Electronic Thesis and Dissertation Repository

Thesis Format



Master of Science


Epidemiology and Biostatistics


Stranges, Saverio

2nd Supervisor

Wilk, Piotr


Immigrants face unique healthcare barriers, which can negatively impact their health and health service use. Those with multimorbidity face a particular challenge as multimorbidity is associated with increased need for healthcare. The purpose of this study was to compare healthcare utilization, as measured by number of visits to family physicians and specialists, between immigrants and Canadian-born populations with multimorbidity, stratified by sex and for specific chronic diseases. A cross-sectional analysis using 2015-2016 Canadian Community Health Survey (CCHS) was conducted. After adjusting for relevant covariates, no statistically significant differences in visits to family physicians or specialists were observed between immigrants and Canadian-born populations with multimorbidity. However, female immigrants with multimorbidity had significantly fewer visits to family physicians than Canadian-born females, while immigrant women with mental illnesses and respiratory diseases revealed significant underutilization of family physician services. Future research should elucidate healthcare barriers to utilization, with an emphasis on immigrants with multimorbidity.

Summary for Lay Audience

Multimorbidity, defined as the coexistence of at least two chronic diseases, has a significant negative impact on health-related quality of life and may result in increased utilization of health services and costs to healthcare. Individuals with multiple chronic diseases require integrated healthcare and continuation of treatment. Primary care can best serve this purpose as it is the first point of contact for healthcare in Canada. However, prior research suggests that despite universal healthcare system, immigrants face several barriers when accessing healthcare which may result in a lower utilization of health services, particularly those related to primary care. Reports also suggest that in addition to their unique health needs, women of certain ethnicities encounter these access barriers to a greater extent because of their culturally perceived health knowledge and socially constructed roles. Thus, the purpose of this study was to compare healthcare utilization between immigrants and Canadian-born populations with multimorbidity as well as to examine sex-specific disparities in service utilization. Using the 2015-2016 Canadian Community Health Survey, two health outcomes: visits to family physicians and specialists in the preceding 12 months were used to describe healthcare utilization. Overall, there were no significant differences in the use of these health services. However, when assessing males and females separately, female immigrants with multimorbidity had lower rates of family physician visits than Canadian-born females, while male immigrants had comparable rates of visits to their Canadian-born peers. For disease-specific outcomes, female immigrants made fewer visits to family physicians for mental illnesses and chronic respiratory diseases. The frequency of visits to specialists was comparable between immigrants and Canadian-born populations with multimorbidity, regardless of sex or disease. This underutilization of family physician services by female immigrants may be explained by their roles in the family, their relative lack of sociocultural integration, financial independence, knowledge gap, and systemic issues within Canada's health care system. Future research should emphasize longitudinal studies to track the health status of immigrants over time, particularly those who have multimorbidity, and pragmatic public health policies should be implemented to reduce cultural and social barriers to care with a special focus on female immigrants.