Delayed Access to Medical Care and Psychological Distress among Chinese Immigrants in Canada during the Pandemic
Abstract
:1. Introduction
2. Methodology
2.1. Study Design, Setting, and Participants
2.2. Main Outcome—Psychological Distress
2.3. Covariates
2.3.1. Sociodemographic Variables
2.3.2. COVID-19-Related Variables
2.4. Missing Data
2.5. Statistical Analysis
3. Results
3.1. Participants’ Sociodemographic Characteristics
3.2. COVID-19-Related Participants’ Characteristics
3.3. Risk Factors Associated with Mild to Severe COVID-19 Peritraumatic Distress Index (CPDI)
3.4. Sensitivity Analysis
4. Discussion
4.1. Fear of COVID-19 and Psychological Distress
4.2. Loneliness and Psychological Distress
4.3. Delayed Medical Care Access and Psychological Distress
4.4. Sociodemographic Factors and Psychological Distress
5. Strengths and Limitations
6. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Canadian Institute for Health Information. COVID-19’s Impact on Hospital Services|CIHI. Available online: https://www.cihi.ca/en/covid-19-resources/impact-of-covid-19-on-canadas-health-care-systems/hospital-services (accessed on 9 December 2021).
- Canadian Medical Association. A Struggling System Understanding the Health CARE Impacts of the Pandemic. Deloitte. Available online: https://digitallibrary.cma.ca/viewer?file=%2Fmedia%2FDigital_Library_PDF%2F2021%2520A%2520struggling%2520system%2520EN.pdf#page=1 (accessed on November 2021).
- Gibney, R.N.; Blackman, C.; Gauthier, M.; Fan, E.; Fowler, R.; Johnston, C.; Katulka, R.J.; Marcushamer, S.; Menon, K.; Miller, T.; et al. COVID-19 Pandemic: The Impact on Canada’s Intensive Care Units. Royal Society of Canada. 2022. Available online: https://rsc-src.ca/sites/default/files/ICU%20PB_EN_0.pdf (accessed on 1 June 2022).
- Khattar, J.; Anderson, L.N.; De Rubeis, V.; de Groh, M.; Jiang, Y.; Jones, A.; Basta, N.E.; Kirkland, S.; Wolfson, C.; Griffith, L.E.; et al. Unmet health care needs during the COVID-19 pandemic among adults: A prospective cohort study in the Canadian Longitudinal Study on Aging. CMAJ Open 2023, 11, E140–E151. [Google Scholar] [CrossRef] [PubMed]
- Statistics Canada. Difficulties Accessing Health Care in Canada during the COVID-19 Pandemic: Comparing Individuals with and without Chronic Conditions. Available online: https://www150.statcan.gc.ca/n1/pub/82-003-x/2022011/article/00002-eng.htm (accessed on 16 November 2022).
- Canadian Institute for Health Information. Virtual Care: A Major Shift for Physicians in Canada|CIHI. (n.d.). Available online: https://www.cihi.ca/en/virtual-care-a-major-shift-for-physicians-in-canada (accessed on 24 March 2022).
