chapter investigates the associations of immigration status, occurrence of hypertension, and occurrence of heart disease. Findings from this chapter show that immigrants have comparable odds of hypertension and heart disease to those of Canadian-born residents after adjusting for other factors. The third chapter examines the effects of time since arrival in Canada on the change in BMI over the 14-year period. This chapter shows that, holding other factors constant, an additional year in Canada leads to a 0.14% increase in an individual's BMI. This association is found to be more pronounced for women than men and for married than non-married individuals. The effect of time since arrival in Canada on the change in BMI is reduced to 0.07% after controlling for sample selection bias, suggesting that by ignoring the sample selection issue, the effects of time since arrival in Canada on the change in BMI may be overestimated.


Supervisor

Peter C. Coyte