COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario: Characteristics of Those Tested and Those Confirmed Positive, as of June 13, 2020 August 2020 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Publication Information How to cite this publication © 2020 ICES. All rights reserved. Guttmann A, Gandhi S, Wanigaratne S, Lu H, Ferreira-Legere LE, Paul J, Gozdyra P, Campbell T, Chung H, Fung K, Chen B, Kwong JC, Rosella L, Shah BR, Saunders N, Paterson JM, Bronskill SE, Azimaee M, Vermeulen MJ, Schull MJ. COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario: Characteristics of Those Tested and Those Confirmed Positive, as of June 13, 2020. Toronto, ON: ICES; 2020. This publication may be reproduced in whole or in part for noncommercial purposes only and on the condition that the original content of the publication or portion of the publication not be altered in any way without the express written permission of ICES. To seek this permission, please contact communications@ices.on.ca. ISBN 978-1-926850-91-7 (Online) ICES G1 06, 2075 Bayview Avenue Toronto, ON M4N 3M5 Telephone: 416-480-4055 Email: communications@ices.on.ca This document is available at www.ices.on.ca. _________________________________________________________________________________________________________________________________________________ ICES ii COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Author Affiliations Hannah Chung, MPH Senior Epidemiologist, ICES Astrid Guttmann, MDCM, MSc, FRCPC Chief Science Officer and Senior Core Scientist, ICES / Staff Paediatrician, Division of Paediatric Medicine, Hospital for Sick Children / Senior Scientist, Child Health Evaluative Sciences, SickKids Research Institute / Professor, Department of Paediatrics and Institute of Health Policy, Management and Evaluation and Division of Epidemiology, Dalla Lana School of Public Health, and Co-Director, Edwin S. Leong Centre for Healthy Children, University of Toronto Sima Gandhi, MSc Senior Epidemiologist, ICES Susitha Wanigaratne, PhD, MHSc RESTRACOMP Fellow, Child Health Evaluative Sciences, Sick Kids Research Institute / Research Fellow, ICES / Research Affiliate, MAP Centre for Urban Health Solutions, Unity Health Kinwah Fung, MSc Research Methodologist, ICES Ruth Croxford, MSc Senior Epidemiologist, ICES Branson Chen, MSc Health Information Analyst, ICES Jeffrey C. Kwong, MD, MSc, CCFP, FRCPC Program Leader, Populations and Public Health Research Program and Senior Core Scientist, ICES / Scientist, Public Health Ontario / Family physician, Toronto Western Family Health Team / Associate Director, Centre for Vaccine Preventable Diseases, University of Toronto / Professor, Department of Family and Community Medicine and Dalla Lana School of Public Health, University of Toronto Hong Lu, PhD, MHSc Senior Research Analyst, ICES Laura Rosella, PhD, MHSc Manager, Public Engagement, ICES Adjunct Scientist and Site Director ICES U of T / Associate Professor and PhD Epidemiology Program Director, Dalla Lana School of Public Health, University of Toronto / Member, Banting and Best Diabetes Centre, Vulnerable Populations/Population Health / Affiliate Scientist, Institute for Better Health, Trillium Health Partners / Faculty Affiliate, Vector Institute for Artificial Intelligence Peter Gozdyra, MA Baiju R. Shah, MD, PhD Medical Geographer, ICES Senior Scientist, ICES / Scientist, Evaluative Clinical Sciences, Sunnybrook Research Institute / Head, Division of Endocrinology, Sunnybrook Health Sciences Centre / Associate Professor, Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto Laura E. Ferreira-Legere, RN, MScN Research Project Manager, ICES Jenine Paul Tonya Campbell, MPH Senior Epidemiologist, ICES _________________________________________________________________________________________________________________________________________________ ICES iii COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Natasha Saunders, MD, MSc, FRCPC Adjunct Scientist, ICES / Staff Physician, Paediatric Medicine, The Hospital for Sick Children / Associate Scientist, SickKids Research Institute / Assistant Professor, Institute of Health Policy, Management and Evaluation, University of Toronto J. Michael Paterson, MSc Program Leader, Chronic Disease and Pharmacotherapy Research Program and Core Scientist, ICES / Assistant Professor, Department of Family Medicine, McMaster University / Assistant Professor, Institute of Health Policy, Management and Evaluation, University of Toronto Susan E. Bronskill, MSc, PhD Program Leader, Life Stage Research Program and Senior Core Scientist, ICES / Associate Professor, Institute of Health Policy, Management and Evaluation and Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto / Associate Scientist, Evaluative Clinical Sciences, Sunnybrook Research Institute / Adjunct Scientist, Women’s College Research Institute Mahmoud Azimaee, PStat ICES Public Advisory Council We sincerely thank the following members of the ICES Public Advisory Council for their feedback and contributions to the figures and interpretations in this report: Bilqis Williams Dawn Mangat Gyan Chandra Katharine Chan Margaret Loong Munira Ratansi Nella Brown Director, Data Quality and Information Management, ICES Marian J. Vermeulen, BScN, MHSc Senior Director, Research and Data, ICES Michael J. Schull, MD, MSc, FRCPC Chief Executive Officer and Senior Core Scientist, ICES / Professor and Clinician-Scientist, Department of Medicine, University of Toronto / Senior Scientist, Evaluative Clinical Sciences, Sunnybrook Research Institute / Professor, Institute of Health Policy, Management and Evaluation, University of Toronto / Staff Emergency Physician, Sunnybrook Health Sciences Centre _________________________________________________________________________________________________________________________________________________ ICES iv COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Acknowledgements About ICES This study was supported by ICES (formerly the Institute for Clinical Evaluative Sciences), which is funded by the Ontario Ministry of Health. The opinions, results and conclusions are those of the authors and are independent from the funding source. No endorsement by ICES or the Ontario Ministry of Health is intended or should be inferred. ICES is an independent, nonprofit research institute. As a prescribed entity under Ontario’s privacy legislation, ICES is authorized to collect and use health care data for the purposes of health system analysis, evaluation and decision support. Secure access to these data is governed by policies and procedures that are approved by the Information and Privacy Commissioner of Ontario. ICES research provides measures of health system performance, a clearer understanding of the shifting health care needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. Parts of this report are based on data and information compiled and provided by the Ontario Ministry of Health, the Canadian Institute for Health Information, Immigration, Refugees and Citizenship Canada, and Public Health Ontario. We would like to acknowledge Public Health Ontario for access to case level data from iPHIS Plus and COVID-19 laboratory data, as well as assistance with data interpretation. We also thank the staff of Ontario’s public health units who are responsible for COVID-19 case and contact management and data collection within iPHIS Plus. All data sets were linked using unique encoded identifiers and analyzed at ICES. The analyses, conclusions, opinions and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred. _________________________________________________________________________________________________________________________________________________ ICES v COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Contents Publication Information ............................................................................................................................................................. ii Author Affiliations .................................................................................................................................................................... iii Acknowledgements ................................................................................................................................................................... v About ICES ................................................................................................................................................................................. v Executive Summary ................................................................................................................................................................ viii Introduction.............................................................................................................................................................................. xi List of Exhibits .......................................................................................................................................................................... xix 1.0 Overview and characteristics of immigrants, refugees and other newcomers in Ontario, as of June 13, 2020 ........................ 1 2.0 COVID-19 testing patterns of immigrants, refugees and other newcomers in Ontario, as of June 13, 2020............................. 7 3.0 and 4.0 COVID-19 testing of immigrants, refugees and other newcomers in Ontario, by age group, sex and sociodemographic characteristics, as of June 13, 2020 ........................................................................................................................................... 14 5.0 World regions and selected countries of birth for immigrants and refugees in Ontario, tested and confirmed positive for COVID-19, as of June 13, 2020 .................................................................................................................................................. 22 6.0 Testing and percent positivity for COVID-19 by selected chronic conditions in immigrants and refugees and Canadian-born and long-term residents in Ontario, as of June 13, 2020 ............................................................................................................ 32 7.0 Testing and positivity for COVID-19 in immigrants and refugees in Ontario’s public health units, as of June 13, 2020 .......... 34 8.0 Proportion of COVID-19 cases among health care workers in Ontario, as of June 13, 2020 .................................................. 37 Appendix 1.1 Baseline characteristics of Canadian-born and long-term residents, newcomers, and immigrants and refugees landed in Ontario between January 1, 1985, and May 31, 2017, as of March 31, 2020 .................................................................. 43 Appendix 1.2 Baseline characteristics of immigrants and refugees landed in Ontario between January 1, 1985, and May 31, 2017, by world region of birth (Eastern Hemisphere), as of March 31, 2020 ....................................................................................... 51 Appendix 1.3 Baseline characteristics of immigrants and refugees landed in Ontario between January 1, 1985, and May 31, 2017, by world region of birth (Western Hemisphere), as of March 31, 2020 ...................................................................................... 58 Appendix 2.1 Baseline characteristics of immigrants and refugees aged 25 years and older at arrival with an earliest landing date of January 1, 2010, by immigrant category , as of March 31, 2020 ............................................................................................. 65 _________________________________________________________________________________________________________________________________________________ ICES vi COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Appendix 3.1 Sociodemographic and clinical characteristics of Ontario residents tested for COVID-19, by immigrant status, as of June 13, 2020 ........................................................................................................................................................................... 72 Appendix 4.1 Sociodemographic and clinical characteristics of individuals who tested positive for COVID-19 and per capita in Ontario, by immigrant status, as of June 13, 2020 ..................................................................................................................... 77 Appendix 4.2 COVID-19 testing and positivity among immigrants and refugees, Canadian-born and long-term residents, and newcomers in Ontario, by age group and sex, as of June 13, 2020 ............................................................................................ 83 Appendix 4.3 COVID-19 testing and positivity among first- and second-generation immigrant and refugee children and youth younger than 19 years in Ontario, by recency of immigration, as of June 13, 2020 .................................................................... 85 Appendix 5.1 COVID-19 testing and positivity among recent immigrants and refugees landed in Ontario in the last 10 years, by sociodemographic characteristics, as of June 13, 2020 .............................................................................................................. 86 Appendix 6.1 Top 20 countries of birth of immigrants and refugees tested and confirmed positive for COVID-19 in Ontario, as of June 13, 2020 ................................................................................................................................................................... 88 Appendix 6.2 Top 20 countries of birth of female immigrants and refugees tested and confirmed positive for COVID-19 in Ontario, as of June 13, 2020 ..................................................................................................................................................... 89 Appendix 6.3 Top 20 countries of birth of male immigrants and refugees tested and confirmed positive for COVID-19 in Ontario, as of June 13, 2020 ................................................................................................................................................................... 90 Appendix 7.1 Number and proportion of health care workers among COVID-19 cases in Ontario adults older than 18 years, overall and by sex and immigration category, as of June 13, 2020 ............................................................................................. 91 Appendix 7.2 Number and proportion of health care workers among COVID-19 cases in Ontario adults older than 18 years, by world region of birth, as of June 13, 2020 ................................................................................................................................. 92 Appendix 7.3 Countries of birth with the 10 highest proportions of health care workers among COVID-19 cases in Ontario adults older than 18 years (ranked from the 20 countries with the highest counts of positive COVID-19 cases), as of June 13, 2020 .... 93 Appendix 8.0 Methods ............................................................................................................................................................. 94 Appendix 9.0 Data sets ............................................................................................................................................................ 97 Appendix 10.0 Definitions used in this report ......................................................................................................................... 102 Appendix 11.0 Diagnostic, procedure and physician billing codes ........................................................................................... 113 References ............................................................................................................................................................................. 116 _________________________________________________________________________________________________________________________________________________ ICES vii COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Executive Summary About This Report COVID-19 infections have taken a disproportionate toll on immigrants and some racialized populations in several countries, including Canada. The pandemic has sharpened the focus on structural and societal inequalities that have long existed; these inequities put many racialized and immigrant populations at higher risk of both contracting the infection and suffering poor outcomes. In Ontario, COVID-19 has disproportionately affected those living in lower-income areas with high proportions of both immigrants and racialized populations. The City of Toronto recently released data showing a disproportionate number of COVID-19-positive residents among those who self-identify as Black, South Asian, Latin American, South East Asian and Arab/Middle Eastern/West Asian. In the last decade, Canada welcomed on average 275,000 immigrants per year as permanent residents, with Ontario receiving almost half. Immigrants who are permanent residents and citizens and those with temporary work permits are critical to Canada’s economy and fill many skilled, semi-skilled and unskilled labour market needs. This report focuses on patterns of testing and test results for immigrants and refugees from the initial phases of COVID-19 testing through to June 13, 2020. We included all Ontario residents eligible for the Ontario Health Insurance Plan (OHIP) apart from those living in long-term care homes where the dynamics of testing and infection are distinct from those living in the community and should be considered separately. We achieved this undertaking through a longstanding data partnership between ICES and Immigration, Refugees and Citizenship Canada that has allowed the linkage of the permanent resident file for immigrants landed in Ontario from 1985 to 2017 with ICES health administrative data. We formally engaged members of the ICES Public Advisory Council who identify either as immigrants or as members of the different ethnic communities represented in this report to provide input into a number of key decisions around data analysis, presentation of exhibits, and interpretation and contextualization of the results. Key Findings • • • Although immigrants, refugees and other newcomers make up just over 25% of the Ontario population, they accounted for 43.5% of all COVID-19 cases. Rates of testing were lower for immigrants and refugees compared with Canadian-born and long-term residents. The exception is those who immigrated to Ontario in the economic caregiver category, many of whom are employed in the health care sector. Percent positivity in those tested and per capita positivity were higher across all immigration categories and among other newcomers than in Canadian-born and long-term residents. o Whereas positivity in those tested peaked at the beginning of April 2020 among Canadian-born and long-term residents, there were two pronounced peaks of positivity for immigrants, refugees and newcomers in April and May. o Refugees had the highest percent positivity in those tested (10.4% compared to 7.6% in other immigrants and 2.9% in Canadian-born and long-term residents). _________________________________________________________________________________________________________________________________________________ ICES viii COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario o • • Immigrants who landed in Ontario as economic caregivers had the highest per capita positivity (0.9% compared to 0.3% in other immigrants and 0.1% in Canadian-born and long-term residents). o The highest rates of positivity (in those tested and per capita) by world region were in immigrants and refugees where a majority were racialized in Canada (Central, Western and East Africa; South America; the Caribbean; South East Asia and South Asia) and who were more likely to live in a low-income neighbourhood. Employment as a health care worker, especially among women, accounted for a disproportionate number of COVID-19 cases among immigrants and refugees. o Among all women who tested positive, 36% were employed as health care workers; immigrants and refugees made up 45% of these health care workers o Being a health care worker accounted for a very high percentage of positive cases among women who immigrated as economic caregivers (55%) and from specific countries of birth (53% from the Philippines, 64% from Jamaica and 76% from Nigeria). Socioeconomic factors are closely related to testing and positivity. o Fewer years of formal education and a lack of English or French language ability at the time of immigration were associated with lower testing but higher percent positivity among recent adult immigrants and refugees. o Some neighbourhood demographic characteristics had differential effects on rates of positive testing among • immigrants and refugees compared with Canadian-born and long-term residents. ▪ While testing rates were higher among those living in lower-income neighbourhoods for Ontarians in general, positivity was strongly correlated with living in lowerincome neighbourhoods for immigrants, refugees and newcomers, but not for Canadian-born and long-term residents. ▪ Living in neighbourhoods with higher household densities was associated with higher positivity among Ontarians in general, but more so for immigrants, refugees and other newcomers. Public health units with large immigrant populations (i.e., Toronto, Peel, Durham, Waterloo, Windsor and York) also included immigrants and refugees with the highest percent positivity. Limitations Results must be interpreted in the context of changes in the testing strategy over time, and we cannot differentiate those who were tested with symptoms from those who were tested without. The immigration data are not complete; we could include only those who landed in Ontario from January 1985 to May 2017 and who became permanent residents. We cannot identify people who immigrated to other provinces prior to moving to Ontario or who are temporary foreign workers such as migrant farmers. We excluded people who are not eligible for OHIP (such as asylum seekers awaiting refugee hearings) and those who are long-term _________________________________________________________________________________________________________________________________________________ ICES ix COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario care residents. We lack data on important risk factors for testing and positivity such as occupation (apart from health care workers) and living conditions. We currently do not have comprehensive data on important outcomes such as hospitalization and death. Finally, we have data on demographic and some census-based characteristics but not on the critical structural factors that play an important role in shaping inequities. Conclusions organizations and groups that represent the higher-risk immigrant and refugee communities to develop programs that address emerging issues as the pandemic continues in the short term, while continuing to support efforts to address social and structural issues that contribute to health inequities. In the long-term, it is critical that efforts be made to address the social and structural issues experienced by temporary and permanent immigrants and other racialized groups underpinning the inequities highlighted in this report. This report adds to the emerging evidence on the inequities of COVID-19 infection in Ontario. The systemic inequities that have resulted in income disparities and related precarious employment and housing for many immigrants and refugees will need multifaceted societal change. In the immediate term, a number of public health initiatives may help to mitigate the disproportionate burden of COVID-19 infections as Ontario prepares for the possibility of a second wave of infections in the fall. This includes initiatives such as more accessible testing options, including mobile testing to help identify and address barriers to testing. A continued focus is needed on securing funding to house those who cannot safely quarantine in their homes and those who are homeless, as well as income supplements for workers who must quarantine but who do not have employer-sponsored sick leave. The high proportion of COVID-19 cases among health care workers, even after the use of personal protective equipment (PPE) was mandated in April, speaks to the need for better training and enforcement of workplace safety measures for all of those at risk of exposure in the workplace. It will be important for Public Health Units with large numbers of immigrants and refugees to continue to work with local _________________________________________________________________________________________________________________________________________________ ICES x COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Introduction Background COVID-19 infections have taken a disproportionate toll on immigrants and some racialized populations in several countries, including the United States, the United Kingdom and France.1-3 The pandemic has sharpened the focus on structural and societal inequalities that have long existed; these inequities put many racialized and immigrant populations at higher risk of both contracting the infection and suffering poor outcomes. There has been less related reporting in Canada, in part due to the lack of comprehensive race and ethnicity data. Analyses of COVID-19 infection at the neighbourhood level in Ontario and Quebec show that COVID-19 has disproportionately affected those living in lowerincome areas with high proportions of both immigrants and Canadian-born residents who self-identify as visible minorities. Evidence from other countries paints a stark picture of COVID-19 inequities. In the United Kingdom, an analysis of the deaths of 119 National Health Service (NHS) employees revealed that those who were Black, Asian and Minority Ethnic (the so-called BAME categorization) accounted for 63% of deaths among nurses, 64% of deaths among support staff and 95% of deaths among medical staff.4 The largest study to date of COVID-19-related mortality included 10,926 deaths in more than 17 million English citizens in the NHS; it showed that compared to White people, Black and South Asian people and those of mixed background were more likely to die with COVID-19, as were those living in areas with the highest degree of material deprivation.2 These results accounted for underlying chronic conditions (e.g., diabetes), many of which are themselves socially determined. A number of U.S. studies have described equally steep gradients in COVID-19 hospitalizations and deaths in Black and Latinx populations and by socioeconomic status.3,5 In Canada, the data that are available indicate that some groups of immigrants are disproportionately affected by COVID-19. Meat packing plants in Alberta that were severely affected by COVID-19 outbreaks were largely staffed by temporary foreign workers and immigrants.6 There have been a number of large COVID-19 outbreaks as well as several deaths among temporary foreign workers who are migrant farmers in Ontario.7 Reports and dashboards from Ontario8 and Quebec9 have shown higher risks of COVID-19 infection and severe disease among those living in neighbourhoods with high proportions of immigrants. Public Health Ontario10 reported that from January 15 to May 14, 2020, people living in the most diverse neighbourhoods (defined as those with a high proportion of recent immigrants and those who identify as visible minorities in census data)11 had higher rates of COVID-19 positivity, hospitalizations, intensive care use, and deaths compared to those living in the least diverse neighbourhoods. Public health units in Ontario have started collecting race and income data on COVID-19 cases. The City of Toronto12 recently released data on positive cases from May 20 to July 16, 2020 (excluding those in longterm care and retirement homes) indicating a disproportionate percentage of COVID-19 positivity among those who reported Black, South Asian, Latin American, South East Asian or Arab/Middle Eastern/West Asian as their race/ethnicity. The proportion of cases among those who are White or East Asian was lower than would be _________________________________________________________________________________________________________________________________________________ ICES xi COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario expected based on population. In addition, cases were much more likely to occur in low-income households. difficulties attending care due to precarious employment, lack of translation services to systemic racism.27,28 Causes of these inequities are complex and often rooted in social and structural inequities, including systemic racism. For COVID-19, occupational risk is critical considering the over-representation of racialized and immigrant populations, especially women, in essential work. 13 Many of these are public facing and predominately low-paying jobs, including health and social care workers, public transit drivers, custodial staff and retail grocery workers.14-21 These communities are also over-represented in occupations that occur in settings such as meat packing plants or factories where physical distancing is difficult and personal protective equipment was initially not universally available. A recent report on the changing workplace in Ontario highlights that employment in many of these sectors is considered precarious -typically low-wage, temporary, unstable with little or no security and mostly without pensions and benefits (e.g., emergency or sick leave) 22 which can impact the ability to access testing and quarantine. Crowded living arrangements are more common in some immigrant populations with multigenerational households, and more generally for those of low income, which make quarantining while distancing from other household members.23 Refugees are at particular risk of housing insecurity. A City of Toronto analysis of people experiencing homelessness in 2018 found that 40% were refugees or asylum seekers.24 Finally, there may be barriers to seeking health care that may be related to poor outcomes with COVID-19. Despite a universal health insurance system, Canadian studies point to barriers to accessible and high quality health care for immigrants,25,26 with causes ranging from In the last decade, Canada welcomed an average of 275,000 immigrants per year as permanent residents, with Ontario receiving almost half of them. Over a similar period, approximately 473,000 foreign nationals held temporary work permits annually.29 Immigrants who are permanent residents and citizens, and also those with temporary work permits, are critical to Canada’s economy and fill many skilled, semiskilled and unskilled labour market needs. Among permanent residents, approximately 60% enter Canada via the economic immigrant stream in which the principal applicant meets specific skill requirements to contribute to Canada’s economy. A sub-category of economic immigrants are caregivers (about 6% of all economic immigrants) who are qualified to provide care for children, the elderly or those with high medical needs, or work as live-in caregivers. A number of those who immigrate as economic caregivers eventually train to become personal support workers or health care aides.30 Other permanent resident categories include those sponsored by a family member (the family class, about 30% of all permanent residents). Refugees (about 10% of all permanent residents) flee their country because of persecution, war and violence and regions of origin have varied over time related to geopolitical circumstances including war. While many racialized Canadians are not immigrants, many immigrants are racialized Canadians, and more recent immigrants come from countries with diverse ethnic backgrounds. Based on the 2016 census, Statistics Canada reports that more than 80% of permanent residents arriving in Canada prior to 1969 considered themselves to be non-visible minorities (defined as “Caucasian in race or White in _________________________________________________________________________________________________________________________________________________ ICES xii COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario colour"). The proportion of White immigrants decreased steadily after 1969, representing 20%–30% of immigrants arriving between 1985 and 2008 and less than 20% of those arriving after 2009. Of the visible minority population of immigrants in Ontario in 2016, 49% arrived between 1985 and 2016, 16% arrived prior to 1985 and 35% were born in Canada.31 Methods While most Canadian analyses have used neighbourhood-level measures of ethnic diversity and socioeconomic status, this report analyzes COVID-19 testing and positivity among Ontario residents known to be immigrants or refugees. We achieve this through ICES’ longstanding data partnership with Immigration, Refugees and Citizenship Canada (IRCC), which has allowed the linkage of the permanent resident file for landed immigrants to Ontario between 1985 to 2017 with ICES health administrative data, which includes COVID-19 testing data. As part of the development of this report, we also formally engaged members of the ICES Public Advisory Council who identify either as immigrants or members of the ethnic communities represented in this report and who volunteered to share their perspectives. PAC members were asked to provide input into a number of key decisions around data analysis, presentation of exhibits, and interpretation and contextualization of the results; they were consulted multiple times throughout the development of the report. This report focuses on testing and testing results from the initial phase of COVID-19 testing to June 13, 2020 (see Appendix 8.0), in all Ontario residents eligible for the Ontario Health Insurance Plan (OHIP). We have focused on Ontarians not living in long-term care homes, as the dynamics of infection and testing are distinct and should be separately considered. The immigrants and refugees included are those who obtained permanent residency between January 1, 1985 and May 31, 2017 (based on the IRCC Permanent Resident File currently available at ICES) and those secondgeneration immigrant children under the age of 19 who were born in Ontario to mothers who gained permanent residence in Ontario since 1985. We classified individuals born or living in Ontario who are not in the IRCC data as the Canadian-born and long-term resident group, although this would include immigrants and refugees who arrived in Ontario prior to 1985 or those who initially immigrated to other provinces. To include other newcomers who arrived in Ontario since June 2017 but in the absence of immigration data, we defined a group who became newly eligible for OHIP since June 2017. This group includes immigrants and refugees who were granted permanent residency, temporary workers who qualified for OHIP,32 as well as those moving to Ontario from other provinces. Since the onset of the pandemic, the Ontario government has waived the three-month waiting period for OHIP coverage for new registrants. In order to provide context to the results, shed light on intersecting factors that contribute to COVID-19 infection, and capture the heterogeneity among immigrants, we have described in detail characteristics related to immigration pathways. These include recency and category of immigration, region of birth, and for recent immigrant adults, language ability and level of education at the time of landing in Ontario. We present other sociodemographic characteristics by immigration category and analyze COVID-19 _________________________________________________________________________________________________________________________________________________ ICES xiii COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario testing in the context of a number of neighbourhood characteristics, and we compare testing and test positivity by these neighbourhood factors in immigrants, refugees and newcomers with Canadian-born and long-term residents. To provide more meaningful descriptions of some communities of immigrants at highest risk of infection, and on the advice of the PAC members, we also present testing and positivity by the top countries of birth with the highest total number of cases. Many of these communities have active organizations involved in advocacy and in some cases partnerships with Public Health Units. Data on ethnicity and race are ideally based on selfreport and so we do not make direct attributions to individuals based on country of birth. However, for many countries of origin a large majority of immigrants will identify with specific ethnic and racial backgrounds. We are limited in available individual-level data related to important factors for exposure to COVID-19 such as housing and occupation. However, through a partnership with Pubic Health Ontario, we linked data from the Integrated Public Health Information System (iPHIS) — the mandatory reporting system on all positive cases — that includes variables on occupation. While data on types of occupations collected by public health units have expanded, we used only the health care worker variable that has been collected since the onset of the pandemic. Interpretative Cautions This report focuses on COVID-19 testing among Ontarians eligible for OHIP