In Canada, immigration status is associated with length of ICU stay after stroke

by American Academy of Neurology

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Among people who have a stroke in Canada, immigrants were admitted to the intensive care unit (ICU) at similar rates to long-term residents or people who were born in Canada, but they were more likely to have longer stays in the ICU, according to a study published Sept. 2, 2026, in Neurology.

People were defined as immigrants if they were born outside Canada and arrived in the country after 1985. They were compared to people born in Canada or who immigrated before 1985, called long-term residents.

"Immigration status is recognized as a key social determinant of health, and with the number of immigrants increasing around the world in recent decades due to war, persecution and climate change, we wanted to take a closer look at how immigration status may be associated with stroke care," said study author Manav V. Vyas, MBBS, Ph.D., of St. Michael's Hospital-Unity Health Toronto and the University of Toronto and a member of the American Academy of Neurology.

For the study, researchers looked at records for all people hospitalized with an ischemic stroke in Ontario, Canada, from 2014 to 2023. Ischemic stroke is the most common kind of stroke. It is caused when blood flow is blocked to part of the brain.

The study examined who received treatments to restore blood flow, either through clot-busting drugs or clot removal procedures. It also looked at who was admitted to the ICU, how long they stayed in the ICU and who received breathing support and feeding tubes.

Of the 85,507 people in the study, 12.9% were immigrants. Immigrants were younger, with an average age of 69 compared with 76 for long-term residents. The immigrants had less severe strokes on average.

Regarding stroke care treatments, immigrants were less likely to receive treatments to restore blood flow than long-term residents, at 17.2% compared with 18.0%. They had slightly higher rates of life-sustaining treatments, including breathing support through a ventilator, at 6.5% versus 5.3%, and feeding tube placement, at 3.0% versus 1.9%.

There was no difference in how often immigrants and long-term residents were admitted to the ICU. But of those who were in the ICU, immigrants had longer stays, an average of 5.6 days compared with 3.8 days for long-term residents. After adjusting for other factors that could affect length of stay, such as age, stroke severity and other health conditions, researchers found that immigrants were 30% more likely to have a longer stay in the ICU.

The researchers didn't find any differences in stroke care between hospitals that cared for a higher-than-average proportion of immigrants and those that cared for a lower-than-average proportion.

"Possible reasons for the longer stays in the ICU could be language barriers and differences in attitudes toward end-of-life care among various cultural and religious practices," Vyas said. "Fewer immigrants had palliative care consultations, or specialized care focused on comfort and quality of life, than long-term residents, which could help explain the longer ICU stays. Improving access to interpreter services and creating educational opportunities for staff to understand cultural practices could help reduce these differences in length of ICU stays."

Vyas noted that the differences in life-sustaining treatments were small and were not adjusted for factors such as patient age, so this information should be interpreted with caution. Another limitation of the study was that some information on treatments to restore blood flow, such as timing and complications, was not available.

The study was supported by IC/ES in Ontario, the PSI Foundation and the Heart and Stroke Foundation of Canada.

Publication details

Neurology (2026).

Journal information: Neurology

Key medical concepts

Ischemic StrokeReperfusionMechanical ventilation

Clinical categories

NeurologyCritical care medicine Provided by American Academy of Neurology Who's behind this story?

Gaby Clark

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