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Research

Hospital stays for hepatitis B or C virus infection or primary liver cancer among immigrants: a census-linked population-based cohort study

Edward Ng, Robert P. Myers, Doug Manuel and Claudia Sanmartin
April 28, 2016 4 (2) E162-E168; DOI: https://doi.org/10.9778/cmajo.20150117
Edward Ng
Statistics Canada (Ng), Health Analysis Division (Ng, Sanmartin, Manuel), Ottawa, Ont.; Liver Unit, Division of Gastroenterology, Department of Medicine (Myers), University of Calgary, Calgary, Alta.
PhD
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Robert P. Myers
Statistics Canada (Ng), Health Analysis Division (Ng, Sanmartin, Manuel), Ottawa, Ont.; Liver Unit, Division of Gastroenterology, Department of Medicine (Myers), University of Calgary, Calgary, Alta.
MDMSc
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Doug Manuel
Statistics Canada (Ng), Health Analysis Division (Ng, Sanmartin, Manuel), Ottawa, Ont.; Liver Unit, Division of Gastroenterology, Department of Medicine (Myers), University of Calgary, Calgary, Alta.
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Claudia Sanmartin
Statistics Canada (Ng), Health Analysis Division (Ng, Sanmartin, Manuel), Ottawa, Ont.; Liver Unit, Division of Gastroenterology, Department of Medicine (Myers), University of Calgary, Calgary, Alta.
PhD
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    Table 1: Selected characteristics of the adult (aged 20 years or more) 2006 census cohort, by immigration status and duration of residence in Canada (excluding Quebec and the territories)
    CharacteristicCanadian-born, no. (%)*
    (n = 2 486 970)
    Immigrants, no. (%)*
    Overall
    (n = 889 625)
    Duration of residence, yr
    > 10
    (n = 664 485)
    ≤ 10
    (n = 225 140)
    Age, yr, mean46515439
    Men 1 209 570 (48.6)420 970 (47.3)316 415 (47.6) 104 555 (46.4)
    Low income257 650 (10.4)161 430 (18.1)93 220 (14.0) 68 210 (30.3)
    Urban residence1 826 720 (73.4)839 400 (94.4)620 445 (93.4)218 960 (97.2)
    Source country risk level†
    HBV infection
        Low- 332 715 (37.4)307 315 (46.2)25 400 (11.3)
        Medium-296 320 (33.3)190 225 (28.6) 106 095 (47.1)
        High-260 590 (29.3) 166 945 (25.1)93 645 (41.6)
    HCV infection
        Low-693 895 (78.0) 546 885 (82.3)147 010 (65.3)
        Medium-145 320 (16.3) 84 975 (12.8)60 345 (26.8)
        High-50 410 (5.7) 32 625 (4.9) 17 785 (7.9)
    Primary liver cancer
        Low-608 080 (68.4) 489 495 (73.7)118 585 (52.7)
        High-281 545 (31.6)174 990 (26.3) 106 555 (47.3)

    Note: HBV = hepatitis B virus, HCV = hepatitis C virus.

    *Unless indicated otherwise.

    †According to estimated prevalence of HBV infection and HCV infection in the source country based on clinical practice guidelines for immigrants and refugees in Canada.10,24 HBV infection: low risk < 2%, medium risk 2% to < 8%, high risk ≥ 8%; HCV infection: low risk < 3%, medium risk 3% to 5%, high risk > 5%; primary liver cancer: high risk = high risk for HBV or HCV infection.

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      Table 2: Annualized crude and age-standardized hospital discharge rates per 100 000 population, by immigrant and risk-related variables, for all liver disease, HBV infection, HCV infection and primary liver cancer
      Group; variable
      Disease; rate per 100 000 population
      All liver diseaseHBV infectionHCV infectionPrimary liver cancer
      CrudeAge-standardized (95% CI)CrudeAge-standardized (95% CI)CrudeAge-standardized (95% CI)CrudeAge-standardized (95% CI)
      Canadian-born75.477.8 (75.8-79.9)2.62.7 (2.3-3.1)6.26.3 (5.8-7.3)7.37.7 (7.1-8.4)
      Immigrant66.459.8* (57.1-62.7)5.14.7* (3.9-5.6)5.55.0* (4.2-5.9)12.410.6* (9.5-11.8)
      Duration of residence, yr
          > 1079.865.0* (61.7-68.5)5.85.1* (4.2-6.2)6.55.3* (4.4-6.3)14.910.9* (9.6-12.3)
          ≤ 1026.945.2* (38.1-53.7)2.85.4 (3.2-9.2)2.84.5 (2.7-7.5)5.915.7* (11.3-22.9)
      Source country risk level
          Low--2.01.7* (1.0-2.7)5.44.6* (3.8-5.5)10.77.8 (6.7-9.0)
          Medium--2.93.0 (2.0-4.4)2.12.1* (1.1-4.1)--
          High--11.412.5* (10.2-15.5)17.923.0* (15.3-34.5)16.820.0* (16.9-23.6)