coverage, excluding those living in long-term care homes. Results need to be interpreted in the context of the Ontario testing strategy, which has evolved over time. Initially, there were constraints on testing capacity such that only those who needed acute medical care or who had a relevant travel history were tested. As the testing strategy evolved, a number of asymptomatic populations were targeted, including those who worked in congregate settings such as long-term care homes, all hospitalized patients and those needing hospital-based procedures. This means that some groups are over-represented in the testing numbers and that positive cases include those who were symptomatic at the time of testing, as well as those who were asymptomatic. This may distort some associations of characteristics with both testing rates and potential to test positive. It also means that there is an unknown number of untested infected individuals in the general population. This may have been more likely early in the pandemic when testing capacity was constrained but also may be true for those who weren’t able to, or did not, access testing as testing criteria were expanded. We try to address these issues by presenting trends over time graphically, identifying when testing criteria changed. We also report two metrics of positivity. The first is percent positivity in those who are tested. In populations where this is relatively high, it is suggestive that the testing strategy may not be reaching all those at high risk. We also present per capita positivity which does present some quantification of the potential burden of disease in any given population. Finally, given that those who have chronic conditions are more likely to be tested as they are more likely to access hospital care for reasons other than COVID-19, we do not describe whether the presence of these conditions relates to testing or positivity. Instead we report testing and positivity in those with a number of chronic conditions by immigration status to _________________________________________________________________________________________________________________________________________________ ICES xiv COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario evaluate whether access to testing for groups for whom testing rates should be similar is different for immigrants and refugees. o Main Findings o Our results point to a number of important inequities in rates of both COVID-19 testing and positivity among immigrants and refugees in Ontario. • While immigrants, refugees and other newcomers made up just over 25% of the Ontario population, they accounted for 43.5% of all COVID-19 cases. • Rates of testing were lower for immigrants and refugees compared with Canadian-born and long-term residents, with the exception of those who immigrated to Ontario in the economic caregiver category, many of whom are employed in the health care sector. • Since the testing strategy evolved in mid-May 2020 to include more asymptomatic contacts, there has been a steeper increase in testing among Canadian-born and long-term residents compared to immigrants and refugees, with the exception of economic caregivers. • Percent positivity in those tested and per capita positivity was higher across all immigration and other newcomer categories, compared with Canadian-born and long-term residents. o Whereas positivity in those tested peaked at the beginning of April in Canadian-born and long-term residents, there were two pronounced peaks of positivity in April and May in immigrants, refugees and newcomers. • Refugees had the highest percent positivity among those tested (10.4% vs. 7.6% in other immigrants and 2.9% in Canadian-born and long-term residents). Immigrants classified as economic caregivers had the highest per capita positivity (0.9% vs. 0.3% in other immigrants and 0.1% in Canadian-born and long-term residents) o The highest rates of positivity (in those tested and per capita) by world region were in immigrants and refugees where a majority are racialized in Canada (Central, Western and East Africa, South America; the Caribbean; South East Asia and South Asia) and who were more likely to live in a low-income neighbourhood. o Immigrants and refugees with the lowest rates of positivity (from North America, Europe, Australasia, Southern Africa and East Asia) had the same per capita positivity as Canadian-born and long-term residents and were characterized by a high proportion who arrived in Ontario as economic immigrants and lived in higher-income neighbourhoods. Employment as a health care worker, especially among women, accounted for a disproportionate number of cases in immigrants and refugees. o Among all adult females who tested positive, 36% were employed as health care workers, and immigrants and refugees make up 45% of these health care workers; those born in the Philippines accounted for 13% and in Jamaica 7% of all cases in female health care workers. _________________________________________________________________________________________________________________________________________________ ICES xv COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario ▪ o 55% of all cases in females who landed in Ontario as economic caregivers were health care workers. o Being a health care worker accounted for a very high percentage of positive cases in adult females from specific countries of birth (53% of those from the Philippines, 64% from Jamaica and 76% from Nigeria). o Among adult males, the proportion of cases that were health care workers was much lower (9%) than in females, but immigrants and refugees similarly made up a disproportionate number of these cases. • Testing rates were similar for first- and second-generation immigrant children and youth, but those in the first generation, especially refugees, were more likely to test positive. • Among those with common chronic conditions, testing rates were lower but test positivity higher in immigrants and refugees compared with Canadian-born and long-term residents with the same conditions. • Socioeconomic factors were closely related to testing rates and positivity. o Among recent adult immigrants and refugees, lower educational attainment and lack of English- or Frenchlanguage ability at the time of immigration was associated with lower testing but higher percent positivity in those tested. o Some neighbourhood demographic characteristics had differential effects on rates of positive testing among immigrants and refugees as compared with Canadianborn and long-term residents. • While testing rates were higher among those living in lower-income neighbourhoods for Ontarians in general, test positivity rates were strongly correlated with living in lower-income neighbourhoods for immigrants, refugees and newcomers, but not for Canadian-born and longterm residents. ▪ Living in neighbourhoods with higher household densities was associated with higher test positivity among Ontarians in general, but more so for immigrants, refugees and other newcomers. Public health units with large immigrant populations (Toronto, Peel, Durham, Waterloo, Windsor and York) also experienced the highest percent positivity among immigrants and refugees tested for COVID-19. Limitations Apart from the challenges in interpreting positivity in the context of a testing strategy that has evolved over time, there are a number of other limitations. The first is that the report only describes immigrants and refugees who landed as permanent residents in Ontario from January 1, 1985, to May 31, 2017. Those who landed either prior to 1985 or in another province and subsequently moved to Ontario would be part of the Canadian-born and long-term resident group in this report. We analyzed those who were new registrants to OHIP since June 2017 (the newcomer group) but cannot describe any of their other characteristics. This group would include immigrants and refugees, as well as temporary foreign workers who met the criteria for OHIP coverage. This newcomer _________________________________________________________________________________________________________________________________________________ ICES xvi COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario group had relatively low COVID-19 testing rates and high positivity and was characterized by a number of neighbourhood sociodemographic characteristics that put them at higher risk of infection. This includes some temporary residents such as migrant farmers who were captured in this newcomer group but cannot be separately described. Until more recent immigration data is integrated at ICES, we cannot further delineate which communities of newcomers are at highest risk. We do not have data on refugee claimants who are waiting for their hearings, as they are not captured in the available immigration data on permanent residents and they are not eligible for OHIP. We do not have comprehensive data for a number of important risk factors for COVID-19 infection that may be particularly important for elucidating causes of COVID19 infection risk in immigrants and refugees. These would include occupations other than health care, congregate living settings such as shelters, and individual household and housing circumstances. We are not able to identify health care workers in the testing data, only in those cases in the public health surveillance system. This means that we cannot describe whether the proportions of cases in immigrant health care workers reflect their proportions in the workforce or whether there are higher occupational risks for those who are immigrants and refugees. We only have data on demographic and some census-based characteristics and not the critical structural factors that play an important role in shaping inequities. Finally, this report focuses only on testing and positivity and not on important outcomes of COVID-19 such as hospitalization or death. Further work will analyze these outcomes in immigrants and refugees as these data become available at ICES. Conclusions This report adds to the emerging evidence of the inequities of COVID-19 infection in Ontario. Immigrants and refugees, many of whom have lived in Ontario for decades, are generally less likely to be tested and more likely to be positive than Canadian-born and long-term residents. There are specific groups of immigrants and refugees at higher risk of COVID-19 infection. These include those who landed in Ontario as refugees, those with lower levels of education and language fluency, those who currently live in lowerincome neighbourhoods and with more crowded housing. While the latter neighbourhood characteristics are associated with higher risk in all Ontarians, they confer a higher risk on immigrants and refugees. For women, much of the risk of COVID-19 infection can be attributed to being a health care worker and working in long-term care settings. This has a disproportionate impact on women who immigrated as economic caregivers and were from a number of countries of origin such as the Philippines and Jamaica. While we do not have data on individual’s self-reported race and ethnicity, the analyses by region and country of origin support recent findings from the City of Toronto that Black people and other people of colour are disproportionately affected by COVID-19. This report raises considerations for policy. The systemic inequities that have resulted in income disparities and related precarious occupation and housing for many immigrants and refugees will need multi-faceted societal change. In the immediate term, a number of public health initiatives may help mitigate the disproportionate burden of COVID-19 infections as Ontario prepares for the possibility of a second wave in the fall. This includes initiatives such as more accessible testing options, including mobile testing to help identify and address barriers to testing. A continued _________________________________________________________________________________________________________________________________________________ ICES xvii COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario focus is needed on securing funding to house those who cannot safely quarantine in their homes or are homeless, as well as for income supplements for workers must quarantine who do not have employer-sponsored sick leave. The high proportion of cases among health care workers, even after the use of personal protective equipment was mandated in April, speaks to the need for better training and enforcement of safety measures for all of those at risk of exposure in the workplace. Finally, it will be important for public health units to continue to work with local organizations and groups that represent the higher-risk immigrant and refugee communities to develop programs that address emerging issues as the pandemic continues. In the long term, it is critical that efforts be made to address the social and structural issues experienced by temporary and permanent immigrants and other racialized groups, issues that underpin the inequities highlighted in this report. _________________________________________________________________________________________________________________________________________________ ICES xviii COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario List of Exhibits Exhibit 1.1 Definitions of immigration category Exhibit 1.2 Sociodemographic characteristics of immigrants and refugees and their children in Ontario, by immigration category at landing, as of March 31, 2020 Exhibit 1.3.1 Characteristics of immigrants and refugees in Ontario, by world region of birth, as of March 31, 2020: Eastern Hemisphere Exhibit 1.3.2 Characteristics of immigrants and refugees in Ontario, by world region of birth, as of March 31, 2020: Western Hemisphere Exhibit 1.4 Overview of COVID-19 testing and positivity among immigrants and refugees in Ontario, as of June 13, 2020 Exhibit 2.1.1 Overview of Ontario residents tested for COVID-19, as of June 13, 2020 Exhibit 3.1.2 Percent positivity in those tested for COVID-19 in Ontario, by immigration status, age group and sex, as of June 13, 2020 Exhibit 3.2 Proportion of first- and second-generation immigrant and refugee children and youth in Ontario tested for COVID-19 and percent positivity in those tested, by immigration category, as of June 13, 2020 Exhibit 4.1 Proportion of recent immigrants and refugees in Ontario (landed since January 1, 2010, and aged 25+ at landing) tested for COVID-19 and percent positivity in those tested, by Canadian language ability and level of education at time of landing in Canada, as of June 13, 2020 Exhibit 4.2 Proportion of Ontario residents tested for COVID-19 and percent positivity in those tested, by immigration status and neighbourhood ethnic diversity, as of June 13, 2020 Exhibit 2.1.2 Overview of Ontario residents confirmed positive for COVID-19, as of June 13, 2020 Exhibit 4.3 Proportion of Ontario residents tested for COVID-19 and percent positivity in those tested, by immigration status and neighbourhood income, as of June 13, 2020 Exhibit 2.2 Proportion of residents tested for COVID-19, percent positivity for COVID-19 in those tested, and per capita positivity in Ontario, by immigration category, as of June 13, 2020 Exhibit 4.4 Proportion of Ontario residents tested for COVID-19 and percent positivity in those tested, by immigration status and number of persons per dwelling, as of June 13, 2020 Exhibit 2.3.1 Weekly number of individuals tested for COVID-19 per 100,000 population in Ontario, by immigration category, January 15 to June 13, 2020 Exhibit 5.1.1 Proportion of those tested for COVID-19, by world region of birth of immigrants and refugees in Ontario, as of June 13, 2020 Exhibit 2.3.2 Weekly percent positivity in those tested for COVID-19 in Ontario, by immigration category, January 15 to June 13, 2020 Exhibit 5.1.2 Countries of birth of immigrants and refugees in Ontario with the top 10 highest proportions of those tested (ranked from the countries with the top 20 counts of COVID-10 positive cases), as of June 13, 2020 Exhibit 2.3.3 Weekly number of individuals in Ontario confirmed positive for COVID-19 per 100,000 population, by immigration category, January 15 to June 13, 2020 Exhibit 3.1.1 Proportion of Ontario residents tested for COVID-19, by immigration status, age group and sex, as of June 13, 2020 Exhibit 5.1.3 Countries of birth of immigrants and refugees in Ontario with the top 10 highest proportions of those tested (ranked from the countries with the top 20 counts of COVID-19 positive cases), by sex, as of June 13, 2020 _________________________________________________________________________________________________________________________________________________ ICES xix COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Exhibit 5.2.1 Percent positivity for COVID-19 in those tested, by world region of birth of immigrants and refugees in Ontario, as of June 13, 2020 Exhibit 5.2.2 Countries of birth of immigrants and refugees in Ontario with the 10 highest rates of percent positivity for COVID-19 among those tested (ranked from the 20 countries with the highest counts of COVID-19 positive cases), as of June 13, 2020 Exhibit 8.2 Proportion of health care workers among COVID-19 cases in Ontario adults older than 18 years, by immigration category, as of June 13, 2020 Exhibit 8.3 Proportion of health care workers among COVID-19 cases in Ontario adults older than 18 years, by world region of birth, as of June 13, 2020 Exhibit 5.2.3 Countries of birth of immigrants and refugees in Ontario with the 10 highest rates of percent positivity for COVID-19 among those tested (ranked from the 20 countries with the highest counts of COVID-19 positive cases), by sex, as of June 13, 2020 Exhibit 8.4 Countries of birth with the highest proportion of health care workers among COVID-19 cases in Ontario adults older than 18 years (ranked from those with the top 20 counts of COVID-19 positive cases), as of June 13, 2020 Exhibit 5.3.1 Per capita positivity for COVID-19 among immigrants and refugees in Ontario, by world region of birth, as of June 13, 2020 Exhibit 8.5 Countries of birth with the highest proportion of health care workers among COVID-19 cases in Ontario adults older than 18 years of age (ranked from those with the top 20 counts of COVID-19 positive cases), by sex, as of June 13, 2020 Exhibit 5.3.2 Countries of birth of immigrants and refugees in Ontario with the 10 highest rates of per capita positivity for COVID-19 (ranked from 20 countries with the highest counts of COVID-19 positive cases), as of June 13, 2020 Exhibit 5.3.3 Countries of birth of immigrants and refugees in Ontario with the 10 highest rates of per capita positivity for COVID-19 (ranked from the 20 countries with the highest counts of COVID-19 positive cases), by sex, as of June 13, 2020 Exhibit 6.1 Proportion tested and confirmed positive for COVID-19 among those with select chronic conditions In Ontario, by immigration status, as of June 13, 2020 Exhibit 7.1 Proportion of those tested for COVID-19 among immigrants and refugees in Ontario, by public health unit, as of June 13, 2020 Exhibit 7.2 Percent positivity for COVID-19 in those tested among immigrants and refugees in Ontario, by public health unit, as of June 13, 2020 Exhibit 8.1 Overview of health care workers in Ontario confirmed positive for COVID-19, by immigration status, as of June 13, 2020 _________________________________________________________________________________________________________________________________________________ ICES xx COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario 1.0 Overview and characteristics of immigrants, refugees and other newcomers in Ontario, as of June 13, 2020 Summary of Exhibits Exhibit 1.1 displays the definitions of each immigration category used within this report. This figure, and all that follow, do not include those who live in a long-term care home. Exhibit 1.2 provides an overview of current characteristics (such as age, sex and world region of birth) of people in different immigration categories. Exhibit 1.4 provides a summary of important findings from the entire report on those testing and those confirmed positive for COVID-19 in Ontario. The key findings highlight some of the differences that exist for immigrants and refugees in Ontario with regard to COVID-19 testing and testing positive, and are described in more detail in subsequent exhibits. Exhibit 1.3.1 depicts a map of continents in the Eastern Hemisphere (Africa, Asia, and Australia) and provides an overview of current characteristics (such as age, sex, and immigration category) of immigrants and refugees in Ontario from these different regions. Exhibit 1.3.1 depicts a map of continents in the Western Hemisphere (North America, South America, and Europe) and provides an overview of current characteristics (such as age, sex, and immigration category) of immigrants and refugees in Ontario from these different regions. Supplementary data for information provided in Exhibits 1.1 to 1.4 can be found in appendices 1.1, 1.2, 1.3, 3.1, 4.1, 7.1, 7.2, and 7.3. _________________________________________________________________________________________________________________________________________________ ICES 1 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Exhibit 1.1 Definitions of immigration categories Newcomer Individuals who became eligible for Ontario Health Insurance Plan (OHIP) after May 31, 2017. Includes immigrants and refugees who landed in Ontario and for whom immigration records are unavailable, temporary residents and those who migrated from another province. Children and youth born in Ontario to mothers who were immigrants and refugees who landed in Ontario since 1985 SecondGeneration Immigrant Permanent Resident Individuals granted permanent resident status who have lived in Canada for at least 730 days (two years) in a five-year period Resettled Refugees* (Selected through the United Nations Refugee Resettlement Program) Immigrants Sponsored family Economic class (caregiver) Economic class (other) Privately sponsored refugee Blended visa office-referred refugees Sponsored by a family member who is a Canadian citizen or permanent resident of Canada and aged 18 years or older. Selected based on skills and ability to contribute to Canada’s economy. Includes live-in caregivers and caregiver caring for children programs. Selected based on skills and ability to contribute to Canada’s economy. Includes skilled workers, business immigrants, provincial or territorial nominees and those in the Canadian Experience Class (a permanent residence category for people with one year of skilled work experience in Canada). Privately sponsored by organizations, individuals or groups of individuals in Canada. Receive resettlement assistance and income support from the sponsoring individuals or groups in the first year. Sponsored by a partnership of the Government of Canada, the United Nations High Commissioner for Refugees and private organizations. Receive income support from the federal government in first 6 months and resettlement assistance and income support from private sponsors in the first year. The program started in 2013. Protected Persons in Canada Other Refugees Government-assisted refugees Sponsored by and receive resettlement assistance and income support from the Government of Canada in the first year. Other Refugees* landed in Canada (asylum seekers or refugee claimants) Refugee* dependents Humanitarian and compassionate or public policy cases Other immigrants Individuals who applied for refugee protection while in Canada and were granted permanent resident status on the basis of a well-founded fear of returning to their country of origin. Not sponsored by the federal government or a private group. Family members of a protected person in Canada, who were living abroad at the time of application and whose application for permanent residence was considered concurrently with that of the protected person in Canada. Sponsored and unsponsored individuals who would not otherwise qualify in any category, in cases where there are strong humanitarian and compassionate considerations, or for public policy reasons. Post-determination refugee claimants in Canada, deferred removal orders and retirees. *The United Nations High Commissioner for Refugees defines a refugee as “someone who is unable or unwilling to return to their country of origin owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group, or political opinion.” _________________________________________________________________________________________________________________________________________________ ICES 2 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Exhibit 1.2 Sociodemographic characteristics of immigrants and refugees and their children in Ontario, by immigration category at landing, as of March 31, 2020 Sponsored Family Members Economic Immigrants – Caregiver Economic Immigrants – Other Total population: 1,228,765 Total population: 85,148 Total population: 1,381,872 Average age is 39 years; 55% are female. Average age is 34 years; 74% are female. Average age is 39 years; 48% are female. 56% arrived in Ontario more than 10 years ago. 29% are from South Asia. 49% arrived in Ontario more than 10 years ago. 88% are from Southeast Asia. 69% arrived in Ontario more than 10 years ago. 27% are from South Asia. 24% live in the lowest-income neighbourhoods and 62% live in the most ethnically diverse neighbourhoods. 42% live in the lowest-income neighbourhoods and 63% live in the most ethnically diverse neighbourhoods. 19% live in the lowest-income neighbourhoods and 60% live in the most ethnically diverse neighbourhoods. Resettled Refugees Protected Persons/Refugees Landed in Canada (Asylum Seekers) Other Refugees and Immigrants Includes privately sponsored, government-assisted, and blended-visa office-referred refugees. Total population: 240,929 Average age is 39 years; 45% are female. 63% arrived in Ontario more than 10 years ago. 28% are from the Middle East. 36% live in the lowest-income neighbourhoods and 52% live in the most ethnically diverse neighbourhoods. Total population: 194,292 Average age is 39 years; 47% are female. 66% arrived in Ontario more than 10 years ago. 28% are from South Asia; 15% are from East Africa. 34% live in the lowest-income neighbourhoods and 65% live in the most ethnically diverse neighbourhoods. Includes refugee dependents, humanitarian and compassionate/ public policy, and other immigrants. Total population: 114,633 Average age is 34 years; 53% are female. 59% arrived in Ontario more than 10 years ago. 27% are from South Asia; 18% are from East Asia. 34% live in the lowest-income neighbourhoods and 66% live in the most ethnically diverse neighbourhoods. Notes: 1. Immigrants and refugees in this report are restricted to those who obtained permanent residency between 1985 and 2017. Includes second-generation children and youth (aged ≤ 19 years) of immigrant and refugee mothers. 2. Neighbourhood diversity was derived from ethnic concentration in the Ontario Marginalization Index2 and reflects the proportion of residents who are new immigrants and visible minorities. _________________________________________________________________________________________________________________________________________________ ICES 3 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Exhibit 1.3.1 Characteristics of immigrants and refugees in Ontario, by world region of birth, as of March 31, 2020: Eastern Hemisphere North Africa (57,607 immigrants) Average age is 37 years; 48% are female. 55% arrived as economic immigrants. 25% live in the lowest-income neighbourhoods and 60% live in the most ethnically diverse neighbourhoods. East Africa (105,667 immigrants) Middle East (306,750 immigrants) Average age is 36 years; 49% are female. 48% arrived as economic immigrants; 22% arrived as resettled refugees. 25% live in the lowest-income neighbourhoods and 57% live in the most ethnically diverse neighbourhoods. East Asia (477,048 immigrants) Average age is 43 years; 53% are female. 57% arrived as economic immigrants. 19% live in the lowest-income neighbourhoods and 70% live in the most ethnically diverse neighbourhoods. Average age is 36 years; 52% are female. 27% arrived as asylum seekers; 27% arrived as sponsored family immigrants. 47% live in the lowest-income neighbourhoods and 66% live in the most ethnically diverse neighbourhoods. South Asia (848,423 immigrants) Average age is 37 years; 49% are female. 42% arrived as sponsored family immigrants, 44% arrived as economic immigrants. 22% live in the lowest-income neighbourhoods and 76% live in the most ethnically diverse neighbourhoods. Southeast Asia (345,353 immigrants) Western Africa (57,093 immigrants) Average age is 34 years old; 49% are female. 44% arrived as sponsored family immigrants. 37% live in the lowest-income neighbourhoods and 70% live in the most ethnically diverse neighbourhoods. Southern Africa (15,069 immigrants) Central Africa (15,237 immigrants) Australasia & Oceania and Asia Unspecified (9,440 immigrants) Average age is 31 years; 50% are female. 31% arrived as asylum seekers. 44% live in the lowest-income neighbourhoods and 56% live in the most ethnically diverse neighbourhoods. Average age is 40 years; 50% are female. 74% arrived as economic immigrants. 12% live in the lowest-income neighbourhoods and 32% live in the most ethnically diverse neighbourhoods. Average age is 38 years; 57% are female. 36% arrived as economic immigrants; 36% arrived as sponsored family immigrants. 32% live in the lowest-income neighbourhoods and 63% live in the most ethnically diverse neighbourhoods. Average age is 38 years; 45% are female. 56% arrived as sponsored family immigrants. 13% live in the lowest-income neighbourhoods and 31% live in the most ethnically diverse neighbourhoods. _________________________________________________________________________________________________________________________________________________ ICES 4 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Exhibit 1.3.2 Characteristics of immigrants and refugees in Ontario, by world region of birth, as of March 31, 2020: Western Hemisphere Eastern Europe (293,942 immigrants): North America (70,287 immigrants): Average age is 33 years; 52% are female. 56% arrived as sponsored family immigrants, 36% arrived as economic immigrants. 17% live in the lowest income neighbourhoods and 30% live in the most ethnically diverse neighbourhoods. Central America (66,332 immigrants): Average age is 37 years; 50% are female. 39% arrived as sponsored family immigrants; 24% arrived as resettled refugees. 28% live in the lowest income neighbourhoods and 38% live in the most ethnically diverse neighbourhoods. Caribbean (191,326 immigrants): Average age is 39 years; 52% are female. 67% arrived as sponsored family immigrants, 23% arrived as economic immigrants. 34% live in the lowest income neighbourhoods and 64% live in the most ethnically diverse neighbourhoods. South America (155,358 immigrants): Average age is 42 years; 53% are female. 45% landed as economic immigrants, 32% arrived as sponsored family immigrants. 20% live in the lowest income neighbourhoods and 39% live in the most ethnically diverse neighbourhoods. Europe Other (230,646 immigrants): Average age is 40 years; 47% are female. 53% arrived as economic immigrants; 32% arrived as sponsored family immigrants. 16% live in the lowest income neighbourhoods and 29% live in the most ethnically diverse neighbourhoods. Average age is 40 years; 52% are female. 51% arrived as sponsored family immigrants, 12% arrived as asylum seekers. 25% live in the lowest income neighbourhoods and 55% live in the most ethnically diverse neighbourhoods. _________________________________________________________________________________________________________________________________________________ ICES 5 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Exhibit 1.4 Overview of COVID-19 testing and positivity among immigrants and refugees in Ontario, as of June 13, 2020 MAIN FINDINGS Testing and Positivity Patterns • While immigrants, refugees and other newcomers make up 25% of the Ontario population, they account for 43.5% of all COVID-19 cases. • Rates of testing are lower for immigrants and refugees compared with Canadian-born and long-term residents, with the exception of immigrants who came to Ontario in the economic caregiver category, many of whom are employed in the health care sector. • Rates of percent positivity in those tested and per capita positivity are higher across all immigration categories and in other newcomers than in Canadian-born and long-term residents. o Among those tested, refugees have the highest percent positivity (10.4% vs. 7.6% in other immigrants and 2.9% in Canadian-born and long-term residents). o The highest rates of positivity for COVID-19 are in immigrants and refugees from world regions where a majority are racialized in Canada (Central, Western and East Africa, South America, the Caribbean, Southeast Asia and South Asia) and more likely to live in a low-income neighbourhood. Testing and Positivity by Key Characteristics • Employment as a health care worker, especially among women, accounts for a disproportionate number of cases of COVID-19 among immigrants and refugees. o Among adult females who tested positive for COVID-19, 36% were employed as health care workers; and immigrants and refugees make up 45% of these health care workers. Female health care workers from the Philippines and Jamaica account for 13% and 7% of all cases, respectively. • Among those with common chronic conditions, testing is lower but positivity higher among immigrants and refugees compared to Canadian-born and long-term residents. • Among recent adult immigrants and refugees, fewer years of formal education and lack of English- or French-language ability at the time of immigration is associated with low testing rates but high percent positivity for COVID-19. • Public health units in Ontario with large immigrant and refugee populations (Toronto, Peel, Durham, Waterloo, Windsor and York) also have the highest percent positivity in immigrants and refugees tested for COVID-19. _________________________________________________________________________________________________________________________________________________ ICES 6 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario 2.0 COVID-19 testing patterns of immigrants, refugees and other newcomers in Ontario, as of June 13, 2020 Summary of Exhibits Exhibit 2.1.1 depicts an overview of the number and percentage of people in Ontario who were tested for COVID-19 according to different immigration categories. Exhibit 2.1.2 depicts an overview of the number and percentage of people in Ontario who were confirmed positive for COVID-19 according to different immigration categories. Exhibit 2.4 provides the weekly proportion of people tested for COVID-19 in Ontario who were confirmed positive (percent positivity) according to immigration category, from the week the first case was detected in Ontario on January 12, to the week of June 13, 2020. Key dates when new COVID-19 testing strategies came into effect in Ontario are included in this graph to provide context. Exhibit 2.2 explores the differences in the percentage of people in Ontario who were tested for COVID-19, confirmed positive among those who were tested, and confirmed positive among the population depending on their immigration category. Exhibits 2.3.1 and 2.3.2 provide the weekly number of rate per capita (rate per 100,000 people) that were tested, and confirmed positive, for COVID-19 in Ontario according to immigration category, starting from the week the first case was detected in Ontario on January 12 to the week of June 13, 2020. Key dates when new COVID-19 testing strategies came into effect in Ontario are provided in both graphs to provide more context into fluctuations in testing. Supplementary data for information provided in Exhibits 2.1.1 to 2.4 can be found in appendices 1.1, 3.1 and 4.1. _________________________________________________________________________________________________________________________________________________ ICES 7 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Exhibit 2.1.1 Overview of Ontario residents tested for COVID -19, as of June 13, 2020 Total number of individuals tested in Ontario: 624,386 Canadian-Born and Long-Term Residents Population: 11,166,755 Number and % tested: 495,304 (4.4%) Resettled Refugees* Population: 240,929 Number and % tested: 8,589 (3.6%) Newcomers to Ontario Immigrants and Refugees Population: 625,671 Population: 3,245,639 Number and % tested: 17,759 (2.8%) Number and % tested: 111,323 (3.4%) Population: 434,689 Number and % tested: 19,951 (4.6%) Refugees Immigrants Population: 549,854 Population: 2,695,785 Number and % tested: 20,785 (3.8%) Number and % tested: 90,538 (3.4%) Protected Persons/Refugees Landed in Canada Other** Population: 114,633 Population: 194,292 Number and % tested: 7,978 (4.1%) Number and % tested: 4,218 (3.7%) Restricted to those aged 25 and older at landing, with an earliest landing date of Jan. 1, 2010 Immigrated Less than 10 Years ago Population: 1,228,765 Economic Immigrants, Caregiver Economic Immigrants, Other Population: 85,148 Population: 1,381,872 Number and % tested: 39,591 (3.2%) Number and % tested: 8,799 (10.3%) Number and % tested: 42,148 (3.1%) Sponsored Family Members Notes: 1. Excludes long-term care residents. Immigrants and refugees were restricted to those who obtained permanent residency between 1985 and 2017 and includes second-generation children and youth (aged ≤ 19 years) of immigrant and refugee mothers. Newcomers include all those who migrated to Ontario from June 2017 onward and for whom no immigration data are available; includes both immigrants and those migrating from other provinces. * Includes privately sponsored, government-assisted, and blended visa office-referred refugees. ** Includes refugee dependents, humanitarian and compassionate/public policy consideration cases, and other immigrants categories. _________________________________________________________________________________________________________________________________________________ ICES 8 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Exhibit 2.1.2 Overview of Ontario residents confirmed positive for COVID -19, as of June 13, 2020 Total number of individuals confirmed positive in Ontario: 24,660 Canadian-Born and Long-Term Residents Total tested: 495,304 Number and % positive: 13,939 (2.9%) Resettled Refugees* Total tested: 8,589 Number and % positive: 968 (11.3%) Newcomers to Ontario Immigrants and Refugees Total tested: 17,759 Total tested: 111,323 Number and % positive: 1,655 (9.4%) Number and % positive: 9,066 (8.1%) Total tested: 19,951 Number and % positive: 1,805 (9.0%) Refugees Immigrants Total tested: 20,785 Total tested: 90,538 Number and % positive: 2,171 (10.4%) Number and % positive: 6,895 (7.6%) Protected Persons/Refugees Landed in Canada Total tested: 7,978 Number and % positive: 804 (10.1%) Other** Total tested: 4,218 Number and % positive: 399 (9.5%) Sponsored Family Members Total tested: 39,591 Number and % positive: 3,479 (8.8%) Restricted to those aged 25 and older with an earliest landing date of Jan. 1, 2010 Immigrated Less than 10 Years Ago Economic Immigrants, Caregiver Economic Immigrants, Other Total tested: 8,799 Total tested: 42,148 Number and % positive: 744 (8.5%) Number and % positive: 2,672 (6.3%) Notes: 1. Excludes long-term care residents. Immigrants and refugees are restricted to those who obtained permanent residency between 1985 and 2017 and includes second-generation children and youth (aged ≤ 19 years) of immigrant and refugee mothers. Newcomers include those who migrated to Ontario from June 2017 onward and for whom no immigration data are available; includes both immigrants and those migrating from other provinces. * Includes privately sponsored, government-assisted and blended visa office-referred refugees. ** Includes refugee dependents, humanitarian and compassionate/public policy consideration cases, and other immigrants categories. _________________________________________________________________________________________________________________________________________________ ICES 9 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Exhibit 2.2 Proportion of residents tested for COVID-19, percent positivity for COVID-19 in those tested, and per capita positivity in Ontario, by immigration category, as of June 13, 2020 Tested 12% Confirmed positive (among tested) Confirmed positive (among population) 11.3% 10.3% 10.1% 9.5% 10% 8.8% 9.3% 8.5% 8% 6.3% 6% 4.4% 4.1% 4% 3.7% 3.6% 3.2% 3.1% 2.8% 2.8% 2% 0.9% 0.3% 0.2% 0.4% 0.4% 0.4% 0.3% 0.1% 0% Sponsored family Economic caregiver Economic other Resettled refugees Protected person/ Refugees landed in Canada Other refugees and immigrants Newcomers to Ontario Canadian-born/ longterm residents Immigration category Key Findings: Economic caregivers were the only immigrant group with a higher proportion of testing than Canadian-born and long-term residents; they also had the highest per capita positivity (0.9% vs. 0.1% in Canadian-born and long-term residents). Both percent positivity in those tested and per capita positivity were higher in all immigrant categories compared with Canadian-born and more pronounced in all refugee sub-groups. Notes: 1. Excludes long-term care residents. Immigrants and refugees restricted to those who obtained permanent residency between 1985 and 2017 and includes second-generation children and youth (aged ≤ 19 years) of immigrant and refugee mothers. Newcomers include all those who migrated to Ontario from June 2017 onward and for whom no immigration data are available; includes both immigrants and those migrating from other provinces. _________________________________________________________________________________________________________________________________________________ ICES 10 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Exhibit 2.3.1 Weekly number of individuals tested for COVID-19 per 100,000 population in Ontario, by immigration category, January 15 to June 13, 2020 Sponsored Family Economic caregiver Economic other Refugees (all) Newcomers to Ontario Canadian-born/ long-term resident Rate tested per 100,000 population 1,800 1,600 1,400 1,200 1,000 800 600 400 200 0 15Jan 14Mar Prior to March 14: Exposure criteria: travel to affected area, close contact with confirmed COVID-19 case or traveler, participated in mass gathering, or laboratory exposure to COVID-19. 