- Bender, J.L.; Scruton, S.; Wong, G.; Abdelmutti, N.; Berlin, A.; Easley, J.; Liu, Z.A.; McGee, S.; Rodin, D.; Sussman, J.; et al. Virtual follow-up care among breast and prostate cancer patients during and beyond the COVID-19 pandemic: Association with distress. Cancer Med. 2024, 13, e6948. [Google Scholar] [CrossRef] [PubMed]
- Caston, E.N.; Lawhon, V.M.; Smith, K.L.; Gallagher, K.; Angove, R.; Anderson, E.; Balch, A.; Azuero, A.; Huang, C.S.; Rocque, G.B. Examining the association among fear of COVID-19, psychological distress, and delays in cancer care. Cancer Med. 2021, 10, 8854–8865. [Google Scholar] [CrossRef] [PubMed]
- Shiraz, M.; Capaldi, C.A.; Ooi, L.L.; Roberts, K.C. Health care barriers and perceived mental health among adults in Canada during the COVID-19 pandemic: A population-based cross-sectional study. Health Promot. Chronic Dis. Prev. Can. 2024, 44, 21–33. [Google Scholar] [CrossRef] [PubMed]
- Luo, Y.; Li, Q.; Jeong, H.; Cheatham, L. The association between social determinants of health and psychological distress during the COVID-19 pandemic: A secondary analysis among four racial/ethnic groups. BMC Public Health 2022, 22, 2193. [Google Scholar] [CrossRef] [PubMed]
- Frey, K.M.; Ellis, A.E.; Zeligs, K.; Chapman-Davis, E.; Thomas, C.; Christos, P.J.; Kolev, V.; Prasad-Hayes, M.; Cohen, S.; Holcomb, K.; et al. Impact of the coronavirus disease 2019 pandemic on the quality of life for women with ovarian cancer. Am. J. Obstet. Gynecol. 2020, 223, 725.e1–725.e9. [Google Scholar] [CrossRef] [PubMed]
- Rodriguez, M.G.; Kumar, D.; Patel, M.I. “I Have Constant Fear”: A National Qualitative Study on the Impact of COVID-19 on Cancer Care and Potential Solutions to Improve the Cancer Care Experience During the COVID-19 Pandemic. JCO Oncol. Pract. 2023, 19, 427–434. [Google Scholar] [CrossRef]
- Lawson, A.K.; McQueen, D.B.; Swanson, A.C.; Confino, R.; Feinberg, E.C.; Pavone, M.E. Psychological distress and postponed fertility care during the COVID-19 pandemic. J. Assist. Reprod. Genet. 2021, 38, 333–341. [Google Scholar] [CrossRef]
- Takeuchi, E.; Kota Katanoda Cheli, S.; Goldzweig, G.; Tabuchi, T. Restrictions on healthcare utilization and psychological distress among patients with diseases potentially vulnerable to COVID-19; Findings from the JACSIS 2020 study. Health Psychol. Behav. Med. 2022, 10, 229–240. [Google Scholar] [CrossRef] [PubMed]
- Zaini, A.M.; Mohd Zain, A.; Din, N.M.; Mustapha, M.; Sidi, H. The psychological status of patients with delayed intravitreal injection for treatment of diabetic macular edema due to the COVID-19 pandemic. PLoS ONE 2023, 18, e0290260. [Google Scholar] [CrossRef]
- Sanyaolu, A.; Okorie, C.; Marinkovic, A.; Abbasi, A.; Mangat, J.; Younis, S.; Chan, H.; Jaferi, U. Stigma, discrimination, and attitude towards the Chinese community in the USA and Canada during the outbreak of COVID-19. Soc. Determ. Health 2020, 6, e12. [Google Scholar] [CrossRef]
- Cooper, J.; Suvabna Theivendrampillai Lee, T.; Marquez, C.; Wai, M.; Straus, S.E.; Fahim, C. Exploring perceptions and experiences of stigma in Canada during the COVID-19 pandemic: A qualitative study. BMC Glob. Public Health 2023, 1, 26. [Google Scholar] [CrossRef]
- Government of Canada, S.C. Fear of COVID-19 Related Stigmatization. Available online: https://www150.statcan.gc.ca/n1/pub/45-28-0001/2020001/article/00051-eng.htm (accessed on 15 July 2020).
