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New ICES report shows immigrants, refugees and other newcomers account for nearly 44% of all COVID-19 cases in Ontario


COVID-19 infections have taken a disproportionate toll on racialized communities, immigrants and low-income populations in many countries, including Canada. ICES, a non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues, has released a report that focuses on patterns of COVID-19 testing and test results among immigrants and refugees in Ontario during the initial phase of testing between January 15 and June 13, 2020.

This is the first report of its kind in Canada to compare COVID-19 testing rates among immigrants and refugees with those of their Canadian-born counterparts.

In Ontario, higher rates of positive COVID-19 tests have been found among people living in neighbourhoods with high rates of ethnic diversity, including more recent immigrants.

“What we found particularly striking was that overall testing rates were lower in most immigrant, refugee and newcomer populations, but the rate of positive cases is significantly higher than Canadian-born or long-term residents,” says Dr. Astrid Guttmann, chief science officer at ICES and lead author on the report.

The report looked at who was tested from among all Ontario residents eligible for OHIP, apart from those living in long-term care homes. The researchers used data from Immigration, Refugees and Citizenship Canada (IRCC) that allowed the linkage of the permanent resident file for immigrants landed in Ontario from 1985 to 2017 with ICES health administrative data.

The report found that:

  • While immigrants, refugees and other newcomers make up just over 25 per cent of the Ontario population, they accounted for 43.5 per cent of all COVID-19 cases.
  • Rates of testing were lower for most immigrants and refugees compared with Canadian-born and long-term residents.
  • Rates of positive results in those tested and per capita were higher across all immigration categories compared with Canadian-born and long-term residents.
  • Employment as a healthcare worker, especially among women, accounted for a disproportionate number of cases in immigrants and refugees, with those from the Philippines, Jamaica and Nigeria being particularly affected.
  • Among all female adults who tested positive for COVID-19, 36 per cent employed as healthcare workers; immigrants and refugees make up 45 per cent of these healthcare workers.
  • While the number of positive COVID-19 tests peaked at the beginning of April in Canadian-born and long-term residents, there were two pronounced peaks of positivity in April and May in immigrants, refugees and other newcomers.
  • Of those tested for COVID-19, refugees had the highest percent positivity: in those tested (10.4 per cent vs 7.6 per cent in other immigrants and 2.9 per cent in Canadian-born and long-term residents.
  • The highest rates of positivity by world region were in immigrants and refugees from Central, Western and East Africa; South America; the Caribbean; South East Asia and South Asia.

“Our report adds to the emerging evidence of the inequities of COVID-19 infection rates in Ontario. We document disproportionately higher rates of infection among those who landed in Ontario as economic caregivers, refugees, those with lower levels of education and language fluency, those who currently live in lower income neighbourhoods and with more crowded housing,” adds Guttmann. “Apart from addressing many of root causes of higher risk of infections, very high test positivity in certain groups of immigrants also suggests that there may be important barriers to testing that will be important to address if there is a second wave in Ontario this fall.”

ICES has been providing information about COVID-19 testing and test recipient characteristics, as well as testing by long-term care facilities and retirement homes, to Public Health Ontario and the Ministry of Health daily since April 17, 2020.

Through partnerships at the provincial level, ICES has rapidly added near-real-time COVID-19-relevant data sets to its collection of linked health data. ICES’ securely held database de-identifies personal health information from the health system data, which can then be accessed for research and analytics by health-system knowledge users and researchers.

ICES is a primary partner in the Ministry of Health’s recently launched Ontario Health Data Platform (OHDP). The OHDP website will provide researchers with secure access to Ontario health data for COVID-19-related research projects. OHDP-approved researchers will initially be accessing data on the ICES platform; eventually a second high-performance computing platform will be accessible through Queen’s University.

ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name. For the latest ICES news, follow us on Twitter: @ICESOntario


Deborah Creatura
Media Advisor, ICES
[email protected]


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