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Health and Chinese Canadians

Overview

Chinese-Canadians make up one of the largest visible minorities in Canada. According to the 2001 Census, approximately 1,094,700 individuals identified themselves as having a Chinese ethnic origin; this represents approximately 3.5% of the total Canadian population (Statistics Canada, 2003). Changes in immigration have occurred over the past few decades. Several decades ago, the majority of immigrants came from Europe. Now, most of the newcomers arriving to Canada are coming from Asia. Between 1991 and 2001, 1.8 million immigrants moved to Canada and 58% of these individuals came from Asia with the majority coming from China (Statistics Canada, 2003).

Chinese-Canadians have common genetic characteristics and lifestyle practices that may have an influence on their rate of disease. Because the Chinese make up such a significant proportion of the Canadian population, lifestyle practices, and health status of this population play a role in the health of the entire nation. Published research on the specific health needs of Chinese-Canadians is limited. The current research to date has outlined specific relationships between health status and health behaviours among Chinese-Canadians.

Cancer has been found to be the leading cause of death among both male and female Chinese-Canadians (Sheth, Nair, Nargundkar, Anand, & Yusuf, 1999). Interestingly, preventative cancer screening rates among Chinese-Canadians have been reported to be significantly lower than that of the general population (McDonald, & Kennedy, 2005). Various chronic diseases and chronic disease risk factors such as obesity (Tremblay, 2005), diabetes, coronary artery disease, heart failure, peripheral vascular disease and myocardial infarction (Tso, & Moe, 2002) have been found to be significantly lower compared to the general Canadian population. In addition, psychiatric symptoms have been reported among the Chinese Canadians (Chan-Yip, & Kirmayer, 1998; Lai, 2000); however, mental health service utilization rates have been low (Chen, & Kazanjian, 2005).

Chinese-Canadians may face a number of barriers that are contributing to their higher prevalence of some health conditions. Barriers such as a lack of understanding of the services available and how to access them, in combination with a language barrier and lack of knowledge surrounding the associated benefits. There are all factors that may be contributing to the low medical services utilization rates and in turn, a higher prevalence of certain health conditions.

Culturally appropriate services directed at Chinese-Canadians are needed. More research on the health status of Chinese-Canadians is required in order to fully understand the health challenges and inequality this population is facing.

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Health Status of Chinese Canadians

Current research on the health status of Chinese Canadians is fairly limited. However, research has demonstrated some health characteristics specific to the Chinese-Canadian population. These include a low preventative screening rate for cancer (Hislop, Inrig, Bajdik, Deschamps, Tu, & Taylor, 2003; Jackson, Hislop, Teh, Yasui, Tu, Kuniyuki, & Taylor, 2003); a low level of Hepatitis B, Pap test and mammogram knowledge (Thompson, Taylor, Yasui, Hislop, Jackson, Kuniyuki, & Teh, 2003); fewer cardiovascular disease risk factors compared to the general population (Tso, & Moe, 2002); a low death rate from diabetes and ischemic heart disease (Tso, & Moe, 2002); a high death rate from cancer (Sheth, Nair, Nargundkar, Anand, & Yusuf, 1999); low obesity rate (Tremblay, 2005); high mental health needs and low mental health services utilization (Chan-Yip, & Kirmayer, 1998; Lai, 2000).

A study by Lai (2004) investigated the health status of the aging Chinese-Canadian population and compared it to data on the general aging population in Canada. A secondary data analysis was performed from the Health and Well-being of Older Chinese in Canada, and from the Medical Outcomes Study 36-Item Short Form. This data on the health status of Chinese elderly in Canada was then compared to Medical Outcomes Study 36-item Short Form (Health status) data from the older Canadian population. The demographic profile of the Chinese sample population indicated that 97.5% were immigrants.

The overall findings of the study indicated that the older Chinese-Canadians reported better overall physical health, but significantly worse mental health compared to the older Canadian population.  Interestingly, a gender difference was identified between the older Chinese-Canadian men and women. Older Chinese-Canadian women were significantly less healthy compared to the men in all of the health aspects measured. This study suggested that Chinese-Canadians may have unmet health needs. Therefore, culturally appropriate health services are required to try and reduce barriers to health services access.