- Leigh, J.P.; Moss, S.J.; Tiifu, F.; FitzGerald, E.; Brundin-Mathers, R.; Dodds, A.; Brar, A.; de Grood, C.M.; Stelfox, H.T.; Fiest, K.M.; et al. Lived experiences of Asian Canadians encountering discrimination during the COVID-19 pandemic: A qualitative interview study. CMAJ Open 2022, 10, E539–E545. [Google Scholar] [CrossRef] [PubMed]
- Yang, L.; Yu, L.; Kandasamy, K.; Wang, Y.; Shi, F.; Zhang, W.; Wang, P.P. Non-Pathological Psychological Distress among Mainland Chinese in Canada and Its Sociodemographic Risk Factors amidst the Pandemic. Healthcare 2022, 10, 2326. [Google Scholar] [CrossRef]
- Quach, T.; Ðoàn, L.N.; Liou, J.; Ponce, N.A. A Rapid Assessment of the Impact of COVID-19 on Asian Americans: Cross-sectional Survey Study. JMIR Public Health Surveill. 2021, 7, e23976. [Google Scholar] [CrossRef]
- Zhang, D.; Li, G.; Shi, L.; Martin, E.; Chen, Z.; Li, J.; Chen, L.; Li, Y.; Wen, M.; Chen, B.; et al. Association between racial discrimination and delayed or forgone care amid the COVID-19 pandemic. Prev. Med. 2022, 162, 107153. [Google Scholar] [CrossRef]
- Wen, M.; Shi, L.; Zhang, D.; Li, Y.; Chen, Z.; Chen, B.; Chen, L.; Zhang, L.; Li, H.; Li, J.; et al. Racial-ethnic disparities in psychological distress during the COVID-19 pandemic in the United States: The role of experienced discrimination and perceived racial bias. BMC Public Health 2023, 23, 957. [Google Scholar] [CrossRef] [PubMed]
- Ye, Y.; Wang, J.; Cai, S.; Fu, X.; Ji, Y. Psychological distress of cancer patients caused by treatment delay during the COVID-19 pandemic in China: A cross-sectional study. Psychol. Oncol. 2022, 31, 1607–1615. [Google Scholar] [CrossRef] [PubMed]
- Marzo, R.R.; Ismail, Z.; Nu Htay, M.N.; Bahari, R.; Ismail, R.; Villanueva, E.Q.; Singh, A.; Lotfizadeh, M.; Respati, T.; Irasanti, S.N.; et al. Psychological distress during pandemic COVID-19 among adult general population: Result across 13 countries. Clin. Epidemiol. Glob. Health 2021, 10, 100708. [Google Scholar] [CrossRef]
- Qiu, J.; Shen, B.; Zhao, M.; Wang, Z.; Xie, B.; Xu, Y. A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: Implications and policy recommendations. Gen. Psychiatry 2020, 33, e100213. [Google Scholar] [CrossRef]
- Gierveld, J.D.J.; Tilburg, T.V. A 6-Item Scale for Overall, Emotional, and Social Loneliness: Confirmatory Tests on Survey Data. Res. Aging 2006, 28, 582–598. [Google Scholar] [CrossRef]
- Gierveld, J.D.; Tilburg, T.V. The De Jong Gierveld short scales for emotional and social loneliness: Tested on data from 7 countries in the UN generations and gender surveys. Eur. J. Ageing 2010, 7, 121–130. [Google Scholar] [CrossRef] [PubMed]
- Zhong, B.-L.; Yuan, M.-D.; Li, F.; Sun, P. The Psychological Network of Loneliness Symptoms Among Chinese Residents During the COVID-19 Outbreak. Psychol. Res. Behav. Manag. 2023, 16, 3767–3776. [Google Scholar] [CrossRef]
- Van Buuren, S.; Brand JP, L.; Groothuis-Oudshoorn CG, M.; Rubin, D.B. Fully conditional specification in multivariate imputation. J. Stat. Comput. Simul. 2006, 76, 1049–1064. [Google Scholar] [CrossRef]
- Wright, S.E.; Walmsley, E.; Harvey, S.E.; Robinson, E.; Ferrando-Vivas, P.; Harrison, D.A.; Canter, R.R.; McColl, E.; Richardson, A.; Richardson, M.; et al. Missing Data and Imputation; NIHR Journals Library. Available online: https://www.ncbi.nlm.nih.gov/books/NBK333183/ (accessed on 1 December 2015).
- Blazek, K.; van Zwieten, A.; Saglimbene, V.; Teixeira-Pinto, A. A practical guide to multiple imputation of missing data in nephrology. Kidney Int. 2021, 99, 68–74. [Google Scholar] [CrossRef]
- Lee, K.J.; Roberts, G.; Doyle, L.W.; Anderson, P.J.; Carlin, J.B. Multiple imputation for missing data in a longitudinal cohort study: A tutorial based on a detailed case study involving imputation of missing outcome data. Int. J. Soc. Res. Methodol. 2016, 19, 575–591. [Google Scholar] [CrossRef]
- Musoro, J.Z.; Zwinderman, A.H.; Puhan, M.A.; ter Riet, G.; Geskus, R.B. Validation of prediction models based on lasso regression with multiply imputed data. BMC Med. Res. Methodol. 2014, 14, 116. [Google Scholar] [CrossRef] [PubMed]
- Li, Y.; Lu, F.; Yin, Y. Applying logistic LASSO regression for the diagnosis of atypical Crohn’s disease. Sci. Rep. 2022, 12, 11340. [Google Scholar] [CrossRef] [PubMed]
- What is Lasso Regression?|IBM. Available online: https://www.ibm.com/topics/lasso-regression (accessed on 18 January 2024).
