Analysing spatial accessibility to health care: a case study of access by different immigrant groups to primary care physicians in Toronto

Figures & data

Table 1. Socio-economic characteristics of selected recent immigrant populations

		Iran	Mainland China	Pakistan	Russia	Sri Lanka	Hong Kong	Toronto CMA
Population
(2006) ^a		45,205	190,515	85,195	29,875	45,205	102,675	5,064,690
Primary language(s)		Farsi (Persian)	Mandarin	Urdu, Hindi	Russian	Tamil, Sinhalese	Cantonese	English, French
Newcomers 1999–2001 ^b	Count of newcomers 1999–2001	9,143	53,739	28,855	6,841	12,104	1,536	119,488
	% Newcomers	22.5	47.9	44.3	48.2	17.5	1.5	20.04
	% Economic	52.8	77	58.3	75.6	11.4	30.4	31^3
	% Family	29.9	19.8	35.1	17.1	39.8	69.5	54
	% Humanitarian	17.3	3.2	6.6	7.3	48.7	0.2	15
	% Bachelor's and above	35.4	52.7	40.5	49.9	7.7	16.7	19.0
	% No proficiency in English or French	46.1	70.2	49.1	56	42.2	40.8%	54.9
Immigrants by place of birth ^c	% Recent immigrants	37.7	34.5	50.9	52	21.8	3.0	16.6
	% Unemployed	10.6	10.2	12.4	11.2	10.2	NA	6.7
	% Mean Household income ($)	51,363	56,406	54,893	54,214	53,503	NA	76,454
	% Low income	35.7	34.1	37.7	33	32.4	NA	22.9
Notes: CMA, Census Metropolitan Area.
^aLo et al. (2007).
^bCanadian Census 2006, Lo et al. (2007).
^cWang and Lo (2000).

Table 2. Aggregated statistics on population and family physicians (FPs) in Toronto CMA

			Same-language family physicians (SLFPs)			By recent arrivals (in past 5 years)		SLFPs accepting new patients
Study populations by source country	Count	%	Count	%	SLFPs/1000 immigrants	Count	%	Count	%	SLFPs accepting new patients/1000 recent immigrants
Iran	45,205	0.9	37	0.6	0.82	13,965	0.03	8	1.0	0.57
Hong Kong	102,675	2.0	404^a	6.6	3.93	3,060	0.01	104	12.5	33.99^b
Mainland China	190,515	3.8	360^a	5.9	1.89	63,370	0.14	88	10.5	1.39
Pakistan	85,195	1.7	212	3.5	2.49	36,975	0.08	61	7.3	1.65
Russia	29,875	0.6	63	1.0	2.11	9,895	0.02	23	2.8	2.32
Sri Lanka	83,835	1.7	42	0.7	0.52	17,135	0.04	18	2.2	1.05
Italy	130,325	2.6	144	2.4	1.12	NA	NA	43	5.1	NA
Portugal	76,025	1.5	58	0.9	0.75	NA	NA	13	1.6	NA
Toronto CMA	Population		FPs		FPs/1,000persons	Recent immigrants		FPs accepting new patients	FPs accepting new patients/all FPs (%)	FPs accepting new patients/1,000 recent immigrants
	5,064,690		6,078		1.20	446,710		835		1.87
Notes: CMA, Census Metropolitan Area.
^aSome physicians self-reported speaking both Mandarin and Cantonese, the two Chinese languages most commonly spoken in Canada; in the table, there is double counting for these two statistics only.
^bThe high ratio results from the much-reduced number of immigrants from Hong Kong after 1997.

Figure 1. Spatial accessibility of general population to family physicians.

Table 3. Accessibility, immigrant population and physician distribution in urban and suburban Toronto