15Mar 21Mar 22Mar 28Mar 29Mar 04Apr March 14: Testing restricted to those with symptoms and requiring urgent medical care, contacts of confirmed cases, health care workers with symptoms, residents of longterm care or retirement homes, and First Nations members living on reserve. 05Apr 11Apr 12Apr 18Apr 19Apr 25Apr April 10: Expansion of proactive testing to other priority groups. 26Apr 02May 03May 09May 10May 16May 17May 23May April 22: Enhanced testing in long-term care homes and other congregate care settings. 24May 30May 31May 06Jun 07Jun - 13Jun May 28: Expansion of testing to include asymptomatic contacts of confirmed cases in all populations and priority groups. Week Start and End Date (2020) Key Findings: The general pattern of per capita testing was similar across most immigration categories, although testing rates were lower compared to Canadian-born and long-term residents. With the expansion of testing to asymptomatic carriers, per capita testing of Canadian-born and long-term residents increased more than in most immigrants and refugees. The exception is those who landed in Ontario as economic caregivers; they had a pronounced peak of testing during the phase of enhanced testing in long-term care and other congregate care settings and high overall levels of testing. Notes: 1. Excludes long-term care residents. Immigrants and refugees restricted to those who obtained permanent residency between 1985 and 2017 and includes second-generation children and youth (aged ≤ 19 years) of immigrant and refugee mothers. Newcomers include all those who migrated to Ontario from June 2017 onward and for whom no immigration data are available; includes both immigrants and those migrating from other provinces. _________________________________________________________________________________________________________________________________________________ ICES 11 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Exhibit 2.3.2 Weekly percent positivity in those tested for COVID -19 in Ontario, by immigration category, January 15 to June 13, 2020 Sponsored Family Economic caregiver Economic other Refugees (all) Newcomers to Ontario Canadian-born/ long-term resident 25% Percent positivity 20% 15% 10% 5% 0% 15Jan 14Mar 15Mar 21Mar Prior to March 14: Exposure criteria: travel to affected area, close contact with confirmed COVID-19 case or traveler, participated in mass gathering, or laboratory exposure to COVID-19. 22Mar 28Mar 29Mar 04Apr 05Apr 11Apr March 14: Testing restricted to those with symptoms and requiring urgent medical care, contacts of confirmed cases, health care workers with symptoms, residents of longterm care or retirement homes, and First Nations members living on reserve. 12Apr 18Apr 19Apr 25Apr April 10: Expansion of proactive testing to other priority groups. 26Apr 02May 03May 09May 10May 16May 17May 23May April 22: Enhanced testing in long-term care homes and other congregate care settings. 24May 30May 31May 06Jun 07Jun - 13Jun May 28: Expansion of testing to include asymptomatic contacts of confirmed cases in all poulations and priority groups. Week Start and End Date (2020) Key Findings: From the first few weeks of the pandemic to mid-June 2020, percent positivity was higher in all immigration categories compared with Canadian-born and long-term residents. The two periods of peak positivity in April and May were much more pronounced among immigrants and refugees, with the highest peak of positivity in April being experienced by those who immigrated under the economic caregiver program. Refugees had the second highest and highest percent positivity in the April and May peaks, respectively. Notes: 1. Excludes long-term care residents. Immigrants and refugees restricted to those who obtained permanent residency between 1985 and 2017 and includes second-generation children and youth (aged ≤ 19 years) of immigrant and refugee mothers. Newcomers include all those who migrated to Ontario from June 2017 onward and for whom no immigration data are available; includes both immigrants and those migrating from other provinces. 2. Data for economic caregivers before the week of March 22 have been suppressed due to low counts (n < 6). _________________________________________________________________________________________________________________________________________________ ICES 12 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Exhibit 2.3.3 Rate confirmed positive per 100,000 population Weekly number of individuals in Ontario confirmed positive for COVID-19 per 100,000 population, by immigration category, January 15 to June 13, 2020 Sponsored Family Economic caregiver Economic other Refugees (all) Newcomers to Ontario Canadian-born/ long-term resident 160 140 120 100 80 60 40 20 0 15Jan 14Mar 15Mar 21Mar Prior to March 14: Exposure criteria: travel to affected area, close contact with confirmed COVID-19 case or traveler, participated in mass gathering, or laboratory exposure to COVID-19. 22Mar 28Mar 29Mar 04Apr 05Apr 11Apr March 14: Testing restricted to those with symptoms and requiring urgent medical care, contacts of confirmed cases, health care workers with symptoms, residents of longterm care or retirement homes, and First nation community members living on reserve. 12Apr 18Apr 19Apr 25Apr April 10: Expansion of proactive testing to other priority groups. 26Apr 02May 03May 09May 10May 16May 17May 23May April 22: Enhanced testing in long-term care homes and other congregate care settings. 24May 30May 31May 06Jun 07Jun - 13Jun May 28: Expansion of testing to include asymptomatic contacts of confirmed cases in all poulations and priority groups. Week start and end date (2020) Key Findings: While the pattern of weekly positive tests per capita among economic caregivers showed a steep incline in March with a peak across three weeks in April, in almost all immigration categories, the number of positive cases peaked later but plateaued for a longer period in April and May. From April onward, per capita positivity was higher in all immigration categories compared to Canadian-born and long-term residents. Notes: 1. Excludes long-term care residents. Immigrants and refugees restricted to those who obtained permanent residency between 1985 and 2017 and includes second-generation children and youth (aged ≤ 19 years) of immigrant and refugee mothers. Newcomers include all those who migrated to Ontario from June 2017 onward and for whom no immigration data are available; includes both immigrants and those migrating from other provinces. 2. Data for economic caregivers prior to the week of March 22, 2020, have been suppressed due to low counts (n<6). _________________________________________________________________________________________________________________________________________________ ICES 13 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario 3.0 and 4.0 COVID-19 testing of immigrants, refugees and other newcomers in Ontario, by age group, sex and sociodemographic characteristics, as of June 13, 2020 Summary of Exhibits Exhibit 3.1.1 and 3.1.2 illustrate the differences in the number of people tested and confirmed positive for COVID-19 depending on immigration status, age group and sex for people living in Ontario. Differences can be seen particularly for immigrants, refugees and newcomers, and between women and men. Exhibit 3.2 compares the number of people tested and confirmed positive for COVID-19 between first-generation (born outside Canada) and second-generation (born in Ontario) immigrant and refugee children and youth in Ontario, and how this differs depending on immigration category. Exhibit 4.1 displays data specifically on recent immigrants and refugees (landed since January 1, 2010, and aged 25 and older at landing) tested and confirmed positive for COVID-19. The figure depicts the relationship between Canadian language ability and level of education at time of landing in Ontario and testing and testing positive for COVID-19. Exhibits 4.2, 4.3, 4.4 and 4.5 explore the relationship between testing and testing positive for COVID-19 in Ontario according to different neighbourhood characteristics (such as ethnic diversity, income and number of people per household) separated into lower and higher groups (quintiles), and according to immigration status. Supplementary data for information provided in Exhibits 3.1.1 to 4.5 can be found in appendices 3.1, 4.1, 4.3 and 5.1. _________________________________________________________________________________________________________________________________________________ ICES 14 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Exhibit 3.1.1 Proportion of Ontario residents tested for COVID-19, by immigration status, age group and sex, as of June 13, 2020 20% All immigrants and refugees Canadian-born/ long-term residents Newcomers to Ontario 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% 0-9 10-19 20-29 30-39 40-49 50-59 60-69 70+ 0-9 Females 10-19 20-29 30-39 40-49 50-59 60-69 70+ Males Age group (in years) Key Findings: Among females, newcomers were the least likely to be tested across all age groups, and apart from those 70 years and older, testing was slightly lower among immigrants and refugees compared with Canadian-born and long-term residents. Among males up to age 59, testing was similar for all immigrant categories. Notes: 1. Excludes long-term care residents. Immigrants and refugees restricted to those who obtained permanent residency between 1985 and 2017 and includes second-generation children and youth (aged ≤ 19 years) of immigrant and refugee mothers. Newcomers include all those who migrated to Ontario from June 2017 onward and for whom no immigration data are available; includes both immigrants and those migrating from other provinces. _________________________________________________________________________________________________________________________________________________ ICES 15 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Exhibit 3.1.2 Percent positivity in those tested for COVID-19 in Ontario, by immigration status, age group and sex, as of June 13, 2020 20% All immigrants and refugees Canadian-born/ long-term residents Newcomers to Ontario 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% 0-9 10-19 20-29 30-39 40-49 50-59 60-69 70+ 0-9 Females 10-19 20-29 30-39 40-49 50-59 60-69 70+ Males Age group (in years) Key Findings: In all age groups, female immigrants, refugees and newcomers had similar rates of test positivity, and all had higher rates than female Canadian-born and long-term residents. Male newcomers (those who migrated to Ontario from June 2017 onward) had higher percent positivity than other immigrants and refugees, especially those in the age groups between 10–19 years and 50–59 years. Notes: 1. Excludes long-term care residents. Immigrants and refugees are restricted to those who obtained permanent residency between 1985 and 2017 and includes second-generation children and youth (aged ≤ 19 years) of immigrant and refugee mothers. Newcomers include all those who migrated to Ontario from June 2017 onward and for whom no immigration data are available; includes both immigrants and those moving from other provinces. _________________________________________________________________________________________________________________________________________________ ICES 16 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Exhibit 3.2 Proportion of first- and second-generation immigrant and refugee children and youth in Ontario tested for COVID19 and percent positivity in those tested, by immigration category, as of June 13, 2020 18% Tested Confirmed positive (among tested) 16% 14% 12% 10% 8% 6% 4% 2% 0% All refugees Sponsored family All other All refugee First-generation immigrant and refugee children/ youth Economic caregivers Sponsored family All other Second-generation immigrant and refugee children/ youth Immigration category Key Finding: Among children and youth whose mothers were immigrants or refugees, testing rates were very similar to first-generation immigrants and refugees. Children and youth who were refugees were most likely to test positive. Notes: 1. Immigrants and refugees were restricted to those who obtained permanent residency between 1985 and 2017 and include second-generation children and youth (aged ≤ 19 years) of immigrant and refugee mothers. Second-generation children were included in the immigration category of their mother. _________________________________________________________________________________________________________________________________________________ ICES 17 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Exhibit 4.1 Proportion of recent immigrants and refugees in Ontario (landed since January 1, 2010, and aged 25+ at landing) tested for COVID-19 and percent positivity in those tested , by Canadian language ability and level of education at time of landing in Canada, as of June 13, 2020 14% Tested Confirmed Positive (among tested) 12% 10% 8% 6% 4% 2% 0% Speaks official language Speaks neither language None/Secondary or Less Some post-secondary Trade or diploma Bachelor's degree or Above Canadian language ability and education level Key Findings: Recent immigrant adults not fluent in English or French at landing were less likely to be tested but more likely to test positive compared with those who spoke either official language. Testing was lowest among immigrants with less than a high school education and those with at least a university degree at landing, whereas percent positivity in those tested was inversely related to the amount of formal education. Notes: 1. Excludes long-term care residents. 2. Excludes those whose Canadian language ability and level of education were not stated. _________________________________________________________________________________________________________________________________________________ ICES 18 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Exhibit 4.2 Proportion of Ontario residents tested for COVID-19 and percent positivity in those tested , by immigration status and neighbourhood ethnic diversity , as of June 13, 2020 Tested Confirmed Positive (among tested) 12% 10% 8% 6% 4% 2% 0% Q1 (least) Q2 Q3 Q4 Q5 (most) All immigrants and refugees Q1 (least) Q2 Q3 Q4 Q5 (most) Canadian-born/ long-term residents Q1 (least) Q2 Q3 Q4 Q5 (most) Newcomers to Ontario Neighbourhood ethnic diversity quintile Key Findings: The trend of testing and percent positivity was similar among immigrants and refugees and Canadian-born and long-term residents, with slightly higher testing in those living in the least diverse neighbourhoods and increasing percent positivity as neighbourhood diversity increased. However, immigrants, refugees and other newcomers had lower rates of testing and much higher percent positivity than Canadian-born and long-term residents in neighbourhoods characterized by the same level of diversity. Notes: 1. Excludes long-term care residents. Immigrants and refugees restricted to those who obtained permanent residency between 1985 and 2017 and includes second-generation children and youth (aged ≤ 19 years) of immigrant and refugee mothers. Newcomers include all those who migrated to Ontario from June 2017 onward and for whom no immigration data are available; includes both immigrants and those migrating from other provinces. 2. Neighbourhood diversity was derived from ethnic concentration in the Ontario Marginalization Index; it reflects the proportion of residents who are new immigrants and visible minorities. _________________________________________________________________________________________________________________________________________________ ICES 19 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Exhibit 4.3 Proportion of Ontario residents tested for COVID-19 and percent positivity in those tested , by immigration status and neighbourhood income, as of June 13, 2020 Tested Confirmed Positive (among tested) 12% 10% 8% 6% 4% 2% 0% Q1 (lowest) Q2 Q3 Q4 Q5 (highest) All immigrants and refugees Q1 (lowest) Q2 Q3 Q4 Q5 (highest) Canadian-born/ long-term residents Q1 (lowest) Q2 Q3 Q4 Q5 (highest) Newcomers to Ontario Neighbourhood income quintile Key Findings: Testing was highest in those living in the lowest income neighbourhoods for all groups. Canadian born and long-term residents had the highest proportions of residents tested in any quintile. Percent positivity was inversely associated with neighbourhood income quintile for immigrants, refugees and other newcomers but not for Canadian-born and long-term residents. Notes: 1. Excludes long-term care residents. Immigrants and refugees restricted to those who obtained permanent residency between 1985 and 2017 and includes second-generation children and youth (aged ≤ 19 years) of immigrant and refugee mothers. Newcomers include all those who migrated to Ontario from June 2017 onward and for whom no immigration data are available; includes both immigrants and those migrating from other provinces. _________________________________________________________________________________________________________________________________________________ ICES 20 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Exhibit 4.4 Proportion of Ontario residents tested for COVID-19 and percent positivity in those tested, by immigration status and number of persons per dwelling, as of June 13, 2020 Tested Confirmed Positive (among tested) 12% 10% 8% 6% 4% 2% 0% Q1 (lowest) Q2 Q3 Q4 Q5 (highest) All immigrants and refugees Q1 (lowest) Q2 Q3 Q4 Q5 (highest) Canadian-born/ long-term residents Q1 (lowest) Q2 Q3 Q4 Q5 (highest) Newcomers to Ontario Number of persons per dwelling quintile Key Findings: Across all groups, testing was the lowest in those living in neighbourhoods with the lowest number of persons per dwelling. The trend for percent positivity generally showed an increase as the number of persons per dwelling increased across all groups although immigrants, refugees and other newcomers had higher rates of positivity than Canadian-born and long-term residents in the same neighbourhood quintile. Notes: 1. Excludes long-term care residents. Immigrants and refugees restricted to those who obtained permanent residency between 1985 and 2017 and includes second-generation children and youth (aged ≤ 19 years) of immigrant and refugee mothers. Newcomers include all those who migrated to Ontario from June 2017 onward and for whom no immigration data are available; includes both immigrants and those migrating from other provinces. _________________________________________________________________________________________________________________________________________________ ICES 21 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario 5.0 World regions and selected countries of birth for immigrants and refugees in Ontario, tested and confirmed positive for COVID-19, as of June 13, 2020 Summary of Exhibits Exhibits 5.1.1, 5.1.2, and 5.1.3 explore whether the number of people tested for COVID-19 and confirmed positive in those tested in Ontario differs in immigrants and refugees depending on the world region or country in which they were born and their sex, and how these results compare to Canadian-born and long-term residents and all immigrants and refugees as a whole. Countries of birth were ranked according to testing rates within the top 20 countries with the most COVID-19 positive cases, and the top 10 are included in the exhibits. Exhibits 5.2.1, 5.2.2, and 5.2.3 examine whether the number of people confirmed positive for COVID-19 in those tested (percent positivity) in Ontario differs in immigrants and refugees depending on the world region or country in which they were born and their sex, and how these results compare to Canadian-born and longterm residents and all immigrants and refugees as a whole. Countries of birth were ranked according to positivity in those tested within the top 20 countries with the most COVID-19 positive cases, and the top 10 are included in the exhibits. Exhibits 5.3.1, 5.3.2 and 5.3.3 differ from the previous exhibits, as they examine the number of people confirmed positive for COVID19 in the population (per capita positivity), rather than in those tested (these represent smaller percentages for this reason). The exhibits portray whether there are differences in immigrants and refugees depending on the world region or country in which they were born and their sex, and how these results compare to Canadian-born and long-term residents and all immigrants and refugees as a whole. Countries of birth were ranked by per capita positivity according to the top 20 countries with the most COVID-19 positive cases, and the top 10 are included in the exhibits. Supplementary data for information provided in Exhibits 5.1.1 to 5.3.3 can be found in appendices 3.1, 4.1, 6.1, 6.2, and 6.3. _________________________________________________________________________________________________________________________________________________ ICES 22 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Exhibit 5.1.1 Proportion of those tested for COVID -19, by world region of birth of immigrants and refugees in Ontario, as of June 13, 2020 12% Canadian-born/ long-term resident All immigrants and refugees 10% Percent tested 8% 6% 4% 2% 0% Southeast Asia Western Africa Caribbean Central Africa East Africa South America Central America Southern Africa Eastern Europe Europe other Australasia South Asia & Oceania North Middle East America North Africa East Asia World region of birth Key Findings: The proportion of those tested is higher among immigrants and refugees from Southeast Asia, all African regions (except North Africa), the Caribbean, South and Central America compared with all immigrants and refugees. Immigrants and refugees from Southeast Asia, Western Africa and the Caribbean had a higher proportion of testing compared with Canadian-born and long-term residents. Immigrants and refugees from East Asia had the lowest rate of testing. Notes: 1. Excludes long-term care residents. Immigrants and refugees restricted to those who obtained permanent residency between 1985 and 2017 and includes second-generation children and youth (aged ≤ 19 years) of immigrant and refugee mothers. ‘Europe other’ excludes Eastern Europe and includes Central Europe, Western Europe, and other parts of Europe in the North and South. 2. Second-generation children are assigned to maternal region of birth. _________________________________________________________________________________________________________________________________________________ ICES 23 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Exhibit 5.1.2 Countries of birth of immigrants and refugees in Ontario with the top 10 highest proportions of those tested (ranked from the countries with the top 20 counts of COVID -10 positive cases), as of June 13, 2020 12% Canadian-born/ long-term residents All immigrants and refugees 10% Percent tested 8% 6% 4% 2% 0% Haiti Philippines Jamaica Ghana Nigeria Ethiopia Guyana El Salvador Colombia Trinidad and Tobago Country of birth Key Findings: The proportion of those tested for COVID-19 is higher among immigrants and refugees from Haiti, Philippines, Jamaica, Ghana, Nigeria, Ethiopia and Guyana compared with all Canadian-born and long-term residents. Compared with the average of all immigrants and refugees, the proportion tested is higher among immigrants and refugees from all countries identified above. Notes: 1. Excludes long-term care residents. Immigrants and refugees restricted to those who obtained permanent residency between 1985 and 2017 and includes second-generation children and youth (aged ≤ 19 years) of immigrant and refugee mothers. 2. Second-generation children are assigned to maternal country of birth. _________________________________________________________________________________________________________________________________________________ ICES 24 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Exhibit 5.1.3 Country of birth of immigrants and refugees in Ontario with the top 10 highest proportions of those tested (ranked from the countries with the top 20 counts of COVID -19 positive cases), by sex, as of June 13, 2020 Canadian-born/ long-term residents All immigrants and refugees 12% Percent tested 10% 8% 6% 4% 2% 0% Philippines Haiti Nigeria Ghana El Salvador Guyana Ethiopia Jamaica Trinidad Afghanistan and Tobago Males Haiti Philippines Jamaica Grenada Ghana Nigeria Ethiopia Guyana El Salvador Poland Females Country of birth Key Findings: The countries of birth with the highest proportion of testing were similar for male and female immigrants and refugees. Female immigrants and refugees had higher rates of testing than males from the same countries. Notes: 1. Excludes long-term care residents. Immigrants and refugees restricted to those who obtained permanent residency between 1985 and 2017 and includes second-generation children and youth (aged ≤ 19 years) of immigrant and refugee mothers. 2. Second-generation children are assigned to maternal country of birth. _________________________________________________________________________________________________________________________________________________ ICES 25 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Exhibit 5.2.1 Percent positivity for COVID-19 in those tested, by world region of birth of immigrants and refugees in Ontario, as of June 13, 2020 12% Canadian-born/ long-term residents All immigrants and refugees Percent positivity (among tested) 10% 8% 6% 4% 2% 0% East Africa Caribbean Western Africa Central America Central Africa South Asia South America Southeast Middle East Asia North Africa Eastern Europe Southern Africa Europe other Australasia & Oceania North America East Asia World region of birth Key Findings: Percent positivity in those tested was higher among immigrants and refugees from East Africa, the Caribbean, Western Africa, Central America, Central Africa, South Asia, South America and Southeast Asia compared with all immigrants and refugees. Immigrants and refugees from all world regions had a higher percent positivity compared with Canadian-born and long-term residents. Immigrants and refugees from East Asia had the lowest percent positivity. Notes: 1. Excludes long-term care residents. Immigrants and refugees restricted to those who obtained permanent residency between 1985 and 2017 and includes second-generation children and youth (aged ≤ 19 years) of immigrant and refugee mothers. ‘Europe other’ excludes Eastern Europe, includes Central Europe, Western Europe, and other parts of Europe in the North and South. 2. Second-generation children are assigned to maternal region of birth. _________________________________________________________________________________________________________________________________________________ ICES 26 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Exhibit 5.2.2 Countries of birth of immigrants and refugees in Ontario with the 10 highest rates of percent positivity for COVID19 among those tested (ranked from the 20 countries with the highest counts of COVID-19 positive cases), as of June 13, 2020 20% Percent positivity (among tested) Canadian-born/ long-term residents All immigrants and refugees 15% 10% 5% 0% Somalia Iraq Haiti Afghanistan Jamaica Nigeria El Salvador Guyana Sri Lanka Ghana Country of birth Key Findings: Percent positivity for COVID-19 in those tested was higher among immigrants and refugees from the countries identified above compared to all immigrants and refugees and to Canadian-born and long-term residents. Immigrants and refugees from Somalia had the highest positivity rate (19.1%). Notes: 1. Excludes long-term care residents. Immigrants and refugees are restricted to those who obtained permanent residency between 1985 and 2017 and includes second-generation children and youth (aged ≤ 19 years) of immigrant and refugee mothers. 2. Second-generation children are assigned to maternal country of birth. _________________________________________________________________________________________________________________________________________________ ICES 27 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Exhibit 5.2.3 Countries of birth of immigrants and refugees in Ontario with the 10 highest rates of percent positivity for COVID19 among those tested (ranked from the 20 countries with the highest counts of COVID-19 positive cases), by sex, as of June 13, 2020 Canadian-born/ long-term residents All immigrants and refugees Percent positivity (among tested) 20% 15% 10% 5% Males Country of birth Females Key Findings: The countries of birth with the highest rates of percent positivity in those tested for COVID-19 were similar for male and female immigrants and refugees. Within the same country of birth, percent positivity was higher among males than females. Percent positivity was higher among immigrants and refugees from the countries identified above compared to all immigrants and refugees and to Canadian-born and long-term residents. Notes: 1. Excludes long-term care residents. Immigrants and refugees are restricted to those who obtained permanent residency between 1985 and 2017 and includes second-generation children and youth (aged ≤ 19 years) of immigrant and refugee mothers. 2. Second-generation children are assigned to maternal country of birth. _________________________________________________________________________________________________________________________________________________ ICES 28 Nigeria Sri Lanka El Salvador Guyana Jamaica Grenada Haiti Afghanistan Iraq Somalia Guyana Ghana Afghanistan El Salvador Jamaica Haiti Iraq Nigeria Grenada Somalia 0% COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Exhibit 5.3.1 Per capita positivity for COVID-19 among immigrants and refugees in Ontario, by world region of birth, as of June 13, 2020 1.4% Canadian-born/ long-term residents All immigrants and refugees Percent positivity (per capita) 1.2% 1.0% 0.8% 0.6% 0.4% 0.2% 0.0% Western Africa Caribbean Southeast East Africa Asia Central Africa Central America South America South Asia Southern Middle East Eastern Africa Europe North Africa North America East Asia Australasia & Oceania Europe other World region of birth Key Findings: Per capita positivity for COVID-19 was higher among immigrants and refugees from Western Africa, the Caribbean, Southeast Asia, East Africa, Central Africa, Central America and South America compared with all immigrants and refugees and with Canadian-born and long-term residents. Immigrants and refugees from North Africa, North America, East Asia, Australasia and Oceania, and other parts of Europe had the lowest per capita positivity, equaling that of Canadian-born and long-term residents. Notes: 1. Excludes long-term care residents. Immigrants and refugees are restricted to those who obtained permanent residency between 1985 and 2017 and includes second-generation children and youth (aged ≤ 19 years) of immigrant and refugee mothers. ‘Europe other’ excludes Eastern Europe, includes Central Europe, Western Europe, and other parts of Europe in the North and South. 2. Second-generation children are assigned to maternal country of birth. _________________________________________________________________________________________________________________________________________________ ICES 29 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Exhibit 5.3.2 Countries of birth of immigrants and refugees in Ontario with the 10 highest rates of per capita positivity for COVID-19 (ranked from 20 countries with the highest counts of COVID-19 positive cases), as of June 13, 2020 Canadian-born/ long-term residents All immigrants and refugees 1.4% Percent positivity (per capita) 1.2% 1.0% 0.8% 0.6% 0.4% 0.2% 0.0% Haiti Jamaica Nigeria Philippines Somalia Ghana Afghanistan El Salvador Ethiopia Guyana Country of birth Key Findings: Per capita positivity for COVID-19 was much higher among immigrants and refugees from the countries identified above, compared with all immigrants and refugees and with Canadian-born and long-term residents. Haiti had the highest measured cumulative incidence of COVID-19 (1.2% compared with 0.1% in Canadian-born and long-term residents and 0.3% in all immigrants and refugees). Notes: 1. Excludes long-term care residents. Immigrants and refugees are restricted to those who obtained permanent residency between 1985 and 2017 and includes second-generation children and youth (aged ≤19 years) of immigrant and refugee mothers. 