- Hosmer, D.W.; Lemeshow, S.; Sturdivant, R.X. Applied Logistic Regression; John Wiley & Sons: Hoboken, NJ, USA, 2013; ISBN 978-0-470-58247-3. [Google Scholar]
- Sterne, J.A.C.; White, I.R.; Carlin, J.B.; Spratt, M.; Royston, P.; Kenward, M.G.; Wood, A.M.; Carpenter, J.R. Multiple imputation for missing data in epidemiological and clinical research: Potential and pitfalls. BMJ 2009, 338, b2393. [Google Scholar] [CrossRef]
- Ng, K.Y.Y.; Zhou, S.; Tan, S.H.; Ishak, N.D.B.; Goh, Z.Z.S.; Chua, Z.Y.; Chia, J.M.X.; Chew, E.L.; Shwe, T.; Mok, J.K.Y.; et al. Understanding the Psychological Impact of COVID-19 Pandemic on Patients With Cancer, Their Caregivers, and Health Care Workers in Singapore. JCO Glob. Oncol. 2020, 6, 1494–1509. [Google Scholar] [CrossRef]
- Wang, C.; Pan, R.; Wan, X.; Tan, Y.; Xu, L.; Ho, C.S.; Ho, R.C. Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China. Int. J. Environ. Res. Public Health 2020, 17, 1729. [Google Scholar] [CrossRef]
- Osman, L.; Fear of COVID-19 is Growing, Suggests New Poll of Canadians. CP24. Available online: https://www.cp24.com/news/fear-of-covid-19-is-growing-suggests-new-poll-of-canadians-1.4885867?cache=xsfskdnkckf (accessed on 7 April 2020).
- Chair, Y.S.; Chien, W.T.; Liu, T.; Lam, L.; Cross, W.; Banik, B.; Rahman, M.A. Psychological Distress, Fear and Coping Strategies among Hong Kong People During the COVID-19 Pandemic. Curr. Psychol. 2021, 42, 2538–2557. [Google Scholar] [CrossRef] [PubMed]
- Koçak, O.; Koçak, Ö.E.; Younis, M.Z. The Psychological Consequences of COVID-19 Fear and the Moderator Effects of Individuals’ Underlying Illness and Witnessing Infected Friends and Family. Int. J. Environ. Res. Public Health 2021, 18, 1836. [Google Scholar] [CrossRef] [PubMed]
- Oti-Boadi, M.; Malm, E.; Dey NE, Y.; Oppong, S. Fear of COVID-19: Psychological distress and coping among university students in Ghana. Curr. Psychol. 2021, 41, 8260–8270. [Google Scholar] [CrossRef] [PubMed]
- Yu, L.; Lecompte, M.; Zhang, W.; Wang, P.; Yang, L. Sociodemographic and COVID-Related Predictors for Mental Health Condition of Mainland Chinese in Canada Amidst the Pandemic. Int. J. Environ. Res. Public Health 2022, 19, 171. [Google Scholar] [CrossRef] [PubMed]
- Fofana, N.K.; Latif, F.; Sarfraz, S.; Bilal Bashir, M.F.; Komal, B. Fear and agony of the pandemic leading to stress and mental illness: An emerging crisis in the novel coronavirus (COVID-19) outbreak. Psychiatry Res. 2020, 291, 113230. [Google Scholar] [CrossRef]
- Dong, L.; Yang, L. COVID-19 anxiety: The impact of older adults’ transmission of negative information and online social networks. Aging Health Res. 2023, 3, 100119. [Google Scholar] [CrossRef] [PubMed]
- Paul, C.; Ayis, S.; Ebrahim, S. Psychological distress, loneliness and disability in old age. Psychol. Health Med. 2006, 11, 221–232. [Google Scholar] [CrossRef] [PubMed]
- Best, L.A.; Law, M.A.; Roach, S.; Wilbiks, J.M.P. The psychological impact of COVID-19 in Canada: Effects of social isolation during the initial response. Can. Psychol./Psychol. Can. 2021, 62, 143–154. [Google Scholar] [CrossRef]
