Since immigrants and their children comprise a sizeable, increasing, and diverse segment of the population in the US and other developed nations, they are key to understanding population health patterns. Despite challenges that immigrants encounter when they arrive and assimilate to a new country, they seem to benefit from better health that native-born populations, particularly in North America. This has been called the “healthy immigrant effect.”     

A recent study in Circulation shows that immigrants to Ontario, Canada, experience lower risk of cardiovascular disease (CVD) in comparison with long-term Canadian residents. Notably, traditional CVD risk factors accounted for only a small portion of this healthy immigrant effect. This analysis used data from the Ontario-based Cardiovascular Health in Ambulatory Care Research Team (CANHART), based on administrative data on immigration, merged with 9 population health databases.

University of Minnesota School of Public Health associate professors Theresa Osypuk and Alvaro Alonso, along with assistant professor Lisa Bates from Columbia’s Mailman School of Public Health, co-authored an editorial in Circulation in response to this study.

The authors comment that this new study contributes to a growing body of literature documenting diverse patterns in CVD risk across receiving and sending country combinations. The authors argue that to fully understand the “healthy immigrant effect,” researchers must look beyond descriptive comparisons and adjustment for proximal risk factors, and move beyond the relatively short-lived “healthy immigrant effect” to understand long-term immigrant health trajectories across generations.

Osypuk et al. make several recommendations for furthering the field on immigrant CVD patterns:

• Exploring the assimilation process may clarify predictors for CVD. For example, over time, socioeconomic status at both individual and community levels shape adaptation trajectories, and should be examined. Immigrants are exposed to harmful factors in their new host country, including discrimination and anti-immigrant sentiment.
• Focusing on age at the time of arrival, instead of the length of time the immigrant has lived in the host country, may inform sensitive periods of exposure for CVD risk, particularly for arrivals in childhood.
• Using cross-national comparisons of both receiving (host) and sending populations is necessary to understand immigrant selection patterns.
• Increased attention to theory could improve understanding of how foreign born status benefits health, and how this effect erodes with time, including incorporating a life course perspective, and the segmented assimilation model of the new sociology of immigration.

Osypuk has published previous research on immigrant health, health disparities, and CVD risk factors. Alonso’s work focuses on CVD, including recent work on atrial fibrillation in African Americans and those with type 2 diabetes.