2. Second-generation children are assigned to maternal country of birth. _________________________________________________________________________________________________________________________________________________ ICES 30 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Exhibit 5.3.3 Countries of birth of immigrants and refugees in Ontario with the 10 highest rates of per capita positivity for COVID-19 (ranked from the 20 countries with the highest counts of COVID -19 positive cases), by sex, as of June 13, 2020 1.6% Canadian-born/ long-term residents All immigrants and refugees Percent positivity (per capita) 1.4% 1.2% 1.0% 0.8% 0.6% 0.4% 0.2% Males Females Country of birth Key Findings: Per capita positivity for COVID-19 was higher for females than males in the top 10 countries. When males and females from the same country are compared, the cumulative incidence of COVID-19 was higher among females. Notes: 1. Excludes long-term care residents. Immigrants and refugees were restricted to those who obtained permanent residency between 1985 and 2017 and includes second-generation children and youth aged ≤ 19 years of immigrant and refugee mothers. 2. Second-generation children are assigned to maternal country of birth. _________________________________________________________________________________________________________________________________________________ ICES 31 El Salvador Guyana Ethiopia Somalia Nigeria Philippines Ghana Jamaica Grenada Haiti Iraq Grenada Ghana El Salvador Afghanistan Somalia Philippines Jamaica Nigeria Haiti 0.0% COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario 6.0 Testing and percent positivity for COVID-19 by selected chronic conditions in immigrants and refugees and Canadian-born and long-term residents in Ontario, as of June 13, 2020 Summary of Exhibit Exhibit 6.1 explores whether immigrants and refugees in Ontario who live with chronic conditions (such as lung and heart conditions and diabetes) are as likely to be tested and confirmed positive for COVID-19 when compared to Canadian-born and long-term residents. Newcomers to Ontario are not included in this exhibit as many have not lived long enough in Ontario to capture an accurate picture from their health care data of the presence of chronic conditions. Supplementary data for information provided in Exhibit 6.1 can be found in appendices 3.1 and 4.1. _________________________________________________________________________________________________________________________________________________ ICES 32 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Exhibit 6.1 Proportion tested and confirmed positive for COVID-19 among those with select chronic conditions In Ontario, by immigration status, as of June 13, 2020 14% All immigrants and refugees Canadian-born or long-term residents 12% 10% 8% 6% 4% 2% 0% Confirmed Positive Tested Chronic Condition Key Finding: Among immigrants and refugees with any of the chronic conditions listed above, the proportion tested for COVID-19 was somewhat lower and the percent positivity in those tested was higher compared to Canadian-born and long-term residents with the same conditions. Notes: 1. Excludes long-term care residents. Immigrants and refugees are restricted to those who obtained permanent residency between 1985 and 2017 and includes second-generation children and youth (aged ≤ 19 years) of immigrant and refugee mothers. Medical conditions have not been reported for Newcomers, as many have not had sufficient time in Ontario to contribute the necessary health care use data to allow for identification of these conditions. 2. Respiratory conditions encompass asthma and chronic obstructive pulmonary disease. Cardiovascular conditions encompass heart failure, history of transient ischemic attack or stroke, hypertension and ischemic heart disease. Inflammatory conditions encompass inflammatory bowel disease and rheumatoid arthritis. These chronic conditions are identified using validated algorithms in ICES data holdings. The latest diagnosis date is March 31, 2019. _________________________________________________________________________________________________________________________________________________ ICES 33 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario 7.0 Testing and positivity for COVID-19 in immigrants and refugees in Ontario’s public health units, as of June 13, 2020 Summary of Exhibits Exhibits 7.1 and 7.2 provide a visual overview of the differences across Ontario in the proportions of immigrants and refugees tested for COVID-19 and confirmed positive. Each map depicts the province’s 34 public health units and illustrates how rates of testing may vary depending on where a person lives. Supplementary data for information provided in Exhibits 7.1 and 7.2 can be found in appendices 3.1 and 4.1. _________________________________________________________________________________________________________________________________________________ ICES 34 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Exhibit 7.1 Proportion of those tested for COVID -19 among immigrants and refugees in Ontario, by public health unit, as of June 13, 2020 Key Finding: Northwestern Health Unit, Thunder Bay District Health Unit, Porcupine Health Unit and Timiskaming Health Unit had the highest proportions of immigrants and refugees tested for COVID-19. Public Health Unit (PHU) Name 1 Windsor-Essex County Health Unit 2 Chatham-Kent Health Unit 3 Lambton Health Unit 4 Middlesex-London Health Unit 5 Southwestern Health Unit 6 Haldimand-Norfolk Health Unit 7 Brant County Health Unit 8 Region of Waterloo Public Health 9 Huron Perth Health Unit 10 Grey Bruce Health Unit 11 Wellington-Dufferin-Guelph Health Unit 12 Hamilton Public Health Services 13 Niagara Region Public Health Department 14 Halton Region Health Department 15 Peel Public Health 16 Toronto Public Health 17 York Region Public Health Services 18 Simcoe Muskoka District Health Unit 19 Haliburton, Kawartha, Pine Ridge District Health Unit 20 Durham Region Health Department 21 Peterborough Public Health Unit 22 Hastings and Prince Edward Counties Health Unit 23 Kingston, Frontenac and Lennox & Addington Health Unit 24 Leeds, Grenville and Lanark District Health Unit 25 Eastern Ontario Health Unit 26 Ottawa Public Health 27 Renfrew County and District Health Unit 28 North Bay Parry Sound District Health Unit 29 Timiskaming Health Unit 30 Sudbury and District Health Unit 31 Algoma Public Health Unit 32 Porcupine Health Unit 33 Thunder Bay District Health Unit 34 Northwestern Health Unit Notes: 1. Excludes long-term care residents. Immigrants and refugees are restricted to those who obtained permanent residency between 1985 and 2017 and includes second-generation children and youth (aged ≤ 19 years) of immigrant and refugee mothers. _________________________________________________________________________________________________________________________________________________ ICES 35 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Exhibit 7.2 Percent positivity for COVID-19 in those tested among immigrants and refugees in Ontario, by public health unit, as of June 13, 2020 Key Finding: Immigrants and refugees who resided in communities served by the Waterloo, Peel, Toronto and Durham public health units had the highest percent positivity for COVID-19 (ranging from 9.2% to 10.0%). Public Health Unit (PHU) Name 1 Windsor-Essex County Health Unit 2 Chatham-Kent Health Unit 3 Lambton Health Unit 4 Middlesex-London Health Unit 5 Southwestern Health Unit 6 Haldimand-Norfolk Health Unit 7 Brant County Health Unit 8 Region of Waterloo Public Health 9 Huron Perth Health Unit 10 Grey Bruce Health Unit 11 Wellington-Dufferin-Guelph Health Unit 12 Hamilton Public Health Services 13 Niagara Region Public Health Department 14 Halton Region Health Department 15 Peel Public Health 16 Toronto Public Health 17 York Region Public Health Services 18 Simcoe Muskoka District Health Unit 19 Haliburton, Kawartha, Pine Ridge District Health Unit 20 Durham Region Health Department 21 Peterborough Public Health Unit 22 Hastings and Prince Edward Counties Health Unit 23 Kingston, Frontenac and Lennox & Addington Health Unit 24 Leeds, Grenville and Lanark District Health Unit 25 Eastern Ontario Health Unit 26 Ottawa Public Health 27 Renfrew County and District Health Unit 28 North Bay Parry Sound District Health Unit 29 Timiskaming Health Unit 30 Sudbury and District Health Unit 31 Algoma Public Health Unit 32 Porcupine Health Unit 33 Thunder Bay District Health Unit 34 Northwestern Health Unit Notes: 1. Excludes long-term care residents. Immigrants and refugees were restricted to those who obtained permanent residency between 1985 and 2017 and includes second-generation children and youth (aged ≤ 19 years) of immigrant and refugee mothers. _________________________________________________________________________________________________________________________________________________ ICES 36 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario 8.0 Proportion of COVID-19 cases among health care workers in Ontario, as of June 13, 2020 Summary of Exhibits Exhibit 8.1 illustrates how many health care workers have been confirmed positive for COVID-19 in Ontario and some of their key characteristics (number who are female and male, immigration status, and the top 5 countries of birth for those who are immigrants and refugees). Exhibit 8.2 compares the differences in the proportion of health care workers (and long-term care workers as a subset of health care workers) in those confirmed positive for COVID-19 in Ontario who are immigrants and refugees, other newcomers and Canadian-born and long-term residents. Exhibits 8.4 and 8.5 explore the differences in proportion of health care and long-term care workers in those confirmed positive for COVID-19 in Ontario according to their countries of birth and further divided by sex. Countries of birth were ranked according to the top 20 countries with the most COVID-19 positive cases. We included the top 10 countries of birth for females but only the top 8 for males as the numbers of health care workers in other countries of birth were very low. Exhibit 8.3 explores the differences in the proportion of health care and long-term care workers in those confirmed positive for COVID19 in Ontario according to world region of birth of immigrants and refugees, compared to other newcomers and Canadian-born and long-term residents. Supplementary data for information provided in Exhibits 8.1 to 8.5 can be found in appendices 4.1, 7.1, 7.2, and 7.3. _________________________________________________________________________________________________________________________________________________ ICES 37 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Exhibit 8.1 Overview of health care workers in Ontario confirmed positive for COVID-19, by immigration status, as of June 13, 2020 Top 5 countries of birth Immigrants and refugees 1,986 (44.9%) Females > 18 years 12,381 (53.8%) Employed as health care workers Newcomers to Ontario 4,426 (35.7%) 132 (3.0%) (number and percentage of immigrant and refugee health care workers confirmed positive) Philippines: 564 (28.4%) Jamaica: 304 (15.3%) India: 191 (9.6%) Nigeria: 68 (3.4%) Guyana: 63 (3.2%) Canadian-born and longterm residents 2,308 (52.1%) Adults > 18 years confirmed positive for COVID-19: 23,003 Top 5 countries of birth Immigrants and refugees 397 (40.6%) Males > 18 years 10,622 (46.2%) Employed as health care workers Newcomers to Ontario 978 (9.2%) 66 (6.7%) (number and percentage of immigrant and refugee health care workers confirmed positive) Philippines: 109 (27.5%) Nigeria: 42 (10.6%) India: 39 (9.8%) Jamaica: 24 (6.0%) Sri Lanka: 12 (3.0%) Canadian-born and longterm residents 515 (52.7%) Notes: 1. Excludes long-term care residents. Immigrants and refugees are restricted to those who obtained permanent residency between 1985 and 2017. Newcomers include all those who migrated to Ontario from June 2017 onward and for whom no immigration data are available; includes both immigrants and those migrating from other provinces. _________________________________________________________________________________________________________________________________________________ ICES 38 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Exhibit 8.2 Proportion of health care workers among COVID-19 cases in Ontario adults older than 18 years, by immigration category, as of June 13, 2020 60% Long-term care workers Health care workers 50% 40% 30% 20% 10% 0% Sponsored Family (N=3,171) Economic caregiver (N=710) Economic (other) (N=2,497) Refugees (N=1,979) Newcomers (N=1,524) Canadian-born/ long-term resident (N=13,122) Immigration category (total number of COVID-19 cases) Key Findings: Among adults who tested positive for COVID-19, a larger proportion of cases among immigrants and refugees were health care workers compared to both Canadian-born and long-term residents and newcomers to Ontario. Almost half of the cases in the economic caregivers category were health care workers, compared to about one-quarter of cases in the sponsored family, economic other and refugee categories. Notes: 1. Long-term care workers represent a subset of health care workers. 2. Excludes long-term care residents. Newcomers include all those who migrated to Ontario from June 2017 onward and for whom no immigration data are available; includes both immigrants and those migrating from other provinces. _________________________________________________________________________________________________________________________________________________ ICES 39 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Exhibit 8.3 Proportion of health care workers among COVID-19 cases in Ontario adults older than 18 years, by world region of birth, as of June 13, 2020 60% Long-term care workers Health care workers 50% 40% 30% 20% 10% 0% World region of birth (total number of COVID-19 cases) Key Findings: Among adults who tested positive for COVID-19, immigrants and refugees from Western Africa, the Caribbean, Central Africa and Southeast Asia had the highest proportions who were health care workers. Those from North America, East Asia, South America, South Asia, Central America and the Middle East had lower proportions of cases who were health care workers compared to Canadian-born and long-term residents. Immigrants and refugees from almost all world regions had a higher proportion of cases who were long-term care workers compared to Canadian-born and long-term residents. Notes: 1. Long-term care workers represent a subset of health care workers. 2. Excludes long-term care residents. Newcomers include those who migrated to Ontario from June 2017 onward and for whom no immigration data are available; includes both immigrants and those migrating from other provinces. 3. Data for long-term care workers from North America and South Africa have been suppressed due to low counts (n<6). Data for all health care workers from Australasia and Oceania world region have been suppressed due to low counts (n<6). _________________________________________________________________________________________________________________________________________________ ICES 40 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Exhibit 8.4 Countries of birth with the highest p roportion of health care workers among COVID-19 cases in Ontario adults older than 18 years (ranked from those with the top 20 counts of COVID -19 positive cases), as of June 13, 2020 70% Long-term care workers Health care worker 60% 50% 40% 30% 20% 10% 0% Nigeria (N=192) Jamaica (N=725) Philippines (N=1,686) Guyana (N=283) India (N=959) China (N=177) Sri Lanka (N=349) Pakistan (N=340) Afghanistan (N=176) Iraq (N=238) Newcomers (N=1,524) Canadianborn/ longterm residents (N=13,122) Country of birth (total number of COVID-19 cases) Key Findings: Among adults who tested positive for COVID-19, those born in Nigeria, Jamaica, the Philippines, Guyana and India had higher proportions of cases who were health care workers compared to Canadian-born and long-term residents. Those from countries of birth other than China, Pakistan, Afghanistan and Iraq had higher proportions of cases who were long-term care workers compared to Canadian-born and long-term residents. Notes: 1. Long-term care workers represent a subset of health care workers. 2. Excludes long-term care residents. Newcomers include all those who migrated to Ontario from June 2017 onward and for whom no immigration data are available; includes both immigrants and those migrating from other provinces. 3. Data for long-term care workers from Afghanistan and Iraq have been suppressed due to low counts (n<6). _________________________________________________________________________________________________________________________________________________ ICES 41 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Exhibit 8.5 Countries of birth with the highest p roportion of health care workers among COVID-19 cases in Ontario adults older than 18 years of age (ranked from those with the top 20 counts of COVID -19 positive cases), by sex, as of June 13, 2020 80% Long-term care workers 70% Health care worker 60% 50% 40% 30% 20% 10% Females Country of birth (total number of COVID-19 cases) Canadian-born/ long-term residents (N=5,980) Newcomers (N=980) Pakistan (N=193) Iraq (N=140) Sri Lanka (N=176) India (N=461) Jamaica (N=247) Philippines (N=623) Nigeria (N=102) Canadian-born/ long-term residents (N=7,142) Newcomers (N=544) Iraq (N=98) Pakistan (N=147) Somalia (N=104) China (N=104) Sri Lanka (N=173) Guyana (N=172) India (N=498) Philippines (N=1,063) Jamaica (N=478) Nigeria (N=90) 0% Males Key Findings: Among adults who tested positive for COVID-19, there was a much higher proportion of females who were health care workers and longterm care workers compared to males born in the same country. Male adults from Nigeria and the Philippines had the highest proportion of cases who were health care workers. Among females, the highest proportion of cases who were health care workers were born in Nigeria, Jamaica and the Philippines. Notes: 1. Long-term care workers represent a subset of health care workers. 2. Excludes long-term care residents; only countries with a minimum of 6 health care workers included. Newcomers include all those who migrated to Ontario from June 2017 onward and for whom no immigration data are available; includes both immigrants and those migrating from other provinces. 3. Data for long-term care workers from Iraq (male and female) and Pakistan and Sri Lanka (male only) have been suppressed due to low counts (n<6). _________________________________________________________________________________________________________________________________________________ ICES 42 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Appendix 1.1 Baseline characteristics of Canadian-born and long-term residents, newcomers, and immigrants and refugees landed in Ontario between January 1, 1985, and May 31, 2017, as of March 31, 2020 Variable Sponsored family members Economic immigrant, caregiver Economic immigrant, other Privately sponsored refugees Blended visa office– referred refugees Govtassisted refugees Protected persons/ Refugees (asylum seekers) Refugee dependents Humanitari an and compassion ate/Public policy cases Other immigrants Other newcomers to Ontario Canadianborn and long-term residents Total Number 1,228,765 85,148 1,381,872 125,744 3,294 111,891 194,292 66,626 41,409 6,598 625,671 11,166,755 15,038,065 39.07 ± 24.08 39 (16–55) 34.34 ± 19.79 40 (14–50) 38.64 ± 19.33 41 (23–54) 42.20 ± 21.15 46 (27–59) 21.49 ± 16.25 16 (8–35) 36.15 ± 21.18 37 (17–54) 39.04 ± 19.96 42 (24–53) 29.13 ± 17.96 28 (16–40) 39.32 ± 21.30 41 (23–55) 58.55 ± 24.02 55 (46–83) 29.90 ± 16.58 29 (21–37) 42.30 ± 23.32 43 (23–61) 40.99 ± 22.87 41 (23–59) 176,066 (14.3%) 171,333 (13.9%) 4,733 (0.4%) 185,986 (15.1%) 165,732 (13.5%) 20,254 (1.6%) 58,168 (4.7%) 195,833 (15.9%) 206,899 (16.8%) 153,753 (12.5%) 93,260 (7.6%) 158,800 (12.9%) 15,410 (18.1%) 15,223 (17.9%) 187 (0.2%) 11,674 (13.7%) 7,482 (8.8%) 4,192 (4.9%) 3,747 (4.4%) 10,204 (12.0%) 22,617 (26.6%) 15,523 (18.2%) 5,076 (6.0%) 897 (1.0%) 123,660 (8.9%) 110,863 (8.0%) 12,797 (0.9%) 167,251 (12.1%) 85,266 (6.2%) 81,985 (5.9%) 158,558 (11.5%) 217,716 (15.8%) 243,310 (17.6%) 267,219 (19.3%) 159,240 (11.5%) 44,918 (3.2%) 12,529 (10.0%) 10,806 (8.6%) 1,723 (1.4%) 13,320 (10.6%) 8,212 (6.5%) 5,108 (4.1%) 8,636 (6.9%) 18,500 (14.7%) 15,295 (12.2%) 27,583 (21.9%) 21,700 (17.3%) 8,181 (6.4%) 963 (29.2%) 15,536 (13.9%) 12,321 (11.0%) 3,215 (2.9%) 16,528 (14.8%) 8,025 (7.2%) 8,503 (7.6%) 11,472 (10.3%) 17,841 (15.9%) 14,680 (13.1%) 17,903 (16.0%) 13,212 (11.8%) 4,719 (4.2%) 19,738 (10.2%) 19,173 (9.9%) 565 (0.3%) 10,074 (15.1%) 9,534 (14.3%) 540 (0.8%) 11,749 (17.6%) 4,461 (6.7%) 7,288 (10.9%) 14,665 (22.0%) 13,246 (19.9%) 6,211 (9.3%) 6,239 (9.4%) 3,360 (5.0%) 1,082 (1.6%) 4,506 (10.9%) 4,303 (10.4%) 203 (0.5%) 4,499 (10.9%) 2,245 (5.4%) 2,254 (5.4%) 4,837 (11.7%) 5,843 (14.1%) 7,319 (17.7%) 7,32 (17.7%) 4,111 (9.9%) 2,965 (7.1%) 219 (3.3%) 219 (3.3%) 0 (0%) 86,140 (13.8%) 1,074,432 (9.6%) 1,539,273 (10.2%) 475 (7.2%) 464 (7.0%) 11 (0.2%) 126 (1.9%) 315 (4.8%) 963 (14.6%) 63,198 (10.1%) 1,146,176 (10.3%) 1,644,219 (10.9%) 164,695 (26.3%) 179,380 (28.7%) 65,079 (10.4%) 27,596 (4.4%) 22,317 (3.6%) 17,266 (2.8%) 1,524,010 (13.6%) 1,435,458 (12.9%) 1,366,303 (12.2%) 1,600,518 (14.3%) 1,471,712 (13.2%) 1,548,146 (13.9%) 1,966,484 (13.1%) 2,125,205 (14.1%) 1,988,709 (13.2%) 2,162,890 (14.4%) 1,812,416 (12.1%) 1,798,869 (11.9%) SOCIODEMPGRAPHIC CHARACTERISTICS Age Mean ± SD Median (IQR) Age group, n (%) 0–9 years Second generation Immigrant or refugee 10–19 years Second generation Immigrant or refugee 20–29 years 30–39 years 40–49 years 50–59 years 60–69 years 70+ years 331 (10.0%) 632 (19.2%) 876 (26.6%) 0 (0%) 876 (26.6%) 367 (11.1%) 542 (16.5%) 371 (11.3%) 112 (3.4%) 46 (1.4%) 17 (0.6%) 22,487 (11.6%) 16,479 (8.5%) 6,008 (3.1%) 17,203 (8.9%) 30,327 (15.6%) 39,662 (20.4%) 37,398 (19.2%) 17,963 (9.2%) 9,514 (4.8%) 1,717 (26.0%) 419 (6.4%) 2,364 (35.8%) _________________________________________________________________________________________________________________________________________________ ICES 43 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Variable Sponsored family members Economic immigrant, caregiver Economic immigrant, other Privately sponsored refugees Blended visa office– referred refugees Govtassisted refugees Protected persons/ Refugees (asylum seekers) Refugee dependents Humanitari an and compassion ate/Public policy cases Other immigrants Other newcomers to Ontario Canadianborn and long-term residents Total Number 1,228,765 85,148 1,381,872 125,744 3,294 111,891 194,292 66,626 41,409 6,598 625,671 11,166,755 15,038,065 677,427 (55.1%) 551,338 (44.9%) 63,354 (74.4%) 21,794 (25.6%) 657,359 (47.6%) 724,513 (52.4%) 55,510 (44.1%) 70,234 (55.9%) 1,614 (49.0%) 1,680 (51.0%) 52,106 (46.6%) 59,785 (53.4%) 90,599 (46.6%) 103,693 (53.4%) 35,688 (53.6%) 30,938 (46.4%) 21,760 (52.5%) 19,649 (47.5%) 3,388 (51.3%) 3,210 (48.7%) 308,057 (49.2%) 317,614 (50.8%) 5,637,060 (50.5%) 5,529,695 (49.5%) 7,603,922 (50.6%) 7,434,143 (49.4%) 295,104 (24.0%) 273,898 (22.3%) 275,275 (22.4%) 224,850 (18.3%) 156,041 (12.7%) 3,597 (0.3%) 35,331 (41.5%) 20,616 (24.2%) 13,532 (15.9%) 9,174 (10.8%) 6,419 (7.5%) 76 (0.1%) 264,909 (19.2%) 267,252 (19.3%) 292,567 (21.2%) 301,077 (21.8%) 250,779 (18.1%) 5,288 (0.4%) 39,102 (31.1%) 24,121 (19.2%) 24,634 (19.6%) 22,316 (17.7%) 15,208 (12.1%) 363 (0.3%) 1,643 (49.9%) 808 (24.5%) 45,494 (40.7%) 22,562 (20.2%) 18,549 (16.6%) 15,178 (13.6%) 9,845 (8.8%) 263 (0.2%) 66,932 (34.4%) 43,066 (22.2%) 36,412 (18.7%) 30,737 (15.8%) 16,597 (8.5%) 548 (0.3%) 23,142 (34.7%) 16,257 (24.4%) 12,585 (18.9%) 9,590 (14.4%) 4,863 (7.3%) 189 (0.3%) 14,046 (33.9%) 9,789 (23.6%) 8,018 (19.4%) 6,015 (14.5%) 3,433 (8.3%) 108 (0.3%) 1,547 (23.4%) 1,436 (21.8%) 1,184 (17.9%) 1,266 (19.2%) 1,139 (17.3%) 26 (0.4%) 180,092 (28.8%) 141,839 (22.7%) 119,894 (19.2%) 99,206 (15.9%) 80,753 (12.9%) 3,887 (0.6%) 1,985,576 (17.8%) 2,111,353 (18.9%) 2,219,074 (19.9%) 2,320,273 (20.8%) 2,491,952 (22.3%) 38,527 (0.3%) 2,952,918 (19.6%) 2,932,997 (19.5%) 3,022,151 (20.1%) 3,039,904 (20.2%) 3,037,218 (20.2%) 52,877 (0.4%) 34,268 (2.8%) 60,435 (4.9%) 114,883 (9.3%) 254,974 (20.8%) 759,952 (61.8%) 4,253 (0.3%) 1,823 (2.1%) 3,971 (4.7%) 7,532 (8.8%) 18,345 (21.5%) 53,366 (62.7%) 111 (0.1%) 31,586 (2.3%) 62,368 (4.5%) 131,931 (9.5%) 323,545 (23.4%) 826,430 (59.8%) 6,012 (0.4%) 3,702 (2.9%) 7,726 (6.1%) 15,396 (12.2%) 30,976 (24.6%) 67,524 (53.7%) 420 (0.3%) 309 (9.4%) 2,844 (2.5%) 7,095 (6.3%) 14,122 (12.6%) 30,455 (27.2%) 57,041 (51.0%) 334 (0.3%) 3,109 (1.6%) 7,261 (3.7%) 16,393 (8.4%) 41,419 (21.3%) 125,473 (64.6%) 637 (0.3%) 827 (1.2%) 2,197 (3.3%) 5,206 (7.8%) 12,741 (19.1%) 45,433 (68.2%) 222 (0.3%) 995 (2.4%) 1,794 (4.3%) 3,915 (9.5%) 8,699 (21.0%) 25,880 (62.5%) 126 (0.3%) 148 (2.2%) 222 (3.4%) 408 (6.2%) 1,121 (17.0%) 4,672 (70.8%) 27 (0.4%) 25,133 (4.0%) 39,185 (6.3%) 70,318 (11.2%) 142,197 (22.7%) 343,757 (54.9%) 5,081 (0.8%) 2,115,320 (18.9%) 2,189,766 (19.6%) 2,240,655 (20.1%) 2,315,545 (20.7%) 2,170,446 (19.4%) 135,023 (1.2%) 2,220,064 (14.8%) 2,382,420 (15.8%) 2,621,323 (17.4%) 3,180,700 (21.2%) 4,481,306 (29.8%) 152,252 (1.0%) Sex, n (%) Female Male Neighbourhood income quintile, n (%) Q1 (lowest) Q2 Q3 Q4 Q5 (highest) Missing Ethnic concentration quintile, n (%) Q1 (lowest) Q2 Q3 Q4 Q5 (highest) Missing 427 (13.0%) 222 (6.7%) 189 (5.7%) <6 400 (12.1%) 564 (17.1%) 683 (20.7%) 1,332 (40.4%) 6 (0.2%) _________________________________________________________________________________________________________________________________________________ ICES 44 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Variable Sponsored family members Economic immigrant, caregiver Economic immigrant, other Privately sponsored refugees Blended visa office– referred refugees Govtassisted refugees Protected persons/ Refugees (asylum seekers) Refugee dependents Humanitari an and compassion ate/Public policy cases Other immigrants Other newcomers to Ontario Canadianborn and long-term residents Total Number 1,228,765 85,148 1,381,872 125,744 3,294 111,891 194,292 66,626 41,409 6,598 625,671 11,166,755 15,038,065 390,349 (31.8%) 205,093 (16.7%) 173,678 (14.1%) 177,678 (14.5%) 277,714 (22.6%) 4,253 (0.3%) 10,963 (12.9%) 9,827 (11.5%) 11,126 (13.1%) 16,959 (19.9%) 36,162 (42.5%) 111 (0.1%) 418,522 (30.3%) 236,955 (17.1%) 199,598 (14.4%) 178,034 (12.9%) 342,751 (24.8%) 6,012 (0.4%) 29,543 (23.5%) 19,272 (15.3%) 17,903 (14.2%) 21,375 (17.0%) 37,231 (29.6%) 420 (0.3%) 183 (5.6%) 17,045 (15.2%) 14,455 (12.9%) 16,057 (14.4%) 20,825 (18.6%) 43,175 (38.6%) 334 (0.3%) 44,867 (23.1%) 28,481 (14.7%) 26,044 (13.4%) 30,969 (15.9%) 63,294 (32.6%) 637 (0.3%) 16,626 (25.0%) 10,135 (15.2%) 9,227 (13.8%) 10,192 (15.3%) 20,224 (30.4%) 222 (0.3%) 9,115 (22.0%) 6,294 (15.2%) 5,950 (14.4%) 7,229 (17.5%) 12,695 (30.7%) 126 (0.3%) 2,153 (32.6%) 1,138 (17.2%) 762 (11.5%) 122,698 (19.6%) 79,683 (12.7%) 81,999 (13.1%) 88,855 (14.2%) 247,355 (39.5%) 5,081 (0.8%) 2,262,962 (20.3%) 2,219,188 (19.9%) 2,155,056 (19.3%) 2,083,435 (18.7%) 2,311,091 (20.7%) 135,023 (1.2%) 3,325,026 (22.1%) 2,830,760 (18.8%) 2,697,802 (17.9%) 2,637,133 (17.5%) 3,395,092 (22.6%) 152,252 (1.0%) 134,377 (10.9%) 116,942 (9.5%) 97,754 (8.0%) 257,664 (21.0%) 617,796 (50.3%) 4,232 (0.3%) 13,674 (16.1%) 12,256 (14.4%) 11,024 (12.9%) 24,498 (28.8%) 23,580 (27.7%) 116 (0.1%) 190,969 (13.8%) 126,109 (9.1%) 108,880 (7.9%) 291,348 (21.1%) 658,334 (47.6%) 6,232 (0.5%) 17,201 (13.7%) 15,862 (12.6%) 12,029 (9.6%) 30,734 (24.4%) 49,475 (39.3%) 443 (0.4%) 965 (29.3%) 21,009 (18.8%) 17,459 (15.6%) 12,731 (11.4%) 27,032 (24.2%) 33,319 (29.8%) 341 (0.3%) 28,423 (14.6%) 21,322 (11.0%) 16,948 (8.7%) 43,796 (22.5%) 83,125 (42.8%) 678 (0.3%) 8,248 (12.4%) 6,900 (10.4%) 5,569 (8.4%) 14,424 (21.6%) 31,232 (46.9%) 253 (0.4%) 5,621 (13.6%) 4,582 (11.1%) 3,951 (9.5%) 9,669 (23.3%) 17,458 (42.2%) 128 (0.3%) 950 (14.4%) 352 (5.3%) 1,115 (16.9%) 3,336 (50.6%) 26 (0.4%) 155,452 (24.8%) 79,310 (12.7%) 58,062 (9.3%) 117,375 (18.8%) 210,159 (33.6%) 5,313 (0.8%) 2,125,780 (19.0%) 2,160,464 (19.3%) 1,677,642 (15.0%) 2,750,338 (24.6%) 2,382,945 (21.3%) 69,586 (0.6%) 2,702,669 (18.0%) 2,562,911 (17.0%) 2,005,328 (13.3%) 3,568,563 (23.7%) 4,111,241 (27.3%) 87,353 (0.6%) 1,247 (0.1%) 5,669 (0.5%) 25 (0.0%) 289 (0.3%) 811 (0.1%) 3,670 (0.3%) 82 (0.1%) 584 (0.5%) 30 (0.9%) 91 (0.1%) 312 (0.3%) 44 (0.0%) 389 (0.2%) 19 (0.0%) 141 (0.2%) 24 (0.1%) 124 (0.3%) 8 (0.1%) 14 (0.2%) 1,044 (0.2%) 2,066 (0.3%) 115,495 (1.0%) 147,247 (1.3%) 118,920 (0.8%) 160,532 (1.1%) Residential instability quintile, n (%) Q1 (lowest) Q2 Q3 Q4 Q5 (highest) Missing Number of persons per dwelling quintile, n (%) Q1 (lowest) Q2 Q3 Q4 Q5 (highest) Missing Public health unit of residence, n (%) Algoma Public Health Brant County Health Unit 239 (7.3%) 402 (12.2%) 842 (25.6%) 1,622 (49.2%) 6 (0.2%) 886 (26.9%) 386 (11.7%) 570 (17.3%) 482 (14.6%) <6 27 (0.8%) 740 (11.2%) 1,778 (26.9%) 27 (0.4%) 819 (12.4%) _________________________________________________________________________________________________________________________________________________ ICES 45 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Variable Sponsored family members Economic immigrant, caregiver Economic immigrant, other Privately sponsored refugees Number Blended visa office– referred refugees Govtassisted refugees Protected persons/ Refugees (asylum seekers) Refugee dependents Humanitari an and compassion ate/Public policy cases Other immigrants Other newcomers to Ontario Canadianborn and long-term residents Total 1,228,765 85,148 1,381,872 125,744 3,294 111,891 194,292 66,626 41,409 6,598 625,671 11,166,755 15,038,065 Durham Region Health Department 60,741 (4.9%) 2,714 (3.2%) 54,607 (4.0%) 5,290 (4.2%) 47 (1.4%) 2,963 (2.6%) 10,137 (5.2%) 3,487 (5.2%) 1,960 (4.7%) 182 (2.8%) 14,325 (2.3%) 567,358 (5.1%) 723,811 (4.8%) Grey Bruce Health Unit 75 (0.1%) 83 (0.1%) 126 (0.1%) 2,846 (0.2%) 1,506 (0.1%) 2,216 (0.2%) 159 (0.1%) 160 (0.1%) 217 (0.2%) 69 (2.1%) 93 (0.1%) 94 (0.1%) 97 (0.1%) 121 (0.1%) Haldimand-Norfolk Health Unit Haliburton, Kawartha, Pine Ridge District Health Unit 2,372 (0.2%) 2,004 (0.2%) 2,426 (0.2%) 57 (0.1%) 24 (0.0%) 47 (0.1%) 35 (0.1%) 71 (0.2%) 82 (0.2%) 9 (0.1%) <6 15 (0.2%) 1,490 (0.2%) 818 (0.1%) 1,087 (0.2%) 165,648 (1.5%) 109,389 (1.0%) 186,596 (1.7%) 172,974 (1.2%) 114,300 (0.8%) 193,137 (1.3%) Halton Region Health Department 45,643 (3.7%) 2,885 (3.4%) 82,433 (6.0%) 4,893 (3.9%) 154 (4.7%) 2,365 (2.1%) 4,937 (2.5%) 1,332 (2.0%) 1,050 (2.5%) 126 (1.9%) 27,991 (4.5%) 450,663 (4.0%) 624,472 (4.2%) City of Hamilton – Public Health & Social Services 33,941 (2.8%) 2,506 (2.9%) 32,656 (2.4%) 7,202 (5.7%) 151 (4.6%) 9,929 (8.9%) 6,914 (3.6%) 2,047 (3.1%) 1,549 (3.7%) 83 (1.3%) 17,149 (2.7%) 472,422 (4.2%) 586,549 (3.9%) Hastings and Prince Edward Counties Health Unit 2,545 (0.2%) 149 (0.2%) 2,086 (0.2%) 171 (0.1%) 15 (0.5%) 163 (0.1%) 162 (0.1%) 63 (0.1%) 51 (0.1%) 7 (0.1%) 2,291 (0.4%) 167,450 (1.5%) 175,153 (1.2%) Huron Perth Health Unit 2,081 (0.2%) 1,978 (0.2%) 3,643 (0.3%) 70 (0.1%) 51 (0.1%) 227 (0.3%) 2,391 (0.2%) 1,074 (0.1%) 5,454 (0.4%) 178 (0.1%) 174 (0.1%) 297 (0.2%) 92 (2.8%) 176 (0.2%) 169 (0.2%) 376 (0.3%) 100 (0.1%) 35 (0.1%) 16 (0.0%) 114 (0.2%) 20–30 <6 94 (0.2%) 64 (0.2%) 11 (0.2%) 7 (0.1%) 1,753 (0.3%) 1,263 (0.2%) 4,987 (0.8%) 137,061 (1.2%) 103,983 (0.9%) 190,858 (1.7%) 143,970 (1.0%) 108,949 (0.7%) 206,361 (1.4%) 75 (0.1%) 138 (0.2%) 1,894 (0.1%) 1,603 (0.1%) 156 (0.1%) 96 (0.1%) 48 (1.5%) Leeds, Grenville and Lanark District Health Unit 2,195 (0.2%) 2,157 (0.2%) 134 (0.1%) 83 (0.1%) 85 (0.0%) 89 (0.0%) 23 (0.0%) 28 (0.0%) 33 (0.1%) 56 (0.1%) 6 (0.1%) 13 (0.2%) 2,004 (0.3%) 2,070 (0.3%) 128,251 (1.1%) 176,413 (1.6%) 134,904 (0.9%) 182,801 (1.2%) Middlesex-London Health Unit Niagara Region Public Health Department 20,843 (1.7%) 16,202 (1.3%) 1,165 (1.4%) 1,134 (1.3%) 26,240 (1.9%) 14,645 (1.1%) 5,419 (4.3%) 2,372 (1.9%) 176 (5.3%) 9,800 (8.8%) 1,261 (1.1%) 5,650 (2.9%) 3,993 (2.1%) 1,408 (2.1%) 1,180 (1.8%) 824 (2.0%) 758 (1.8%) 59 (0.9%) 64 (1.0%) 19,789 (3.2%) 9,533 (1.5%) 414,089 (3.7%) 434,929 (3.9%) 505,462 (3.4%) 486,158 (3.2%) Chatham-Kent Health Unit Kingston, Frontenac and Lennox & Addington Health Unit Lambton Health Unit 1–10 37 (1.1%) 44 (1.3%) 42 (1.3%) 55 (1.7%) 87 (2.6%) 140 (0.1%) 191 (0.1%) 92 (0.0%) 292 (0.2%) _________________________________________________________________________________________________________________________________________________ ICES 46 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Blended visa office– referred refugees Govtassisted refugees Protected persons/ Refugees (asylum seekers) Refugee dependents Humanitari an and compassion ate/Public policy cases Other immigrants Other newcomers to Ontario Canadianborn and long-term residents Total 125,744 3,294 111,891 194,292 66,626 41,409 6,598 625,671 11,166,755 15,038,065 100 (0.1%) 21 (0.6%) 62 (0.1%) 54 (0.0%) 10–20 30 (0.1%) <6 1,084 (0.2%) 130,820 (1.2%) 134,606 (0.9%) 609 (0.0%) 71,450 (5.2%) 294,471 (21.3%) 2,322 (0.2%) 15 (0.0%) 6,761 (5.4%) 21,714 (17.3%) 306 (0.2%) 7 (0.2%) 459 (13.9%) 15 (0.0%) 14,227 (12.7%) 11,019 (9.8%) 325 (0.3%) 14 (0.0%) 15,592 (8.0%) 26,143 (13.5%) 268 (0.1%) 7 (0.0%) 4,501 (6.8%) 9,662 (14.5%) 91 (0.1%) 16 (0.0%) 2,295 (5.5%) 6,398 (15.5%) 55 (0.1%) 8 (0.1%) 197 (3.0%) 617 (9.4%) <6 1,710 (0.3%) 57,028 (9.1%) 115,009 (18.4%) 1,746 (0.3%) 86,421 (0.8%) 832,340 (7.5%) 802,002 (7.2%) 141,805 (1.3%) 89,681 (0.6%) 1,069,452 (7.1%) 1,592,535 (10.6%) 149,500 (1.0%) 76 (0.1%) 56 (0.1%) 502 (0.0%) 1,177 (0.1%) 22 (0.0%) 76 (0.1%) <6 10–20 57 (0.1%) 19 (0.0%) 1–10 20 (0.0%) 25 (0.1%) <6 18 (0.5%) 38 (0.0%) 45 (0.0%) 774 (0.1%) 1,935 (0.3%) 85,910 (0.8%) 103,069 (0.9%) 87,967 (0.6%) 107,631 (0.7%) 2,285 (0.2%) 22,155 (1.8%) 145 (0.2%) 1,302 (1.5%) 1,859 (0.1%) 18,580 (1.3%) 87 (0.1%) 2,607 (2.1%) 10–20 133 (0.1%) 1,428 (1.3%) 346 (0.2%) 134 (0.2%) 1,060 (1.6%) 91 (0.2%) 878 (2.1%) <6 38 (0.6%) 5,077 (0.8%) 8,399 (1.3%) 211,999 (1.9%) 546,750 (4.9%) 222,174 (1.5%) 606,343 (4.0%) Sudbury and District Health Unit 2,084 (0.2%) 103 (0.1%) 2,112 (0.2%) 137 (0.1%) 33 (1.0%) 88 (0.1%) 176 (0.1%) 85 (0.1%) 38 (0.1%) 7 (0.1%) 2,989 (0.5%) 199,270 (1.8%) 207,122 (1.4%) Thunder Bay District Health Unit 1,810 (0.1%) 107 (0.1%) 1,455 (0.1%) 411 (0.3%) 42 (1.3%) 310 (0.3%) 90 (0.0%) 27 (0.0%) 26 (0.1%) 6 (0.1%) 2,411 (0.4%) 154,379 (1.4%) 161,074 (1.1%) Timiskaming Health Unit <6 13 (0.0%) 7,309 (5.8%) 0 (0.0%) 384 (11.7%) <6 <6 11,557 (10.3%) 11 (0.0%) 4,561 (2.3%) <6 1,262 (1.5%) 150 (0.0%) 41,056 (3.0%) <6 Region of Waterloo Public Health 257 (0.0%) 36,425 (3.0%) 1,377 (2.1%) 923 (2.2%) 70 (1.1%) 299 (0.0%) 26,943 (4.3%) 33,874 (0.3%) 463,066 (4.1%) 34,621 (0.2%) 594,933 (4.0%) Wellington-DufferinGuelph Health Unit 14,819 (1.2%) 1,141 (1.3%) 14,829 (1.1%) 2,539 (2.0%) 124 (3.8%) 1,220 (1.1%) 1,111 (0.6%) 445 (0.7%) 271 (0.7%) 33 (0.5%) 7,479 (1.2%) 270,815 (2.4%) 314,826 (2.1%) Variable Sponsored family members Economic immigrant, caregiver Economic immigrant, other Privately sponsored refugees Number 1,228,765 85,148 1,381,872 1,298 (0.1%) 52 (0.1%) 1,067 (0.1%) 742 (0.1%) 59,957 (4.9%) 295,614 (24.1%) 2,431 (0.2%) 117 (0.1%) 4,645 (5.5%) 9,717 (11.4%) 114 (0.1%) Renfrew County and District Health Unit 585 (0.0%) 1,161 (0.1%) Eastern Ontario Health Unit Simcoe Muskoka District Health Unit North Bay Parry Sound District Health Unit Northwestern Health Unit Ottawa Public Health Peel Public Health Peterborough County-City Health Unit Porcupine Health Unit 169 (5.1%) 30–40 86 (2.6%) 3,060 (1.6%) <6 _________________________________________________________________________________________________________________________________________________ ICES 47 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Variable Sponsored family members Economic immigrant, caregiver Economic immigrant, other Privately sponsored refugees Number Blended visa office– referred refugees Govtassisted refugees Protected persons/ Refugees (asylum seekers) Refugee dependents Humanitari an and compassion ate/Public policy cases Other immigrants Other newcomers to Ontario Canadianborn and long-term residents Total 1,228,765 85,148 1,381,872 125,744 3,294 111,891 194,292 66,626 41,409 6,598 625,671 11,166,755 15,038,065 Windsor-Essex County Health Unit 25,062 (2.0%) 655 (0.8%) 22,851 (1.7%) 5,340 (4.2%) 135 (4.1%) 8,445 (7.5%) 4,433 (2.3%) 1,334 (2.0%) 1,279 (3.1%) 102 (1.5%) 17,214 (2.8%) 364,418 (3.3%) 451,268 (3.0%) York Region Public Health Services 157,727 (12.8%) 6,706 (7.9%) 230,825 (16.7%) 6,681 (6.0%) 24,702 (12.7%) 9,515 (14.3%) 5,109 (12.3%) 2,233 (33.8%) 52,940 (8.5%) 752,800 (6.7%) 1,261,060 (8.4%) Southwestern Health Unit 5,660 (0.5%) 389,455 (31.7%) 3,551 (0.3%) 192 (0.2%) 46,969 (55.2%) 73 (0.1%) 3,865 (0.3%) 431,320 (31.2%) 5,240 (0.4%) 565 (0.4%) 38,188 (30.4%) 356 (0.3%) 44 (1.3%) 381 (0.3%) 27,556 (24.6%) 262 (0.2%) 334 (0.2%) 92 (0.1%) 28,043 (42.1%) 185 (0.3%) 162 (0.4%) 16,878 (40.8%) 107 (0.3%) 6 (0.1%) 2,624 (39.8%) 26 (0.4%) 2,304 (0.4%) 206,804 (33.1%) 3,866 (0.6%) 206,375 (1.8%) 1,779,714 (15.9%) 33,076 (0.3%) 219,980 (1.5%) 3,047,548 (20.3%) 47,291 (0.3%) 160,493 (13.1%) 24,457 (2.0%) 135,996 (11.1%) 235,750 (19.2%) 7,928 (9.3%) 830 (1.0%) 6,120 (7.2%) 13,193 (15.5%) 136,426 (9.9%) 15,773 (1.1%) 121,189 (8.8%) 211,508 (15.3%) 17,712 (14.1%) 2,169 (1.7%) 15,175 (12.1%) 28,341 (22.5%) 114 (3.5%) 14,384 (12.9%) 1,513 (1.4%) 11,108 (9.9%) 17,667 (15.8%) 28,470 (14.7%) 3,453 (1.8%) 25,089 (12.9%) 35,361 (18.2%) 6,559 (9.8%) 572 (0.9%) 4,289 (6.4%) 5,824 (8.7%) 4,573 (11.0%) 804 (1.9%) 4,847 (11.7%) 7,820 (18.9%) 1,155 (17.5%) 340 (5.2%) 1,269 (19.2%) 2,562 (38.8%) 3,197 (0.5%) 2,202 (0.4%) 9,069 (1.4%) 12,238 (2.0%) 2,396,958 (21.5%) 242,761 (2.2%) 1,071,906 (9.6%) 2,525,735 (22.6%) 2,777,969 (18.5%) 294,893 (2.0%) 1,406,168 (9.4%) 3,096,090 (20.6%) 8,321 (0.7%) 8,328 (0.7%) 6,009 (0.5%) 366 (0.4%) 339 (0.4%) 227 (0.3%) 6,719 (0.5%) 8,216 (0.6%) 6,196 (0.4%) 985 (0.8%) 1,175 (0.9%) 903 (0.7%) 19 (0.6%) <6 1,088 (1.0%) 848 (0.8%) 769 (0.7%) 2,709 (1.4%) 1,536 (0.8%) 1,302 (0.7%) 432 (0.6%) 324 (0.5%) 255 (0.4%) 398 (1.0%) 253 (0.6%) 287 (0.7%) 86 (1.3%) 60–70 814 (0.1%) 296 (0.0%) 341 (0.1%) 100,174 (0.9%) 156,790 (1.4%) 75,972 (0.7%) 122,111 (0.8%) 178,171 (1.2%) 92,326 (0.6%) Toronto Public Health Unknown/ missing 563 (17.1%) <6 79,434 (40.9%) 544 (0.3%) CLINICAL CHARACTERISTICS Chronic conditions, n (%) Respiratory (asthma, COPD) Chronic kidney disease (incl. chronic dialysis) Diabetes Cardiovascular (CHF, TIA/ stroke, Ischemic cardiac disease, hypertension) Immuno-compromised Inflammatory (IBD, rheumatoid arthritis) Liver disease 19 (0.6%) 111 (3.4%) 91 (2.8%) <6 60–70 _________________________________________________________________________________________________________________________________________________ ICES 48 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Variable Sponsored family members Economic immigrant, caregiver Economic immigrant, other Privately sponsored refugees Blended visa office– referred refugees Govtassisted refugees Protected persons/ Refugees (asylum seekers) Refugee dependents Humanitari an and compassion ate/Public policy cases Other immigrants Other newcomers to Ontario Canadianborn and long-term residents Total Number 1,228,765 85,148 1,381,872 125,744 3,294 111,891 194,292 66,626 41,409 6,598 625,671 11,166,755 15,038,065 55,853 (4.5%) 148,858 (12.1%) 686,929 (55.9%) 337,125 (27.4%) 10,664 (12.5%) 10,169 (11.9%) 41,608 (48.9%) 22,707 (26.7%) 40,233 (2.9%) 194,866 (14.1%) 950,596 (68.8%) 196,177 (14.2%) 11,634 (9.3%) 10,568 (8.4%) 84,521 (67.2%) 19,021 (15.1%) 2830–2840 2,384 (1.2%) 27,747 (14.3%) 128,497 (66.1%) 35,664 (18.4%) 4,167 (6.3%) 11,809 (17.7%) 36,653 (55.0%) 13,997 (21.0%) 1,464 (3.5%) 8,063 (19.5%) 25,333 (61.2%) 6,549 (15.8%) <6 0 (0.0%) 331 (10.0%) 13,484 (12.1%) 11,166 (10.0%) 66,892 (59.8%) 20,349 (18.2%) 3,017 (0.2%) 25,018 (2.0%) 28,782 (2.3%) 2,761 (0.2%) 64,196 (5.2%) 14,649 (1.2%) 26,069 (2.1%) 79,462 (6.5%) 127,793 (10.4%) 39,053 (3.2%) 165,622 (13.5%) 29 (0.0%) 223 (0.3%) 328 (0.4%) 39 (0.0%) 203 (0.2%) 113 (0.1%) 224 (0.3%) 1,127 (1.3%) 1,826 (2.1%) 45 (0.1%) 1,321 (1.6%) 2,276 (0.2%) 16,734 (1.2%) 19,013 (1.4%) 11,215 (0.8%) 148,203 (10.7%) 31,714 (2.3%) 13,375 (1.0%) 44,545 (3.2%) 43,651 (3.2%) 25,044 (1.8%) 272,562 (19.7%) 445 (0.4%) 2,496 (2.0%) 11,970 (9.5%) 154 (0.1%) 32,105 (25.5%) 1,127 (0.9%) 4,921 (3.9%) 2,475 (2.0%) 227 (0.2%) 359 (0.3%) 1,140 (0.9%) 31 (0.9%) 41 (1.2%) 171 (5.2%) <6 2,314 (2.1%) 1,089 (1.0%) 9,958 (8.9%) 160–170 1,585 (2.4%) 2,016 (3.0%) 4,733 (7.1%) 110–120 2,762 (83.8%) 59 (1.8%) 0 (0.0%) 30 (0.9%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 32,922 (29.4%) 3,770 (3.4%) 10,920 (9.8%) 2,174 (1.9%) 119 (0.1%) 340 (0.3%) 392 (0.4%) 4,675 (2.4%) 7,897 (4.1%) 28,687 (14.8%) 488 (0.3%) 19,648 (10.1%) 4,641 (2.4%) 7,097 (3.7%) 18,414 (9.5%) 8,854 (4.6%) 682 (0.4%) 14,883 (7.7%) 838 (2.0%) 1,525 (3.7%) 1,863 (4.5%) 89 (0.2%) 2,225 (5.4%) 408 (1.0%) 2,037 (4.9%) 3,742 (9.0%) 5,515 (13.3%) 1,528 (3.7%) 5,886 (14.2%) IMMIGRATION CHARACTERISTICS Recency of immigration, n (%) Recent (0 to ≤ 5 years) Intermediate (>5 to ≤10 years) Long-term residents (>10 years) Second generation children and youth World subregion of origin, n (%) Central Africa Western Africa East Africa Southern Africa Middle East North Africa Central America South America Caribbean North America East Asia 120–130 4,088 (6.1%) 1,012 (1.5%) 1,591 (2.4%) 3,236 (4.9%) 3,098 (4.6%) 3,120 (4.7%) 11,251 (16.9%) 40–50 5,863 (88.9%) 684 (10.4%) 27 (0.4%) 54 (0.8%) 162 (2.5%) 20–30 398 (6.0%) 114 (1.7%) 98 (1.5%) 153 (2.3%) 243 (3.7%) 116 (1.8%) 3,991 (60.5%) _________________________________________________________________________________________________________________________________________________ ICES 49 142,720 (0.9%) 423,423 (2.8%) 2,026,892 (13.5%) 652,604 (4.3%) 15,237 (0.1%) 57,093 (0.4%) 105,667 (0.7%) 15,069 (0.1%) 306,750 (2.0%) 57,607 (0.4%) 66,332 (0.4%) 155,358 (1.0%) 191,326 (1.3%) 70,287 (0.5%) 477,048 (3.2%) COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Variable Sponsored family members Economic immigrant, caregiver Economic immigrant, other Privately sponsored refugees Blended visa office– referred refugees Govtassisted refugees Protected persons/ Refugees (asylum seekers) Refugee dependents Humanitari an and compassion ate/Public policy cases Other immigrants Other newcomers to Ontario Canadianborn and long-term residents Total Number 1,228,765 85,148 1,381,872 125,744 3,294 111,891 194,292 66,626 41,409 6,598 625,671 11,166,755 15,038,065 5,318 (0.4%) 74 (0.1%) 3,774 (0.3%) 152 (0.1%) 0 (0.0%) 1–6 28 (0.0%) 1–6 75 (0.2%) 11 (0.2%) 9,440 (0.1%) 125,018 (10.2%) 354,393 (28.8%) 94,754 (7.7%) 72,844 (5.9%) 74,976 (88.1%) 1,541 (1.8%) 1,703 (2.0%) 1,375 (1.6%) 123,912 (9.0%) 370,460 (26.8%) 132,234 (9.6%) 123,158 (8.9%) 7,562 (6.0%) 23,972 (19.1%) 30,717 (24.4%) 5,897 (4.7%) 148 (4.5%) <6 10,338 (9.2%) 13,119 (11.7%) 8,669 (7.7%) 15,577 (13.9%) 847 (0.4%) 53,553 (27.6%) 17,301 (8.9%) 6,593 (3.4%) 591 (0.9%) 23,056 (34.6%) 4,441 (6.7%) 2,688 (4.0%) 1,742 (4.2%) 7,735 (18.7%) 3,991 (9.6%) 2,209 (5.3%) 219 (3.3%) 500–600 345,353 (2.3%) 848,423 (5.6%) 293,942 (2.0%) 230,646 (1.5%) 61 (0.0%) Australasia & Oceania/Asia unspecified Southeast Asia South Asia Eastern Europe Europe other 0 (0.0%) 42 (1.3%) 132 (2.0%) 263 (4.0%) Not stated Notes: 1. Denominator includes children aged ≤19 years of immigrant and refugee mothers in IRCC (second generation). 2. Chronic conditions have not been reported for newcomers due to an insufficient 2-year look-back period. 3. Chronic conditions were identified using validated algorithms for ICES data holdings; the latest diagnosis date is March 31, 2019. 4. Numbers are too low to report for ‘not stated’ group. 5. Some cells are suppressed due to low counts (n < 6) or reported as ranges to protect privacy. _________________________________________________________________________________________________________________________________________________ ICES 50 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Appendix 1.2. Baseline characteristics of immigrants and refugees landed in Ontario between January 1, 1985, and May 31, 2017, by world region of birth (Eastern Hemisphere), as of March 31, 2020 Eastern Hemisphere Variable North Africa East Africa Western Africa Central Africa Southern Africa Australasia & Oceania/ Asia unspecified Middle East East Asia South Asia Southeast Asia Not stated Total Number 57,607 105,667 57,093 15,237 15,069 9,440 306,750 477,048 848,423 345,353 61 3,245,639 36.58 ± 21.13 38 (17–53) 35.74 ± 21.01 37 (17–52) 34.13 ± 20.06 36 (15–50) 30.77 ± 18.80 31 (14–46) 40.17 ± 21.69 41 (23–56) 37.62 ± 19.20 40 (21–51) 35.70 ± 20.87 36 (18–51) 42.84 ± 22.24 45 (28–58) 36.85 ± 21.59 38 (17–52) 38.43 ± 21.43 41 (19–54) 38.60 ± 21.53 40 (19–54) 7,067 (12.3%) 6,401 (11.1%) 666 (1.2%) 9,279 (16.1%) 5,344 (9.3%) 3,935 (6.8%) 5,905 (10.3%) 7,632 (13.2%) 10,154 (17.6%) 9,458 (16.4%) 4,974 (8.6%) 3,138 (5.4%) 14,472 (13.7%) 13,897 (13.2%) 575 (0.5%) 17,093 (16.2%) 13,007 (12.3%) 4,086 (3.9%) 8,922 (8.4%) 16,748 (15.8%) 17,822 (16.9%) 17,106 (16.2%) 8,523 (8.1%) 4,981 (4.7%) 8,645 (15.1%) 8,264 (14.5%) 381 (0.7%) 9,359 (16.4%) 6,220 (10.9%) 3,139 (5.5%) 4,874 (8.5%) 9,092 (15.9%) 9,893 (17.3%) 9,328 (16.3%) 4,770 (8.4%) 1,132 (2.0%) 2,685 (17.6%) 2,575 (16.9%) 110 (0.7%) 2,297 (15.1%) 1,351 (8.9%) 946 (6.2%) 2,266 (14.9%) 2,535 (16.6%) 2,649 (17.4%) 1,923 (12.6%) 685 (4.5%) 197 (1.3%) 1,524 (10.1%) 1,382 (9.2%) 142 (0.9%) 1,808 (12.0%) 1,123 (7.5%) 685 (4.5%) 1,457 (9.7%) 2,460 (16.3%) 2,373 (15.7%) 2,410 (16.0%) 1,744 (11.6%) 1,293 (8.6%) 918 (9.7%) 771 (8.2%) 147 (1.6%) 1,354 (14.3%) 827 (8.8%) 527 (5.6%) 664 (7.0%) 1,705 (18.1%) 2,147 (22.7%) 1,581 (16.7%) 695 (7.4%) 376 (4.0%) 37,698 (12.3%) 30,640 (10.0%) 7,058 (2.3%) 47,036 (15.3%) 20,167 (6.6%) 26,869 (8.8%) 37,396 (12.2%) 52,594 (17.1%) 47,187 (15.4%) 43,608 (14.2%) 23,818 (7.8%) 17,413 (5.7%) 47,572 (10.0%) 45,626 (9.6%) 1,946 (0.4%) 45,392 (9.5%) 35,556 (7.5%) 9,836 (2.1%) 36,417 (7.6%) 70,221 (14.7%) 76,494 (16.0%) 93,522 (19.6%) 53,905 (11.3%) 53,525 (11.2%) 111,193 (13.1%) 103,634 (12.2%) 7,559 (0.9%) 126,197 (14.9%) 90,958 (10.7%) 35,239 (4.2%) 71,200 (8.4%) 142,568 (16.8%) 152,252 (17.9%) 113,602 (13.4%) 69,988 (8.2%) 61,423 (7.2%) 40,918 (11.8%) 39,593 (11.5%) 1,325 (0.4%) 47,028 (13.6%) 31,735 (9.2%) 15,293 (4.4%) 31,415 (9.1%) 46,419 (13.4%) 64,012 (18.5%) 59,519 (17.2%) 34,129 (9.9%) 21,913 (6.3%) 378,701 (11.7%) 354,106 (54.3%) 24,595 (0.9%) 434,845 (13.4%) 298,366 (45.7%) 136,479 (5.3%) 277,779 (8.6%) 510,367 (15.7%) 557,327 (17.2%) 534,776 (16.5%) 318,387 (9.8%) 233,457 (7.2%) SOCIODEMOGRAPHIC CHARACTERISTICS Age Mean ± SD Median (IQR) Age group, n (%) 0–9 years Second generation Immigrants and refugees 10–19 years Second generation Immigrants and refugees 20–29 years 30–39 years 40–49 years 50–59 years 60–69 years 70+ years _________________________________________________________________________________________________________________________________________________ ICES 51 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Eastern Hemisphere Variable North Africa East Africa Western Africa Central Africa Southern Africa Australasia & Oceania/ Asia unspecified Middle East East Asia South Asia Southeast Asia Not stated Total Number 57,607 105,667 57,093 15,237 15,069 9,440 306,750 477,048 848,423 345,353 61 3,245,639 27,515 (47.8%) 30,092 (52.2%) 54,605 (51.7%) 51,062 (48.3%) 27,662 (48.5%) 29,431 (51.5%) 7,638 (50.1%) 7,599 (49.9%) 7,583 (50.3%) 7,486 (49.7%) 4,279 (45.3%) 5,161 (54.7%) 148,801 (48.5%) 157,949 (51.5%) 252,950 (53.0%) 224,098 (47.0%) 418,706 (49.4%) 429,717 (50.6%) 195,949 (56.7%) 149,404 (43.3%) 1,658,805 (51.1%) 1,586,834 (48.9%) 14,351 (24.9%) 9,725 (16.9%) 9,924 (17.2%) 12,791 (22.2%) 10,538 (18.3%) 278 (0.5%) 49,837 (47.2%) 19,516 (18.5%) 15,725 (14.9%) 12,722 (12.0%) 7,626 (7.2%) 241 (0.2%) 21,094 (36.9%) 11,056 (19.4%) 12,132 (21.2%) 8,084 (14.2%) 4,421 (7.7%) 306 (0.5%) 6,767 (44.4%) 2,869 (18.8%) 2,529 (16.6%) 1,927 (12.6%) 1,068 (7.0%) 77 (0.5%) 1,816 (12.1%) 2,169 (14.4%) 2,455 (16.3%) 3,444 (22.9%) 5,134 (34.1%) 51 (0.3%) 1,218 (12.9%) 1,711 (18.1%) 1,934 (20.5%) 1,991 (21.1%) 2,552 (27.0%) 34 (0.4%) 77,157 (25.2%) 56,619 (18.5%) 56,055 (18.3%) 63,397 (20.7%) 52,240 (17.0%) 1,282 (0.4%) 91,199 (19.1%) 103,159 (21.6%) 84,994 (17.8%) 104,977 (22.0%) 91,675 (19.2%) 1,044 (0.2%) 183,090 (21.6%) 187,885 (22.1%) 222,065 (26.2%) 163,472 (19.3%) 88,450 (10.4%) 3,461 (0.4%) 111,594 (32.3%) 81,904 (23.7%) 70,523 (20.4%) 52,248 (15.1%) 28,421 (8.2%) 663 (0.2%) 787,250 (24.3%) 679,805 (20.9%) 683,183 (21.0%) 620,425 (19.1%) 464,513 (14.3%) 10,463 (0.3%) Q1 (lowest) 821 (1.4%) 1,307 (1.2%) 790 (1.4%) 314 (2.1%) 936 (6.2%) 858 (9.1%) 4,960 (1.6%) 5,169 (1.1%) 7,522 (0.9%) 6,472 (1.9%) 79,611 (2.5%) Q2 2,263 (3.9%) 5,012 (8.7%) 14,398 (25.0%) 34,784 (60.4%) 329 (0.6%) 3,616 (3.4%) 8,053 (7.6%) 22,160 (21.0%) 70,208 (66.4%) 323 (0.3%) 1,826 (3.2%) 4,216 (7.4%) 10,070 (17.6%) 39,861 (69.8%) 330 (0.6%) 690 (4.5%) 1,640 (10.8%) 4,008 (26.3%) 8,492 (55.7%) 93 (0.6%) 1,562 (10.4%) 2,649 (17.6%) 4,969 (33.0%) 4,887 (32.4%) 66 (0.4%) 1,248 (13.2%) 1,916 (20.3%) 2,441 (25.9%) 2,930 (31.0%) 47 (0.5%) 13,265 (4.3%) 29,777 (9.7%) 81,246 (26.5%) 176,100 (57.4%) 1,402 (0.5%) 12,180 (2.6%) 30,973 (6.5%) 94,255 (19.8%) 333,333 (69.9%) 1,138 (0.2%) 18,243 (2.2%) 42,499 (5.0%) 133,142 (15.7%) 643,416 (75.8%) 3,601 (0.4%) 14,289 (4.1%) 30,228 (8.8%) 76,791 (22.2%) 216,792 (62.8%) 781 (0.2%) 153,469 (4.7%) 310,350 (9.6%) 722,958 (22.3%) 1,967,103 (60.6%) 12,148 (0.4%) Sex, n (%) Female Male Neighbourhood income quintile, n (%) Q1 (lowest) Q2 Q3 Q4 Q5 (highest) Missing Ethnic concentration quintile, n (%) Q3 Q4 Q5 (highest) Missing _________________________________________________________________________________________________________________________________________________ ICES 52 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Eastern Hemisphere Variable North Africa East Africa Western Africa Central Africa Southern Africa Australasia & Oceania/ Asia unspecified Middle East East Asia South Asia Southeast Asia Not stated Total Number 57,607 105,667 57,093 15,237 15,069 9,440 306,750 477,048 848,423 345,353 61 3,245,639 15,873 (27.6%) 9,156 (15.9%) 7,716 (13.4%) 7,885 (13.7%) 16,648 (28.9%) 329 (0.6%) 15,795 (14.9%) 11,884 (11.2%) 12,307 (11.6%) 20,814 (19.7%) 44,544 (42.2%) 323 (0.3%) 14,505 (25.4%) 7,282 (12.8%) 7,123 (12.5%) 9,625 (16.9%) 18,228 (31.9%) 330 (0.6%) 2,065 (13.6%) 1,847 (12.1%) 1,958 (12.9%) 2,901 (19.0%) 6,373 (41.8%) 93 (0.6%) 4,486 (29.8%) 2,638 (17.5%) 2,193 (14.6%) 2,306 (15.3%) 3,380 (22.4%) 66 (0.4%) 2,374 (25.1%) 1,620 (17.2%) 1,513 (16.0%) 1,572 (16.7%) 2,314 (24.5%) 47 (0.5%) 75,803 (24.7%) 50,076 (16.3%) 41,762 (13.6%) 41,525 (13.5%) 96,182 (31.4%) 1,402 (0.5%) 161,736 (33.9%) 90,826 (19.0%) 65,628 (13.8%) 50,134 (10.5%) 107,586 (22.6%) 1,138 (0.2%) 347,800 (41.0%) 135,769 (16.0%) 113,880 (13.4%) 100,826 (11.9%) 146,547 (17.3%) 3,601 (0.4%) 70,348 (20.4%) 51,825 (15.0%) 49,776 (14.4%) 63,217 (18.3%) 109,406 (31.7%) 781 (0.2%) 939,366 (28.9%) 531,889 (16.4%) 460,747 (14.2%) 464,843 (14.3%) 836,646 (25.8%) 12,148 (0.4%) 8,760 (15.2%) 5,954 (10.3%) 4,876 (8.5%) 11,550 (20.0%) 26,122 (45.3%) 345 (0.6%) 20,260 (19.2%) 14,219 (13.5%) 10,142 (9.6%) 24,036 (22.7%) 36,658 (34.7%) 352 (0.3%) 5,988 (10.5%) 5,206 (9.1%) 4,757 (8.3%) 13,723 (24.0%) 27,089 (47.4%) 330 (0.6%) 3,173 (20.8%) 2,350 (15.4%) 1,617 (10.6%) 3,506 (23.0%) 4,490 (29.5%) 101 (0.7%) 2,514 (16.7%) 1,887 (12.5%) 1,673 (11.1%) 3,464 (23.0%) 5,473 (36.3%) 58 (0.4%) 1,821 (19.3%) 1,347 (14.3%) 1,184 (12.5%) 2,088 (22.1%) 2,957 (31.3%) 43 (0.5%) 51,488 (16.8%) 33,427 (10.9%) 26,681 (8.7%) 68,142 (22.2%) 125,548 (40.9%) 1,464 (0.5%) 62,715 (13.1%) 41,554 (8.7%) 25,040 (5.2%) 85,288 (17.9%) 261,115 (54.7%) 1,336 (0.3%) 54,228 (6.4%) 48,696 (5.7%) 44,423 (5.2%) 141,764 (16.7%) 555,557 (65.5%) 3,755 (0.4%) 45,447 (13.2%) 41,661 (12.1%) 35,413 (10.3%) 89,600 (25.9%) 132,420 (38.3%) 812 (0.2%) 421,437 (13.0%) 323,137 (10.0%) 269,624 (8.3%) 700,850 (21.6%) 1,518,137 (46.8%) 12,454 (0.4%) 20 (0.0%) 119 (0.2%) 30 (0.0%) 177 (0.2%) 58 (0.1%) 252 (0.4%) 10 (0.1%) 58 (0.4%) 16 (0.1%) 68 (0.5%) 21 (0.2%) 72 (0.8%) 121 (0.0%) 498 (0.2%) 184 (0.0%) 514 (0.1%) 331 (0.0%) 2,923 (0.3%) 109 (0.0%) 1,387 (0.4%) 2,381 (0.1%) 11,219 (0.3%) Residential instability quintile, n (%) Q1 (lowest) Q2 Q3 Q4 Q5 (highest) Missing Number of persons per dwelling quintile, n (%) Q1 (lowest) Q2 Q3 Q4 Q5 (highest) Missing Public health unit of residence, n (%) Algoma Public Health Brant County Health Unit _________________________________________________________________________________________________________________________________________________ ICES 53 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Eastern Hemisphere Variable North Africa East Africa Western Africa Central Africa Southern Africa Australasia & Oceania/ Asia unspecified Middle East East Asia South Asia Southeast Asia Not stated Total 61 3,245,639 Number 57,607 105,667 57,093 15,237 15,069 9,440 306,750 477,048 848,423 345,353 Durham Region Health Department 1,847 (3.2%) 3,068 (2.9%) 2,825 (4.9%) 845 (5.5%) 546 (3.6%) 431 (4.6%) 7,216 (2.4%) 8,483 (1.8%) 53,124 (6.3%) 13,741 (4.0%) 142,128 (4.4%) Grey Bruce Health Unit 55 (0.1%) 19 (0.0%) 57 (0.1%) 25 (0.0%) 65 (0.1%) 53 (0.1%) 17 (0.1%) 18 (0.1%) 69 (0.5%) 52 (0.3%) 60 (0.6%) 32 (0.3%) 257 (0.1%) 160 (0.1%) 388 (0.1%) 174 (0.0%) 957 (0.1%) 318 (0.0%) 354 (0.1%) 267 (0.1%) 5,836 (0.2%) 4,093 (0.1%) Haliburton, Kawartha, Pine Ridge District Health Unit 30–40 69 (0.1%) 42 (0.1%) <6 87 (0.6%) 67 (0.7%) 204 (0.1%) 465 (0.1%) 626 (0.1%) 467 (0.1%) 5,454 (0.2%) Halton Region Health Department 5,534 (9.6%) 2,149 (2.0%) 2,240 (3.9%) 379 (2.5%) 1,833 (12.2%) 634 (6.7%) 13,941 (4.5%) 16,750 (3.5%) 40,868 (4.8%) 10,375 (3.0%) 145,818 (4.5%) City of Hamilton – Public Health & Social Services 2,304 (4.0%) 3,728 (3.5%) 1,777 (3.1%) 1,146 (7.5%) 684 (4.5%) 368 (3.9%) 14,230 (4.6%) 5,925 (1.2%) 16,410 (1.9%) 11,454 (3.3%) 96,978 (3.0%) Hastings and Prince Edward Counties Health Unit 37 (0.1%) 75 (0.1%) 51 (0.1%) 13 (0.1%) 46 (0.3%) 52 (0.6%) 226 (0.1%) 526 (0.1%) 993 (0.1%) 631 (0.2%) 5,412 (0.2%) Huron Perth Health Unit 20–30 30–40 33 (0.1%) 50 (0.1%) <6 Chatham-Kent Health Unit 101 (0.1%) 54 (0.1%) 50 (0.3%) 16 (0.1%) 46 (0.5%) 20 (0.2%) 220 (0.1%) 218 (0.1%) 279 (0.1%) 212 (0.0%) 483 (0.1%) 411 (0.0%) 427 (0.1%) 409 (0.1%) 5,156 (0.2%) 3,703 (0.1%) Kingston, Frontenac and Lennox & Addington Health Unit 349 (0.6%) 220 (0.2%) 167 (0.3%) 60 (0.4%) 84 (0.6%) 107 (1.1%) 941 (0.3%) 1,432 (0.3%) 1,694 (0.2%) 944 (0.3%) 10,516 (0.3%) Lambton Health Unit 52 (0.1%) 42 (0.1%) 80 (0.1%) 62 (0.1%) 81 (0.1%) 47 (0.1%) 14 (0.1%) 12 (0.1%) 64 (0.4%) 63 (0.4%) 39 (0.4%) 74 (0.8%) 298 (0.1%) 207 (0.1%) 335 (0.1%) 251 (0.1%) 750 (0.1%) 422 (0.0%) 392 (0.1%) 395 (0.1%) 4,649 (0.1%) 4,318 (0.1%) Middlesex-London Health Unit 2,675 (4.6%) 2,045 (1.9%) 1,008 (1.8%) 413 (2.7%) 376 (2.5%) 315 (3.3%) 14,151 (4.6%) 6,264 (1.3%) 9,505 (1.1%) 5,619 (1.6%) 71,584 (2.2%) Niagara Region Public Health Department 1,308 (2.3%) 1,234 (1.2%) 645 (1.1%) 285 (1.9%) 330 (2.2%) 203 (2.2%) 2,584 (0.8%) 3,762 (0.8%) 4,923 (0.6%) 4,713 (1.4%) 41,696 (1.3%) North Bay Parry Sound District Health Unit 24 (0.0%) 37 (0.0%) 62 (0.1%) 7 (0.0%) 41 (0.3%) 51 (0.5%) 107 (0.0%) 202 (0.0%) 420 (0.0%) 172 (0.0%) 2,702 (0.1%) Northwestern Health Unit 1–10 20–30 11 (0.0%) <6 13 (0.1%) 16 (0.2%) 33 (0.0%) 51 (0.0%) 84 (0.0%) 322 (0.1%) 1,550 (0.0%) Haldimand-Norfolk Health Unit Leeds, Grenville and Lanark District Health Unit <6 _________________________________________________________________________________________________________________________________________________ ICES 54 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Eastern Hemisphere Variable North Africa East Africa Western Africa Central Africa Southern Africa Australasia & Oceania/ Asia unspecified Middle East East Asia South Asia Southeast Asia Not stated Total Number 57,607 105,667 57,093 15,237 15,069 9,440 306,750 477,048 848,423 345,353 61 3,245,639 Ottawa Public Health 7,281 (12.6%) 12,307 (21.4%) 78 (0.1%) 17,195 (16.3%) 11,956 (11.3%) 147 (0.1%) 3,806 (6.7%) 16,340 (28.6%) 119 (0.2%) 4,448 (29.2%) 1,388 (9.1%) 44 (0.3%) 670 (4.4%) 1,212 (8.0%) 78 (0.5%) 668 (7.1%) 1,435 (15.2%) 61 (0.6%) 32,828 (10.7%) 45,436 (14.8%) 484 (0.2%) 21,552 (4.5%) 37,579 (7.9%) 647 (0.1%) 24,473 (2.9%) 324,943 (38.3%) 1,063 (0.1%) 15,820 (4.6%) 59,200 (17.1%) 628 (0.2%) 180,084 (5.5%) 675,524 (20.8%) 5,949 (0.2%) 21 (0.0%) 35 (0.1%) 27 (0.0%) 27 (0.0%) 45 (0.1%) 11 (0.0%) 12 (0.1%) 1–10 32 (0.2%) <6 19 (0.2%) 30 (0.3%) 34 (0.0%) 117 (0.0%) 98 (0.0%) 262 (0.1%) 211 (0.0%) 334 (0.0%) 262 (0.1%) 199 (0.1%) 1,283 (0.0%) 2,627 (0.1%) Eastern Ontario Health Unit 138 (0.2%) 180 (0.2%) 94 (0.2%) 136 (0.9%) 23 (0.2%) 39 (0.4%) 238 (0.1%) 220 (0.0%) 979 (0.1%) 364 (0.1%) 5,098 (0.2%) Simcoe Muskoka District Health Unit 351 (0.6%) 679 (0.6%) 1,210 (2.1%) 130 (0.9%) 368 (2.4%) 276 (2.9%) 3,756 (1.2%) 3,545 (0.7%) 7,817 (0.9%) 5,133 (1.5%) 51,194 (1.6%) Sudbury and District Health Unit 150 (0.3%) 166 (0.2%) 202 (0.4%) 170 (1.1%) 82 (0.5%) 84 (0.9%) 249 (0.1%) 418 (0.1%) 891 (0.1%) 469 (0.1%) 4,863 (0.1%) Thunder Bay District Health Unit 109 (0.2%) <6 87 (0.1%) <6 12 (0.1%) <6 17 (0.1%) 1–10 Region of Waterloo Public Health 2,998 (5.2%) 5,489 (5.2%) 122 (0.2%) 19 (0.0%) 1,183 (2.1%) 360 (2.4%) 458 (3.0%) 73 (0.8%) 14 (0.1%) 246 (2.6%) 351 (0.1%) 8 (0.0%) 10,559 (3.4%) 308 (0.1%) 21 (0.0%) 9,279 (1.9%) 470 (0.1%) 75 (0.0%) 23,006 (2.7%) 674 (0.2%) 29 (0.0%) 8,258 (2.4%) 4,284 (0.1%) 448 (0.0%) 104,924 (3.2%) Wellington-Dufferin-Guelph Health Unit 586 (1.0%) 1,262 (1.2%) 705 (1.2%) 112 (0.7%) 275 (1.8%) 230 (2.4%) 1,813 (0.6%) 2,693 (0.6%) 8,222 (1.0%) 5,602 (1.6%) 36,532 (1.1%) Windsor-Essex County Health Unit 1,912 (3.3%) 1,888 (1.8%) 1,184 (2.1%) 565 (3.7%) 194 (1.3%) 89 (0.9%) 18,458 (6.0%) 5,554 (1.2%) 10,919 (1.3%) 5,253 (1.5%) 69,636 (2.1%) York Region Public Health Services 5,138 (8.9%) 5,746 (5.4%) 2,804 (4.9%) 290 (1.9%) 3,179 (21.1%) 689 (7.3%) 59,297 (19.3%) 169,507 (35.5%) 76,741 (9.0%) 31,881 (9.2%) 455,320 (14.0%) Southwestern Health Unit 37 (0.1%) 135 (0.1%) 156 (0.3%) 20 (0.1%) 84 (0.6%) 68 (0.7%) 307 (0.1%) 403 (0.1%) 1,656 (0.2%) 1,083 (0.3%) 11,301 (0.3%) Toronto Public Health 11,690 (20.3%) 47,205 (44.7%) 19,321 (33.8%) 4,175 (27.4%) 3,898 (25.9%) 2,777 (29.4%) 75,924 (24.8%) 177,723 (37.3%) 227,929 (26.9%) 157,660 (45.7%) 1,061,030 (32.7%) Unknown/missing 278 (0.5%) 240 (0.2%) 305 (0.5%) 76 (0.5%) 47 (0.3%) 34 (0.4%) 1,279 (0.4%) 1,042 (0.2%) 3,452 (0.4%) 660 (0.2%) 10,349 (0.3%) Peel Public Health Peterborough County-City Health Unit Porcupine Health Unit Renfrew County and District Health Unit Timiskaming Health Unit _________________________________________________________________________________________________________________________________________________ ICES 55 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Eastern Hemisphere Variable North Africa East Africa Western Africa Central Africa Southern Africa Australasia & Oceania/ Asia unspecified Middle East East Asia South Asia Southeast Asia Not stated Total Number 57,607 105,667 57,093 15,237 15,069 9,440 306,750 477,048 848,423 345,353 61 3,245,639 Respiratory (asthma, COPD) 6,467 (11.2%) 15,309 (14.5%) 5,818 (10.2%) 991 (6.5%) 2,230 (14.8%) 1,120 (11.9%) 32,872 (10.7%) 39,502 (8.3%) 106,849 (12.6%) 42,389 (12.3%) 377,814 (11.6%) Chronic kidney disease (incl. chronic dialysis) Diabetes 1,017 (1.8%) 5,849 (10.2%) 8,881 (15.4%) 478 (0.8%) 407 (0.7%) 322 (0.6%) 1,493 (1.4%) 10,912 (10.3%) 14,211 (13.4%) 2,183 (2.1%) 644 (0.6%) 510 (0.5%) 1,084 (1.9%) 5,080 (8.9%) 11,964 (21.0%) 1,262 (2.2%) 183 (0.3%) 235 (0.4%) 173 (1.1%) 841 (5.5%) 1,888 (12.4%) 480 (3.2%) 48 (0.3%) 63 (0.4%) 249 (1.7%) 947 (6.3%) 2,407 (16.0%) 195 (1.3%) 171 (1.1%) 54 (0.4%) 123 (1.3%) 632 (6.7%) 1,123 (11.9%) 60 (0.6%) 52 (0.6%) 19 (0.2%) 3,933 (1.3%) 23,609 (7.7%) 37,227 (12.1%) 1,398 (0.5%) 2,007 (0.7%) 1,044 (0.3%) 5,634 (1.2%) 36,870 (7.7%) 73,023 (15.3%) 1,786 (0.4%) 1,730 (0.4%) 3,340 (0.7%) 15,045 (1.8%) 118,610 (14.0%) 154,123 (18.2%) 3,617 (0.4%) 6,618 (0.8%) 3,665 (0.4%) 6,514 (1.9%) 38,085 (11.0%) 72,416 (21.0%) 1,820 (0.5%) 1,511 (0.4%) 1,971 (0.6%) 49,930 (1.5%) 325,193 (10.0%) 558,117 (17.2%) 21,123 (0.7%) 21,085 (0.6%) 16,013 (0.5%) Recent (0 to ≤5 years) 2,530 (4.4%) 4,171 (3.9%) 2,332 (4.1%) 992 (6.5%) 437 (2.9%) 396 (4.2%) 31,363 (10.2%) 13,416 (2.8%) 39,725 (4.7%) 20,828 (6.0%) 142,720 (4.4%) Intermediate (>5 to ≤10 years) 10,882 (18.9%) 13,136 (12.4%) 9,421 (16.5%) 2,974 (19.5%) 1,593 (10.6%) 1,557 (16.5%) 54,888 (17.9%) 60,741 (12.7%) 120,777 (14.2%) 47,064 (13.6%) 423,423 (13.0%) CLINICAL CHARACTERISTICS Chronic conditions, n (%) Cardiovascular (CHF, TIA/stroke, Ischemic cardiac disease, hypertension) Immunocompromised Inflammatory (IBD, rheumatoid arthritis) Liver disease IMMIGRATION CHARACTERISTICS Recency of immigration, n (%) _________________________________________________________________________________________________________________________________________________ ICES 56 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Eastern Hemisphere Variable North Africa East Africa Western Africa Central Africa Southern Africa Australasia & Oceania/ Asia unspecified Middle East East Asia South Asia Southeast Asia Not stated Total Number 57,607 105,667 57,093 15,237 15,069 9,440 306,750 477,048 848,423 345,353 61 3,245,639 Long-term residents (>10 years) 32,446 (56.3%) 11,749 (20.4%) 61,443 (58.1%) 26,917 (25.5%) 30,855 (54.0%) 14,485 (25.4%) 7,345 (48.2%) 3,926 (25.8%) 10,533 (69.9%) 2,506 (16.6%) 5,887 (62.4%) 1,600 (16.9%) 169,684 (55.3%) 50,815 (16.6%) 321,690 (67.4%) 81,201 (17.0%) 493,253 (58.1%) 194,668 (22.9%) 206,130 (59.7%) 71,331 (20.7%) 2,026,892 (62.4%) 652,604 (20.1%) 14,649 (25.4%) 113 (0.2%) 31,714 (55.1%) 1,127 (2.0%) 59 (0.1%) 3,770 (6.5%) 4,641 (8.1%) 1,012 (1.8%) 408 (0.7%) 114 (0.2%) 28,782 (27.2%) 328 (0.3%) 19,013 (18.0%) 11,970 (11.3%) 171 (0.2%) 9,958 (9.4%) 28,687 (27.1%) 4,733 (4.5%) 1,863 (1.8%) 162 (0.2%) 25,018 (43.8%) 223 (0.4%) 16,734 (29.3%) 2,496 (4.4%) 41 (0.1%) 1,089 (1.9%) 7,897 (13.8%) 2,016 (3.5%) 1,525 (2.7%) 54 (0.1%) 3,017 (19.8%) 29 (0.2%) 2,276 (14.9%) 445 (2.9%) 31 (0.2%) 2,314 (15.2%) 4,675 (30.7%) 1,585 (10.4%) 838 (5.5%) 27 (0.2%) 2,761 (18.3%) 39 (0.3%) 11,215 (74.4%) 154 (1.0%) <6 5,318 (56.3%) 74 (0.8%) 3,774 (40.0%) 152 (1.6%) <6 <6 488 (3.2%) 114 (0.8%) 89 (0.6%) 28 (0.2%) 28 (0.3%) 6 (0.1%) 75 (0.8%) 11 (0.1%) 165,622 (34.7%) 1,321 (0.3%) 272,562 (57.1%) 1,140 (0.2%) 0 (0.0%) 392 (0.1%) 14,883 (3.1%) 11,251 (2.4%) 5,886 (1.2%) 3,991 (0.8%) 354,393 (41.8%) 1,541 (0.2%) 370,460 (43.7%) 23,972 (2.8%) <6 170–180 64,196 (20.9%) 203 (0.1%) 148,203 (48.3%) 32,105 (10.5%) 2,762 (0.9%) 32,922 (10.7%) 19,648 (6.4%) 4,088 (1.3%) 2,225 (0.7%) 398 (0.1%) 125,018 (36.2%) 74,976 (21.7%) 123,912 (35.9%) 7,562 (2.2%) 148 (0.0%) 10,338 (3.0%) 847 (0.2%) 591 (0.2%) 1,742 (0.5%) 219 (0.1%) 1,228,765 (37.9%) 85,148 (2.6%) 1,381,872 (42.6%) 125,744 (3.9%) 3,294 (0.1%) 111,891 (3.4%) 194,292 (6.0%) 66,626 (2.1%) 41,409 (1.3%) 6,598 (0.2%) Second generation children and youth Immigration category, n (%) Sponsored family member Economic immigrant, caregiver Economic immigrant, other Privately sponsored refugee Blended visa office–referred refugee Government-assisted refugee Protected person/Refugee (asylum seeker) Refugee dependent Humanitarian and compassionate/Public policy case Other immigrant 13,110– 13,120 53,553 (6.3%) 23,056 (2.7%) 7,735 (0.9%) 589 (0.1%) Notes: 1. Denominator includes children aged ≤19 years of immigrant and refugee mothers in IRCC (second generation), 2. Chronic conditions were identified using validated algorithms for ICES data holdings; the latest diagnosis date is March 31, 2019. 3. Numbers are too low to report for ‘not stated’ group, 4. Some cells are suppressed due to low counts (n < 6) or reported as ranges to protect privacy. _________________________________________________________________________________________________________________________________________________ ICES 57 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Appendix 1.3 Baseline characteristics of immigrants and refugees landed in Ontario between January 1, 1985, and May 31, 2017, by world region of birth (Western Hemisphere), as of March 31, 2020 Western Hemisphere Variable North America Central Africa Caribbean South America Eastern Europe Europe other Not stated Total Number 70,287 15,237 191,326 155,358 293,942 230,646 61 3,245,639 33.23 ± 20.57 30.77 ± 18.80 38.89 ± 20.82 40.21 ± 21.23 41.80 ± 21.48 40.34 ± 20.87 38.60 ± 21.53 31 (16–50) 31 (14–46) 41 (21–54) 42 (24–56) 44 (27–58) 42 (25–56) 40 (19–54) 7,906 (11.2%) 6,354 (9.0%) 1,552 (2.2%) 16,543 (23.5%) 5,009 (7.1%) 11,534 (16.4%) 9,791 (13.9%) 9,614 (13.7%) 8,667 (12.3%) 8,646 (12.3%) 6,036 (8.6%) 3,084 (4.4%) 2,685 (17.6%) 2,575 (16.9%) 110 (0.7%) 2,297 (15.1%) 1,351 (8.9%) 946 (6.2%) 2,266 (14.9%) 2,535 (16.6%) 2,649 (17.4%) 1,923 (12.6%) 685 (4.5%) 197 (1.3%) 20,838 (10.9%) 20,422 (10.7%) 416 (0.2%) 25,301 (13.2%) 19,906 (10.4%) 5,395 (2.8%) 14,107 (7.4%) 31,962 (16.7%) 33,760 (17.6%) 34,839 (18.2%) 19,389 (10.1%) 11,130 (5.8%) 16,538 (10.6%) 16,167 (10.4%) 371 (0.2%) 18,139 (11.7%) 14,607 (9.4%) 3,532 (2.3%) 12,580 (8.1%) 23,138 (14.9%) 27,794 (17.9%) 28,149 (18.1%) 17,693 (11.4%) 11,327 (7.3%) 29,775 (10.1%) 29,133 (9.9%) 642 (0.2%) 31,291 (10.6%) 24,711 (8.4%) 6,580 (2.2%) 18,802 (6.4%) 45,292 (15.4%) 50,142 (17.1%) 54,024 (18.4%) 40,197 (13.7%) 24,419 (8.3%) 22,721 (9.9%) 21,318 (9.2%) 1,403 (0.6%) 27,672 (12.0%) 20,513 (8.9%) 7,159 (3.1%) 17,465 (7.6%) 36,933 (16%) 38,785 (16.8%) 46,297 (20.1%) 25,839 (11.2%) 14,934 (6.5%) 378,701 (11.7%) 354,106 (54.3%) 24,595 (0.9%) 434,845 (13.4%) 298,366 (45.7%) 136,479 (5.3%) 277,779 (8.6%) 510,367 (15.7%) 557,327 (17.2%) 534,776 (16.5%) 318,387 (9.8%) 233,457 (7.2%) SOCIODEMOGRAPHIC CHARACTERISTICS Age Mean ± SD Median (IQR) Age group, n (%) 0–9 years Second generation Immigrants and refugees 10–19 years Second generation Immigrants and refugees 20–29 years 30–39 years 40–49 years 50–59 years 60–69 years 70+ years _________________________________________________________________________________________________________________________________________________ ICES 58 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Western Hemisphere Variable North America Central Africa Caribbean South America Eastern Europe Europe other Not stated Total Number 70,287 15,237 191,326 155,358 293,942 230,646 61 3,245,639 36,747 (52.3%) 33,540 (47.7%) 7,638 (50.1%) 7,599 (49.9%) 98,636 (51.6%) 92,690 (48.4%) 80,618 (51.9%) 74,740 (48.1%) 154,565 (52.6%) 139,377 (47.4%) 109,338 (47.4%) 121,308 (52.6%) 1,658,805 (51.1%) 1,586,834 (48.9%) 11,752 (16.7%) 12,406 (17.7%) 13,930 (19.8%) 14,175 (20.2%) 17,759 (25.3%) 265 (0.4%) 6,767 (44.4%) 2,869 (18.8%) 2,529 (16.6%) 1,927 (12.6%) 1,068 (7.0%) 77 (0.5%) 64,645 (33.8%) 42,726 (22.3%) 41,714 (21.8%) 26,422 (13.8%) 15,211 (8.0%) 608 (0.3%) 39,327 (25.3%) 35,438 (22.8%) 33,953 (21.9%) 26,856 (17.3%) 19,314 (12.4%) 470 (0.3%) 57,148 (19.4%) 51,128 (17.4%) 54,480 (18.5%) 69,284 (23.6%) 61,002 (20.8%) 900 (0.3%) 37,653 (16.3%) 45,475 (19.7%) 47,469 (20.6%) 48,082 (20.8%) 51,335 (22.3%) 632 (0.3%) 787,250 (24.3%) 679,805 (20.9%) 683,183 (21.0%) 620,425 (19.1%) 464,513 (14.3%) 10,463 (0.3%) 8,007 (11.4%) 9,557 (13.6%) 13,423 (19.1%) 17,714 (25.2%) 21,039 (29.9%) 547 (0.8%) 314 (2.1%) 690 (4.5%) 1,640 (10.8%) 4,008 (26.3%) 8,492 (55.7%) 93 (0.6%) 4,137 (2.2%) 7,910 (4.1%) 16,726 (8.7%) 39,647 (20.7%) 122,215 (63.9%) 691 (0.4%) 3,481 (2.2%) 8,042 (5.2%) 17,462 (11.2%) 40,001 (25.7%) 85,836 (55.3%) 536 (0.3%) 12,446 (4.2%) 23,719 (8.1%) 48,207 (16.4%) 92,593 (31.5%) 115,874 (39.4%) 1,103 (0.4%) 18,906 (8.2%) 28,491 (12.4%) 46,389 (20.1%) 70,069 (30.4%) 65,832 (28.5%) 959 (0.4%) 79,611 (2.5%) 153,469 (4.7%) 310,350 (9.6%) 722,958 (22.3%) 1,967,103 (60.6%) 12,148 (0.4%) 16,310 (23.2%) 2,065 (13.6%) 44,121 (23.1%) 37,967 (24.4%) 67,137 (22.8%) 50,681 (22.0%) 939,366 (28.9%) Sex, n (%) Female Male Neighbourhood income quintile, n (%) Q1 (lowest) Q2 Q3 Q4 Q5 (highest) Missing Ethnic concentration quintile, n (%) Q1 (lowest) Q2 Q3 Q4 Q5 (highest) Missing Residential instability quintile, n (%) Q1 (lowest) _________________________________________________________________________________________________________________________________________________ ICES 59 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Western Hemisphere Variable North America Central Africa Caribbean South America Eastern Europe Europe other Not stated Total Number 70,287 15,237 191,326 155,358 293,942 230,646 61 3,245,639 Q2 12,219 (17.4%) 11,984 (17.1%) 12,230 (17.4%) 16,997 (24.2%) 547 (0.8%) 1,847 (12.1%) 1,958 (12.9%) 2,901 (19.0%) 6,373 (41.8%) 93 (0.6%) 28,333 (14.8%) 27,135 (14.2%) 34,234 (17.9%) 56,812 (29.7%) 691 (0.4%) 24,635 (15.9%) 23,615 (15.2%) 25,211 (16.2%) 43,394 (27.9%) 536 (0.3%) 52,026 (17.7%) 43,154 (14.7%) 39,834 (13.6%) 90,688 (30.9%) 1,103 (0.4%) 41,093 (17.8%) 40,107 (17.4%) 39,249 (17.0%) 58,557 (25.4%) 959 (0.4%) 531,889 (16.4%) 460,747 (14.2%) 464,843 (14.3%) 836,646 (25.8%) 12,148 (0.4%) 13,111 (18.7%) 11,387 (16.2%) 9,006 (12.8%) 15,850 (22.6%) 20,555 (29.2%) 378 (0.5%) 3,173 (20.8%) 2,350 (15.4%) 1,617 (10.6%) 3,506 (23.0%) 4,490 (29.5%) 101 (0.7%) 21,876 (11.4%) 20,886 (10.9%) 17,621 (9.2%) 47,003 (24.6%) 83,234 (43.5%) 706 (0.4%) 21,804 (14.0%) 15,798 (10.2%) 14,957 (9.6%) 38,077 (24.5%) 64,168 (41.3%) 554 (0.4%) 56,607 (19.3%) 35,547 (12.1%) 32,638 (11.1%) 75,354 (25.6%) 92,688 (31.5%) 1,108 (0.4%) 40,832 (17.7%) 33,737 (14.6%) 30,980 (13.4%) 62,772 (27.2%) 61,403 (26.6%) 922 (0.4%) 421,437 (13.0%) 323,137 (10.0%) 269,624 (8.3%) 700,850 (21.6%) 1,518,137 (46.8%) 12,454 (0.4%) 532 (0.8%) 533 (0.8%) 2,790 (4.0%) 10 (0.1%) 58 (0.4%) 845 (5.5%) 101 (0.1%) 944 (0.5%) 19,733 (10.3%) 137 (0.1%) 440 (0.3%) 9,541 (6.1%) 282 (0.1%) 1,563 (0.5%) 7,593 (2.6%) 371 (0.2%) 1,413 (0.6%) 8,245 (3.6%) 2,381 (0.1%) 11,219 (0.3%) 142,128 (4.4%) 582 (0.8%) 281 (0.4%) 17 (0.1%) 18 (0.1%) 250 (0.1%) 337 (0.2%) 233 (0.1%) 141 (0.1%) 668 (0.2%) 467 (0.2%) 1,660 (0.7%) 1,102 (0.5%) 5,836 (0.2%) 4,093 (0.1%) Q3 Q4 Q5 (highest) Missing Number of persons per dwelling quintile, n (%) Q1 (lowest) Q2 Q3 Q4 Q5 (highest) Missing Public health unit of residence, n (%) Algoma Public Health Brant County Health Unit Durham Region Health Department Grey Bruce Health Unit Haldimand-Norfolk Health Unit _________________________________________________________________________________________________________________________________________________ ICES 60 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Western Hemisphere Variable North America Central Africa Caribbean South America Eastern Europe Europe other Not stated Total Number 70,287 15,237 191,326 155,358 293,942 230,646 61 3,245,639 Haliburton, Kawartha, Pine Ridge District Health Unit 516 (0.7%) <6 316 (0.2%) 271 (0.2%) 777 (0.3%) 1,388 (0.6%) 5,454 (0.2%) Halton Region Health Department 4,063 (5.8%) 379 (2.5%) 4,985 (2.6%) 7,865 (5.1%) 16,693 (5.7%) 15,217 (6.6%) 145,818 (4.5%) City of Hamilton – Public Health & Social Services 2,672 (3.8%) 1,146 (7.5%) 4,901 (2.6%) 4,085 (2.6%) 10,647 (3.6%) 13,259 (5.7%) 96,978 (3.0%) Hastings and Prince Edward Counties Health Unit 408 (0.6%) 13 (0.1%) 359 (0.2%) 261 (0.2%) 487 (0.2%) 1,052 (0.5%) 5,412 (0.2%) Huron Perth Health Unit 498 (0.7%) 410 (0.6%) <6 200 (0.1%) 272 (0.1%) 147 (0.1%) 114 (0.1%) 324 (0.1%) 401 (0.1%) 1,790 (0.8%) 485 (0.2%) 5,156 (0.2%) 3,703 (0.1%) Kingston, Frontenac and Lennox & Addington Health Unit 828 (1.2%) 60 (0.4%) 411 (0.2%) 349 (0.2%) 881 (0.3%) 1,747 (0.8%) 10,516 (0.3%) Lambton Health Unit 718 (1.0%) 717 (1.0%) 14 (0.1%) 12 (0.1%) 162 (0.1%) 157 (0.1%) 166 (0.1%) 137 (0.1%) 408 (0.1%) 449 (0.2%) 863 (0.4%) 1,158 (0.5%) 4,649 (0.1%) 4,318 (0.1%) Middlesex-London Health Unit 2,445 (3.5%) 413 (2.7%) 2,402 (1.3%) 5,428 (3.5%) 7,697 (2.6%) 7,931 (3.4%) 71,584 (2.2%) Niagara Region Public Health Department 2,972 (4.2%) 285 (1.9%) 2,590 (1.4%) 2,638 (1.7%) 5,615 (1.9%) 5,881 (2.5%) 41,696 (1.3%) North Bay Parry Sound District Health Unit 376 (0.5%) 7 (0.0%) 99 (0.1%) 89 (0.1%) 367 (0.1%) 599 (0.3%) 2,702 (0.1%) Northwestern Health Unit 625 (0.9%) <6 51 (0.0%) 18 (0.0%) 45 (0.0%) 205 (0.1%) 1,550 (0.0%) Ottawa Public Health 4,732 (6.7%) 7,502 (10.7%) 391 (0.6%) 4,448 (29.2%) 1,388 (9.1%) 44 (0.3%) 10,704 (5.6%) 48,055 (25.1%) 286 (0.1%) 5,045 (3.2%) 31,872 (20.5%) 248 (0.2%) 13,496 (4.6%) 43,361 (14.8%) 679 (0.2%) 13,055 (5.7%) 26,005 (11.3%) 900 (0.4%) 180,084 (5.5%) 675,524 (20.8%) 5,949 (0.2%) Chatham-Kent Health Unit Leeds, Grenville and Lanark District Health Unit Peel Public Health Peterborough County-City Health Unit <6 _________________________________________________________________________________________________________________________________________________ ICES 61 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Western Hemisphere Variable North America Central Africa Caribbean South America Eastern Europe Europe other Not stated Total Number 70,287 15,237 191,326 155,358 293,942 230,646 61 3,245,639 Porcupine Health Unit 89 (0.1%) 291 (0.4%) 12 (0.1%) 1–10 86 (0.0%) 71 (0.0%) 56 (0.0%) 90 (0.1%) 132 (0.0%) 378 (0.1%) 129 (0.1%) 701 (0.3%) 1,283 (0.0%) 2,627 (0.1%) Eastern Ontario Health Unit 492 (0.7%) 136 (0.9%) 381 (0.2%) 155 (0.1%) 347 (0.1%) 1,158 (0.5%) 5,098 (0.2%) Simcoe Muskoka District Health Unit 1,643 (2.3%) 130 (0.9%) 3,529 (1.8%) 3,809 (2.5%) 9,072 (3.1%) 8,126 (3.5%) 51,194 (1.6%) Sudbury and District Health Unit 365 (0.5%) 170 (1.1%) 212 (0.1%) 176 (0.1%) 462 (0.2%) 651 (0.3%) 4,863 (0.1%) Thunder Bay District Health Unit 446 (0.6%) 12 (0.1%) 154 (0.1%) 183 (0.1%) 558 (0.2%) 551 (0.2%) 4,284 (0.1%) Timiskaming Health Unit 58 (0.1%) 3,085 (4.4%) <6 360 (2.4%) 22 (0.0%) 3,789 (2.0%) 16 (0.0%) 5,279 (3.4%) 69 (0.0%) 12,578 (4.3%) 80 (0.0%) 13,698 (5.9%) 448 (0.0%) 104,924 (3.2%) 1,277 (1.8%) 4,040 (5.7%) 5,276 (7.5%) 713 (1.0%) 112 (0.7%) 565 (3.7%) 290 (1.9%) 20 (0.1%) 1,992 (1.0%) 1,603 (0.8%) 9,694 (5.1%) 593 (0.3%) 1,594 (1.0%) 1,196 (0.8%) 12,892 (8.3%) 438 (0.3%) 3,690 (1.3%) 6,911 (2.4%) 52,826 (18.0%) 1,272 (0.4%) 5,435 (2.4%) 6,373 (2.8%) 15,736 (6.8%) 2,801 (1.2%) 36,532 (1.1%) 69,636 (2.1%) 455,320 (14.0%) 11,301 (0.3%) Toronto Public Health 17,681 (25.2%) 4,175 (27.4%) 71,283 (37.3%) 59,787 (38.5%) 91,869 (31.3%) 70,275 (30.5%) 1,061,030 (32.7%) Unknown/missing 240 (0.3%) 76 (0.5%) 602 (0.3%) 462 (0.3%) 878 (0.3%) 606 (0.3%) 10,349 (0.3%) 8,778 (12.5%) 991 (6.5%) 25,719 (13.4%) 20,659 (13.3%) 31,726 (10.8%) 29,074 (12.6%) 377,814 (11.6%) Renfrew County and District Health Unit Region of Waterloo Public Health Wellington-Dufferin-Guelph Health Unit Windsor-Essex County Health Unit York Region Public Health Services Southwestern Health Unit CLINICAL CHARACTERISTICS Chronic conditions, n (%) Respiratory (asthma, COPD) _________________________________________________________________________________________________________________________________________________ ICES 62 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Western Hemisphere Variable North America Central Africa Caribbean South America Eastern Europe Europe other Not stated Total Number 70,287 15,237 191,326 155,358 293,942 230,646 61 3,245,639 Chronic kidney disease (incl. chronic dialysis) 612 (0.9%) 2,823 (4.0%) 6,839 (9.7%) 443 (0.6%) 415 (0.6%) 213 (0.3%) 173 (1.1%) 841 (5.5%) 1,888 (12.4%) 480 (3.2%) 48 (0.3%) 63 (0.4%) 4,422 (2.3%) 24,125 (12.6%) 42,230 (22.1%) 2,610 (1.4%) 1,374 (0.7%) 618 (0.3%) 3,021 (1.9%) 17,990 (11.6%) 28,386 (18.3%) 1,311 (0.8%) 1,489 (1.0%) 800 (0.5%) 3,434 (1.2%) 17,855 (6.1%) 56,318 (19.2%) 1,482 (0.5%) 2,090 (0.7%) 1,647 (0.6%) 2,388 (1.0%) 14,949 (6.5%) 37,799 (16.4%) 1,358 (0.6%) 1,821 (0.8%) 1,038 (0.5%) 49,930 (1.5%) 325,193 (10.0%) 558,117 (17.2%) 21,123 (0.7%) 21,085 (0.6%) 16,013 (0.5%) 3,283 (4.7%) 12,357 (17.6%) 43,284 (61.6%) 11,363 (16.2%) 992 (6.5%) 2,974 (19.5%) 7,345 (48.2%) 3,926 (25.8%) 6,505 (3.4%) 21,387 (11.2%) 123,105 (64.3%) 40,329 (21.1%) 3,566 (2.3%) 15,121 (9.7%) 105,896 (68.2%) 30,775 (19.8%) 5,706 (1.9%) 22,132 (7.5%) 212,260 (72.2%) 53,844 (18.3%) 5,825 (2.5%) 21,862 (9.5%) 161,127 (69.9%) 41,832 (18.1%) 142,720 (4.4%) 423,423 (13.0%) 2,026,892 (62.4%) 652,604 (20.1%) 39,053 (55.6%) 45 (0.1%) 25,044 (35.6%) 359 (0.5%) 0 (0.0%) 3,017 (19.8%) 29 (0.2%) 2,276 (14.9%) 445 (2.9%) 31 (0.2%) 127,793 (66.8%) 1,826 (1.0%) 43,651 (22.8%) 227 (0.1%) 0 (0.0%) 79,462 (51.1%) 1,127 (0.7%) 44,545 (28.7%) 2,475 (1.6%) 30 (0.0%) 94,754 (32.2%) 1,703 (0.6%) 132,234 (45.0%) 30,717 (10.5%) 0 (0.0%) 72,844 (31.6%) 1,375 (0.6%) 123,158 (53.4%) 5,897 (2.6%) 42 (0.0%) 1,228,765 (37.9%) 85,148 (2.6%) 1,381,872 (42.6%) 125,744 (3.9%) 3,294 (0.1%) Diabetes Cardiovascular (CHF, TIA/stroke, Ischemic cardiac disease, hypertension) Immunocompromised Inflammatory (IBD, rheumatoid arthritis) Liver disease IMMIGRATION CHARACTERISTICS Recency of immigration, n (%) Recent (0 to ≤5 years) Intermediate (>5 to ≤10 years) Long-term residents (>10 years) Second generation children and youth Immigration category, n (%) Sponsored family member Economic immigrant, caregiver Economic immigrant, other Privately sponsored refugee Blended visa office–referred refugee _________________________________________________________________________________________________________________________________________________ ICES 63 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Western Hemisphere Variable North America Central Africa Caribbean South America Eastern Europe Europe other Not stated Total Number 70,287 15,237 191,326 155,358 293,942 230,646 61 3,245,639 Government-assisted refugee 340 (0.5%) 682 (1.0%) 3,120 (4.4%) 1,528 (2.2%) 116 (0.2%) 2,314 (15.2%) 4,675 (30.7%) 1,585 (10.4%) 838 (5.5%) 27 (0.2%) 119 (0.1%) 8,854 (4.6%) 3,098 (1.6%) 5,515 (2.9%) 243 (0.1%) 2,174 (1.4%) 18,414 (11.9%) 3,236 (2.1%) 3,742 (2.4%) 153 (0.1%) 8,669 (2.9%) 17,301 (5.9%) 4,441 (1.5%) 3,991 (1.4%) 132 (0.0%) 15,577 (6.8%) 6,593 (2.9%) 2,688 (1.2%) 2,209 (1.0%) 263 (0.1%) Protected person/Refugee (asylum seeker) Refugee dependent Humanitarian and compassionate/Public policy case Other immigrant Notes: 1. Denominator includes children aged ≤19 years of immigrant and refugee mothers in IRCC (second generation). 