With 250,000 new immigrants entering each year, Canada is becoming increasingly multicultural. Over 50 per cent of these individuals choose to settle in Ontario, and many of them experience stress associated with the process of resettlement.
National data has revealed that recent immigrants are less likely to have chronic conditions or disabilities than their Canadian-born counterparts. This phenomenon has been termed the “healthy immigrant effect.” However, resettlement typically involves behavioural and environmental adjustments, including changes in diet, employment, housing, social relationships, climate, and language. These sudden changes may predispose immigrants to chronic stress.
While the healthy immigrant effect may initially protect new immigrants from stroke, chronic social stress may increase their risk. This negative stress may be further worsened by a lack of emotional support or social isolation in a new country. If left untreated, it will continue to affect the cardiovascular system by increasing the activity of the sympathetic nervous system.
Very little has been done to investigate a possible association between immigration and the risk of cerebrovascular disease, particularly premature stroke. University of Toronto researchers Drs. Gustavo Saposnik, Joel Ray, Donald Redelmeier, Esme-Fuller Thompson, and Patrice Lindsay have set out to explain this phenomenon in a unique study titled “PREmature risk of Stroke Associated with Recency of Immigration to Ontario (PRESARIO).”
Funded by the Heart and Stroke Foundation, the primary objective of PRESARIO is to determine whether recency of immigration, approximated by the date of receipt of OHIP coverage, is associated with a higher risk for ischemic or hemorrhagic stroke in subjects 50 years and younger. The control groups will be comprised of individuals who have resided in Ontario for more than five years.
Other objectives include comparing the control group to recent immigrants to determine whether, following a stroke, the latter have different hospital visit durations and a need for placement in long-term care facilities. Since new immigrants may lack economic or social stability, they may not have the resources to return to their home environment if they suffer a stroke, necessitating long-term care placement. In addition, the PRESARIO study hopes to identify which subgroups of immigrants in Ontario are at a higher risk for stroke by considering factors such as income, age, sex, and settlement area. To achieve these objectives, the study will use data from the provincial healthcare databases.
According to Dr. Saposnik, leader of Stroke Outcome Research Canada (SORCan), this research may have profound implications for health policy. If a link is found between recent immigration and stroke, this may guide policy-makers to consider early access to stroke prevention therapy for immigrants. Dr. Saposnik also suggests that the PRESARIO study might help to implement quality improvement strategies that extend beyond the screening process for new Canadians, to the period after their arrival. For instance, if an association between the recency of immigration and a higher stroke risk is found, a health check-up with a general practitioner for immigrants could be made mandatory.
Unfortunately, these concepts have not been properly researched. Dr. Saposnik hopes that his study will help to fill in this crucial gap of knowledge before any recommendations are made to change health policies and practices. Ultimately, the PRESARIO study has the potential to open up a whole new avenue of research, addressing whether there is a predisposed risk to cardiovascular disease for immigrants due to psychosocial stress.