- Latikka, R.; Koivula, A.; Oksa, R.; Savela, N.; Oksanen, A. Loneliness and psychological distress before and during the COVID-19 pandemic: Relationships with social media identity bubbles. Soc. Sci. Med. 2021, 293, 114674. [Google Scholar] [CrossRef]
- Simpson, J.N.; Oliffe, J.L.; Rice, S.M.; Kealy, D.; Seidler, Z.E.; Ogrodniczuk, J.S. Social Disconnection and Psychological Distress in Canadian Men During the COVID-19 Pandemic. Am. J. Men’s Health 2022, 16, 155798832210781. [Google Scholar] [CrossRef] [PubMed]
- Bao, L.; Li, W.-T.; Zhong, B.-L. Feelings of loneliness and mental health needs and services utilization among Chinese residents during the COVID-19 epidemic. Glob. Health 2021, 17, 51. [Google Scholar] [CrossRef] [PubMed]
- Lin, S. The “loneliness epidemic”, intersecting risk factors and relations to mental health help-seeking: A population-based study during COVID-19 lockdown in Canada. J. Affect. Disord. 2023, 320, 7–17. [Google Scholar] [CrossRef] [PubMed]
- Feng, Y.R.; Krygsman, A.; Vaillancourt, T.; Vitoroulis, I. Experiences of racial microaggression among immigrant and Canadian-born young adults: Effects of double stigma on mental health and service use. Int. J. Soc. Psychiatry 2023, 69, 1723–1735. [Google Scholar] [CrossRef] [PubMed]
- Sieffien, W.; Law, S.; Andermann, L. Immigrant and refugee mental health during the COVID-19 pandemic: Additional key considerations. Can. Fam. Phys. 2021. Available online: https://www.cfp.ca/news/2020/06/23/06-23-1 (accessed on 23 June 2020).
- Patterson, P.B.; Roddick, J.; Pollack, C.A.; Dutton, D.J. Virtual care and the influence of a pandemic: Necessary policy shifts to drive digital innovation in healthcare. Healthc. Manag. Forum 2022, 35, 272–278. [Google Scholar] [CrossRef] [PubMed]
- Brual, J.; Chu, C.; Fang, J.; Fleury, C.; Stamenova, V.; Bhattacharyya, O.; Tadrous, M. Virtual care use among older immigrant adults in Ontario, Canada during the COVID-19 pandemic: A repeated cross-sectional analysis. PLoS Digit. Health 2023, 2, e0000092. [Google Scholar] [CrossRef] [PubMed]
- Yang, L.; Kandasamy, K.; Na, L.; Zhang, W.; Wang, P. Perceived and experienced anti-Chinese discrimination and its associated psychological impacts among Chinese Canadians during the wave 2 of the COVID-19 pandemic. Psychol. Health Med. 2024, 29, 108–125. [Google Scholar] [CrossRef] [PubMed]
- Silberzahn, R.; Uhlmann, E.L.; Martin, D.P.; Anselmi, P.; Aust, F.; Awtrey, E.; Bahník, Š.; Bai, F.; Bannard, C.; Bonnier, E.; et al. Many Analysts, One Data Set: Making Transparent How Variations in Analytic Choices Affect Results. Adv. Methods Pract. Psychol. Sci. 2018, 1, 337–356. [Google Scholar] [CrossRef]
- Andrade, C. A Student’s Guide to the Classification and Operationalization of Variables in the Conceptualization and Design of a Clinical Study: Part 2. Indian J. Psychol. Med. 2021, 43, 265–268. [Google Scholar] [CrossRef]
- Canada’s Permanent Residence Card: A Newcomer’s Guide (n.d.). Canadavisa.com. Available online: https://www.canadavisa.com/canadian-immigration-permanent-resident-card.html (accessed on 1 December 2023).
- Government of Canada, S.C. Difficulty Accessing Health Care Services in Canada. Available online: https://www150.statcan.gc.ca/n1/pub/82-624-x/2016001/article/14683-eng.htm# (accessed on 8 December 2016).