2. Chronic conditions were identified using validated algorithms for ICES data holdings; the latest diagnosis date is March 31, 2019. 3. Numbers are too low to report for ‘not stated’ group. 4. Some cells are suppressed due to low counts (n < 6) or reported as ranges to protect privacy. _________________________________________________________________________________________________________________________________________________ ICES 64 111,891 (3.4%) 194,292 (6.0%) 66,626 (2.1%) 41,409 (1.3%) 6,598 (0.2%) COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Appendix 2.1 Baseline characteristics of immigrants and refugees aged 25 years and older at arrival with an earliest landing date of January 1, 2010, by immigrant category , as of March 31, 2020 Variable Sponsored family members Economic immigrant, caregiver Economic class, other Privately sponsored refugees Blended visa office– referred refugees Governmentassisted refugees Protected persons/ Refugees (asylum seekers) Refugee dependents Humanitarian and compassionate /Public policy cases Other immigrants Total Number 167,649 31,249 168,777 12,300 1,124 10,692 28,268 5,166 9,019 157 434,401 51.33 ± 17.08 44.43 ± 7.63 42.14 ± 8.26 47.02 ± 12.97 41.16 ± 9.30 47.08 ± 12.10 46.31 ± 10.52 45 (36–67) 43 (39–49) 41 (36–47) 44 (37–55) 39 (35–45) 45.71 ± 12.23 43 (36–52) 44 (38–53) 45 (38–53) 51.65 ± 13.50 49 (42–59) 51.43 ± 12.75 51 (41–60) 46.65 ± 13.56 43 (36–53) 2,434 (1.5%) 60,043 (35.8%) 30,692 (18.3%) 14,620 (8.7%) 23,932 (14.3%) 35,928 (21.5%) 178 (0.6%) 8,947 (28.6%) 14,366 (46.0%) 6,635 (21.2%) 1,074 (3.4%) 49 (0.2%) 2,113 (1.3%) 73,109 (43.3%) 61,202 (36.3%) 26,654 (15.8%) 5,210 (3.1%) 489 (0.3%) 235 (1.9%) 4,120 (33.5%) 3,493 (28.4%) 2,248 (18.3%) 1,351 (11.0%) 853 (6.9%) 40–50 149 (1.4%) 3,933 (36.8%) 3,316 (31.0%) 1,814 (17.0%) 874 (8.2%) 606 (5.7%) 234 (0.8%) 8,504 (30.1%) 9,788 (34.6%) 5,619 (19.9%) 2,288 (8.1%) 1,835 (6.5%) 81 (1.6%) 1,454 (28.1%) 1,799 (34.8%) 1,245 (24.1%) 449 (8.7%) 138 (2.7%) 40 (0.4%) 1,611 (17.9%) 2,951 (32.7%) 2,261 (25.1%) 1,102 (12.2%) 1,054 (11.7%) <6 5,507 (1.3%) 162,287 (37.4%) 128,021 (29.5%) 61,250 (14.1%) 36,355 (8.4%) 40,981 (9.4%) 92,562 (55.2%) 75,087 (44.8%) 26,201 (83.8%) 5,048 (16.2%) 77,989 (46.2%) 90,788 (53.8%) 5,905 (48.0%) 6,395 (52.0%) 5,452 (51.0%) 5,240 (49.0%) 14,096 (49.9%) 14,172 (50.1%) 3,072 (59.5%) 2,094 (40.5%) 5,235 (58.0%) 3,784 (42.0%) SOCIODEMOGRAPHIC CHARACTERISTICS Age Mean ± SD Median (IQR) Age group, n (%) 20–29 years 30–39 years 40–49 years 50–59 years 60–69 years 70+ years 536 (47.7%) 371 (33.0%) 112 (10.0%) 46 (4.1%) 10–20 30 (19.1%) 43 (27.4%) 42 (26.8%) 29 (18.5%) 10–20 Sex, n (%) Female Male 552 (49.1%) 572 (50.9%) 74 (47.1%) 83 (52.9%) Neighbourhood income quintile, n (%) _________________________________________________________________________________________________________________________________________________ ICES 65 231,138 (53.2%) 203,263 (46.8%) COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Variable Sponsored family members Economic immigrant, caregiver Economic class, other Privately sponsored refugees Blended visa office– referred refugees Governmentassisted refugees Protected persons/ Refugees (asylum seekers) Refugee dependents Humanitarian and compassionate /Public policy cases Other immigrants Total Number 167,649 31,249 168,777 12,300 1,124 10,692 28,268 5,166 9,019 157 434,401 Q1 (lowest) 38,355 (22.9%) 14,287 (45.7%) 37,485 (22.2%) 6,176 (50.2%) 585 (52.0%) 6,401 (59.9%) 12,061 (42.7%) 2,250 (43.6%) 3,421 (37.9%) 56 (35.7%) 121,077 (27.9%) Q2 37,122 (22.1%) 36,227 (21.6%) 32,009 (19.1%) 23,486 (14.0%) 450 (0.3%) 7,311 (23.4%) 4,355 (13.9%) 2,870 (9.2%) 2,400 (7.7%) 26 (0.1%) 33,873 (20.1%) 35,745 (21.2%) 33,661 (19.9%) 27,390 (16.2%) 623 (0.4%) 2,392 (19.4%) 1,880 (15.3%) 1,233 (10.0%) 599 (4.9%) 20 (0.2%) 261 (23.2%) 135 (12.0%) 78 (6.9%) 64 (5.7%) <6 2,134 (20.0%) 1,117 (10.4%) 702 (6.6%) 311 (2.9%) 27 (0.3%) 6,251 (22.1%) 4,532 (16.0%) 3,502 (12.4%) 1,841 (6.5%) 81 (0.3%) 1,284 (24.9%) 774 (15.0%) 565 (10.9%) 279 (5.4%) 14 (0.3%) 2,125 (23.6%) 1,582 (17.5%) 1,164 (12.9%) 701 (7.8%) 26 (0.3%) 31 (19.7%) 30 (19.1%) 21 (13.4%) 19 (12.1%) 0 (0.0%) 92,784 (21.4%) 86,377 (19.9%) 75,805 (17.5%) 57,090 (13.1%) 1,268 (0.3%) 5,386 (3.2%) 697 (2.2%) 3,133 (1.9%) 168 (1.4%) 101 (9.0%) 174 (1.6%) 409 (1.4%) 55 (1.1%) 210 (2.3%) 13 (8.3%) 10,346 (2.4%) 8,809 (5.3%) 16,232 (9.7%) 36,045 (21.5%) 100,593 (60.0%) 584 (0.3%) 1,390 (4.4%) 2,679 (8.6%) 6,398 (20.5%) 20,050 (64.2%) 35 (0.1%) 6,758 (4.0%) 15,797 (9.4%) 39,313 (23.3%) 103,069 (61.1%) 707 (0.4%) 445 (3.6%) 951 (7.7%) 2,326 (18.9%) 8,385 (68.2%) 25 (0.2%) 134 (11.9%) 180 (16.0%) 238 (21.2%) 470 (41.8%) <6 485 (4.5%) 987 (9.2%) 2,451 (22.9%) 6,565 (61.4%) 30 (0.3%) 1,021 (3.6%) 2,436 (8.6%) 5,930 (21.0%) 18,380 (65.0%) 92 (0.3%) 156 (3.0%) 391 (7.6%) 918 (17.8%) 3,629 (70.2%) 17 (0.3%) 371 (4.1%) 893 (9.9%) 1,986 (22.0%) 5,531 (61.3%) 28 (0.3%) 11 (7.0%) 16 (10.2%) 52 (33.1%) 65 (41.4%) 0 (0.0%) 19,580 (4.5%) 40,562 (9.3%) 95,657 (22.0%) 266,737 (61.4%) 1,519 (0.3%) 49,313 (29.4%) 27,146 (16.2%) 23,850 (14.2%) 23,703 (14.1%) 3,264 (10.4%) 3,073 (9.8%) 3,742 (12.0%) 6,355 (20.3%) 42,862 (25.4%) 25,092 (14.9%) 23,986 (14.2%) 22,089 (13.1%) 1,752 (14.2%) 1,236 (10.0%) 1,281 (10.4%) 2,479 (20.2%) 63 (5.6%) 74 (6.6%) 126 (11.2%) 252 (22.4%) 733 (6.9%) 767 (7.2%) 1,130 (10.6%) 1,895 (17.7%) 4,716 (16.7%) 3,556 (12.6%) 3,707 (13.1%) 4,676 (16.5%) 937 (18.1%) 730 (14.1%) 668 (12.9%) 815 (15.8%) 1,615 (17.9%) 1,215 (13.5%) 1,215 (13.5%) 1,672 (18.5%) 26 (16.6%) 21 (13.4%) 25 (15.9%) 31 (19.7%) 105,281 (24.2%) 62,910 (14.5%) 59,730 (13.7%) 63,967 (14.7%) Q3 Q4 Q5 (highest) Missing Ethnic concentration quintile, n (%) Q1 (lowest) Q2 Q3 Q4 Q5 (highest) Missing Residential instability quintile, n (%) Q1 (lowest) Q2 Q3 Q4 _________________________________________________________________________________________________________________________________________________ ICES 66 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Variable Sponsored family members Economic immigrant, caregiver Economic class, other Privately sponsored refugees Blended visa office– referred refugees Governmentassisted refugees Protected persons/ Refugees (asylum seekers) Refugee dependents Humanitarian and compassionate /Public policy cases Other immigrants Total Number 167,649 31,249 168,777 12,300 1,124 10,692 28,268 5,166 9,019 157 434,401 Q5 (highest) 43,053 (25.7%) 584 (0.3%) 14,780 (47.3%) 35 (0.1%) 54,041 (32.0%) 707 (0.4%) 5,527 (44.9%) 25 (0.2%) 608 (54.1%) <6 6,137 (57.4%) 30 (0.3%) 11,521 (40.8%) 92 (0.3%) 1,999 (38.7%) 17 (0.3%) 3,274 (36.3%) 28 (0.3%) 54 (34.4%) 0 (0.0%) 140,994 (32.5%) 1,519 (0.3%) 23,692 (14.1%) 17,245 (10.3%) 13,802 (8.2%) 33,989 (20.3%) 78,359 (46.7%) 562 (0.3%) 5,387 (17.2%) 4,754 (15.2%) 4,298 (13.8%) 9,059 (29.0%) 7,710 (24.7%) 41 (0.1%) 31,390 (18.6%) 16,494 (9.8%) 13,709 (8.1%) 34,534 (20.5%) 71,875 (42.6%) 775 (0.5%) 1,827 (14.9%) 2,130 (17.3%) 1,223 (9.9%) 2,850 (23.2%) 4,242 (34.5%) 28 (0.2%) 355 (31.6%) 302 (26.9%) 123 (10.9%) 185 (16.5%) 158 (14.1%) <6 2,727 (25.5%) 2,053 (19.2%) 1,218 (11.4%) 2,162 (20.2%) 2,501 (23.4%) 31 (0.3%) 5,046 (17.9%) 3,544 (12.5%) 2,773 (9.8%) 6,539 (23.1%) 10,270 (36.3%) 96 (0.3%) 766 (14.8%) 621 (12.0%) 476 (9.2%) 1,185 (22.9%) 2,100 (40.7%) 18 (0.3%) 1,449 (16.1%) 1,062 (11.8%) 1,002 (11.1%) 2,213 (24.5%) 3,265 (36.2%) 28 (0.3%) 35 (22.3%) 23 (14.6%) 15 (9.6%) 40 (25.5%) 44 (28.0%) 0 (0.0%) 72,674 (16.7%) 48,228 (11.1%) 38,639 (8.9%) 92,756 (21.4%) 180,524 (41.6%) 1,580 (0.4%) <6 9 (0.8%) 9 (0.8%) 16 (1.4%) 20 (1.8%) <6 20 (0.2%) 7 (0.1%) 60 (0.6%) <6 <6 <6 108 (0.3%) 783 (2.5%) 27 (0.1%) 31 (0.1%) 38 (0.1%) 141 (0.1%) 445 (0.3%) 6,077 (3.6%) 290 (0.2%) 121 (0.1%) 194 (0.1%) 0 (0.0%) 22 (0.2%) 250 (2.0%) <6 8 (0.2%) 173 (3.3%) <6 0 (0.0%) 0 (0.0%) 8 (5.1%) <6 <6 9 (0.1%) 15 (0.2%) <6 10 (0.9%) 60 (0.2%) 1,022 (3.6%) 20 (0.1%) 15 (0.1%) 22 (0.1%) 6 (0.1%) 31 (0.3%) 357 (4.0%) <6 Haliburton, Kawartha, Pine Ridge District Health Unit 220 (0.1%) 718 (0.4%) 6,930 (4.1%) 386 (0.2%) 223 (0.1%) 376 (0.2%) 406 (0.1%) 1,408 (0.3%) 15,676 (3.6%) 755 (0.2%) 415 (0.1%) 671 (0.2%) Halton Region Health Department 7,321 (4.4%) 1,102 (3.5%) 11,591 (6.9%) 354 (2.9%) 50–60 155 (1.4%) 743 (2.6%) 86 (1.7%) 234 (2.6%) <6 Missing Number of persons per dwelling quintile, n (%) Q1 (lowest) Q2 Q3 Q4 Q5 (highest) Missing Public health unit of residence, n (%) Algoma Public Health Brant County Health Unit Durham Region Health Department Grey Bruce Health Unit Haldimand-Norfolk Health Unit 7 (0.1%) 8 (0.1%) <6 <6 <6 <6 _________________________________________________________________________________________________________________________________________________ ICES 67 21,641 (5.0%) COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Variable Sponsored family members Economic immigrant, caregiver Economic class, other Privately sponsored refugees Blended visa office– referred refugees Governmentassisted refugees Protected persons/ Refugees (asylum seekers) Refugee dependents Humanitarian and compassionate /Public policy cases Other immigrants Total Number 167,649 31,249 168,777 12,300 1,124 10,692 28,268 5,166 9,019 157 434,401 City of Hamilton – Public Health & Social Services Hastings and Prince Edward Counties Health Unit 4,450 (2.7%) 419 (0.2%) 809 (2.6%) 64 (0.2%) 3,588 (2.1%) 252 (0.1%) 661 (5.4%) 11 (0.1%) 50–60 1,109 (3.9%) 31 (0.1%) 163 (3.2%) <6 328 (3.6%) 13 (0.1%) <6 <6 1,192 (11.1%) <6 12,351 (2.8%) 802 (0.2%) Huron Perth Health Unit 255 (0.2%) 250 (0.1%) 658 (0.4%) 31 (0.1%) 13 (0.0%) 95 (0.3%) 219 (0.1%) 121 (0.1%) 810 (0.5%) 16 (0.1%) 11 (0.1%) 41 (0.3%) 28 (2.5%) 11 (1.0%) 11 (1.0%) 11 (0.1%) 8 (0.1%) 54 (0.5%) 14 (0.0%) 22 (0.1%) 30 (0.1%) 0 (0.0%) <6 9 (0.1%) 21 (0.2%) 13 (0.1%) 0 (0.0%) <6 357 (0.2%) 408 (0.2%) 29 (0.1%) 45 (0.1%) 218 (0.1%) 147 (0.1%) 8 (0.1%) 7 (0.1%) 15 (1.3%) 17 (1.5%) 7 (0.1%) <6 13 (0.0%) 8 (0.0%) <6 14 (0.2%) 12 (0.1%) <6 392 (1.3%) 400 (1.3%) 3,865 (2.3%) 1,623 (1.0%) 503 (4.1%) 147 (1.2%) 60–70 29 (2.6%) 1,203 (11.3%) 31 (0.3%) 963 (3.4%) 570 (2.0%) 111 (2.1%) 88 (1.7%) 207 (2.3%) 157 (1.7%) <6 Niagara Region Public Health Department 2,935 (1.8%) 2,333 (1.4%) North Bay Parry Sound District Health Unit 237 (0.1%) 18 (0.1%) 139 (0.1%) 9 (0.1%) 8 (0.7%) 0 (0.0%) 7 (0.0%) <6 8 (0.1%) <6 427 (0.1%) Northwestern Health Unit 131 (0.1%) 9,317 (5.6%) 36,203 (21.6%) 381 (0.2%) 36 (0.1%) 1,625 (5.2%) 3,122 (10.0%) 38 (0.1%) 88 (0.1%) 9,108 (5.4%) 38,121 (22.6%) 327 (0.2%) 0 (0.0%) 890 (7.2%) 1,867 (15.2%) 34 (0.3%) <6 <6 <6 <6 <6 155 (13.8%) 58 (5.2%) 9 (0.8%) 1,545 (14.5%) 1,109 (10.4%) 67 (0.6%) 2,167 (7.7%) 3,631 (12.8%) 30 (0.1%) 0 (0.0%) 409 (7.9%) 621 (12.0%) 0 (0.0%) 690 (7.7%) 1,512 (16.8%) 1–6 30 (19.1%) 18 (11.5%) <6 269 (0.1%) 25,936 (6.0%) 86,262 (19.9%) 893 (0.2%) 113 (0.1%) 196 (0.1%) 445 (0.3%) 30 (0.1%) 18 (0.1%) 49 (0.2%) 112 (0.1%) 125 (0.1%) 218 (0.1%) <6 <6 <6 <6 <6 8 (0.0%) <6 <6 <6 <6 0 (0.0%) 10 (0.2%) <6 9 (0.1%) 0 (0.0%) 0 (0.0%) <6 0 (0.0%) <6 Chatham-Kent Health Unit Kingston, Frontenac and Lennox & Addington Health Unit Lambton Health Unit Leeds, Grenville and Lanark District Health Unit Middlesex-London Health Unit Ottawa Public Health Peel Public Health Peterborough County-City Health Unit Porcupine Health Unit Renfrew County and District Health Unit Eastern Ontario Health Unit 47 (0.2%) <6 <6 28 (0.3%) 0 (0.0%) <6 <6 7 (4.5%) _________________________________________________________________________________________________________________________________________________ ICES 68 583 (0.1%) 458 (0.1%) 1,718 (0.4%) 664 (0.2%) 649 (0.1%) 10,247 (2.4%) 5,385 (1.2%) 276 (0.1%) 349 (0.1%) 813 (0.2%) COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Variable Sponsored family members Economic immigrant, caregiver Economic class, other Privately sponsored refugees Blended visa office– referred refugees Governmentassisted refugees Protected persons/ Refugees (asylum seekers) Refugee dependents Humanitarian and compassionate /Public policy cases Other immigrants Total Number 167,649 31,249 168,777 12,300 1,124 10,692 28,268 5,166 9,019 157 434,401 3,071 (1.8%) 364 (0.2%) 296 (0.2%) 49 (0.0%) 5,192 (3.1%) 1,953 (1.2%) 456 (1.5%) 50 (0.2%) 32 (0.1%) <6 130 (1.1%) 12 (0.1%) 19 (0.2%) 0 (0.0%) 868 (7.1%) 363 (3.0%) 20–30 60 (0.6%) <6 158 (1.8%) <6 <6 39 (0.4%) 0 (0.0%) 1,044 (9.8%) 56 (0.5%) 499 (1.8%) 45 (0.2%) 23 (0.1%) 0 (0.0%) 742 (2.6%) 182 (0.6%) 96 (1.9%) 7 (0.1%) <6 8 (0.1%) <6 <6 536 (1.7%) 457 (1.5%) 1,858 (1.1%) 435 (0.3%) 249 (0.1%) 24 (0.0%) 5,552 (3.3%) 1,777 (1.1%) 6,359 (1.5%) 932 (0.2%) 682 (0.2%) 76 (0.0%) 14,366 (3.3%) 4,903 (1.1%) 3,059 (1.8%) 24,797 (14.8%) 683 (0.4%) 52,479 (31.3%) 444 (0.3%) 223 (0.7%) 2,433 (7.8%) 75 (0.2%) 18,053 (57.8%) 26 (0.1%) 2,015 (1.2%) 21,273 (12.6%) 323 (0.2%) 56,710 (33.6%) 621 (0.4%) 891 (7.2%) 706 (5.7%) 12 (0.1%) 4,418 (35.9%) 20 (0.2%) 1,202 (11.2%) 435 (4.1%) 11 (0.1%) 2,328 (21.8%) 27 (0.3%) 614 (2.2%) 2,847 (10.1%) 51 (0.2%) 12,642 (44.7%) 81 (0.3%) 88 (1.7%) 612 (11.8%) <6 6,895 (4.1%) 4,054 (2.4%) 1,147 (3.7%) 325 (1.0%) 5,245 (3.1%) 1,341 (0.8%) 618 (5.0%) 239 (1.9%) 44 (3.9%) 14 (1.2%) 758 (7.1%) 253 (2.4%) 21,423 (12.8%) 36,715 (21.9%) 2,296 (7.3%) 5,431 (17.4%) 11,577 (6.9%) 18,279 (10.8%) 1,569 (12.8%) 2,586 (21.0%) 104 (9.3%) 91 (8.1%) 820 (0.5%) 94 (0.3%) 398 (0.2%) 74 (0.6%) 9 (0.8%) Simcoe Muskoka District Health Unit Sudbury and District Health Unit Thunder Bay District Health Unit Timiskaming Health Unit Region of Waterloo Public Health Wellington-Dufferin-Guelph Health Unit Windsor-Essex County Health Unit York Region Public Health Services Southwestern Health Unit Toronto Public Health Unknown/missing 10 (0.9%) 15 (1.3%) 0 (0.0%) 131 (11.7%) 40 (3.6%) 46 (4.1%) 20–30 13 (1.2%) 220 (19.6%) <6 0 (0.0%) 108 (2.1%) 25 (0.5%) 193 (2.1%) 50 (0.6%) <6 0 (0.0%) 0 (0.0%) 0 (0.0%) 2,514 (48.7%) 14 (0.3%) 292 (3.2%) 768 (8.5%) 19 (0.2%) 3,817 (42.3%) 26 (0.3%) 11 (7.0%) <6 53 (33.8%) 0 (0.0%) 8,441 (1.9%) 53,903 (12.4%) 1,191 (0.3%) 153,234 (35.3%) 1,260 (0.3%) 1,708 (6.0%) 582 (2.1%) 196 (3.8%) 73 (1.4%) 615 (6.8%) 298 (3.3%) 26 (16.6%) 11 (7.0%) 17,252 (4.0%) 7,190 (1.7%) 1,636 (15.3%) 2,060 (19.3%) 3,741 (13.2%) 5,752 (20.3%) 607 (11.7%) 815 (15.8%) 1,467 (16.3%) 2,357 (26.1%) 33 (21.0%) 42 (26.8%) 44,453 (10.2%) 74,128 (17.1%) 111 (1.0%) 565 (2.0%) 50 (1.0%) 131 (1.5%) 18 (11.5%) 2,270 (0.5%) <6 CLINICAL CHARACTERISTICS Chronic conditions, n (%) Respiratory (asthma, COPD) Chronic kidney disease (incl. chronic dialysis) Diabetes Cardiovascular (CHF, TIA/stroke, Ischemic cardiac disease, hypertension) Immunocompromised _________________________________________________________________________________________________________________________________________________ ICES 69 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Variable Sponsored family members Economic immigrant, caregiver Economic class, other Privately sponsored refugees Blended visa office– referred refugees Governmentassisted refugees Protected persons/ Refugees (asylum seekers) Refugee dependents Humanitarian and compassionate /Public policy cases Other immigrants Total Number 167,649 31,249 168,777 12,300 1,124 10,692 28,268 5,166 9,019 157 434,401 Inflammatory diseases (IBD, rheumatoid arthritis) 787 (0.5%) 91 (0.3%) 536 (0.3%) 70 (0.6%) <6 66 (0.6%) 161 (0.6%) 27 (0.5%) 67 (0.7%) <6 1,809 (0.4%) Liver disease 723 (0.4%) 77 (0.2%) 409 (0.2%) 41 (0.3%) <6 67 (0.6%) 181 (0.6%) 26 (0.5%) 65 (0.7%) 1–6 1,598 (0.4%) 3,216 (1.9%) 98,118 (58.5%) 1,886 (1.1%) 63,558 (37.9%) 871 (0.5%) 103 (0.3%) 29,595 (94.7%) 63 (0.2%) 1,460 (4.7%) 28 (0.1%) 8,171 (4.8%) 144,507 (85.6%) 1,182 (0.7%) 14,748 (8.7%) 169 (0.1%) 102 (0.8%) 6,071 (49.4%) 121 (1.0%) 5,859 (47.6%) 147 (1.2%) <6 110 (1.0%) 2,338 (21.9%) 153 (1.4%) 7,901 (73.9%) 190 (1.8%) 1,018 (3.6%) 22,334 (79.0%) 1,081 (3.8%) 3,752 (13.3%) 83 (0.3%) 111 (2.1%) 2,359 (45.7%) 328 (6.3%) 2,283 (44.2%) 85 (1.6%) 190 (2.1%) 7,574 (84.0%) 332 (3.7%) 759 (8.4%) 164 (1.8%) <6 13,027 (3.0%) 313,343 (72.1%) 5,155 (1.2%) 101,115 (23.3%) 1,761 (0.4%) 36,181 (21.6%) 48,993 (29.2%) 7,872 (4.7%) 22,756 (13.6%) 50,262 (30.0%) 1,585 (0.9%) 524 (1.7%) 1,527 (4.9%) 2,661 (8.5%) 7,355 (23.5%) 19,098 (61.1%) 80–90 11,538 (6.8%) 9,203 (5.5%) 2,909 (1.7%) 16,303 (9.7%) 116,709 (69.1%) 12,115 (7.2%) 1,590 (12.9%) 6,143 (49.9%) 476 (3.9%) 1,598 (13.0%) 2,265 (18.4%) 228 (1.9%) 2,143 (20.0%) 6,542 (61.2%) 186 (1.7%) 603 (5.6%) 996 (9.3%) 222 (2.1%) 1,147 (4.1%) 12,831 (45.4%) 2,030 (7.2%) 5,173 (18.3%) 6,938 (24.5%) 149 (0.5%) 798 (15.4%) 2,247 (43.5%) 275 (5.3%) 775 (15.0%) 842 (16.3%) 229 (4.4%) 528 (5.9%) 4,197 (46.5%) 593 (6.6%) 2,292 (25.4%) 1,304 (14.5%) 105 (1.2%) CHARACTERISTICS AT LANDING Canadian language ability, n (%) Bilingual English French Neither Not stated Highest education level (aged 25 years and older), n (%) None Secondary or less Some university – no degree Trade/diploma Bachelor's degree or higher Not stated 307 (27.3%) 1–10 785 (69.8%) 20–25 119 (10.6%) 723 (64.3%) 14 (1.2%) 42 (3.7%) 63 (5.6%) 163 (14.5%) 140 (89.2%) <6 10 (6.4%) <6 1–6 70 (44.6%) 11 (7.0%) 34 (21.7%) 33 (21.0%) <6 World subregion of origin, n (%) _________________________________________________________________________________________________________________________________________________ ICES 70 54,574 (12.6%) 92,476 (21.3%) 17,027 (3.9%) 56,931 (13.1%) 198,510 (45.7%) 14,883 (3.4%) COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Variable Sponsored family members Economic immigrant, caregiver Economic class, other Privately sponsored refugees Blended visa office– referred refugees Governmentassisted refugees Protected persons/ Refugees (asylum seekers) Refugee dependents Humanitarian and compassionate /Public policy cases Other immigrants Total Number 167,649 31,249 168,777 12,300 1,124 10,692 28,268 5,166 9,019 157 434,401 Central Africa 574 (0.3%) 2,896 (1.7%) 3,575 (2.1%) 502 (0.3%) 9,804 (5.8%) 2,427 (1.4%) 3,751 (2.2%) 7,348 (4.4%) 12,128 (7.2%) 6,970 (4.2%) 33,533 (20.0%) 1,152 (0.7%) 14,976 (8.9%) 45,044 (26.9%) 11,879 (7.1%) 11,087 (6.6%) <6 10–20 438 (0.3%) 3,079 (1.8%) 1,556 (0.9%) 803 (0.5%) 19,919 (11.8%) 5,388 (3.2%) 1,656 (1.0%) 4,434 (2.6%) 2,957 (1.8%) 2,535 (1.5%) 25,976 (15.4%) 697 (0.4%) 14,422 (8.5%) 65,395 (38.7%) 7,914 (4.7%) 11,608 (6.9%) 0 (0.0%) 88 (0.7%) 19 (0.2%) 1,921 (15.6%) <6 13 (1.2%) 10–20 292 (2.7%) 40 (0.4%) 744 (7.0%) <6 712 (2.5%) 1,766 (6.2%) 2,990 (10.6%) 209 (0.7%) 3,239 (11.5%) 607 (2.1%) 1,033 (3.7%) 3,014 (10.7%) 3,229 (11.4%) <6 159 (3.1%) 295 (5.7%) 449 (8.7%) 15 (0.3%) 305 (5.9%) 54 (1.0%) 175 (3.4%) 285 (5.5%) 473 (9.2%) 24 (0.5%) 1,146 (22.2%) <6 215 (2.4%) 282 (3.1%) 476 (5.3%) 25 (0.3%) 497 (5.5%) 136 (1.5%) 624 (6.9%) 953 (10.6%) 1,722 (19.1%) 70 (0.8%) 572 (6.3%) 1–6 <6 20 (0.4%) 1,346 (26.1%) 293 (5.7%) 126 (2.4%) <6 458 (5.1%) 1,526 (16.9%) 964 (10.7%) 492 (5.5%) <6 2,506 (0.6%) 8,458 (1.9%) 11,921 (2.7%) 1,562 (0.4%) 50,981 (11.7%) 8,949 (2.1%) 7,318 (1.7%) 16,358 (3.8%) 20,810 (4.8%) 9,628 (2.2%) 65,117 (15.0%) 1,861 (0.4%) 59,454 (13.7%) 121,592 (28.0%) 23,696 (5.5%) 24,186 (5.6%) <6 Western Africa East Africa Southern Africa Middle East North Africa Central America South America Caribbean North America East Asia Australasia & Oceania/ Asia unspecified Southeast Asia South Asia Eastern Europe Europe other Not stated 59 (0.2%) 128 (0.4%) <6 37 (0.1%) 24 (0.1%) 67 (0.2%) 252 (0.8%) 267 (0.9%) 16 (0.1%) 576 (1.8%) <6 29,070 (93.0%) 383 (1.2%) 277 (0.9%) 73 (0.2%) 0 (0.0%) 8,203 (66.7%) 133 (1.1%) <6 26 (0.2%) <6 <6 <6 0 (0.0%) 80 (0.7%) 1,800 (14.6%) 11 (0.1%) 10 (0.1%) 0 (0.0%) 67 (6.0%) 0 (0.0%) 936 (83.3%) 20 (1.8%) 0 (0.0%) 10 (0.9%) <6 0 (0.0%) 0 (0.0%) 0 (0.0%) 58 (5.2%) <6 0 (0.0%) 0 (0.0%) 0 (0.0%) 8,030 (75.1%) 160 (1.5%) <6 26 (0.2%) 10 (0.1%) 0 (0.0%) 8 (0.1%) 0 (0.0%) 259 (2.4%) 1,081 (10.1%) 24 (0.2%) 12 (0.1%) 0 (0.0%) 3,296 (11.7%) 0 (0.0%) 96 (0.3%) 4,985 (17.6%) 2,328 (8.2%) 763 (2.7%) <6 <6 15 (9.6%) <6 11 (7.0%) 0 (0.0%) 6 (3.8%) 10 (6.4%) 23 (14.6%) 11 (7.0%) <6 <6 15 (9.6%) 20–30 6 (3.8%) 15 (9.6%) 0 (0.0%) Notes: 1. Includes immigrants who landed between January 1, 2010 and May 31, 2017. 2. Chronic conditions were identified using validated algorithms for ICES data holdings; the latest diagnosis date is March 31, 2019. 3. Some cells are suppressed due to low counts (n < 6) or reported as ranges to protect privacy. _________________________________________________________________________________________________________________________________________________ ICES 71 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Appendix 3.1. Sociodemographic and clinical characteristics of Ontario residents tested for COVID-19, by immigrant status, as of June 13, 2020 Population tested (N=624,386) Variable Number tested for COVID-19 Immigrants Canadian-born and long-term residents Other newcomers to Ontario 111,323 495,304 17,759 3,236 (0.9%) 10,933 (1.0%) 583 (0.7%) 17,604 (1.5%) 565 (0.9%) SOCIODEMOGRAPHIC CHARACTERISTICS Age group, n (%) 0–9 years Second generation Immigrants and refugees 10–19 years 3,120 (0.9%) 116 (0.5%) 4,103 (0.9%) Second generation 2,684 (0.9%) Immigrants and refugees 1,419 (1.0%) 20–29 years 11,066 (4.0%) 70,272 (4.6%) 6,053 (3.7%) 30–39 years 21,807 (4.3%) 69,486 (4.8%) 6,129 (3.4%) 40–49 years 26,439 (4.7%) 67,200 (4.9%) 2,352 (3.6%) 50–59 years 25,805 (4.8%) 85,693 (5.4%) 924 (3.3%) 60–69 years 12,731 (4%) 70,310 (4.8%) 514 (2.3%) 70+ years 6,136 (8.3%) 103,806 (29.1%) 639 (25.5%) Female 69,376 (4.2%) 300,690 (5.3%) 9,266 (3.0%) Male 41,947 (2.6%) 194,614 (3.5%) 8,493 (2.7%) Q1 (lowest) 30,974 (3.9%) 99,853 (5.0%) 5,818 (3.2%) Q2 24,654 (3.6%) 98,883 (4.7%) 4,139 (2.9%) Q3 23,157 (3.4%) 97,909 (4.4%) 3,292 (2.7%) Q4 19,267 (3.1%) 97,325 (4.2%) 2,479 (2.5%) Sex, n (%) Neighbourhood income quintile, n (%) _________________________________________________________________________________________________________________________________________________ ICES 72 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Population tested (N=624,386) Variable Immigrants Canadian-born and long-term residents Other newcomers to Ontario 12,938 (2.8%) 99,484 (4.0%) 1,918 (2.4%) 333 (3.2%) 1,850 (4.8%) 113 (2.9%) Q1 (lowest) 3,140 (3.9%) 104,791 (5.0%) 951 (3.8%) Q2 5,752 (3.7%) 104,056 (4.8%) 1,442 (3.7%) Q3 11,176 (3.6%) 98,607 (4.4%) 2,174 (3.1%) Q4 25,102 (3.5%) 95,772 (4.1%) 3,822 (2.7%) Q5 (highest) 65,736 (3.3%) 84,978 (3.9%) 9,207 (2.7%) 417 (3.4%) 7,100 (5.3%) 163 (3.2%) Q1 (lowest) 27,335 (2.9%) 81,848 (3.6%) 2,982 (2.4%) Q2 17,369 (3.3%) 92,141 (4.2%) 2,120 (2.7%) Q3 15,946 (3.5%) 94,821 (4.4%) 2,318 (2.8%) Q4 18,478 (4.0%) 99,731 (4.8%) 2,930 (3.3%) Q5 (highest) 31,778 (3.8%) 119,663 (5.2%) 7,246 (2.9%) 417 (3.4%) 7,100 (5.3%) 163 (3.2%) Q1 (lowest) 15,399 (3.7%) 114,393 (5.4%) 4,494 (2.9%) Q2 12,235 (3.8%) 103,526 (4.8%) 2,497 (3.1%) Q3 10,394 (3.9%) 75,165 (4.5%) 1,799 (3.1%) Q4 25,972 (3.7%) 113,683 (4.1%) 3,476 (3.0%) Q5 (highest) 46,906 (3.1%) 84,940 (3.6%) 5,322 (2.5%) 417 (3.3%) 3,597 (5.2%0 171 (3.2%) Q5 (highest) Missing Ethnic concentration quintile, n (%) Missing Residential instability quintile, n (%) Missing Number of persons per dwelling quintile, n (%) Missing Public health unit of residence, n (%) _________________________________________________________________________________________________________________________________________________ ICES 73 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Population tested (N=624,386) Variable Immigrants Canadian-born and long-term residents Other newcomers to Ontario Algoma Public Health 94 (3.9%) 5,798 (5.0%) 37 (3.5%) Brant County Health Unit 430 (3.8%) 7,257 (4.9%) 57 (2.8%) 4,553 (3.2%) 19,330 (3.4%) 330 (2.3%) Grey Bruce Health Unit 171 (2.9%) 5,267 (3.2%) 44 (3.0%) Haldimand-Norfolk Health Unit 133 (3.2%) 4,679 (4.3%) 33 (4.0%) 275 (5%) 11,552 (6.2%) 44 (4.0%) Halton Region Health Department 3,707 (2.5%) 14,673 (3.3%) 464 (1.7%) City of Hamilton – Public Health & Social Services 3,922 (4.0%) 19,376 (4.1%) 506 (3.0%) Hastings and Prince Edward Counties Health Unit 225 (4.2%) 8,208 (4.9%) 83 (3.6%) Huron Perth Health Unit 166 (3.2%) 5,544 (4%) 65 (3.7%) Chatham-Kent Health Unit 114 (3.1%) 3,762 (3.6%) 76 (6.0%) Kingston, Frontenac and Lennox & Addington Health Unit 357 (3.4%) 8,393 (4.4%) 145 (2.9%) Lambton Health Unit 162 (3.5%) 6,368 (5.0%) 65 (3.2%) Leeds, Grenville and Lanark District Health Unit 197 (4.6%) 9,097 (5.2%) 74 (3.6%) Middlesex-London Health Unit 2,342 (3.3%) 16,817 (4.1%) 606 (3.1%) Niagara Region Public Health Department 1,628 (3.9%) 19,762 (4.5%) 304 (3.2%) North Bay Parry Sound District Health Unit 90 (3.3%) 6,084 (4.7%) 45 (4.2%) Northwestern Health Unit 119 (7.7%) 5,047 (5.8%) 78 (4.6%) Ottawa Public Health 6,565 (3.6%) 37,453 (4.5%) 1,704 (3.0%) Peel Public Health Durham Region Health Department Haliburton, Kawartha, Pine Ridge District Health Unit 22,301 (3.3%) 32,276 (4%) 2,909 (2.5%) Peterborough County-City Health Unit 336 (5.6%) 11,926 (8.4%) 82 (4.7%) Porcupine Health Unit 103 (8.0%) 4,537 (5.3%) 33 (4.3%) Renfrew County and District Health Unit 116 (4.4%) 6,467 (6.3%) 74 (3.8%) Eastern Ontario Health Unit 206 (4.0%) 11,438 (5.4%) 218 (4.3%) 1,938 (3.8%) 23,293 (4.3%) 277 (3.3%) 253 (5.2%) 12,658 (6.4%) 131 (4.4%) Simcoe Muskoka District Health Unit Sudbury and District Health Unit _________________________________________________________________________________________________________________________________________________ ICES 74 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Population tested (N=624,386) Variable Immigrants Canadian-born and long-term residents Other newcomers to Ontario Thunder Bay District Health Unit 285 (6.7%) 10,278 (6.7%) 170 (7.1%) Timiskaming Health Unit 34 (7.6%) 1,988 (5.9%) 11 (3.7%) Region of Waterloo Public Health 2,861 (2.7%) 16,009 (3.5%) 687 (2.5%) Wellington-Dufferin-Guelph Health Unit 1,600 (4.4%) 14,696 (5.4%) 252 (3.4%) Windsor-Essex County Health Unit 2,031 (2.9%) 18,972 (5.2%) 623 (3.6%) York Region Public Health Services 12,208 (2.7%) 28,374 (3.8%) 1,091 (2.1%) Southwestern Health Unit 352 (3.1%) 8,597 (4.2%) 75 (3.3%) 41,122 (3.9%) 77,713 (4.4%) 6,254 (3%) 327 (3.2%) 1,615 (4.9%) 112 (2.9%) 14,881 (3.9%) 144,678 (6.0%) Chronic kidney disease (incl. chronic dialysis) 4,370 (8.8%) 28,766 (11.8%) Diabetes 16,030 (4.9%) 73,255 (6.8%) Cardiovascular (CHF, TIA/stroke, cardiac ischemic disease, hypertension) 28,279 (5.1%) 164,936 (6.5%) Immunocompromised 1,826 (8.6%) 10,098 (10.1%) Inflammatory (IBD, rheumatoid arthritis) 1,200 (5.7%) 11,618 (7.4%) Liver disease 1,069 (6.7%) 7,348 (9.7%) Toronto Public Health Unknown/missing CLINICAL CHARACTERISTICS Chronic conditions, n (%) Respiratory (asthma, COPD) Recency of immigration, n (%) Recent (0 to ≤ 5 years) 4,293 (3.0%) Intermediate (> 5 to ≤ 10 years) 15,768 (3.7%) Long-term residents (> 10 years) 85,457 (4.2%) Second-generation children and youth 5,805 (0.9%) Immigrant class, n (%) Sponsored family member 39,591 (3.2%) Economic immigrant, caregiver 8,799 (10.3%) _________________________________________________________________________________________________________________________________________________ ICES 75 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Population tested (N=624,386) Variable Immigrants Economic immigrant, other 42,148 (3.1%) Privately sponsored refugee 4,700 (3.7%) Blended visa office–referred refugee Other newcomers to Ontario 56 (1.7%) Government-assisted refugee 3,833 (3.4%) Protected person/Refugee (asylum seeker) 7,978 (4.1%) Refugee dependent 2,275 (3.4%) Humanitarian and compassionate/Public policy case 1,732 (4.2%) Other immigrant Canadian-born and long-term residents 211 (3.2%) World subregion of origin, n (%) Central Africa 673 (4.4%) Western Africa 3,354 (5.9%) East Africa 4,582 (4.3%) Southern Africa 549 (3.6%) Middle East 7,897 (2.6%) North Africa 1,507 (2.6%) Central America 2,540 (3.8%) South America 6,707 (4.3%) Caribbean 10,994 (5.7%) North America 1,905 (2.7%) East Asia 7,866 (1.6%) Australasia & Oceania/Asia unspecified 286 (3.0%) Southeast Asia 22,300 (6.5%) South Asia 23,443 (2.8%) Eastern Europe 9,451 (3.2%) Europe other 7,267 (3.2%) Not stated <6 Notes: 1. Denominator excludes long-term care residents. 2. Includes children born in Ontario to immigrant mothers (second generation). 3. Chronic conditions have not been reported for newcomers due to an insufficient 2-year look-back period. 4. Chronic conditions were identified using validated algorithms for ICES data holdings; the latest diagnosis date is March 31, 2019. 5. Results are shown in row percentages. 6. Some cells are suppressed due to low counts (n < 6) or reported as ranges to protect privacy. _________________________________________________________________________________________________________________________________________________ ICES 76 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Appendix 4.1 Sociodemographic and clinical characteristics of individuals who tested positive for COVID-19 and per capita in Ontario, by immigrant status, as of June 13, 2020 Variable Immigrants and refugees Canadian-born and long-term residents Other newcomers to Ontario Number 9,066 13,939 1,655 Number tested positive % Positive in those tested % Positive per capita Number tested positive % Positive in those tested % Positive per capita Number tested positive % Positive in those tested % Positive per capita 171 5.3% 0.0% 196 1.8% 0.0% 37 6.3% 0.0% Second generation 161 5.2% 0.0% Immigrant and refugees 10 8.6% 0.0% 414 2.4% 0.0% 77 13.6% 0.1% SOCIODEMOGRAPHIC CHARACTERISTICS Age group, n (%) 0–9 years 10–19 years 380 9.3% 0.1% Second generation 229 8.5% 0.1% Immigrant and refugees 151 10.6% 0.1% 20–29 years 835 7.5% 0.3% 2386 3.4% 0.2% 581 9.6% 0.4% 30–39 years 1525 7.0% 0.3% 1833 2.6% 0.1% 535 8.7% 0.3% 40–49 years 2,125 8.0% 0.4% 1887 2.8% 0.1% 249 10.6% 0.4% 50–59 years 2,364 9.2% 0.4% 2512 2.9% 0.2% 101 10.9% 0.4% 60–69 years 1,184 9.3% 0.4% 1932 2.7% 0.1% 42 8.2% 0.2% 482 21.3% 0.6% 2779 8.4% 0.8% 33 14.0% 0.9% Female 5,063 7.3% 0.3% 7,573 2.5% 0.1% 597 6.4% 0.2% Male 4,003 9.5% 0.3% 6,366 3.3% 0.1% 1,058 12.5% 0.3% Q1 (lowest) 3,199 10.3% 0.4% 3,027 3.0% 0.2% 662 11.4% 0.4% Q2 2,117 8.6% 0.3% 2,683 2.7% 0.1% 350 8.5% 0.2% 70+ years Sex, n (%) Neighbourhood income quintile, n (%) _________________________________________________________________________________________________________________________________________________ ICES 77 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Variable Immigrants and refugees Canadian-born and long-term residents Other newcomers to Ontario Number 9,066 13,939 1,655 Number tested positive % Positive in those tested % Positive per capita Number tested positive % Positive in those tested % Positive per capita Number tested positive % Positive in those tested % Positive per capita Q3 1,788 7.7% 0.3% 2,922 3.0% 0.1% 290 8.8% 0.2% Q4 1,273 6.6% 0.2% 2,603 2.7% 0.1% 188 7.6% 0.2% Q5 (highest) 669 5.2% 0.1% 2,646 2.7% 0.1% 149 7.8% 0.2% Missing 20 6.0% 0.2% 58 3.1% 0.2% 16 14.2% 0.4% Q1 (lowest) 101 3.2% 0.1% 1,595 1.5% 0.1% 68 7.2% 0.3% Q2 243 4.2% 0.2% 1,970 1.9% 0.1% 127 8.8% 0.3% Q3 669 6.0% 0.2% 2,511 2.5% 0.1% 155 7.1% 0.2% Q4 1,724 6.9% 0.2% 3,066 3.2% 0.1% 274 7.2% 0.2% Q5 (highest) 6,304 9.6% 0.3% 4,648 5.5% 0.2% 1,013 11.0% 0.3% 25 6.0% 0.2% 149 2.1% 0.1% 18 11.0% 0.4% Q1 (lowest) 2,244 8.20% 0.20% 3,025 3.70% 0.10% 287 9.6% 0.20% Q2 1,217 7.00% 0.20% 2,488 2.70% 0.10% 225 10.6% 0.30% Q3 1,215 7.60% 0.30% 2,302 2.40% 0.10% 246 10.6% 0.30% Q4 1,705 9.20% 0.40% 2,544 2.60% 0.10% 302 10.3% 0.30% Q5 (highest) 2,660 8.40% 0.30% 3,431 2.90% 0.10% 577 8.0% 0.20% Missing 25 6.00% 0.20% 149 2.10% 0.10% 18 11.0% 0.40% Number of persons per dwelling quintile, n (%) Q1 (lowest) 962 6.20% 0.20% 2,520 2.20% 0.10% 208 4.6% 0.10% Q2 862 7.00% 0.30% 2,017 1.90% 0.10% 230 9.2% 0.30% Q3 775 7.50% 0.30% 1,703 2.30% 0.10% 201 11.2% 0.30% Ethnic concentration quintile, n (%) Missing Residential instability quintile, n (%) _________________________________________________________________________________________________________________________________________________ ICES 78 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Variable Immigrants and refugees Canadian-born and long-term residents Other newcomers to Ontario Number 9,066 13,939 1,655 Number tested positive % Positive in those tested % Positive per capita Number tested positive % Positive in those tested % Positive per capita Number tested positive % Positive in those tested % Positive per capita Q4 2,168 8.30% 0.30% 3,539 3.10% 0.10% 414 11.9% 0.40% Q5 (highest) 4,275 9.10% 0.30% 4,036 4.80% 0.20% 586 11.0% 0.30% 24 5.80% 0.20% 124 3.40% 0.20% 16 9.4% 0.35 23 0.4% 0.0% <6 12.7% 0.3% 24.2% 1.0% Missing Public health unit of residence, n (%) Algoma Public Health <6 Brant County Health Unit 17 4.0% 0.2% 156 2.1% 0.1% <6 Durham Region Health Department 456 10.0% 0.3% 757 3.9% 0.1% 42 10 7 5.8% 5.3% 0.2% 0.2% 64 1.2% 0.0% <6 163 3.5% 0.1% 8 147 1.3% 0.1% <6 Grey Bruce Health Unit Haldimand-Norfolk Health Unit Haliburton, Kawartha, Pine Ridge District Health Unit <6 Halton Region Health Department 178 4.8% 0.1% 497 3.4% 0.1% 24 5.2% 0.1% City of Hamilton – Public Health & Social Services Hastings and Prince Edward Counties Health Unit 176 4.5% 0.2% 503 2.6% 0.1% 25 4.9% 0.1% 8 3.6% 0.1% 40 0.5% 0.0% <6 6 3.6% 0.1% 47 0.8% 0.0% <6 47.4% 2.9% 10.8% 0.3% Huron Perth Health Unit Chatham-Kent Health Unit <6 99 2.6% 0.1% 36 Kingston, Frontenac and Lennox & Addington Health Unit <6 75 0.9% 0.0% <6 230 3.6% 0.2% 7 225 2.5% 0.1% <6 Lambton Health Unit 6 3.7% 0.1% Leeds, Grenville and Lanark District Health Unit Middlesex-London Health Unit <6 86 3.7% 0.1% 364 2.2% 0.1% 25 4.1% 0.1% Niagara Region Public Health Department North Bay Parry Sound District Health Unit 61 3.7% 0.1% 514 2.6% 0.1% 21 6.9% 0.2% 0 0.0% 0.0% 38 0.6% 0.0% 0 0.0% 0.0% _________________________________________________________________________________________________________________________________________________ ICES 79 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Variable Immigrants and refugees Canadian-born and long-term residents Other newcomers to Ontario Number 9,066 13,939 1,655 Number tested positive % Positive in those tested % Positive per capita Number tested positive % Positive in those tested % Positive per capita Number tested positive % Positive in those tested % Positive per capita 0 0.0% 0.0% 22 0.4% 0.0% 0 0.0% 0.0% 444 6.8% 0.2% 840 2.2% 0.1% 115 6.7% 0.2% 2,057 9.2% 0.3% 1,745 5.4% 0.2% 276 9.5% 0.2% Peterborough County-City Health Unit 6 1.8% 0.1% 107 0.9% 0.1% <6 Porcupine Health Unit 0 0.0% 0.0% 69 1.5% 0.1% 0 0.0% 0.0% 24 0.4% 0.0% <6 119 1.0% 0.1% <6 347 1.5% 0.1% 16 5.8% 0.2% 56 0.4% 0.0% <6 82 0.8% 0.1% 0 0.0% 0.0% Northwestern Health Unit Ottawa Public Health Peel Public Health Renfrew County and District Health Unit <6 Eastern Ontario Health Unit <6 Simcoe Muskoka District Health Unit 105 Sudbury and District Health Unit <6 Thunder Bay District Health Unit 10 3.5% 0.2% Timiskaming Health Unit 5.4% 0.2% 0 0.0% 0.0% 12 0.6% 0.0% 0 0.0% 0.0% Region of Waterloo Public Health 263 9.2% 0.3% 555 3.5% 0.1% 97 14.1% 0.4% Wellington-Dufferin-Guelph Health Unit 69 4.3% 0.2% 300 2.0% 0.1% 14 5.6% 0.2% Windsor-Essex County Health Unit 173 8.5% 0.2% 549 2.9% 0.2% 166 26.6% 1.0% York Region Public Health Services 853 7.0% 0.2% 1,259 4.4% 0.2% 107 9.8% 0.2% 7 2.0% 0.1% 86 1.0% 0.0% 7 9.3% 0.3% 4,027 9.8% 0.4% 3,778 4.9% 0.2% 635 10.2% 0.3% 19 5.8% 0.2% 47 2.9% 0.1% 16 14.3% 0.4% 1,140 7.7% 0.3% 3,597 2.5% 0.2% 302 6.9% 0.6% 786 2.7% 0.3% 1,579 9.9% 0.5% 2,350 3.2% 0.2% 2,621 9.3% 0.5% 4,670 2.8% 0.2% Southwestern Health Unit Toronto Public Health Unknown/missing CLINICAL CHARACTERISTICS Chronic conditions, n (%) Respiratory (asthma, COPD) Chronic kidney disease (incl. chronic dialysis) Diabetes Cardiovascular (CHF, TIA/stroke, Ischemic cardiac disease, hypertension) _________________________________________________________________________________________________________________________________________________ ICES 80 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Variable Immigrants and refugees Canadian-born and long-term residents Other newcomers to Ontario Number 9,066 13,939 1,655 Number tested positive % Positive in those tested % Positive per capita Number tested positive % Positive in those tested % Positive per capita Immunocompromised 85 4.7% 0.4% 224 2.2% 0.2% Inflammatory (IBD, rheumatoid arthritis) 78 6.5% 0.4% 241 2.1% 0.2% Liver disease 57 5.3% 0.4% 161 2.2% 0.2% 454 10.6% 0.3% Intermediate (>5 to ≤10 years) 1,445 9.2% 0.3% Long-term residents (>10 years) 6,776 7.9% 0.3% 391 6.7% 0.1% 3,479 8.8% 0.3% 744 8.5% 0.9% Economic immigrant, other 2,672 6.3% 0.2% Privately sponsored refugee 525 11.2% 0.4% Blended visa office– referred refugee <6 Government-assisted refugee 439 11.5% 0.4% Protected person/Refugee (asylum seeker) Refugee dependent 804 10.1% 0.4% 226 9.9% 0.3% Humanitarian and compassionate/Public policy case 157 9.1% 0.4% 10–20 7.6% 0.2% Central Africa 65 9.7% 0.4% Western Africa 366 10.9% 0.6% Number tested positive % Positive in those tested % Positive per capita Recency of immigration, n (%) Recent (≤5 years) Second generation children and youth Immigrant class, n (%) Sponsored family member Economic immigrant, caregiver Other immigrant World subregion of origin, n (%) _________________________________________________________________________________________________________________________________________________ ICES 81 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Variable Immigrants and refugees Canadian-born and long-term residents Other newcomers to Ontario Number 9,066 13,939 1,655 Number tested positive % Positive in those tested % Positive per capita East Africa 511 11.2% 0.5% Southern Africa 25 4.6% 0.2% Middle East 635 8.0% 0.2% North Africa 84 5.6% 0.1% Central America 250 9.8% 0.4% South America 583 8.7% 0.4% Caribbean 1,220 11.1% 0.6% North America 72 3.8% 0.1% East Asia 302 3.8% 0.1% Australasia & Oceania/Asia unspecified 12 4.2% 0.1% Southeast Asia 1,946 8.7% 0.6% South Asia 2,205 9.4% 0.3% Eastern Europe 456 4.8% 0.2% Europe other 334 4.6% 0.1% 0 0.0% 0.0% Not stated Number tested positive % Positive in those tested % Positive per capita Number tested positive % Positive in those tested % Positive per capita Notes: 1. Denominator excludes long-term care residents. 