Introduction

This concept describes how Duration of Residence is operationalized for immigration-related research at MCHP. The concept includes the following sections:


• a brief definition,
  
• some Background Information on the subject,
  
• a list of Data Sources where the data comes from,
  
• a description of the Methods employed,
  
• links to Research Findings reported in MCHP publications,
  
• any Cautions / Limitations found during development of this concept, and
  
• a relevant SAS® code example in the SAS code and formats section.

Definition: duration of residence is defined as the length of time an individual spends in a particular place, and is a concept that is often used in immigration-related research.

Background Information

The duration of residence is an important predictor of health-related outcomes. Immigrants are usually subcategorised according to their length of stay, particularly "recent immigrants," or "newcomers' who are supposed to constitute a vulnerable group in terms of healthcare access and utilisation. Duration of residence is a continuous measure and may be collapsed into groups (e.g. one-year or five-year durations).


1. Duration of residence in Canada - for immigrants, this refers to the difference between the date of an immigrant’s arrival (or landing) in Canada, and to the date of the event of interest.
   
2. Duration of residence in Manitoba - for immigrants, this refers to the difference between their health insurance coverage start date on the Manitoba health card, and to the date of the event of interest. For non-immigrants (e.g., individuals born in Canada) duration of residence is the difference between the date of birth and the date of the event of interest.

NOTE: Duration of residence in Canada could mean anywhere in Canada or only in Manitoba. Using the landing data from the IRCC database, and without using the provincial health insurance registry, one can calculate duration of residence in Canada as a simple difference between the landing date and date of other event of interest. But this simple calculation makes the assumption that the person stayed in Canada after landing, and we don’t have data to confirm this on a country-wide basis.

Therefore, this concept describes a method developed at MCHP to define and operationalize "duration of residence in Manitoba." At MCHP, duration of residence is derived from healthcare coverage records in the Manitoba Health Insurance Registry. Manitoba residents include all persons who reside in Manitoba, persons who reside temporarily out of the province (e.g. students attending post-secondary schools out of province) and residents who have moved to another province (for three months after their move). In addition, new Manitobans arriving from another province (eligible after a three-month waiting period) and new Manitobans arriving from another country (eligible for coverage immediately) are also included.

Data Sources

The data used to operationalize this concept came from the following Repository databases:


• Manitoba Health Insurance Registry data
  
• Immigration Refugees and Citizenship Canada (IRCC) – Permanent Residence Database

Methods

The Manitoba Health Insurance Registry (MHIR) contains longitudinal histories of each individual registered with the Manitoba Health Insurance Plan since 1970, including the dates their healthcare coverage started and ended. For immigrants who are permanent residents, the Immigration, Refugees and Citizenship Canada (IRCC) Permanent Resident Database is also used to determine the landing date (date when permanent residence was granted).

The "coverage start date" is accompanied by a "coverage added" code (COVCODE) in the Registry, and the "coverage end date" (if applicable) is similarly accompanied by a "coverage cancellation reason" code. These two codes help explain the reasons a coverage episode began and ended, including information about the location from which the person came to Manitoba, as well as where the person went after leaving, or other reasons for cancellation of coverage.

For individuals born in Manitoba, interprovincial migrants and long-term Manitoba residents, duration of residence was calculated from the coverage start date to the coverage end date (if applicable) available from the MHIR. Gaps in residence of 360 days or less were ignored.

Many international immigrants resided in Manitoba as temporary immigrants before they obtained their permanent resident status. Therefore, to calculate the duration of permanent residence for immigrants, the start of residence was the later of their Landing Date or Coverage Start Date, ignoring gaps in residence of 360 days or less.

Research Findings

In the deliverable The Diversity of Immigrants to Manitoba, Migration Dynamics and Basic Healthcare Service Use by Urquia et al. (2020) they investigated duration of residence and reported on the years of permanent residence among immigrants to Manitoba by landing year.

Please see the following information reported in the on-line deliverable:


• Figure 3.15: Years of Permanent Residence in Manitoba Among Immigrants by Landing Year, 1985-2017

Cautions / Limitations

The following limitations were identified during development of this concept:


• Coverage start and end dates in the Manitoba Health Insurance Registry are a proxy for the start and end of residence period. This is an approximation and may not fully capture duration of residence. For example, the "cannot locate" code as reason for cancellation of coverage in the Registry may indicate that a resident has moved away, or the resident may still be in Manitoba but has not made contact with health services for over a year.

SAS code and formats

An example of the SAS® code used to operationalize the methods for determining the duration of permanent residence in Manitoba can be found in the SAS code and formats section of the Number of Years of Permanent Residence in Manitoba concept.