- Pandey, M.; Kamrul, R.; Michaels, C.R.; McCarron, M. Identifying Barriers to Healthcare Access for New Immigrants: A Qualitative Study in Regina, Saskatchewan, Canada. J. Immigr. Minor. Health 2021, 24, 188–198. [Google Scholar] [CrossRef] [PubMed]
- Moroz, N.; Moroz, I.; D’Angelo, M.S. Mental health services in Canada: Barriers and cost-effective solutions to increase access. Healthc. Manage Forum 2020, 33, 282–287. [Google Scholar] [CrossRef] [PubMed]
- Starling Minds Inc. (n.d.). Starling Minds COVID-19 Program Discontinued. Available online: https://info.starlingminds.com/starling-minds-covid-19-program-discontinued?_ga=2.163399487.2088629503.1585619688-1217452730.1585619688 (accessed on 9 August 2024).
- Leung, D.; Lee, C.; Wang, A.H.; Guruge, S. Immigrants’ and refugees’ experiences of access to health and social services during the COVID-19 pandemic in Toronto, Canada. J. Health Serv. Res. Policy 2022, 28, 34–41. [Google Scholar] [CrossRef] [PubMed]
Variables | N | CPDI | p-Value | |
---|---|---|---|---|
Normal (<28) (n = 419) | Mild-to-Severe (≥28) (n = 327) | |||
Age | 0.7799 | |||
Under 35 | 51 (6.84) | 26 (6.21) | 25 (7.65) | |
35–44 | 96 (12.87) | 52 (12.41) | 44 (13.46) | |
45–54 | 265 (35.52) | 146 (34.84) | 119 (36.39) | |
55–64 | 194 (26.01) | 111 (26.49) | 83 (25.38) | |
65 or above | 140 (18.77) | 84 (20.05) | 56 (17.13) | |
Gender | 0.0165 | |||
Men | 251 (34.15) | 156 (37.86) | 95 (29.41) | |
Women | 484 (65.85) | 256 (62.14) | 228 (70.59) | |
Birthplace | 0.0074 | |||
Mainland China | 710 (95.17) | 391 (93.32) | 319 (97.55) | |
Other | 36 (4.83) | 28 (6.68) | 8 (2.45) | |
Mother language | 0.7580 | |||
Mandarin | 694 (93.53) | 389 (93.29) | 305 (93.85) | |
Other | 48 (6.47) | 28 (6.71) | 20 (6.15) | |
Province | 0.7181 | |||
Ontario | 661 (89.08) | 373 (89.45) | 288 (88.62) | |
Other | 81 (10.92) | 44 (10.55) | 37 (11.38) | |
Length in Canada | 0.1976 | |||
Under 6 years | 79 (10.59) | 41 (9.79) | 38 (11.62) | |
6 to less than 15 years | 238 (31.90) | 125 (29.83) | 113 (34.56) | |
At least 15 years | 429 (57.51) | 253 (60.38) | 176 (53.82) | |
Marital status | 0.2670 | |||
Married/Common law | 643 (86.54) | 366 (87.77) | 277 (84.97) | |
Other | 100 (13.46) | 51 (12.23) | 49 (15.03) | |
Living status | 0.4310 | |||
With family | 679 (91.14) | 384 (91.87) | 295 (90.21) | |
Other | 66 (8.86) | 34 (8.13) | 32 (9.79) | |
Highest educational status | 0.1327 | |||
Under university | 165 (22.12) | 84 (20.05) | 81 (24.77) | |
University | 322 (43.16) | 178 (42.48) | 144 (44.04) | |
Master/PhD | 259 (34.72) | 157 (37.47) | 102 (31.19) | |
Employment status | 0.2767 | |||
Employed | 312 (41.82) | 183 (43.68) | 129 (39.45) | |
Self-employed | 141 (18.90) | 74 (17.66) | 67 (20.49) | |
Unemployed | 105 (14.08) | 52 (12.41) | 53 (16.21) | |
Other | 188 (25.20) | 110 (26.25) | 78 (23.85) | |
Work in healthcare | 0.5312 | |||
Yes | 67 (9.05) | 40 (9.64) | 27 (8.31) | |