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Cervical Cancer

Cervical cancer is a major health concern among Chinese women, as it remains a leading cause of cancer deaths in China. Chinese-Canadian women have been reported to have higher incidence rates of cervical cancer compared to the general population (Archibald, Coldman, Wong, Band, Gallager, 1993). Between 1985-1988, Chinese-Canadian women had a cervical cancer prevalence rate approximately 4 times higher than the rate for Caucasian Canadians. In addition, Chinese-Canadian women have been found to have significantly lower pap testing rates compared to the general population (Hislop, Inrig, Bajdik, Deschamps, Tu, & Taylor, 2003; Tu, Jackson, Yasui, Deschamp, Hislop, Taylor, 2005). It is suggested, that the low Pap test rates observed among the Chinese-Canadian women may be contributing to the high incidence of cervical cancer. The effectiveness of the pap test in preventing and identifying cervical cancer and reducing morbidity and mortality has been well established.

A study by Hislop, Teh, Lai, Ralston, Shu, Taylor (2004) conducted a survey among 528 Chinese immigrant women in British Columbia to identify barriers to pap testing. The average knowledge of cervical cancer risk factors among this population is low. 74% of the sample reported having at least one pap test in the past. 56% of women reported having a pap test within the last two years. Individuals who scored higher on their knowledge of cervical cancer risk factors were more likely to have recently received a pap test. In addition, low levels of cervical cancer risk factor knowledge were associated with a low education background and the individual having regular care from a male doctor. An individual’s belief in the value of pap testing in preventing cancer and the general knowledge an individual has about the pap test, was found to be correlated to those who had a pap test.

For more information on Cervical Cancer among Chinese Canadian women, refer to the following article http://www.bcma.org/public/bc_medical_journal/BCMJ/2000/december_2000/CervicalCancer.asp
 

Cervical Cancer in Canada.
http://www.phac-aspc.gc.ca/publicat/updates/cervix-98_e.html

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Breast Cancer

The breast cancer incidence among Chinese-Canadian women is not available. However, incidence data from the United States indicate that breast cancer is a common type of cancer faced by Chinese women in the United States (National Institute of Health, 1998)

A Canadian study by Jackson, Hislop, Teh, Yasui, Tu, Kuniyuki, & Taylor (2003), investigated the utilization of mammography among Chinese women living in Vancouver. Findings indicated that 75% of women reported having a prior mammogram. Of worry was the result that 25% of women in the study had not had a mammogram and over half of the study participants were not on par with the recommended mammogram routine of one mammogram every 2 years.

As a result of the low rates of cancer prevention strategies such as pap tests and mammograms reported among Chinese-Canadians, the Asian Women’s Health Clinic was opened in Vancouver, British Columbia to help educate the women and provide screening for early cancer detection. For more information on the Asian Women’s Health Clinic, refer to the following document http://epe.lac-bac.gc.ca/100/201/300/cdn_medical_association/cmaj/vol-159/issue-4/0350.htm

For more comprehensive information about the Chinese-Canadians and cancer screening, refer to the document “Ethnicity, Immigration and Cancer Screening: Evidence for Canadian Women” available at the following site http://socserv2.socsci.mcmaster.ca/~sedap/p/sedap145.pdf

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Hepatitis B

Hepatitis B virus (HBV) is a highly prevalent viral infection in China (Sun, Ming, Zhu, Lu, 2002). It is suggested that most transmission of HBV occurs during the perinatal period, early in life, making Chinese immigrants highly susceptible. Hepatitis B virus can be transmitted from the mother to child at birth, sexual transmission, and injection drug use or by living in close quarters with someone that is infected. Individuals can be asymptomatic carriers of the virus, and therefore, HBV is a concern among Chinese immigrants from China.