2. Includes children born in Ontario to immigrant mothers (second generation). 3. Chronic conditions have not been reported for newcomers due to an insufficient 2-year look-back period. 4. Chronic conditions were identified using validated algorithms for ICES data holdings; the latest diagnosis date is March 31, 2019. 5. Results are shown in row percentages. 6. Some cells are suppressed due to low counts (n < 6) or reported as ranges to protect privacy. _________________________________________________________________________________________________________________________________________________ ICES 82 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Appendix 4.2 COVID-19 testing and positivity among immigrants and refugees, Canadian-born and long-term residents, and newcomers in Ontario, by age group and sex, as of June 13, 2020 Females Immigrants and refugees % Tested Number tested positive Canadian-born and long-term residents Variable Total population Number tested % Positive in those tested Number 1,658,805 69,376 Age group, n (%) < 10 y 184,533 1,450 0.8% 90 6.2% 10–19 210,726 2,087 1.0% 193 20–29 136,885 6,464 4.7% 30–39 271,446 13,565 40–49 300,156 50–59 266,553 60–69 70+ % Positive per capita Total population Number tested Total population Number tested 5,637,060 300,690 308,057 9,266 0.0% 523,684 5,118 1.0% 87 1.7% 0.0% 41,835 263 0.6% 9.2% 0.1% 559,185 10,456 1.9% 217 2.1% 0.0% 30,634 275 432 6.7% 0.2% 745,134 45,079 6.0% 1,409 3.1% 0.2% 84,188 5.0% 865 6.4% 0.2% 714,135 43,485 6.1% 945 2.2% 0.1% 18,132 6.0% 1,262 7.0% 0.3% 685,110 16,959 6.4% 1,364 8.0% 0.3% 808,770 43,829 6.4% 1,038 2.4% 54,458 6.7% 1,394 2.6% 156,980 7,394 4.7% 602 8.1% 0.2% 760,710 40,008 5.3% 961 131,526 3325 2.5% 255 7.7% 0.2% 840,332 58,257 6.9% 1522 % Positive in those tested % Positive per capita Total population Number tested 5,529,695 194,614 5,063 % Tested Number tested positive % Positive in those tested Other newcomers to Ontario % Positive per capita % Positive in those tested % Positive per capita 17 6.5% 0.0% 0.9% 27 9.8% 0.1% 3,325 3.9% 201 6.0% 0.2% 87,057 3,130 3.6% 192 6.1% 0.2% 0.2% 29,506 1,172 4.0% 83 7.1% 0.3% 0.2% 12,941 472 3.6% 40 8.5% 0.3% 2.4% 0.1% 12,358 263 2.1% 21 8.0% 0.2% 2.6% 0.2% 9538 366 3.8% 16 4.4% 0.2% % Positive per capita Total population Number tested % Positive in those tested % Positive per capita 317,614 8,493 7,573 % Tested Number tested positive 597 Males Immigrants and refugees Variable Total population Number tested Number % tested Number tested positive Canadian-born and long-term residents 4,003 % tested Number tested positive % Positive in those tested Other newcomers to Ontario 6,366 % tested Number tested positive 1,586,834 41,947 Age group, n (%) < 10 y 1,058 194,168 1,786 0.9% 81 4.5% 0.0% 550,748 5,815 1.1% 109 1.9% 0.0% 44,305 320 0.7% 20 6.3% 0.0% 10–19 224,119 2,016 0.9% 187 9.3% 0.1% 586,991 7,148 1.2% 197 2.8% 0.0% 32,564 290 0.9% 50 17.2% 0.2% 20–29 140,894 4,602 3.3% 403 8.8% 0.3% 778,876 25,193 3.2% 977 3.9% 0.1% 80,507 2,728 3.4% 380 13.9% 0.5% 30–39 238,921 8,242 3.4% 660 8.0% 0.3% 721,323 26,001 3.6% 888 3.4% 0.1% 92,323 2,999 3.2% 343 11.4% 0.4% _________________________________________________________________________________________________________________________________________________ ICES 83 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Males Immigrants and refugees Variable Total population Number tested Number % tested Number tested positive Canadian-born and long-term residents % Positive in those tested % Positive per capita 4,003 Total population Number tested % tested Number tested positive Other newcomers to Ontario % Positive in those tested % Positive per capita 6,366 Total population Number tested % tested Number tested positive % Positive in those tested % Positive per capita 1,586,834 41,947 5,529,695 194,614 317,614 8,493 40–49 257,171 8,307 3.2% 863 10.4% 0.3% 681,193 23,371 3.4% 849 3.6% 0.1% 35,573 1,180 3.3% 1,058 166 14.1% 0.5% 50–59 268,223 8,846 3.3% 1,000 11.3% 0.4% 791,748 31,235 3.9% 1,118 3.6% 0.1% 14,655 452 3.1% 61 13.5% 0.4% 60–69 161,407 5,337 3.3% 582 10.9% 0.4% 711,002 30,302 4.3% 971 3.2% 0.1% 9,959 251 2.5% 21 8.4% 0.2% 70+ 101,931 2,811 2.8% 227 8.1% 0.2% 707,814 45,549 6.4% 1,257 2.8% 0.2% 7,728 273 3.5% 17 6.2% 0.2% Notes: 1. Denominator excludes long-term care residents. 2. Includes children born in Ontario to immigrant mothers (second generation). 3. Results are shown in row percentages. _________________________________________________________________________________________________________________________________________________ ICES 84 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Appendix 4.3 COVID-19 testing and positivity among first- and second-generation immigrant and refugee children and youth younger than 19 years in Ontario, by recency of immigration, as of June 13, 2020 First-Generation Immigrant and Refugee Children and Youth All refugees Total population Number tested % tested All 36,915 421 Recent (≤ 10 years) Not recent (> 10 years) 28,157 273 8,758 148 Sponsored family members Number tested positive % Positive in those tested Total population Number tested % tested 1.1% 69 16.4% 24,987 254 1.0% 50–60 14,404 138 1.7% 10–20 10,583 116 All other Total Number tested positive % Positive in those tested Total population Number tested % tested Number tested positive % Positive in those tested Total population Number tested % tested Number tested positive % Positive in those tested 1.0% 19 7.5% 99,173 861 0.9% 1.0% 10–20 58,859 489 0.8% 73 8.5% 161,075 1,536 1.0% 161 10.5% 53 10.8% 101,420 900 0.9% 118 13.1% 1.1% <6 40,314 372 0.9% 20 5.4% 59,655 636 1.1% 43 6.8% Second-Generation Immigrant and Refugee Children and Youth All refugees Total population Number tested % tested All 95,890 958 Recent (≤ 10 years) Not recent (> 10 years) 13,919 160 81,971 798 Economic immigrant, caregiver Number tested positive % Positive in those tested Total population Number tested % tested 1.0% 82 8.6% 22,705 238 1.1% 10–20 2,861 39 1.0% 70–80 19,844 199 All other Sponsored family member Number tested positive % Positive in those tested Total population Number tested % tested Number tested positive % Positive in those tested 1.0% 17 7.1% 337,065 2,986 0.9% 225 7.5% 1.4% <6 53,971 508 0.9% 15 3.0% 1.0% 10–20 283,094 2,478 0.9% 210 8.5% Total Total population Number tested % tested Number tested positive % Positive in those tested Total population Number tested % tested Number tested positive % Positive in those tested All 196,812 1,622 0.8% 66 4.1% 652,472 5,804 0.9% 390 6.7% Recent (≤ 10 years) Not recent (> 10 years) 31,585 292 0.9% 9 3.1% 102,336 999 1.0% 37 3.7% 165,227 1,330 0.8% 57 4.3% 550,136 4,805 0.9% 353 7.3% Notes: 1. Second-generation children and youth include those born in Ontario to immigrant and refugee mothers. 2. Results are shown in row percentages. 3. Some cells are suppressed due to low counts (n < 6) or reported as ranges to protect privacy. _________________________________________________________________________________________________________________________________________________ ICES 85 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Appendix 5.1 COVID-19 testing and positivity among recent immigrants and refugees landed in Ontario in the last 10 years, by sociodemographic characteristics, as of June 13, 2020 Recent Immigrants and Refugees Variable Number Canadian language ability, n (%) Bilingual Number tested % Tested 19,951 Number tested positive % Positive in those tested % Positive per capita 1,805 486 3.7% 46 9.5% 0.4% 16,339 5.2% 1,409 8.6% 0.4% French 317 6.1% 40 12.6% 0.8% Neither 2,724 2.7% 296 10.9% 0.3% 85 4.8% 14 16.5% 0.8% None 1,875 3.4% 195 10.4% 0.4% Secondary or less 3,400 3.7% 444 13.1% 0.5% English Not stated Highest education level (aged 25 and older), n (%) Some university – no degree 967 5.7% 102 10.5% 0.6% Trade/diploma 3,651 6.4% 366 10.0% 0.6% Bachelor's degree or higher 9,623 4.8% 673 7.0% 0.3% 435 2.9% 25 5.7% 0.2% Sponsored family member 5,377 3.2% 500 9.3% 0.3% Economic immigrant, caregiver 4,595 14.7% 409 8.9% 1.3% Economic immigrant, other 6,502 3.9% 436 6.7% 0.3% Privately sponsored refugee 490 4.0% 95 19.4% 0.8% Blended visa office–referred refugee 37 3.3% <6 Not stated Immigrant category, n (%) Government-assisted refugee Protected person/Refugee (asylum seeker) Refugee dependent 361 3.4% 67 18.6% 0.6% 1,759 6.2% 197 11.2% 0.7% 277 5.4% 43 15.5% 0.8% _________________________________________________________________________________________________________________________________________________ ICES 86 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Recent Immigrants and Refugees Variable Number tested % Tested Number tested positive % Positive in those tested % Positive per capita 19,951 546 6.1% 1,805 55 10.1% 0.6% 7 4.5% <6 Central Africa 175 7.0% 12 6.9% 0.5% Western Africa 730 8.6% 81 11.1% 1.0% East Africa 698 5.9% 97 13.9% 0.8% Southern Africa 68 4.4% <6 Middle East 1,545 3.0% 147 9.5% 0.3% North Africa 248 2.8% 14 5.6% 0.2% Central America 302 4.1% 35 11.6% 0.5% South America 836 5.1% 72 8.6% 0.4% 1,461 7.0% 186 12.7% 0.9% North America 363 3.8% 15 4.1% 0.2% East Asia 990 1.5% 43 4.3% 0.1% Australasia & Oceania/Asia unspecified 40–50 2.5% <6 Southeast Asia 6,551 11.0% 616 9.4% 1.0% South Asia 4,433 3.6% 397 9.0% 0.3% Eastern Europe 723 3.1% 50 6.9% 0.2% Europe other 781 3.2% 35 4.5% 0.1% Not stated <6 0 0.0% 0.0% Number Humanitarian & compassionate/Public policy case Other immigrant World subregion of origin, n (%) Caribbean Notes: 1. Denominator excludes long-term care residents. 2. Includes children born in Ontario to immigrant mothers (second generation). 3. Some cells are suppressed due to low counts (n < 6) or reported as ranges to protect privacy. _________________________________________________________________________________________________________________________________________________ ICES 87 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Appendix 6.1 Top 20 countries of birth of immigrants and refugees tested and confirmed positive for COVID-19 in Ontario, as of June 13, 2020 All Immigrants and Refugees Tested Positive % Positive in those tested % Positive per capita 201 14.2% 0.5% 119 8.6% 0.2% 192 3.8% 0.1% 84 6.5% 0.3% 111 12.1% 0.5% 128 9.9% 0.5% 6.1% 134 10.1% 0.6% 2,789 4.7% 300 10.8% 0.5% 770 8.0% 111 14.4% 1.2% 420,902 12,077 2.9% 1,064 8.8% 0.3% Iran 96,846 3,017 3.1% 169 5.6% 0.2% Iraq 57,451 1,703 3.0% 265 15.6% 0.5% Jamaica 96,229 6,358 6.6% 779 12.3% 0.8% Nigeria 28,246 1,709 6.1% 208 12.2% 0.7% Pakistan 194,801 4,190 2.2% 383 9.1% 0.2% Philippines 257,950 20,269 7.9% 1,774 8.8% 0.7% Poland 78,662 2,893 3.7% 133 4.6% 0.2% Somalia 31,445 1,082 3.4% 207 19.1% 0.7% Sri Lanka 130,230 3,778 2.9% 385 10.2% 0.3% Trinidad and Tobago 37,965 1,536 4.0% 108 7.0% 0.3% 1,220,943 36,506 3.0% 2,211 6.1% 0.2% Value Population Number tested All countries 3,245,639 111,323 Afghanistan 44,605 1,419 3.2% Bangladesh 47,708 1,383 2.9% China 333,501 5,010 1.5% Colombia 31,885 1,300 4.1% El Salvador 21,331 917 4.3% Ethiopia 24,854 1,295 5.2% Ghana 21,555 1,322 Guyana 58,878 Haiti 9,652 India All other countries % tested Number tested positive 9,066 Notes: 1. Denominator excludes long-term care residents. 2. Includes children born in Ontario to immigrant mothers (second generation). 3. The top 20 countries included those with the highest counts of positive cases, among which the top 10 are presented for % tested, % positive among those tested and % positive per capita. _________________________________________________________________________________________________________________________________________________ ICES 88 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Appendix 6.2 Top 20 countries of birth of female immigrants and refugees tested and confirmed positive for COVID-19 in Ontario, as of June 13, 2020 Female Immigrants and Refugees Value Tested Positive Total Number Number tested % Tested All countries 1,658,805 69,376 Afghanistan 21,999 715 3.3% Bangladesh 23,723 728 China 176,368 El Salvador 10,200 Ethiopia Ghana Number tested positive % Positive in those tested % Positive per capita 97 13.6% 0.4% 3.1% 52 7.1% 0.2% 3,296 1.9% 114 3.5% 0.1% 529 5.2% 50 9.5% 0.5% 12,690 877 6.9% 77 8.8% 0.6% 10,427 914 8.8% 81 8.9% 0.8% 5,063 Grenada 4,370 410 9.4% 45 11.0% 1.0% Guyana 30,998 1,823 5.9% 180 9.9% 0.6% Haiti 5,070 546 10.8% 73 13.4% 1.4% India 205,957 6,762 3.3% 544 8.0% 0.3% Iran 47,498 1,678 3.5% 80 4.8% 0.2% Iraq 28,518 813 2.9% 112 13.8% 0.4% Jamaica 48,850 4,738 9.7% 512 10.8% 1.0% Nigeria 13,692 1,090 8.0% 98 9.0% 0.7% Pakistan 95,270 2,063 2.2% 164 7.9% 0.2% Philippines 147,398 14,584 9.9% 1,111 7.6% 0.8% Poland 40,776 1,943 4.8% 78 4.0% 0.2% Somalia 16,727 660 3.9% 125 18.9% 0.7% Sri Lanka 66,700 1,989 3.0% 189 9.5% 0.3% Trinidad and Tobago 19,617 934 4.8% 64 6.9% 0.3% All other countries 631,957 22,284 3.5% 1217 5.5% 0.2% Notes: 1. Denominator excludes long-term care residents. 2. Includes children born in Ontario to immigrant mothers (second generation). 3. The top 20 countries included those with the highest counts of positive cases, among which the top 10 are presented for % tested, % positive among those tested and % positive per capita. _________________________________________________________________________________________________________________________________________________ ICES 89 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Appendix 6.3 Top 20 countries of birth of male immigrants and refugees tested and confirmed positive for COVID-19 in Ontario, as of June 13, 2020 Male Immigrants and Refugees Value All countries Afghanistan Tested Tested Positive Total Number Number tested % Tested Number tested positive % Positive in those tested % Positive per capita 1,586,834 22,606 41,947 704 3.1% 4,003 104 14.8% 0.5% Bangladesh 23,985 655 2.7% 67 10.2% 0.3% China 157,133 1,714 1.1% 78 4.6% 0.0% El Salvador 11,131 388 3.5% 61 15.7% 0.5% Ethiopia 12,164 418 3.4% 51 12.2% 0.4% Ghana 11,128 408 3.7% 53 13.0% 0.5% Grenada 3,552 105 3.0% 19 18.1% 0.5% Guyana 27,880 966 3.5% 120 12.4% 0.4% Haiti 4,582 224 4.9% 38 17.0% 0.8% India 214,945 5,315 2.5% 520 9.8% 0.2% Iran 49,348 1,339 2.7% 89 6.6% 0.2% Iraq 28,933 890 3.1% 153 17.2% 0.5% Jamaica 47,379 1,620 3.4% 267 16.5% 0.6% Nigeria 14,554 619 4.3% 110 17.8% 0.8% Pakistan 99,531 2,127 2.1% 219 10.3% 0.2% Philippines 110,552 5,685 5.1% 663 11.7% 0.6% Poland 37,886 950 2.5% 55 5.8% 0.1% Somalia 14,718 422 2.9% 82 19.4% 0.6% Sri Lanka 63,530 1,789 2.8% 196 11.0% 0.3% Trinidad and Tobago 18,348 602 3.3% 44 7.3% 0.2% All other countries 612,949 15,007 2.4% 1014 6.8% 0.2% Notes: 1. Denominator excludes long-term care residents. 2. Includes children born in Ontario to immigrant mothers (second generation). 3. The top 20 countries includes those with the highest counts of positive cases, among which the top 10 are presented for % tested, % positive among those tested and % positivity per capita. _________________________________________________________________________________________________________________________________________________ ICES 90 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Appendix 7.1 Number and proportion of health care workers among COVID-19 cases in Ontario adults older than 18 years, overall and by sex and immigration category, as of June 13, 2020 Overall Variable Sponsored family members Economic immigrant, other Refugees (all) Other newcomers to Ontario Canadian-born and long-term residents Total 3,171 Economic immigrant, caregiver 710 Number 2,497 1,979 1,524 13,122 23,003 922 (29.1%) 342 (48.2%) 682 (27.3%) 437 (22.1%) 198 (13.0%) 2,823 (21.5%) 5,404 (23.5%) 451 (14.2%) 150 (21.1%) 246 (9.9%) 204 (10.3%) 79 (5.2%) 912 (7.0%) 2,042 (8.9%) 988 (31.2%) 78 (11.0%) 849 (34.0%) 658 (33.2%) 590 (38.7%) 5,108 (38.9%) 8,271 (36.0%) 1,261 (39.8%) 290 (40.8%) 966 (38.7%) 884 (44.7%) 736 (48.3%) 5,191 (39.6%) 9,328 (40.6%) Variable Sponsored family members Economic immigrant, other Refugees (all) Other newcomers to Ontario Canadian-born and long-term residents TOTAL Number 1,857 Economic immigrant, caregiver 596 1,242 1,000 544 7,142 12,381 788 (42.4%) 325 (54.5%) 529 (42.6%) 344 (34.4%) 132 (24.3%) 2,308 (32.3%) 4,426 (35.7%) Health care worker Yes Long-term care worker No Unknown Females Health care worker Yes 400 (21.5%) 145 (24.3%) 205 (16.5%) 170 (17.0%) 61 (11.2%) 792 (11.1%) 1,773 (14.3%) No Long-term care worker 456 (24.6%) 58 (9.7%) 322 (25.9%) 241 (24.1%) 197 (36.2%) 2,368 (33.2%) 3,642 (29.4%) Unknown 613 (33.0%) 213 (35.7%) 391 (31.5%) 415 (41.5%) 215 (39.5%) 2,466 (34.5%) 4,313 (34.8%) Variable Sponsored family members Economic immigrant, other Refugees (all) Other newcomers to Ontario Canadian-born and long-term residents Total Number 1,314 Economic immigrant, caregiver 114 1,255 979 980 5,980 10,622 134 (10.2%) 17 (14.9%) 153 (12.2%) 93 (9.5%) 66 (6.7%) 515 (8.6%) 978 (9.2%) 51 (3.9%) <6 41 (3.3%) 34 (3.5%) 18 (1.8%) 120 (2.0%) 269 (2.5%) No 532 (40.5%) 20 (17.5%) 527 (42.0%) 417 (42.6%) 393 (40.1%) 2,740 (45.8%) 4,629 (43.6%) Unknown 648 (49.3%) 77 (67.5%) 575 (45.8%) 469 (47.9%) 521 (53.2%) 2,725 (45.6%) 5,015 (47.2%) Males Health care worker Yes Long-term care worker Notes: 1. Long-term care workers represent a subset of health care workers. 2. Some cells are suppressed due to low counts (n < 6) to protect privacy. _________________________________________________________________________________________________________________________________________________ ICES 91 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Appendix 7.2 Number and proportion of health care workers among COVID-19 cases in Ontario adults older than 18 years, by world region of birth, as of June 13, 2020 Variable Central Africa Number 55 Western Africa East Africa Southern Africa Middle East North Africa Central America South America Caribbean North America East Asia Southeast Asia South Asia Eastern Europe Europe other 341 453 22 573 77 233 542 1,135 61 284 1,841 1,976 435 317 179 (52.5%) 80 (23.5%) 41 (12.0%) 121 (35.5%) 137 (30.2%) 66 (14.6%) 106 (23.4%) 210 (46.4%) 7 (31.8%) 1–6 68 (11.9%) 13 (2.3%) 222 (38.7%) 283 (49.4%) 19 (24.7%) 10 (13.0%) 28 (36.4%) 30 (39.0%) 36 (15.5%) 19 (8.2%) 90 (38.6%) 107 (45.9%) 103 (19.0%) 46 (8.5%) 172 (31.7%) 267 (49.3%) 497 (43.8%) 289 (25.5%) 226 (19.9%) 412 (36.3%) 12 (19.7%) 1–6 57 (20.1%) 17 (6.0%) 103 (36.3%) 124 (43.7%) 685 (37.2%) 284 (15.4%) 362 (19.7%) 794 (43.1%) 375 (19.0%) 143 (7.2%) 889 (45.0%) 712 (36.0%) 103 (23.7%) 32 (7.4%) 161 (37.0%) 171 (39.3%) 79 (24.9%) 32 (10.1%) 120 (37.9%) 118 (37.2%) Health care worker Yes Long-term care worker No Unknown 23 (41.8%) 14 (25.5%) 15 (27.3%) 17 (30.9%) 8 (36.4%) 7 (31.8%) 23 (37.7%) 26 (42.6%) Notes: 1. Long-term care workers represent a subset of health care workers. 2. Some cells are suppressed due to low counts (n < 6) or reported as ranges to protect privacy. _________________________________________________________________________________________________________________________________________________ ICES 92 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Appendix 7.3 Countries of birth with the 10 highest proportions of health care workers among COVID-19 cases in Ontario adults older than 18 years (ranked from the 20 countries with the highest counts of positive COVID19 cases), as of June 13, 2020 Overall Variable Afghanistan China Guyana India Iraq Jamaica Nigeria Pakistan Philippines Sri Lanka Other Total Number 176 177 283 959 238 725 192 340 1,686 349 3,232 8,357 15 (8.5%) 39 (22.0%) 68 (24.0%) 230 (24.0%) 17 (7.1%) 328 (45.2%) 110 (57.3%) 35 (10.3%) 673 (39.9%) 63 (18.1%) 805 (24.9%) 2,383 (28.5%) 1–6 12 (6.8%) 37 (13.1%) 89 (9.3%) 1–6 186 (25.7%) 41 (21.4%) 7 (2.1%) 280 (16.6%) 29 (8.3%) 364 (11.3%) 1,051 (12.6%) No 70 (39.8%) 62 (35.0%) 78 (27.6%) 454 (47.3%) 71 (29.8%) 154 (21.2%) 20 (10.4%) 172 (50.6%) 280 (16.6%) 148 (42.4%) 1,064 (32.9%) 2,573 (30.8%) Unknown 91 (51.7%) 76 (42.9%) 137 (48.4%) 275 (28.7%) 150 (63.0%) 243 (33.5%) 62 (32.3%) 133 (39.1%) 733 (43.5%) 138 (39.5%) 1,363 (42.2%) 3,401 (40.7%) Health care worker Yes Long-term care worker Females Variable China Guyana India Iraq Jamaica Nigeria Pakistan Philippines Somalia Sri Lanka Other Total Number 104 172 498 98 478 90 147 1,063 104 173 1,768 4,695 28 (26.9%) 63 (36.6%) 191 (38.4%) 11 (11.2%) 304 (63.6%) 68 (75.6%) 28 (19.0%) 564 (53.1%) 27 (26.0%) 51 (29.5%) 651 (36.8%) 1,986 (42.3%) 9 (8.7%) 36 (20.9%) 79 (15.9%) 1–6 175 (36.6%) 32 (35.6%) 1–6 238 (22.4%) 8 (7.7%) 25 (14.5%) 310 (17.5%) 920 (19.6%) No 32 (30.8%) 35 (20.3%) 195 (39.2%) 30 (30.6%) 57 (11.9%) 1–6 65 (44.2%) 123 (11.6%) 10–20 54 (31.2%) 466 (26.4%) 1,077 (22.9%) Unknown 44 (42.3%) 74 (43.0%) 112 (22.5%) 57 (58.2%) 117 (24.5%) 10–20 54 (36.7%) 376 (35.4%) 60–70 68 (39.3%) 651 (36.8%) 1,632 (34.8%) Health care worker Yes Long-term care worker Males Variable India Iraq Jamaica Nigeria Pakistan Philippines Sri Lanka Other Total Number 461 140 247 102 193 623 176 1,720 3,662 39 (8.5%) 6 (4.3%) 24 (9.7%) 42 (41.2%) 7 (3.6%) 109 (17.5%) 12 (6.8%) 158 (9.2%) 397 (10.8%) 10 (2.2%) 1–6 11 (4.5%) 9 (8.8%) 1–6 42 (6.7%) 1–6 53 (3.1%) 131 (3.6%) 259 (56.2%) 41 (29.3%) 97 (39.3%) 16 (15.7%) 107 (55.4%) 157 (25.2%) 94 (53.4%) 725 (42.2%) 1,496 (40.9%) 163 (35.4%) 93 (66.4%) 126 (51.0%) 44 (43.1%) 79 (40.9%) 357 (57.3%) 70 (39.8%) 837 (48.6%) 1,769 (48.3%) Health care worker Yes Long-term care worker No Unknown Notes: 1. Long-term care workers represent a subset of health care workers. 2. Countries of birth with the highest number of cases (ranked), 3. Afghanistan, Guyana, and Iran moved to 'other' category. 4. Some cells are reported as ranges to protect privacy. _________________________________________________________________________________________________________________________________________________ ICES 93 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Appendix 8.0 Methods Study Period The observation period began on January 15, 2020, to align with the COVID-19 surveillance period in Canada. We included all individuals in Ontario who were tested for COVID-19 between January 15 and June 13, 2020. Study Population Using the Registered Persons Database (RPDB), we identified a cohort of community-dwelling Ontario residents who were alive, eligible for the Ontario Health Insurance Plan (OHIP) and living in Ontario at the beginning of the observation period. Long-term care residents were excluded. A cumulative population cohort was created, where we retained individuals who were born and individuals who died during the observation period. We created a comprehensive data set that integrated all available COVID-19 diagnostic laboratory results in Ontario from multiple sources, including the Ontario Laboratory Information System (OLIS) database, Public Health Ontario (PHO) Labware, and distributed testing data from laboratories in the COVID-19 Diagnostic Network. The latter two data sets contained test results up to April 13, 2020. We converted each of these data sets to identify unique COVID-19 testing days per individual (i.e., testing episodes). To avoid double counting testing episodes across data sets, we considered testing episodes within +/- 3 days of each other for the same individual (using the linked, encrypted ICES identifier) as the same testing episode, and assigned the testing episode date as the OLIS specimen collection date (if found in OLIS) or the earliest log-in date. Where the results were discordant, we classified the testing episode based on the more clinically severe result (i.e., positive > indeterminate > negative > pending result) and used this result’s date as the testing episode date. We also incorporated confirmed COVID-19 cases from the Integrated Public Health Information System (iPHIS). We identified the closest positive testing episode associated with each iPHIS case using the earliest of the specimen collection or case reported date recorded in iPHIS. Where there were no positive testing episodes found, we added the iPHIS case to the integrated data set as a unique testing episode. Using this integrated data set, we selected one testing episode per individual based on a hierarchy (i.e., the earliest testing episode where the individual was confirmed positive for COVID-19, or their earliest episode where the results were indeterminate, or earliest episode where the individual tested negative COVID-19) and identified individuals who were ever tested for COVID-19 in our population cohort. Individuals tested for COVID-19 whose testing episodes were not linked were excluded from the analysis (N=15,791). We used the Immigration, Refugees and Citizenship Canada (IRCC) Permanent Resident Database to identify immigrants and refugees. The IRCC database includes records for immigrants and refugees who landed in Ontario between January 1, 1985, and May 31, 2017 and captures information at the time of admission approval or entry into Canada such as immigration category, Canadian language ability, level of education, and country of birth. The permanent resident database does not include those in Canada under _________________________________________________________________________________________________________________________________________________ ICES 94 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario temporary resident permits, such as students and workers, nor asylum seekers who have not yet had their refugee hearing. Ontario residents without an immigration record in the IRCC permanent resident database were categorized as ‘Canadian-born or long-term resident’, and includes residents born in Canada, immigrants and refugees who arrived in Ontario before January 1, 1985, or landed in another province and subsequently moved to Ontario. We identified second-generation children and youth aged 19 years and younger who were born in Ontario to mothers who are immigrants or refugees using the Ontario Mother-Baby linked data set (MOMBABY), which links delivering mothers’ inpatient admission records to those of their newborns. These children and youth were assigned the same immigration category and country or world region of origin as their mother, essentially assigning these as a household attribute but only for children and youth of an age likely to be still living in the same household as their mother. To account for the gap in immigration data after May 31, 2017, we created a category of other newcomers. These were individuals who became eligible for OHIP coverage after May 31, 2017. This group would include immigrants and refugees, as well as those who moved to Ontario from another Canadian province. Temporary residents who are eligible for OHIP would be included in the newcomer group. We created two subgroups of adults for certain analyses. The first was a more recent group of immigrants and refugees who had landed in Ontario at age 25 years or older since April 1, 2010 in order to describe COVID-19 testing and results by education and language ability. We restricted these analyses to a recent cohort as the education and language data are available only at the time of landing in Canada and can change after resettlement. The second subgroup were adults (older than 18 years) who had tested positive and were in the iPHIS Plus surveillance data set. We used the health care worker flag from iPHIS Plus to identify those cases who selfreported or were identified through outbreak numbers as health care workers. We used the generic health care worker flag and also reported on a subset of health care workers identified as working in long-term care homes. Analyses We assigned an index date to all individuals in our study cohort to describe current sociodemographic and clinical characteristics for those eligible to be tested for COVID-19 testing between January 15 and June 13, 2020. The index date was March 31, 2020, the most recent date of available data for select health administrative databases. For those who were tested or died before March 31, 2020, the date of COVID-19 testing or death was used as the index date. For individuals who were tested or who died thereafter, March 31, 2020, was used as the index date. We linked to multiple health and demographic administrative data sets to examine baseline sociodemographic and clinical characteristics of Ontario residents by immigration status, as of the index date. For newcomers to Ontario, we did not report chronic conditions, as many did not have sufficient time in Ontario to contribute the necessary health care use data to the allow identification of these conditions. Outcomes included the proportion of individuals tested among the population, percent positivity among those tested, and positivity per population (per capita). We reported these by immigration category, recency of _________________________________________________________________________________________________________________________________________________ ICES 95 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario immigration, and world region of birth. World region country classifications aligned with those of the World Bank with some regions with smaller populations further aggregated. To further describe specific communities of immigrants and refugees, we identified countries with the top 20 counts of positive COVID-19 cases overall and by sex, and among these, present the top 10 by testing outcome, by positivity among those tested, and by positivity per capita. To explore whether certain neighbourhood factors are differentially related to testing and positivity among immigrants, refugees and newcomers compared with Canadian-born and longterm residents, we stratified outcomes by neighbourhood quintiles of household income, ethnic diversity and a measure of household density. Finally, to determine whether there might be differential access to testing in similar clinical populations, we calculated testing and positivity in groups with chronic conditions by immigration status. Given the large sample sizes for most of our analyses, we did not do tests of statistical significance but report differences that we interpret as clinically meaningful. Data Limitations The OLIS COVID-19 and iPHIS test data used in this report are current to June 13, 2020, and DL and PHO Labware to April 13. The overall linkage rate for DL and PHO Labware was 86% and 97%, respectively. Cases created in iPHIS underwent only deterministic linkage;3,551 iPHIS records were unlinked at the time of the analysis. For this report, the date of the testing episode represents the date of specimen collection. Due to the time required for transportation and processing of specimens, it takes 6 days for approximately 95% of results to be finalized and reported into OLIS for a given testing date. OLIS is a transactional database and not all laboratories in Ontario contributed their COVID-19 testing data to OLIS. Among the laboratories that contributed, some did not contribute for the full time period covered by the study. The integrated data set was compiled to create a comprehensive COVID-19 testing data set; however, we are likely under-reporting the number of individuals tested during the study period. For example, test results submitted to OLIS with only a medical record number and unconsented test results were excluded from the study. Of 23,533 records of adults with positive COVID-19 tests, 530 could not be linked to iPHIS Plus cases. This is likely due to missing personal health identifiers needed for linkage. There were no significant differences in the percentage unlinked by immigration category, region or country of birth. The health care worker variable contains missing data which we have enumerated in the tables. It is unknown whether these missing data bias the results that we present. Characterization of the tested cohort required linkage to the RPDB, which for this analysis included individuals born by March 31, 2020 and recorded in the healthcare registry. As a result, the number of infants tested for COVID-19 is underestimated. Due to data limitations, we are unable to identify immigrants and refugees who landed in Ontario after May 31, 2017; therefore, the number of immigrants and refugees currently residing in Ontario is underestimated and the newcomer group is heterogeneous. _________________________________________________________________________________________________________________________________________________ ICES 96 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Appendix 9.0 Data Sets The following data sets from the ICES Data Repository were used to compile this report. housing; language; ethnicity diversity; immigration and citizenship; education and training; labour; income; and Indigenous peoples. Asthma Database The Ontario Asthma Database is an ICES-derived cohort that is created using a definition of 2 or more physician billing claims with a diagnosis of asthma (OHIP diagnosis code: 493) and/or 1 or more inpatient hospitalization or same-day surgery records with a diagnosis of asthma (ICD-9 diagnosis code 493; ICD-10 diagnosis codes J45, J46; in any diagnostic code space) in a 2-year period applied to hospitalization (DAD), same-day surgery (SDS) and physician billing claims (OHIP) data to determine the