The Association between Immigration Status and Stroke Incidence, Care and Outcomes
Bibliographic record
Abstract
Immigrants to high-income countries have a lower cardiovascular disease incidence and mortality compared to host populations, a phenomenon termed the healthy immigrant effect. However, differences in stroke incidence, care and outcomes between immigrants and host populations have not been well-characterized. We studied the incidence, acute care, and short-term and long-term outcomes of stroke in immigrants compared to long-term residents in Ontario, Canada. People born outside of Canada who immigrated after 1985 were considered immigrants. Compared to long-term residents, immigrants had stroke at a younger age and had a lower adjusted hazard of stroke (hazard ratio [HR] 0.67; 95% confidence interval [CI] 0.66-0.68). Compared to long-term residents, immigrants were less likely to seek care for transient ischemic attacks, and among patients with ischemic stroke, immigrants received equal or better acute stroke care, had higher disability on discharge (adjusted risk ratio 1.18, 95% CI 1.13-1.22), and marginally lower long-term (15 years) mortality (adjusted HR 0.94, 95% CI 0.88-1.00). These associations varied with age at the time of stroke, stroke subtype, ethnicity, country of origin, and immigration class, highlighting heterogeneity in the observed healthy immigrant effect. While the lower incidence of stroke and the lower mortality following stroke in immigrants compared to long-term residents may suggest a healthy immigrant effect, the younger age at the time of stroke and the higher disability on discharge in immigrants compared to long-term residents highlights a higher risk of premature and disabling stroke in immigrants. Further research should evaluate the reasons for the observed differences, which could then inform the design of effective interventions to improve stroke outcomes for both immigrants and long-term residents.
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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 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 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".