In approximately 80% of cases of Hepatocellular carcinoma worldwide, HBV virus is the identified cause (Chen, Yu, & Liaw, 1997). Early identification and prevention of Hepatocelluar carcinoma can occur through regular HBV screening and HBV vaccination for those individuals with poor immunity. The incidence and mortality rates of Hepatocellular carcinoma have increased over the past 30 years, with incidence rates highest in British Columbia (ElSaadany, Tepper, Mao, Semenciw, Giulivi, 2002). Canadian studies are needed in the area of hepatocellular carcinoma prevalence among Chinese-Canadians.

A study by Thompson, Taylor, Yasui, Hislop, Jackson, Kuniyuki, & Teh (2003), conducted a community based survey on Chinese Women in Vancouver, British Columbia to determine the level of HBV knowledge and practices among the population. 96% of the Chinese-Canadians in the study were immigrants and born in an Asian country. Findings indicated that 85%, of women interviewed had heard of HBV. However, the level of HBV knowledge among this group was relatively poor. Twelve HBV knowledge related questions were given to the women. The average correct response rate for all 12 questions was 57%, indicating a relatively low level of HBV knowledge among this group. Individuals that were highly educated and spoke fluent English were more likely to score higher on the knowledge test. 39% of the women surveyed reported never being tested for HBV. Of those women with a past history of being tested, 9% indicated that they were carriers, 12% indicated that they were immune, and 79% were unaware of their test results (Thompson, Taylor, Yasui, Hislop, Jackson, Kuniyuki, The, 2003).

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Cardiovascular Disease

Cardiovascular diseases are one of the leading causes of death in Canada (Statistics Canada, 2005). The frequency of cardiovascular disease including the death rate from cardiovascular disease has been investigated among the Chinese-Canadian population (Tso, Moe, 2002; Sheth, Nair, Nargundkar, Anand, & Yusuf, 1999).

A study by Tso, & Moe (2002) investigated the frequency of cardiovascular diseases and risk factors among Chinese-Canadians attending an urban tertiary cardiac clinic in Canada. Cardiac diagnosis between Chinese-Canadian and Caucasian clients was compared. Findings indicated that Coronary artery disease, heart failure, peripheral vascular disease and myocardial infarction were less frequent among the Chinese-Canadian cardiac patients compared to the Caucasian patients. However, valvular heart disease was more prevalent among the Chinese patients compared to the Caucasian. Chinese cardiac patients had significantly fewer cardiovascular disease risk factors compared to the Caucasian patients. Diabetes, smoking and family history of heart disease were less common among the Chinese patients. However, the prevalence of hypertension and high cholesterol were equally prevalent among the Chinese as they were among the Caucasian (Tso, & Moe, 2002).

A study by Sheth, Nair, Nargundkar, Anand, & Yusuf (1999), investigated the cardiovascular and cancer mortality rates among Canadians aged 35-74 years from European, Chinese and South Asian origin between 1979-1993. A total of 1.2 million deaths occurred among these groups during the 14 period. The findings indicated that deaths from ischemic heart disease were significantly lower among the Chinese-Canadians. However, cerebrovascular disease was significantly higher among Chinese-Canadian women compared to all other groups. Further, cancer was the leading cause of death among Chinese-Canadians between 1979 and 1993. 43% of Chinese Canadian men died of cancer during this period and 45% of Chinese women. Lung and liver cancer were the most common types of cancer deaths that occurred in Chinese Canadian men. Lung and breast cancer were the leading cause of cancer-related deaths among the Chinese-Canadian women. Diabetes was low among Chinese-Canadians compared to other Canadian populations. In summary, this study showed that Chinese-Canadians had a very low rate of death from Ischemic heart disease, and a relatively high rate of death from cancer.

For more detailed information on the results of this study, refer to the following link http://www.cmaj.ca/cgi/reprint/161/2/132

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Obesity

Currently, the rate of obesity in China is one of the lowest around the world. Approximately 5% of the Chinese population is overweight or obese, compared to 24% in Canada (Canadian Community Health Survey, 2002). However, data is indicating a rise in the obesity rates across some areas of Asia over the past twenty five years (WHO, 2006). Further, this rise in overweight and obesity places Chinese individuals at increased risk for diabetes, cardiovascular disease, hypertension, stroke and certain cancers. If the increase in overweight and obesity continues among this population, higher incidence of obesity-related illness may be apparent in the near future.

