Incident chronic kidney disease among Canadian immigrants: a population-based cohort study
Bibliographic record
Abstract
Introduction A ‘healthy immigrant effect’ has been demonstrated for a number of chronic health conditions including cardiovascular disease, diabetes mellitus and dementia; however, the link between immigrant status and kidney health remains uncertain. We sought to compare the risk for incident chronic kidney disease (CKD) between Canadian immigrants and non-immigrants. Methods We conducted a population-level, observational cohort study of all adult (≥18 years of age) Ontario residents, including foreign-born immigrant Canadian citizens and non-immigrant Canadian citizens by birth, with normal baseline kidney function (outpatient estimated glomerular filtration rate (eGFR) ≥70 mL/min/1.73 m2) between 1 April 2007 and 30 September 2020 using provincial health administrative data. Multivariable Cox proportional hazard regression modelling was used to evaluate the relationship between immigrant status and the development of incident CKD (outpatient eGFR <60 mL/min/1.73m2). Results The study cohort included 10 440 210 Ontario residents, consisting of 22% immigrants (n=2 253 360) and 78% (n=8 186 850) non-immigrants. The mean (SD) age and eGFR were 45 (17) years and 102 (16) mL/min/1.73 m2, respectively, and 54% of individuals were female. A total of 117 028 immigrants (5%, 7 events per 1000 person-years) and 984 277 non-immigrants (12%, 16 events per 1000 person-years) developed incident CKD during follow-up. Immigrants experienced a 20% lower risk for incident CKD compared with non-immigrants (adjusted HR 0.80, 95% CI 0.80 to 0.81). Consistent findings were seen for refugee and non-refugee immigrants, immigrants with remote (1985–2004) and recent (2005–2020) landing dates, and immigrants from different world regions. Results were similar on re-defining incident CKD as two outpatient eGFR measurements <60 mL/min/1.73 m2 at least 90 days apart, treating death as a competing risk, and adjusting for baseline albuminuria. Conclusion Immigrants experience a lower risk for incident CKD compared with non-immigrants. These findings provide evidence of a ‘healthy immigrant effect’ in relation to kidney health.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.004 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".