diagnosis date for incident cases of asthma in Ontario. CHF Database The Ontario Congestive Heart Failure Database is an ICES-derived cohort that was created using a definition of 2 or more physician billing claims with a diagnosis of CHF (OHIP diagnosis code 428) and/or 1 or more inpatient hospitalization or same-day surgery records with a diagnosis of CHF (ICD-9 diagnosis code 428; ICD-10 diagnosis code I50; in the primary diagnostic code space) in a 2-year period applied to hospitalization (DAD), same-day surgery (SDS) and physician billing claims (OHIP) data to determine the diagnosis date for incident cases of CHF in Ontario. Canadian Organ Replacement Register (CORR) The Canadian Organ Replacement Register (CORR) is the national information system that records and analyzes the level of activity and outcome of vital organ transplantation and renal dialysis activities. At ICES, we have access only to the data of donors and recipients treated in Ontario. Ontario residents receiving treatment outside Ontario would not appear in our data cut. COPD Database The Ontario COPD Database is an ICES-derived cohort that is created using two separate algorithms applied to inpatient hospitalization (DAD), same-day surgery (SDS) records, and physician billing claims (OHIP) data to determine the diagnosis date for incident cases of COPD in Ontario. In an algorithm which maximizes sensitivity, the definition for COPD is any physician billing claim with a diagnosis of COPD (OHIP diagnosis codes 491, 492, 496) or any inpatient hospitalization or same-day surgery record with a diagnosis of COPD (ICD-9 diagnosis codes 491, 492, 496; ICD-10 diagnosis codes J41–J44; in any diagnostic code space). Census Area Profiles The Census of Population, which is conducted by Statistics Canada every 5 years, provides sociodemographic information used to plan public services such as health care and education. Data are presented at multiple levels of geography, including census division, census metropolitan area, census tract and dissemination area. The main data elements and topics include families, households and Discharge Abstract Database (DAD) The DAD is compiled by the Canadian Institute for Health Information and contains administrative, clinical (diagnoses and _________________________________________________________________________________________________________________________________________________ ICES 97 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario procedures/interventions), demographic and administrative information for all admissions to acute care hospitals and rehabilitation, chronic care and day-surgery institutions in Ontario. At ICES, consecutive DAD records are linked together to form ‘episodes of care’ among the hospitals to which patients have been transferred after their initial admission. HIV Database (HIV) The Ontario HIV Database is an ICES-derived cohort that is created using a definition of 3 or more physician billing claims with a diagnosis of HIV (OHIP diagnosis codes 042, 043, 044) in a 3-year period applied to physician billing claims (OHIP) data to determine the diagnosis date for incident cases of HIV in Ontario. Hypertension Database (HYPER) The Ontario Hypertension Database is an ICES-derived cohort and created using a definition of 2 or more physician billing claims with a diagnosis of hypertension (OHIP diagnosis codes 401-405) and/or 1 or more inpatient hospitalization or same-day surgery records with a diagnosis of hypertension (ICD-9 diagnosis codes 401–405; ICD-10 diagnosis codes I10–I13, I15; in any diagnostic code space) in a twoyear period applied to hospitalization (DAD), same-day surgery (SDS), and physician billing claims (OHIP) data to determine the diagnosis date for incident cases of hypertension in Ontario. Physician claims and hospitalizations with a diagnosis of hypertension occurring within 120 prior to and 180 days after a gestational hospitalization record are excluded. The IPDB provides information about all physicians who have practiced in Ontario and is comprised of data contained in the OHIP Claims History Database, the OHIP Corporate Provider Database (CPDB), and the Ontario Physician Human Resource Data Centre (OPHRDC) Database. The database contains information on demographics (age, gender, year of graduation, school of graduation), specialty (functional and certified), location of practice, and measures of physician activity (billings and workload data). Immigrant, Refugees and Citizenship Canada Permanent Resident Database The Ontario portion of the IRCC Permanent Resident Database includes immigration application records for people who initially applied to land in Ontario since 1985. The data set contains permanent residents’ demographic information such as country of citizenship, level of education, mother tongue and landing date. Immigrants and refugees currently residing in Ontario but originally landed in another province are not captured in this data set. National Ambulatory Care Reporting System (NACRS) NACRS is compiled by the Canadian Institute for Health Information. It contains administrative, clinical (diagnoses and procedures), demographic and administrative information for all patient visits made to hospital- and community-based ambulatory care centres (emergency departments, day-surgery units, hemodialysis units and cancer care clinics). At ICES, NACRS records are linked with other data sources (DAD, OMHRS) to identify transitions to other care settings, such as inpatient acute care or psychiatric care. ICES Physician Database (IPDB) _________________________________________________________________________________________________________________________________________________ ICES 98 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Ontario Crohn’s and Colitis Cohort (OCCC) The Ontario Crohn’s and Colitis Cohort Database includes all Ontario patients identified with Crohn’s disease or ulcerative colitis (i.e., inflammatory bowel disease) when they were younger than 105 years. Ontario Diabetes Database (ODD) The Ontario Diabetes Database is an ICES-derived cohort created by using algorithms applied to inpatient hospitalization (DAD) records, same-day surgery (SDS) records, and physician billing claims (OHIP) data to determine the diagnosis date for incident cases of diabetes in Ontario. For adults aged 19 years and older, the definition for diabetes is 2 physician billing claims with a diagnosis of diabetes (OHIP diagnosis code 250) or 1 inpatient hospitalization or same-day surgery record with a diagnosis of diabetes (ICD-9 diagnosis code 250; ICD-10 diagnosis codes E10, E11, E13, E14; in any diagnostic code space) within a 2-year period. Physician claims and hospitalizations with a diagnosis of diabetes occurring within 120 days prior to and 180 days after a gestational hospitalization record were excluded. Ontario Health Insurance Plan (OHIP) The OHIP claims database contains information on inpatient and outpatient services provided to Ontario residents eligible for the province’s publicly funded health insurance system by fee-forservice health care practitioners (primarily physicians) and “shadow billings” for those paid through non-fee-for-service payment plans. The main data elements include patient and physician identifiers (encrypted), code for service provided, date of service, associated diagnosis and fee paid. Ontario Laboratories Information System (OLIS) The Ontario Laboratories Information System contains laboratory information collected from eHealth Ontario, submitted from all Public Health Ontario laboratories. As of August 2016, OLIS had completed connections with additional hospital laboratories in 13 of the 14 Local Health Integration Networks (LHINs). The OLIS data set consists of information on lab orders, test requests and observations. Ontario Marginalization Index (ONMARG) ONMARG is a geographically (census) based index developed to quantify the degree of marginalization occurring across the province of Ontario. It is comprised of four major dimensions thought to underlie the construct of marginalization: residential instability, material deprivation, dependency and ethnic concentration. The data set contains census divisions (CDs), census tracts (CTs), census subdivisions (CSDs), consolidated municipal service managers (CMSMs), public health units (PHUs), Local Health Integration Networks (LHINs), sub-LHINs and dissemination areas (DAs). Ontario Mother-Baby Linked Data (MOMBABY) The ICES MOMBABY Database is an ICES-derived cohort that links the DAD inpatient admission records of delivering mothers and their newborns. From 2002 onward, this linkage is performed deterministically using a maternal-newborn chart matching number. Prior to 2002, mothers were linked to their children by matching on the institutions to which they were admitted, their postal codes, and their admission and discharge dates. _________________________________________________________________________________________________________________________________________________ ICES 99 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Ontario Rheumatoid Arthritis Database (ORAD) The Ontario Rheumatoid Arthritis Database is an ICES-derived cohort created using a definition of 3 or more physician billing claims (at least 1 of which was billed by a musculoskeletal specialist) with a diagnosis of rheumatoid arthritis (OHIP diagnosis code 714) and/or 1 or more inpatient hospitalization or same-day surgery records with a diagnosis of rheumatoid arthritis (ICD-9 diagnosis code 714; ICD-10 diagnosis codes M05, M06; in any diagnostic code space) in a 2-year period applied to hospitalization (DAD), same-day surgery (SDS), and physician billing claims (OHIP) data to determine the diagnosis date for incident cases of rheumatoid arthritis in Ontario. Same Day Surgery (SDS) The SDS is compiled by the Canadian Institute for Health Information and contains administrative, clinical (diagnoses and procedures), demographic and administrative information for all patient visits made to day-surgery institutions in Ontario. The main data elements include patient demographics, clinical data (diagnoses, procedures, physician), administrative data (institution/hospital number, etc.), financial data, and servicespecific data elements for day surgery. Postal Code Conversion File (PCCF) The PCCF database will link to postal codes within a given cohort and determine other census geographic identifiers, such as dissemination/enumeration area, census division, longitude/ latitude, urban/rural flag and neighbourhood income quintile. Integrated Public Health Information System (iPHIS) and other local data entry systems (iPHIS Plus) The iPHIS is the information system used in Ontario for reporting case information on all reportable communicable diseases for provincial and national surveillance, as described in the Health Protection and Promotion Act. Each public health unit (PHU) is responsible for conducting case and contact management, collecting case and contact information on reportable communicable diseases occurring within their boundaries, and entering information into iPHIS. Certain PHUs enter data into their own local system, and then the data are integrated into a combined data set, which includes both iPHIS and local system data (i.e., iPHIS Plus). The PHUs that use their own local system include the Toronto Public Health Coronavirus Rapid Entry System (CORES), the Ottawa Public Health COVID-19 Ottawa Database (The COD) and the Middlesex-London COVID-19 Case and Contact Management Tool (CCMtool). Registered Persons Database (RPDB) The RPDB provides basic demographic information (age, sex, location of residence, date of birth, and date of death for deceased individuals) for those issued an Ontario health insurance number. The RPDB also indicates the time periods for which an individual was eligible to receive publicly funded health insurance benefits and the best-known postal code for each registrant on July 1 of each year. The following external data sets were imported and linked to the ICES Data Repository for this report. _________________________________________________________________________________________________________________________________________________ ICES 100 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario DL and PHO Labware Distributed Testing Lab data include testing data from laboratories in the COVID-19 Diagnostic Network, and PHO Labware includes all COVID-19 tests performed by a Public Health Ontario laboratory to April 13, 2020. _________________________________________________________________________________________________________________________________________________ ICES 101 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Appendix 10.0 Definitions Used in This Report Variable Definition Data Source (Latest Data Availability) Reference Sociodemographic Characteristics Age Age was calculated as of index (date of testing or death, if before March 31, 2020, or March 31, 2020, for those not tested during the reporting period). Age was reported for all residents, immigrants and refugees and for second-generation children and youth aged 19 years and younger by the following groups: • 0–9 years • 10–19 • 20–29 • 30–39 • 40–49 • 50–59 • 60–69 • 70+ Registered Persons Database (March 31, 2020) Dates of birth and death are available up to March 31, 2020. Due to delays in reporting deaths to the Ministry of Health, this information will change with subsequent RPDB updates. Infants born after March 31, 2020, are not included. Sex Sex was determined using the RPDB • Female • Male Registered Persons Database (March 31, 2020) Neighbourhood income quintile Neighbourhood-based income was determined using methods developed by Statistics Canada, where income was adjusted for household and community size so that each dissemination area (DA) would have 20% of its population in each income quintile. Individuals’ postal codes were Registered Persons Database (March 31, 2020) Postal Code Conversion File (PCCF) _________________________________________________________________________________________________________________________________________________ ICES 102 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Variable Definition Data Source (Latest Data Availability) Reference matched to DAs, and individuals were categorized based on the corresponding neighbourhood income quintile of that DA. • Quintile 1 (lowest) • Quintile 2 • Quintile 3 • Quintile 4 • Quintile 5 (highest) • Missing information Residential Instability11 A dimension of the Ontario Marginalization Index (ON-MARG) that is measured at the DA level, consistent with neighbourhood income quintile, using information from the census and weighted using weights obtained to calculate factor scores, which are standardized across Canada. Quintiles are created by placing 20% of the geographic units in the province into each quintile. • Quintile 1 (least marginalized) • Quintile 2 • Quintile 3 • Quintile 4 • Quintile 5 (most marginalized) • Missing information Registered Persons Database (March 31, 2020) Postal Code Conversion File Ontario Census Area Profiles (2016) Matheson FI, van Ingen T. 2016 Ontario Marginalization Index: User Guide. Toronto, ON: St. Michael’s Hospital; 2018. Joint publication with Public Health Ontario. Available at https://www.publichealthontario.ca /-/media/documents/o/2017/onmarg-userguide.pdf. The census variables and indicators used to define the Residential Instability dimension include the following: • Proportion of the population living alone • Proportion of the population who are not youth (age 5–15 years) • Average number of persons per dwelling _________________________________________________________________________________________________________________________________________________ ICES 103 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Variable Definition • • • • Persons per dwelling11 Neighbourhood diversity (Ethnic concentration)11 Data Source (Latest Data Availability) Reference Proportion of the dwellings that are apartment buildings Proportion of the population that is single/ divorced/widowed Proportion of dwellings that are not owned Proportion of the population that moved during the past 5 years A census variable measured at the DA level which is part of the residential instability dimension of ON-MARG. The average number of persons per dwelling indicator is used to describe neighbourhoods by average number of individuals living in a private household. • Quintile 1 (least marginalized) • Quintile 2 • Quintile 3 • Quintile 4 • Quintile 5 (most marginalized) • Missing information Registered Persons Database (March 31, 2020) A dimension of ON-MARG that is measured at the DA level, consistent with neighbourhood income quintile, using information from the census and weighted using weights obtained to calculate factor scores, which are standardized across Canada. Quintiles are created by placing 20% of the geographic units in the province into each quintile. • Quintile 1 (least marginalized) • Quintile 2 • Quintile 3 Registered Persons Database (March 31, 2020) Postal Code Conversion File Ontario Census Area Profiles (2016) Postal Code Conversion File Ontario Census Area Profiles (2016) Matheson FI, van Ingen T. 2016 Ontario Marginalization Index: User Guide. Toronto, ON: St. Michael’s Hospital; 2018. Joint publication with Public Health Ontario. Available at https://www.publichealthontario.ca /-/media/documents/o/2017/onmarg-userguide.pdf. Matheson FI, van Ingen T. 2016 Ontario Marginalization Index: User Guide. Toronto, ON: St. Michael’s Hospital; 2018. Joint publication with Public Health Ontario. Available at https://www.publichealthontario.ca /-/media/documents/o/2017/onmarg-userguide.pdf. _________________________________________________________________________________________________________________________________________________ ICES 104 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Variable Definition • • • Data Source (Latest Data Availability) Reference Quintile 4 Quintile 5 (most marginalized) Missing information The Ethnic Concentration dimension was used as a proxy for neighbourhood diversity. Census variables and indicators used to define include the following: • Proportion of the population who are recent immigrants (arrived in the past 5 years) • Proportion of the population who self-identify as a visible minority Public health unit of residence Public health unit associated with the residence was determined based on the individual’s postal code recorded in the RPDB and in the PCCF, which maps postal codes regional areas. Registered Persons Database (March 31, 2020) Asthma33 Individuals were diagnosed with asthma based on an algorithm of 2 or more physician billings within 2 years, or one hospitalization with an asthma diagnosis code prior to the index date. Ontario Asthma Database (March 31, 2019). Postal Code Conversion File (PCCF) Chronic Conditions Respiratory conditions Gershon AS, Wang C, Guan J, Vasilevska-Ristovska J, Cicutto L, To T. Identifying patients with physician-diagnosed asthma in health administrative databases. Can Respir J. 2009; 16(6):183–8. In accordance with available data, individuals with an asthma diagnosis date prior to March 31, 2019, were identified as having this comorbidity. The reported prevalence of asthma in these cohorts is likely underestimated. _________________________________________________________________________________________________________________________________________________ ICES 105 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Variable Definition Data Source (Latest Data Availability) Chronic obstructive pulmonary disease34 Ontario Chronic Obstructive Pulmonary Individuals were diagnosed with COPD based on an Disease Database (March 31, 2019) algorithm of 1 or more physician billings within 2 years, or one hospitalization with a COPD diagnosis code prior to index date. Reference Gershon AS, Wang C, Guan J, Vasilevska-Ristovska J, Cicutto L, To T. Identifying individuals with physician diagnosed COPD in health administrative databases. COPD. 2009; 6(5):388–94. Due to current data availability, individuals with a COPD diagnosis date prior to March 31, 2019, were identified as having this comorbidity. The reported prevalence of COPD in these cohorts is likely underestimated. Chronic kidney disease35,36 Individuals were classified as having a diagnosis of chronic kidney disease (CKD) if they had a physician billing, emergency department visit or hospitalization with a CKD diagnosis code, or if there was evidence of recent chronic dialysis (i.e., dialysis billing code in each of the 3 months prior to index). Discharge Abstract Database (March 31, 2020) National Ambulatory Care Reporting System (March 31, 2020) Ontario Health Insurance Plan database (March 31, 2020) Fleet JL, Dixon SN, Shariff SZ, et al. Detecting chronic kidney disease in population-based administrative databases using an algorithm of hospital encounter and physician claim codes. BMC Nephrol. 2013; 14:81. Quinn RR, Laupacis A, Austin PC, et al. Using administrative data sets to study outcomes in dialysis patients: a validation study. Med Care. 2010; 48(8):745–50. Diabetes37 Individuals were diagnosed with diabetes based on an algorithm of 2 or more physician billings within a year or 1 hospitalization or 1 diabetes medication prescription (adult definition), or 4 or more physician billings within 2 years with a diabetes diagnosis code or 1 or more physician Ontario Diabetes Database (March 31, 2019) Hux JE, Ivis F, Flintoft V, Bica A. Diabetes in Ontario: determination of prevalence and incidence using a validated administrative data algorithm. Diabetes Care. 2002; 25(3):512–6. _________________________________________________________________________________________________________________________________________________ ICES 106 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Variable Definition Data Source (Latest Data Availability) Reference billings with a diabetes fee code (pediatric definition) prior to index date. In accordance with available data, individuals with a diabetes diagnosis date prior to March 31, 2019, were identified as having this comorbidity. The reported prevalence of diabetes in these cohorts is likely underestimated. Cardiovascular diseases Congestive heart failure38 Individuals were diagnosed with congestive heart failure (CHF) based on an algorithm of 1 hospitalization or 1 physician billing or emergency department visit followed by another health care encounter within a year, with a CHF diagnosis code prior to index date. Ontario Congestive Heart Failure Database (March 31, 2019) Schultz SE, Rothwell DM, Chen Z, Tu K. Identifying cases of congestive heart failure from administrative data: a validation study using primary care patient records. Chronic Dis Inj Can. 2013; 33(3): 160–6. Ontario Hypertension Database (March 31, 2019) Tu K, Campbell NR, Chen Z, CauchDudek K, McAlister FA. Accuracy of administrative databases in identifying patients with hypertension. Open Med. 2007; 1(1):18–26. In accordance with available data, individuals with a CHF diagnosis date prior to March 31, 2019, were identified as having this comorbidity. The reported prevalence of CHF in these cohorts is likely underestimated. Hypertension39 Individuals were diagnosed with hypertension based on an algorithm of 1 hospitalization or 1 physician billing followed by another physician billing or hospitalization within 2 years, with a hypertension diagnosis code prior to index date. Due to current data availability, individuals with a hypertension diagnosis date prior to March 31, 2019, were identified as having this comorbidity. _________________________________________________________________________________________________________________________________________________ ICES 107 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Variable Definition Data Source (Latest Data Availability) Reference The reported prevalence of hypertension in these cohorts is likely underestimated. Immunocompromised41 Ischemic heart disease40 Individuals were classified as having ischemic heart disease if there was a diagnosis code for angina, chronic ischemic heart disease or myocardial infarction, based on hospitalization records in the previous 5 years or a coronary artery bypass graft or percutaneous coronary intervention procedure in the previous 20 years. Discharge Abstract Database (March 31, 2020) History of TIA or stroke Individuals were classified as having a history of transient ischemic attack or acute ischemic stroke code if they had a hospitalization or emergency department visit prior to index date. Discharge Abstract Database (March 31, 2020) Individuals were identified as immunocompromised if they met any of the following conditions: • HIV diagnosis (3 physician billings with an HIV diagnosis within 3 years) • History of a solid organ transplant or allogenic/autologous bone marrow transplant • History of any condition causing immunodeficiency (sickle cell disease, hereditary immunodeficiency, neutropenia, functional disorders of polymorphonuclear neutrophils and genetic anomalies of leukocytes, hyposplenism, hypersplenism and chronic congestive splenomegaly, asplenia) Discharge Abstract Database (March 31, 2020) Same Day Surgery Database (March 31, 2019) Tu JV, Chu A, Donovan LR, et al. The Cardiovascular Heath in Ambulatory Care Research Team (CANHEART): Using big data to measure and improve cardiovascular health and healthcare services. Circ Cardiovasc Qual Outcomes. 2015; 8(2):204–12. National Ambulatory Care Reporting System (March 31, 2020) Ontario HIV Database (March 31, 2019) Ontario Health Insurance Plan Database (March 31, 2020) Antoniou T, Zagorski B, Loutfy MR, Strike C, Glazier RH. Validation of case-finding algorithms derived from administrative data for identifying adults living with human immunodeficiency virus infection. PLoS One. 2011; 6(6):e21748. Canadian Organ Replacement Registry (December 31, 2018) _________________________________________________________________________________________________________________________________________________ ICES 108 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Variable Inflammatory conditions Definition Inflammatory bowel disease42,43 Individuals were diagnosed with inflammatory bowel disease (IBD) based on one of the following algorithms: • For individuals aged <18 years, either 1 procedure code for sigmoidoscopy/colonoscopy or 2 hospitalizations or 4 physician billings/emergency department visits with an IDB diagnosis code within 3 years. • For individuals aged 18– 64 years, 5 health care contacts with an IBD diagnosis code within 4 years • For individuals aged ≥65 years, 5 health care contacts with an IBD diagnosis code within 4 years and one claim with IBD medication. Data Source (Latest Data Availability) Ontario Crohn’s and Colitis Cohort Database (March 31, 2019) Reference Benchimol EI, Guttmann A, Griffiths AM, et al. Increasing incidence of paediatric inflammatory bowel disease in Ontario, Canada: evidence from health administrative data. Gut. 2009; 58(11):1490–7. Benchimol EI, Guttmann A, Mack DR, et al. Validation of international algorithms to identify adults with inflammatory bowel disease in health administrative data from Ontario, Canada. J Clin Epidemiol. 2014; 67(8):887–96 (These algorithms are based on at least 2 years of OHIP eligibility.) In accordance with available data, individuals with an IDB diagnosis date prior to March 31, 2019, were identified as having this comorbidity. The reported prevalence of IBD in these cohorts is likely underestimated. Rheumatoid arthritis44,45 Individuals were diagnosed with rheumatoid arthritis (RA) based on an algorithm of 1 hospitalization or 3 physician billings (1 of which was by a musculoskeletal specialist) within 2 years, with an RA diagnosis code prior to index date. Ontario Rheumatoid Arthritis Database (March 31, 2019) Widdifield J, Bombardier C, Bernatsky S, et al. An administrative data validation study of the accuracy of algorithms for identifying rheumatoid arthritis: the influence of the reference standard on _________________________________________________________________________________________________________________________________________________ ICES 109 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Variable Definition Data Source (Latest Data Availability) algorithm performance. BMC Musculoskelet Disord. 2014; 15(1):216. Due to current data availability, individuals with an RA diagnosis date prior to March 31, 2019, were identified as having this comorbidity. The reported prevalence of RA in these cohorts is likely underestimated. Liver disease46 Individuals were classified as having advanced liver disease (cirrhosis or decompensated cirrhosis) if they met either of the following algorithms: • 2 or more outpatient visits (physician billing or emergency department visits) or 1 hospitalization with a cirrhosis diagnosis code • 1 or more outpatient visit and 1 hospitalization or 1 procedure code for decompensated cirrhosis Reference Widdifield J, Bernatsky S, Paterson JM et al. Accuracy of Canadian health administrative databases in identifying patients with rheumatoid arthritis: a validation study using the medical records of rheumatologists. Arthritis Care Res. 2013; 65(10): 1582–91. Discharge Abstract Database (March 31, 2020) National Ambulatory Care Reporting System (March 31, 2020) Ontario Health Insurance Plan Database (March 31, 2020) Lapointe-Shaw L, Georgie F, Carlone D, et al. Identifying cirrhosis, decompensated cirrhosis and hepatocellular carcinoma in health administrative data: a validation study. PLoS One. 2018; 13(8): e0201120. Immigration Characteristics Immigrant category Category under which immigrant or refugee is Immigration, Refugees and Citizenship admitted to Canada among individuals at the time Canada Permanent Resident Database of entry into Ontario, including sponsored immigrants (family class immigrants) economic class immigrants (economic caregivers, economic other), resettled refugees (privately sponsored, government assisted, blended visa office-referred), protected persons in Canada, refugee dependents, _________________________________________________________________________________________________________________________________________________ ICES 110 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Variable Definition Data Source (Latest Data Availability) Reference humanitarian and compassionate/public policy cases and other Recency of immigration Measured as the length of time in Canada between Immigration, Refugees and Citizenship landing in Ontario and index date Canada Permanent Resident Database World region of birth47 Based on individuals’ country of birth, world region Immigration, Refugees and Citizenship country classifications aligned with those of the Canada Permanent Resident Database World Bank with some regions with the following modifications: "Eastern Europe" included Eastern Europe and the USSR (former). "Europe other" included Northern Europe, Southern Europe, the United Kingdom, Western Europe, Yugoslavia (former) and Europe unspecified. "North America" included North America and Western Hemisphere (Others). "Australasia & Oceania" included Australasia, Oceania & Asia Unspecified. If country of birth was missing, country of citizenship was used to identify world region of origin. Canadian language ability Self-declared indicator of knowledge of Canada's official languages (English, French, English and French, or neither) among permanent residents at the time of entry into Ontario. Immigration, Refugees and Citizenship Canada Permanent Resident Database Education level Level of education among permanent residents who are 15 years of age or older at the time of entry into Ontario, based on the number of years of schooling or the certificate, diploma or degree obtained. Categories included secondary or less, some university (no degree), trade or diploma, bachelor’s degree and higher, or none. Immigration, Refugees and Citizenship Canada Permanent Resident Database United Nations High Commissioner for Refugees. What is a refugee? https://www.unhcr.org/afr/what-isa-refugee.html. Updated 2019. Accessed July 15, 2020. _________________________________________________________________________________________________________________________________________________ ICES 111 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Variable Definition Data Source (Latest Data Availability) Reference Health Care Workers Health care worker (generic) Occupation involving caring for patients. Includes health care worker, doctor, nurse, dentist, dental hygienist, midwife, other medical technicians, personal support worker, respiratory therapist and first responder. This list of health care worker occupations entered into iPHIS Plus expanded over the study period. Integrated Public Health Information System (iPHIS) Plus Long-term care worker Any health care worker (e.g., doctor, nurse, dentist, dental hygienist, midwife, other medical technicians, personal support worker, respiratory therapist and first responder) who was part of an outbreak associated with a long-term care home, using the outbreak number recorded in the case’s record. Integrated Public Health Information System (iPHIS) Plus _________________________________________________________________________________________________________________________________________________ ICES 112 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Appendix 11.0 Diagnostic, Procedure and Physician Billing Codes Comorbidity Asthma Chronic kidney disease (including dialysis) Chronic obstructive pulmonary disease Diabetes Heart failure ICD-9/ICD-10-CA Diagnostic Codes 493 J45, J46 Chronic kidney disease: E102, E112, E132, E142, I12, I13, N08, N18, N19 OHIP Physician Billing Diagnostic Codes OHIP Physician Billing Fee Codes 493 Dialysis: 1PZ21HPD4, 1PZ21HQBR, 1PZ21HQBS 491, 492, 496 J41–J44 250 E10, E11, E13, E14 428 I500, I501, I509 HIV History of solid organ transplant Chronic kidney disease: 403, 585 Dialysis: G082, G083, G085, G090– G096, G294, G295, G323, G325, G326, G330, G331, G332, G333, G860–G866, H540, H740, R849 491, 492, 496 250 428 K029, K030, K045, K046, Q040 Q050 042, 043, 044 1GR85, 1GT85 (Lung) 1HY85 (Heart & lung) 1HZ85 (Heart) 1OA85 (Liver) 1OB85 (Spleen) 1OK85 (Pancreas) 1PC85 (Kidney) History of allogenic/autologous bone marrow transplant History of conditions associated with immunodeficiency CCP/CCI Procedure Codes 530 1LZ19HHU7, 1LZ19HHU8, 1WY19 Z426 Sickle cell disease: 282.6 D570–D572, D578 Hereditary immunodeficiency: _________________________________________________________________________________________________________________________________________________ ICES 113 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Comorbidity ICD-9/ICD-10-CA Diagnostic Codes CCP/CCI Procedure Codes OHIP Physician Billing Diagnostic Codes OHIP Physician Billing Fee Codes 279 D80-D84, D898, D899 Neutropenia: 2880 D70 Functional disorders of polymorphonuclear neutrophils and genetic anomalies of leukocytes: 2881, 2882 D71, D72 Hyposplenism, hypersplenism and chronic congestive splenomegaly: 2894, 2895 D730–D732 Asplenia: 7590 Q890 Hypertension Inflammatory bowel disease Ischemic heart disease 401–405 I10–I13, I15 555, 556 K50, K51 Angina: I20 Chronic ischemic heart disease: I25 401–405 E705, E740, E741, E747, Z535, Z555, Z580 Coronary artery bypass grafting: 481 1IJ76 555, 556 _________________________________________________________________________________________________________________________________________________ ICES 114 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario Comorbidity Liver disease Rheumatoid arthritis History of transient ischemic attack/acute ischemic stroke ICD-9/ICD-10-CA Diagnostic Codes CCP/CCI Procedure Codes Myocardial infarction: I21, I22 Percutaneous coronary intervention: 1IJ5, 1IJ50, 1IJ57 4802, 4803 Cirrhosis: 4561, 5712, 5715 I859, I982, K476, K703, K717 Decompensated cirrhosis: 1006, 6691 1KQ76GP-NR, 1NA13BA-BD, 1NA13BA-FA, 1NA13BA-X7, 1OT52HA Decompensated cirrhosis: 4560, 4562, 57.2, 5723, 5724, 7824, 7895 I850, I864, I9820, I983, K721, K729, K766, K767, R17, R18 714 M05, M06 TIA: 435, 3623 G450–G453, G458, G459, H340 OHIP Physician Billing Diagnostic Codes Cirrhosis: 571 OHIP Physician Billing Fee Codes Decompensated cirrhosis: J057, Z591 714 Acute ischemic stroke: 434, 436 I63 (excluding I63.6), I64, H341 _________________________________________________________________________________________________________________________________________________ ICES 115 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario References 1. 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Accessed July 15, 2020. _________________________________________________________________________________________________________________________________________________ ICES 118 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario _________________________________________________________________________________________________________________________________________________ ICES 119 COVID-19 in Immigrants, Refugees and Other Newcomers in Ontario ICES G1 06, 2075 Bayview Avenue Toronto, Ontario M4N 3M5 www.ices.on.ca _________________________________________________________________________________________________________________________________________________ ICES 120