A study of by Tremblay (2005) investigated the prevalence of overweight and obesity among ethnic groups between the ages of 20-64 years in Canada. East and South Eastern Asians reported the lowest rate of overweight and obesity in Canada. Aboriginal people reported the highest. When age, income, education level, and physical activity level had been controlled for, Asians had significantly lower odds of overweight and obesity compared to all other ethnic groups (Tremblay, 2005).

For more information on Obesity in Canada, visit the Obesity Canada webpage at http://www.obesitycanada.com/  or the Overweight and Obesity in Canada Report at
http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=GR_1130_E

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Mental Health

Statistics show that Asian Canadians underutilize mental health services, but have a relatively high prevalence of psychiatric symptoms (Chan-Yip, & Kirmayer, 1998; Chen, & Kazanjian, 2005). The stigma associated with the mentally ill may deter Chinese- Canadians from seeking treatment. In addition, strong family ties and understanding when in need of help, may contribute to the low mental health service utilization often evident among this population.

The following document by Chan-Yip & Kirmayer (1998) explains the cultural views of mental health by Chinese Canadians and the stigma associated with it. In addition, the prevalence of psychiatric symptoms is compared with the utilization rates for mental health services. http://upload.mcgill.ca/tcpsych/Report7.pdf

Chen, & Kazanjian (2005) conducted a study that investigated Chinese immigrant utilization of mental health services in British Columbia. Information was taken from a database of immigrants who came to Canada between 1985 and 2000. This information was compared to a general population control. The findings were interesting. Women in both the Chinese immigrant and general population groups had higher rates of mental health visits compared to males in each category. Visits to a physician or psychiatrist for consultation or treatment related to a mental health issue was significantly lower among the Chinese population. This difference was even more exaggerated with the Chinese men. Chinese men had approximately 7 times fewer mental health visits to a physician and approximately 10 times fewer visits to a psychiatrist compared to the general male population.

Estimates of between 10-15% of the elderly population in Canada have been reported to suffer from depression (McEwan, Donnelly, Robertson, Herzman, 1991; Statistics Canada, 2005; Blazer, 2002). A research study by Lai (2000) investigated the rate of depression among a Chinese elderly population in Calgary, Alberta. The tool used to measure depression among this population was the Chinese version of the Geriatric Depression Scale (Lai, 2000). The results indicated that 9.4% of the elderly Chinese population were mildly depressed and 11.5% of the elderly Chinese population were moderately or severely depressed. Depression among the female elderly was significantly greater than that of the male, 28.8% and 10% respectively. This study suggests that mental illness is a considerable issue for elderly Chinese in Canada. Language barriers may exist preventing elderly Chinese Canadians from accessing services. Culturally appropriate mental health services are required for this high-risk population.

Psychotherapy with Asian-Canadian Clients: Cultural Barriers and Help-Seeking. (2003).

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Websites:

Calgary Chinese Elderly Citizens Association

http://www.cadvision.com/cceca/

Calgary Chinese Community Services Association

http://www.cccsa.ca

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References:

1. Lai, D. (2004). Health Status of Older Chinese in Canada. Canadian Journal of Public Health, 95(3), 193-197.

2. Facilitators and Barriers to Cervical Cancer Screening Among Chinese Canadian Women. (2003).

3. Hislop, T., Inrig, K., Bajdik, C., Deschamp, M., Tu, S., Taylor, V. (2003). Health care services and Pap testing behaviour for Chinese Women in British Columbia, Journal of Immigrant Health. 5(4), 143-152.

4. Tu, S., Jackson, S., Yasui, Y., Deschamps, M., Hislop, T., Taylor, V. (2005). Cancer Prevention screening: a cross-border comparison of United States and Canadian Chinese Women. Preventative Medicine, 41(1), 36-46.

5. Hislop, T., Teh, C., Lai, A., Ralston, J., Shu, J., Taylor, V. (2004). Pap screening and knowledge of risk factors for cervical cancer in Chinese women in British Columbia, Canada. Ethnicity and Health, 9(3), 267-281.

