Linguistic mortality gradients in Quebec and the role of migrant composition

• Published in: Canadian journal of public health Vol. 109; no. 1; pp. 15 - 26
• Main Authors: Lo, Ernest, Tu, Mai Thanh, Trempe, Normand, Auger, Nathalie
• Format: Journal Article
• Language: English
• Published: Cham Springer Science + Business Media 01.02.2018; Springer International Publishing; Springer Nature B.V
• Subjects: Adolescent; Adult; Aged; Anglophones; Composition; Cross-Sectional Studies; Female; Francophones; Health Status Disparities; Humans; Immigrants; Language; Linguistics; Male; Medicine; Medicine & Public Health; Middle Aged; Migrants; Minority & ethnic groups; Minority Groups - statistics & numerical data; Mortality; Mortality - trends; Noncitizens; Public Health; QUANTITATIVE RESEARCH; Quebec - epidemiology; Risk analysis; Risk Factors; Socioeconomics; Transients and Migrants - statistics & numerical data; Young Adult; Quebec; Canada; Quebec Canada; Modération; Minority language; Moderation; Effet de l’immigrant en santé; Mortality; Mortalité; Quebec; Langue minoritaire; Healthy immigrant effect; Québec
• ISSN: 0008-4263; 1920-7476
• DOI: 10.17269/s41997-018-0023-z

Objective Anglophones and Allophones in Quebec (Canada) have lower mortality than Francophones, despite being linguistic minorities. This study assesses whether (1) language is a risk factor for mortality after accounting for migrant composition and (2) interprovincial migrants differ in mortality with respect to Quebec-born individuals. Methods We analyzed death records between 2004 and 2008 from Quebec (all-cause and main causes) and population data from the 2006 census to estimate age-adjusted mortality rates according to language and migrant status. Risk ratios by language and migrant status, adjusted for age, sex, and socioeconomic status, were estimated using Poisson generalized estimating equations. Results Francophone Quebec-borns had the highest mortality. Among Quebec-borns, Anglophones [RR= 0.85, 95% CI (0.79–0.91)] and Allophones [RR = 0.16, 95 %CI (0.12–0.22)] had lower mortality relative to Francophones. Interprovincial migrants had lower mortality (Anglophones [RR = 0.58, 95% CI (0.53–0.63)], Francophones [RR = 0.55, 95% CI (0.50–0.60)]) relative to Francophone Quebec-borns (Allophones were excluded due to small sample size). Among immigrants, mortality was lower for Francophones [RR = 0.62, 95% CI (0.57–0.67] and Allophones [RR = 0.35, 95% CI (0.31–0.38], but not Anglophones [RR = 0.92, 95% CI (0.84–1.01)], relative to Francophone Quebec-borns. Conclusion In Quebec, linguistic disparities in mortality remained after accounting for migrant status, and both Francophone and Anglophone interprovincial migrants in Quebec had lower mortality than Quebec-born Francophones. Public health initiatives to reduce linguistic disparities in health should account for migrant status.