	Immigrants		Recent immigrants		SLFPs		Accessibility to SLFPs (mean)		Newcomers' accessibility to SLFPs accepting new patients (mean)
Country of origin	Urban	Suburb	Urban	Suburb	Urban	Suburb	Urban	Suburb	Urban	Suburb
Total of Toronto
CMA	1,082,375	1,234,245	238,290	208,420	4,652^a	1,430^a	2.107^b	0.623^b	4.151^b	1.264^b
	47%	53%	53%	47%	76%	24%	NA	NA	NA	NA
Iran	22,120	23,085	8,515	5,450	19	18	0.696	0.624	0.017	0.039
	49%	51%	61%	39%	51%	49%	NA	NA	NA	NA
Hong Kong	36,965	65,710	43,165	20,205	245	159	7.42	3.56	1.171	0.636
	36%	64%	68%	32%	61%	40%	NA	NA	NA	NA
Mainland China	112,265	78,250	43,165	20,205	220	140	2.13	2.042	0.169	0.115
	59%	41%	68%	32%	61%	39%	NA	NA	NA	NA
Pakistan	32,890	52,305	16,500	20,475	111	101	2.404	1.598	0.151	0.129
	39%	61%	45%	55%	52%	48%	NA	NA	NA	NA
Russia	12,865	17,010	238,290	208,420	50	12	2.133	0.91	0.163	0.071
	43%	57%	53%	47%	81%	19%	NA	NA	NA	NA
Sri Lanka	46,435	37,400	10,990	6,145	28	14	0.394	0.269	0.068	0.047
	55%	45%	64%	33%	67%	33%	NA	NA	NA	NA
Italy	58,560	71,765	NA	NA	115	29	2.206	0.644	NA	NA
	45%	55%	NA	NA	80%	20%	NA	NA	NA	NA
Portugal	41,705	34,320	NA	NA	48	10	0.864	0.244	NA	NA
	55%	45%	NA	NA	83%	17%	NA	NA	NA	NA
Notes: SLFPs, same-language family physicians; CMA, Census Metropolitan Area.
^aThey are the numbers of family physicians in urban and suburban Toronto.
^bThey are calculated accessibility to SLFPs for all the immigrants and recent immigrants in the Toronto CMA.

Figure 2. Spatial accessibility of immigrants from Pakistan, Hong Kong and Italy to same-language family physicians.

Figure 3. Accessibility of newcomers from Mainland China, Sri Lanka and Russia to SLFPs accepting new patients.

Table 4. Descriptive statistics for calculated accessibility in scenarios 1 and 2

	Minimum	Maximum	Mean	Median	SD
General accessibility	0	4.0	1.4	0.000.8	1.251
Scenario 1: accessibility of immigrants to SLFPs
Mainland China	0	12.5	2.2	2.1	1.479
Hong Kong	0	23.9	5.7	3.6	6.258
Pakistan	0	11.5	2.1	2.0	1.932
Sri Lanka	0	2.6	0.3	0.2	0.385
Iran	0	11.7	0.7	0.4	1.046
Russia	0	13.3	1.6	0.0	2.119
Italy	0	6.7	1.5	1.0	1.464
Portugal	0	6.8	0.6	0.3	0.803
Scenario 2: accessibility of newcomers to SLFPs accepting new patients
Mainland China	0	0.8	0.1	0.2	0.149
Hong Kong	0	36.2	0.9	0.0	3.106
Pakistan	0	1.1	0.1	0.0	0.188
Sri Lanka	0	0.9	0.1	0.0	0.113
Iran	0	2.1	0.0	0.0	0.125
Russia	0	1.5	0.1	0.0	0.222
Notes: SLFPs, same-language family physicians.
Accessibility scores in this table are inflated by 1000.

Table 5. Correlations between calculated accessibility and immigrant population (N = 944 census tracts)

			Scenario 1: accessibility of immigrants to SLFPs								Scenario 2: accessibility of newcomers to SLFPs accepting new patients
		Ai ^1	MainlandChina	HongKong	Pakistan	Sri Lanka	Italy	Portugal	Iran	Russia	Mainland China	HongKong	Pakistan	Sri Lanka	Iran	Russia
	Ai	1
Immigrants	Mainland China	−0.015	−0.165**
	Hong Kong	−0.156**		−0.135**
	Pakistan	−0.130**			0.078**
	Sri Lanka	−0.156**				0.205*
	Italy	−0.155**					−0.152**
	Portugal	0.233**						0.117**
	Iran	−0.084**							0.017
	Russia	−0.064**								0.060
Recent Immigrants	Mainland China	0.009									0.184**
	Hong Kong	−0.105**										0.416**
	Pakistan	−0.064*											0.258**
	Sri Lanka	−0.125**												0.465**
	Iran	−0.039													0.135**
	Russia	−0.018														0.334**
CMA	Total population	−0.183**
Notes: SLFPs, same-language family physicians. is the general accessibility to family physicians regardless of ethnicity and language.
*Correlation is significant at the 0.05 level two-tailed.
**Correlation is significant at the 0.01 level two-tailed.

Lo , L. 2007 . Immigrant settlement services in the Toronto CMA: a GIS-assisted analysis of demand and supply , Toronto : CERIS, the Ontario Metropolis Centre, Working Paper Series 59 .

 Google Scholar

Wang , S. and Lo , L. 2000 . Economic impacts of immigrants in the Toronto CMA: a tax-benefit analysis . Journal of International Migration and Integration , 1 ( 3 ) : 273 – 303 .

 Google Scholar