      Note: CI = confidence interval, HBV = hepatitis B virus, HCV = hepatitis C virus.

      *Significantly different from the value for the Canadian-born cohort.

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        Table 3: Age- and sex-adjusted and fully adjusted* odds ratios for hospital discharge for all liver disease, HBV infection, HCV infection and primary liver cancer on multivariate logistic regression analyses†
        Group; variableDisease; OR (95% CI)
        All liver-related diseaseHBV infectionHCV infectionPrimary liver cancer
        Age- and sex-adjustedFully adjustedAge- and sex-adjustedFully adjustedAge- and sex-adjustedFully adjustedAge- and sex-adjustedFully adjusted
        Canadian-born1.001.001.001.001.001.001.001.00
        Immigrant0.83‡
        (0.78-0.89)
        0.92‡
        (0.85-0.98)
        2.02‡
        (1.57-2.60)
        2.07‡
        (1.58-2.71)
        0.92
        (0.73-1.16)
        0.85
        (0.66-1.08)
        1.43‡
        (1.22-1.68)
        1.40‡
        (1.18-1.64)
        Canadian-born1.001.001.001.001.001.001.001.00
        Immigrant duration of residence, yr
            > 100.89‡
        (0.83-0.95)
        0.99
        (0.92-1.06)
        2.17‡
        (1.66-2.83)
        2.29‡
        (1.73-3.03)
        0.98
        (0.76-1.25)
        0.93
        (0.72-1.21)
        1.44‡
        (1.22-1.70)
        1.40‡
        (1.18-1.66)
            ≤ 100.54‡
        (0.45-0.64)
        0.56‡
        (0.47-0.67)
        1.45
        (0.85-2.47)
        1.30
        (0.75-2.26)
        0.66
        (0.37-1.18)
        0.51
        (0.28-0.91)
        1.32
        (0.88-1.98)
        1.26
        (0.83-1.90)
        Canadian-born1.001.001.001.001.001.00
        Risk level of immigrant source country
            Low0.72
        (0.44-1.20)
        0.79
        (0.48-1.33)
        0.88
        (0.68-1.14)
        0.83
        (0.63-1.08)
        1.10
        (0.89-1.30)
        1.10
        (0.87-1.29)
            Medium1.13
        (0.70-1.82)
        1.20
        (0.73-1.96)
        0.47
        (0.22-0.99)
        0.41
        (0.19-0.87)
            High5.15‡
        (3.87-6.84)
        5.28‡
        (3.87-7.20)
        2.98‡
        (1.74-5.11)
        2.49‡
        (1.44-4.29)
        2.60‡
         (2.12-3.27)
        2.60‡
         (2.05-3.22)

        Note: CI = confidence interval, OR = odds ratio.

        *Adjusted for rural v. urban residence and for low income status in addition to age and sex.

        †All analyses used Canadian-born as the reference group. ORs are estimates.

        ‡Significantly different from the value for the Canadian-born cohort.

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        Hospital stays for hepatitis B or C virus infection or primary liver cancer among immigrants: a census-linked population-based cohort study
        Edward Ng, Robert P. Myers, Doug Manuel, Claudia Sanmartin
        Apr 2016, 4 (2) E162-E168; DOI: 10.9778/cmajo.20150117

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        Hospital stays for hepatitis B or C virus infection or primary liver cancer among immigrants: a census-linked population-based cohort study
        Edward Ng, Robert P. Myers, Doug Manuel, Claudia Sanmartin
        Apr 2016, 4 (2) E162-E168; DOI: 10.9778/cmajo.20150117
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