No | 673 (90.95) | 375 (90.36) | 298 (91.69) | |
Work requiring public contact | 0.1215 | |||
Yes | 132 (17.79) | 66 (15.87) | 66 (20.25) | |
No | 610 (82.21) | 350 (84.13) | 260 (79.75) | |
Financial status | <0.0001 | |||
Dissatisfied | 173 (23.22) | 71 (16.99) | 102 (31.19) | |
Neutral | 305 (40.94) | 168 (40.19) | 137 (41.90) | |
Satisfied | 267 (35.84) | 179 (42.82) | 88 (26.91) | |
Current health status | 0.0001 | |||
Poor | 32 (4.30) | 9 (2.15) | 23 (7.06) | |
Fair | 299 (40.19) | 154 (36.84) | 145 (44.48) | |
Good | 413 (55.51) | 255 (61.00) | 158 (48.47) | |
COVID-19 infectious history | 1.0000 a | |||
Yes | 4 (0.54) | 2 (0.48) | 2 (0.61) | |
No | 742 (99.46) | 417 (99.52) | 325 (99.39) | |
Fear of COVID-19 | <0.0001 | |||
Yes | 537 (71.98) | 254 (60.62) | 283 (86.54) | |
No | 209 (28.02) | 165 (39.38) | 44 (13.46) | |
Discriminate | 0.0774 | |||
Perceived/experienced | 286 (38.34) | 149 (35.56) | 137 (41.90) | |
Other | 460 (61.66) | 270 (64.44) | 190 (58.10) | |
Delayed medical care access | <0.0001 | |||
Yes | 600 (80.43) | 314 (74.94) | 286 (87.46) | |
Non-response about delay | 146 (19.57) | 105 (25.06) | 41 (12.54) | |
Social Loneliness Score | ||||
N | 713 | 411 | 302 | |
Mean | 16.21 ± 2.73 | 19.18 ± 2.98 | <0.0001 |
Variables | CPDI | p-Value | |
---|---|---|---|
OR | 95% CI | ||
Age | |||
Under 35 | 1.442 | 0.757–2.748 | 0.4354 |
35–44 | 1.269 | 0.751–2.145 | 0.7636 |
45–54 | 1.223 | 0.807–1.853 | 0.8957 |
55–64 | 1.122 | 0.721–1.745 | 0.6249 |
65 or above | ref | ||
Gender | |||
Men | 0.684 | 0.501–0.933 | 0.0167 |
Women | ref | ||
Birthplace | |||
Mainland China | 2.855 | 1.284–6.352 | 0.0101 |
Other | ref | ||
Mother language | |||
Mandarin | 1.097 | 0.606–1.985 | 0.7594 |
Other | ref | ||
Province | |||
Ontario | 0.918 | 0.577–1.459 | 0.7171 |
Other | ref | ||
Length in Canada | |||
Under 6 years | 1.332 | 0.823–2.156 | 0.5149 |
6 to less than 15 years | 1.299 | 0.945–1.788 | 0.5072 |
At least 15 years | ref | ||
Marital status | |||
Married/Common law | 0.788 | 0.517–1.201 | 0.2678 |
Other | ref | ||
Living status | 0.4316 | ||
With family | 0.816 | 0.492–1.354 | |
Other | ref | ||
Highest educational status | |||
Under university | 1.484 | 1.001–2.201 | 0.1076 |
University | 1.245 | 0.893–1.736 | 0.8846 |
Master/PhD | ref | ||
Employment status | |||
Employed | 0.994 | 0.688–1.435 | 0.1700 |
Self-employed | 1.277 | 0.823–1.982 | 0.5119 |
Unemployed | 1.437 | 0.889–2.232 | 0.1825 |
Other | ref | ||
Work in healthcare | 0.5316 | ||
Yes | 0.849 | 0.509–1.416 | |
No | ref | ||
Work requiring public contact | 0.1223 | ||
Yes | 1.346 | 0.923–1.963 | |
No | ref | ||
Financial status | |||
Dissatisfied | 2.922 | 1.966–4.342 | <0.0001 |
Neutral | 1.659 | 1.180–2.332 | 0.8440 |
Satisfied | ref | ||
Current health status | |||
Poor | 4.123 | 1.860–9.135 | 0.0026 |
Fair | 1.520 | 1.124–2.054 | 0.2149 |
Good | ref | ||
COVID-19 infectious history | |||