6. Archibald, C., Coldman, A., Wong, F., Band, P., Gallager, R. (1993). The incidence of cervical cancer among Chinese and Caucasians in British Columbia. Canadian Journal of Public Health, 84, 238-245.

7. Sun Z, Ming L, Zhu X, Lu J. Prevention and control of Hepatitis B in China. J Med Virol. 2002;67:447–50.

8. Thompson, M., Taylor, V., Yasui, Y., Hislop, T., Jackson, J., Kuniyuki, A., Teh, C. (2003). Hepatitis B Knowledge and practices among Chinese women in Vancouver, British Columbia. Canadian Journal of Public Health. 94(4), 281-286.

9. Chen, C., Yu, M., Liaqw, Y. (1996). Epidemiological characteristics and risk factors of hepatocellular carcinoma. Journal of Gastroenterology and Hepatology, 12, S294-S308.

10. El Saadany, S., Tepper, M., Mao, Y., Semenciw, R., Giulivi, A. (2002). An epidemiologic study of Hepatocellular carcinoma in Canada. Canadian Journal of Public Health, 93(6), 443-446.

11. World Health Organization. (2006). Obesity and Overweight. Available at http://www.who.int/topics/en/

12. Statistics Canada. (2002). Canadian Community Health Survey. Available at http://www.statcan.ca/Daily/English/020508/d020508a.htm

13. National Institutes of Health. (1998). The state of federal health statistics on racial and ethnic groups. JAMA 267(2):268-271.

14. Jackson, S., Hislop, T., Teh, C., Yasui, Y., Tu, S., Kuniyuki, A., Jackson, J., Taylor, V. (2003). Screening Mammography among Chinese Canadian Women. Canadian Journal of Public Health. 94(4), 275-280.

15. Statistics Canada. (2005). Selected leading Causes of Death. Available at http://www40.statcan.ca/l01/cst01/health36.htm

16. Tso, D., Moe, G. (2002). Cardiovascular Disease in Chinese Canadians: a case mix study from an urban tertiary care cardiology clinic. The Canadian Journal of Cardiology, 18(8), 861-869.

17. Chen, A., Kazanjian, A. (2005). Rate of mental health service utilization by Chinese immigrants in British Columbia. Canadian Journal of Public Health. 96(1), 49-51.

18. Sheth, T., Nair, C., Nargundkar, M., Anand, S., Yusuf, S. (1999). Cardiovascular and cancer mortality among Canadians of European, south Asian and Chinese origin from 1979 to 1993: an Analysis of 1.2 million deaths. Canadian Medical Association Journal. 161(2), 132-138.

19. Statistics Canada. (2003). Canada’s ethnocultural portrait: the Changing mosaic. Available at http://www12.statcan.ca/english/census01/products/analytic/companion/
etoimm/canada.cfm#immigrants_increasingly_asia

20. Weibe, E., Janssen, P., Henderson, A., Fung, I. (2004). Ethnic Chinese women’s perceptions about condoms, withdrawal and rhythm methods of birth control. Contraception, 69(6), 493-496.

21. Tremblay, M. (2005). Obesity, overweight and ethnicity. Health Rep. 16(4), 23-34.

22. Deng, L. (2003). Psychotherapy with Asian-Canadian Clients: Cultural Barriers and Help-Seeking. (2003).

23. Chan-Yip, A., & Kirmayer, L. (1998). Health Care Utilization and Child Care Practices among Chinese-Canadian Women in a Pediatric Practice. Available at http://upload.mcgill.ca/tcpsych/Report7.pdf

24. Lai, D. (2000). Prevalence of Depression among the elderly Chinese in Canada. Canadian Journal of Public Health, 91(1), 64-66.

25. Blazer, D. (2002). The prevalence of depressive symptoms. Journal of Gerontology and Biological Scientific Medicine, 57, M150-M151.

26. Lai. D. (2000). Measuring Depression in Canada’s Elderly Chinese Population: Use of a Community Screening Instrument. Canadian Journal of Psychiatry, 45, 279-284.

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