Jun 7, 2023

Examining the relationship between immigration status and risk of stroke

Image of Dr. Manav Vyas

Fourteen years ago, Dr. Manav Vyas immigrated to Canada with his parents from India.  As a young, newcomer to Canada, Dr. Vyas went on to complete his neurology residency training here in the Department of Medicine (DoM), followed by a PhD in immigrant health. Now, as a neurologist at St. Michael’s Hospital and an assistant professor in the DoM, Dr. Vyas is combining his lived experience and education to study the link between immigration and risk of stroke.

Dr. Vyas’s work begins by examining the intersections of some social determinants of health – ethnicity, acculturation, socio-economic status – and how these factors change with being an immigrant to influence experiences in healthcare including whether a newcomer seeks care (or not) and how they interact with the system.

In his research, Dr. Vyas has found that newcomers to Canada are generally healthier than their Canadian-born counterpart at their time of arrival.  Why then, when a newcomer to Canada experiences a stroke, are worse health outcomes observed with an increased risk in a second stroke in comparison to their Canadian-born counterpart in some immigrants? Dr. Vyas’ hypothesizes the answer lies somewhere in the acculturation process – the changes in their social determinants of health; their habits, routines and access to a physician (or lack thereof) that begin to influence health outcomes over their increasing time in Canada.

A key measurement in Dr. Vyas’s work is the “proportion of life lived in Canada”. This measurement combines the age at which an immigrant arrived in Canada with the amount of time they’ve lived here since. Dr. Vyas uses his personal experience as an example. When he first arrived in Canada with his parents, he was 23 and his parents were 58. While they have both spent the same amount of time in Canada, their age difference on arrival has had differing influence in their respective experiences acculturating to a new country.

Dr. Vyas than applies this example to health outcomes and stroke risk. His research has found an increased risk of stroke among immigrants who have spent a greater proportion life in Canada, irrespective of the country of origin or their immigration class. As one might guess, this has to do with cultural and societal perspectives being more malleable in one’s younger years. However, he also postulates that most immigrants upon arrival to Canada are often placed in the precarious position of needing to exchange their health for economic stability, accumulating negative health behaviours and risk factors along the way. Further, many face discrimination and underemployment rates that may have negative cumulative effects over time. He hopes that policies that spend considerable effort in helping immigrants obtain employment also focus on supporting newcomers incorporating into and navigating the Canadian healthcare system.

For Dr. Vyas, stroke is a unique health outcome to study, because its symptoms are unavoidable – meaning most often individuals experiencing a stroke will have to seek care. In this way, Dr. Vyas is accurately able clearly capture on what is happening health-wise in this at-risk population. So, what can be done?  By studying these associations, Dr. Vyas’s work has the potential to influence policy and programs that support newcomers to Canada, helping them navigate through our healthcare system. With his research, there is a prime opportunity to support newcomers’ access to care regardless of other social factors, so that they might live longer, healthier lives.