Yes | 1.283 | 0.180–9.158 | 0.8037 |
No | ref | ||
Fear of COVID-19 | |||
Yes | 4.178 | 2.877–6.068 | <0.0001 |
No | ref | ||
Discriminate | |||
Perceived/experienced | 1.307 | 0.971–1.759 | 0.0777 |
No | ref | ||
Delayed medical care access | |||
Yes | 2.333 | 1.572–3.462 | <0.0001 |
Non-response about delay | ref | ||
Social Loneliness Score | 1.447 | 1.354–1.545 | <0.0001 |
Variables | Completed Cases Analysis | Imputed Cases Analysis | ||||
---|---|---|---|---|---|---|
OR | 95% CI | p-Value | OR | 95% CI | p-Value | |
Age | ||||||
Under 35 | 1.946 | 0.858–4.411 | 0.3016 | 1.317 | 0.734–2.363 | 0.3551 |
35–44 | 1.534 | 0.802–2.934 | 0.7602 | 1.111 | 0.723–1.706 | 0.6307 |
45–54 | 1.510 | 0.897–2.540 | 0.7458 | 1.065 | 0.780–1.455 | 0.6899 |
55–64 | 1.343 | 0.771–2.339 | 0.7201 | 0.952 | 0.666–1.361 | 0.7867 |
65 or above | ref | ref | ||||
Length in Canada | ||||||
Under 6 years | 1.339 | 0.771–2.339 | 0.6733 | 1.108 | 0.759–1.616 | 0.5961 |
6 to less than 15 years | 1.403 | 0.924–2.129 | 0.3770 | 1.120 | 0.844–1.486 | 0.4307 |
At least 15 years | ref | ref | ||||
Highest educational status | ||||||
Under university | 1.303 | 0.793–2.143 | 0.2299 | 1.170 | 0.880–1.556 | 0.2797 |
University | 0.999 | 0.661–1.510 | 0.4690 | 0.943 | 0.743–1.196 | 0.6263 |
Master/PhD | ref | ref | ||||
Financial status | ||||||
Dissatisfied | 1.314 | 0.803–2.150 | 0.3736 | 1.133 | 0.852–1.507 | 0.3910 |
Neutral | 1.168 | 0.776–1.758 | 0.9176 | 1.004 | 0.792–1.272 | 0.9757 |
Satisfied | ref | ref | ||||
Fear of COVID-19 | ||||||
Yes | 2.617 | 1.694–4.041 | <0.0001 | 1.604 | 1.293–1.989 | <0.0001 |
No | ref | ref | ||||
Delayed medical care access | ||||||
Yes | 1.900 | 1.184–3.048 | 0.0078 | 1.362 | 1.078–1.720 | 0.0095 |
Non-response about delay | ref | ref | ||||
Social Loneliness Score | 1.384 | 1.291–1.483 | <0.0001 | 1.408 | 1.314–1.508 | <0.0001 |
Work requiring public contact | ||||||
Yes | 1.245 | 0.782–1.982 | 0.3563 | - | - | - |
No | ref | - | - | - | ||
Current health status | ||||||
Poor | - | - | - | 1.529 | 0.815–2.869 | 0.1860 |
Fair | - | - | - | 0.782 | 0.544–1.124 | 0.1838 |
Good | - | - | - | ref |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Vo, A.T.; Yang, L.; Urquhart, R.; Yi, Y.; Wang, P.P. Delayed Access to Medical Care and Psychological Distress among Chinese Immigrants in Canada during the Pandemic. Healthcare 2024, 12, 1639. https://doi.org/10.3390/healthcare12161639
Vo AT, Yang L, Urquhart R, Yi Y, Wang PP. Delayed Access to Medical Care and Psychological Distress among Chinese Immigrants in Canada during the Pandemic. Healthcare. 2024; 12(16):1639. https://doi.org/10.3390/healthcare12161639
Chicago/Turabian StyleVo, Anh Thu, Lixia Yang, Robin Urquhart, Yanqing Yi, and Peizhong Peter Wang. 2024. "Delayed Access to Medical Care and Psychological Distress among Chinese Immigrants in Canada during the Pandemic" Healthcare 12, no. 16: 1639. https://doi.org/10.3390/healthcare12161639