The impact of COVID-19 on Immigrants and Refugees living with Cancer: A Population-Based Cohort Study in Ontario, Canada
What is this research about?
This article explores the impact of COVID-19 on immigrants and refugees living with cancer in Ontario, Canada. About 43% of Canadians are diagnosed with cancer.
The COVID-19 pandemic has taken an enormous toll on communities across Canada. But the negative impacts of the pandemic have not been experienced equally within immigrant and refugee communities, in particular racialized immigrants and low-income populations. There is little information on the impact of COVID-19 on immigrants and refugees in Ontario living with active cancer. This study addresses this gap.
Researchers compared COVID-19-related outcomes (vaccination rates, diagnoses, hospitalizations, ICU admissions, and mortality) among immigrants and refugees with active cancers versus three comparison groups:
- Immigrants and refugees without active cancer
- non-immigrants with cancer
- non-immigrants without cancer
They also sought to determine the role that socio-demographic and healthcare-related variables (e.g., sex, age, immigration status, region of origin, neighbourhood income quintile, neighbourhood marginalization index, access to primary care) play in COVID-19-related outcomes for immigrants and refugees with active cancers vs. comparison groups.
The study highlights the need for system-level interventions to protect those at the intersection of clinical and social disadvantage during pandemic recovery and in future crises.
What do you need to know?
It is clear that people living with cancer are more vulnerable to COVID infection. Immigrants and refugees in Canada face systemic social and economic marginalization, which can impact health outcomes. Immigrants and refugees experience additional social and clinical disadvantages while living with cancer, increasing risk of COVID-19 infection and prognosis.
The study is unique in its comprehensive approach, using population-level data to compare outcomes across multiple groups (immigrants and non-immigrants, with and without cancer). Researchers examined various socioeconomic factors to understand the complex interplay between social determinants of health and clinical vulnerability during the pandemic.
Importantly, researchers brought a social determinants of health (SDOH) lens to their work, integrating socio-demographic and healthcare-related variables. Immigrants and refugees often face socioeconomic disparities that increase their vulnerability to adverse health outcomes. These include low income, precarious employment, living and working in crowded spaces, disproportionate representation in precarious, low-paid jobs and sectors, immigration status, constrained social support, limited literacy of Canada’s official languages, and limited or no access to available lifesaving health care services due to systemic stigma and discrimination.
A cancer diagnosis, despite increased connection to the healthcare system, does not protect against these ongoing social and structural barriers.
What did the researchers find?
The most common region of origin for immigrants and refugees with active cancer was Europe and Central Asia (31.7%) followed by East Asia and Pacific (29.2%), South Asia (16.7%), Latin America and the Caribbean (13.7%), and Sub-Saharan Africa (7.0%).
Immigrants and refugees with active cancer had significantly worse COVID-19 outcomes compared to other groups, particularly non-immigrants without cancer. They were 66% more likely to be diagnosed with COVID-19, 3.3 times more likely to be hospitalized, 3 times more likely to be admitted to ICU, and 4.2 times more likely to die from COVID-19.
Immigrants and refugees with or without cancer were less likely to receive COVID-19 vaccinations, with uptake dropping dramatically after the first dose.
A considerably higher proportion of immigrants and refugees with active cancer lived in low-income, residentially unstable, materially deprived, and ethnically diverse neighbourhoods than non-immigrants with active cancer. These multiple vulnerabilities had a compounding effect on COVID-19 outcomes.
The Family Health Team primary care model had a protective effect. When immigrants and refugees were attached to primary care they had better outcomes. Patients without primary care providers were less likely to get vaccinated and more likely to have poor COVID-19-related outcomes.
In general, immigrants and refugees were 48% less likely to be vaccinated, especially for subsequent doses after the first. Only 25.5% of immigrants and refugees with cancer received at least 4 vaccine doses vs. 46.4% of non-immigrants with cancer.
How can you use this research?
This research has implications for various stakeholders:
Healthcare providers:
- Recognize the heightened vulnerability of immigrant cancer patients.
- Ensure culturally appropriate care and communication, especially around vaccination.
Policymakers:
- Address structural inequities in housing, employment, and healthcare access.
- Develop targeted interventions for high-risk populations during health crises, including funding culturally specific outreach, education and care in multiple languages.
Public health officials:
- Connecting people to primary care, including interprofessional team-based care, should be prioritized by health systems, with a focus on people experiencing social and/or clinical disadvantage.
- Create culturally specific outreach and education programs, such as community ambassadors/champions, and mobile clinics, to reach vulnerable populations in high-needs areas.
- Improve access to primary care, especially team-based models.
Researchers:
- Connect ongoing SDOH and health equity-related research to crisis situations to further explore interventions to improve health outcomes for vulnerable populations.
- Further investigate the reasons for lower vaccination uptake among immigrants, including public health promotion and education challenges.
What did the researchers do?
The study cohort included 10,356,878 Ontario residents aged 18 or older. 24% of this population were identified as immigrants and 16,248 (0.7%) lived with active cancer (compared with 93,564 (1.2%) non-immigrants with active cancer). The study period spanned from March 31, 2020, to December 31, 2021, using linked Ontario healthcare administrative databases. Researchers used multivariable regression to assess odds ratios for COVID-19 outcomes, adjusting for various sociodemographic and healthcare-related variables.
Study authors and journal/book name
Authors: Vahabi M, Matai L, Damba C, Kopp A, Wong J, Rayner J, Narushima M, Tharao W, Hawa R, Janczur A, Datta G, Fung K, Lofters A.
Publication: Journal of Environmental Science and Public Health. 8 (2024): 116-132
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This article examines the compounded effects of social and clinical disadvantages, specifically focusing on the combined impact of immigration status and pre-existing mental health and addiction, on COVID-19 outcomes (vaccination rates, diagnoses, hospitalizations, ICU admissions, and mortality).
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