Life Satisfaction in Canada and the Immigrant Experience

Life Satisfaction in Canada and the Immigrant Experience | medRxiv /* */ /* */ <!-- <!-- /*! * yepnope1.5.4 * (c) WTFPL, GPLv2 */ (function(a,b,c){function d(a){return"[object Function]"==o.call(a)}function e(a){return"string"==typeof a}function f(){}function g(a){return!a||"loaded"==a||"complete"==a||"uninitialized"==a}function h(){var a=p.shift();q=1,a?a.t?m(function(){("c"==a.t?B.injectCss:B.injectJs)(a.s,0,a.a,a.x,a.e,1)},0):(a(),h()):q=0}function i(a,c,d,e,f,i,j){function k(b){if(!o&&g(l.readyState)&&(u.r=o=1,!q&&h(),l.onload=l.onreadystatechange=null,b)){"img"!=a&&m(function(){t.removeChild(l)},50);for(var d in y[c])y[c].hasOwnProperty(d)&&y[c][d].onload()}}var j=j||B.errorTimeout,l=b.createElement(a),o=0,r=0,u={t:d,s:c,e:f,a:i,x:j};1===y[c]&&(r=1,y[c]=[]),"object"==a?l.data=c:(l.src=c,l.type=a),l.width=l.height="0",l.onerror=l.onload=l.onreadystatechange=function(){k.call(this,r)},p.splice(e,0,u),"img"!=a&&(r||2===y[c]?(t.insertBefore(l,s?null:n),m(k,j)):y[c].push(l))}function j(a,b,c,d,f){return q=0,b=b||"j",e(a)?i("c"==b?v:u,a,b,this.i++,c,d,f):(p.splice(this.i++,0,a),1==p.length&&h()),this}function k(){var a=B;return a.loader={load:j,i:0},a}var l=b.documentElement,m=a.setTimeout,n=b.getElementsByTagName("script")[0],o={}.toString,p=[],q=0,r="MozAppearance"in l.style,s=r&&!!b.createRange().compareNode,t=s?l:n.parentNode,l=a.opera&&"[object Opera]"==o.call(a.opera),l=!!b.attachEvent&&!l,u=r?"object":l?"script":"img",v=l?"script":u,w=Array.isArray||function(a){return"[object Array]"==o.call(a)},x=[],y={},z={timeout:function(a,b){return b.length&&(a.timeout=b[0]),a}},A,B;B=function(a){function b(a){var a=a.split("!"),b=x.length,c=a.pop(),d=a.length,c={url:c,origUrl:c,prefixes:a},e,f,g;for(f=0;f<d;f++)g=a[f].split("="),(e=z[g.shift()])&&(c=e(c,g));for(f=0;f<b;f++)c=x[f](c);return c}function g(a,e,f,g,h){var i=b(a),j=i.autoCallback;i.url.split(".").pop().split("?").shift(),i.bypass||(e&&(e=d(e)?e:e[a]||e[g]||e[a.split("/").pop().split("?")[0]]),i.instead?i.instead(a,e,f,g,h):(y[i.url]?i.noexec=!0:y[i.url]=1,f.load(i.url,i.forceCSS||!i.forceJS&&"css"==i.url.split(".").pop().split("?").shift()?"c":c,i.noexec,i.attrs,i.timeout),(d(e)||d(j))&&f.load(function(){k(),e&&e(i.origUrl,h,g),j&&j(i.origUrl,h,g),y[i.url]=2})))}function h(a,b){function c(a,c){if(a){if(e(a))c||(j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}),g(a,j,b,0,h);else if(Object(a)===a)for(n in m=function(){var b=0,c;for(c in a)a.hasOwnProperty(c)&&b++;return b}(),a)a.hasOwnProperty(n)&&(!c&&!--m&&(d(j)?j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}:j[n]=function(a){return function(){var b=[].slice.call(arguments);a&&a.apply(this,b),l()}}(k[n])),g(a[n],j,b,n,h))}else!c&&l()}var h=!!a.test,i=a.load||a.both,j=a.callback||f,k=j,l=a.complete||f,m,n;c(h?a.yep:a.nope,!!i),i&&c(i)}var i,j,l=this.yepnope.loader;if(e(a))g(a,0,l,0);else if(w(a))for(i=0;i (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0];var j=d.createElement(s);var dl=l!='dataLayer'?'&l='+l:'';j.src='//www.googletagmanager.com/gtm.js?id='+i+dl;j.type='text/javascript';j.async=true;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-P4HH5NV'); Skip to main content Home About Submit ALERTS / RSS Search for this keyword Advanced Search Life Satisfaction in Canada and the Immigrant Experience View ORCID Profile Sonia S. Anand , Shreni Patel , Scott A. Lear , Trevor J.B. Dummer , Vikki Ho , Jean-Claude Tardif , Jennifer E. Vena , Karleen Schulze , Paul Poirier , Dipika Desai , View ORCID Profile Matthias G. Friedrich CAHHM Study Investigators doi: https://doi.org/10.1101/2025.06.02.25328814 Sonia S. Anand 1 Chanchlani Research Centre, Department of Medicine, McMaster University , Hamilton, ON, Canada 2 Global Health Program, Faculty of Health Sciences, McMaster University , Hamilton, ON, Canada 3 Population Health Research Institute, Hamilton Health Sciences , Hamilton, ON, Canada Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Sonia S. Anand For correspondence: anands{at}mcmaster.ca Shreni Patel 1 Chanchlani Research Centre, Department of Medicine, McMaster University , Hamilton, ON, Canada Find this author on Google Scholar Find this author on PubMed Search for this author on this site Scott A. Lear 4 Faculty of Health Sciences, Simon Fraser University , Burnaby, BC, Canada Find this author on Google Scholar Find this author on PubMed Search for this author on this site Trevor J.B. Dummer 5 School of Population and Public Health, University of British Columbia , Vancouver, BC, Canada Find this author on Google Scholar Find this author on PubMed Search for this author on this site Vikki Ho 6 Université de Montréal Hospital Research Centre (CRCHUM) , Montreal, QC, Canada 7 Department of Social and Preventive Medicine, Université de Montréal , Montreal, QC, Canada Find this author on Google Scholar Find this author on PubMed Search for this author on this site Jean-Claude Tardif 8 Department of Medicine, Montreal Heart Institute, Université de Montréal , Montreal, QC, Canada Find this author on Google Scholar Find this author on PubMed Search for this author on this site Jennifer E. Vena 9 Alberta’s Tomorrow Project, Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services , Calgary, AB, Canada Find this author on Google Scholar Find this author on PubMed Search for this author on this site Karleen Schulze 10 Department of Medicine, McMaster University , Hamilton, ON, Canada 11 Department of Medicine and Diagnostic Radiology, McGill University , Montreal, QC, Canada Find this author on Google Scholar Find this author on PubMed Search for this author on this site Paul Poirier 12 Faculté de pharmacie, Université Laval, Institut universitaire de cardiologie et de pneumologie de Québec , Québec City, QC, Canada Find this author on Google Scholar Find this author on PubMed Search for this author on this site Dipika Desai 3 Population Health Research Institute, Hamilton Health Sciences , Hamilton, ON, Canada Find this author on Google Scholar Find this author on PubMed Search for this author on this site Matthias G. Friedrich 13 Departments of Cardiology and Diagnostic Radiology, McGill University Health Center , Montréal, QC, Canada Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Matthias G. Friedrich Abstract Full Text Info/History Metrics Data/Code Preview PDF Abstract High-income countries like Canada have the highest self-reported levels of life satisfaction in the world, although little is known regarding the experiences of racialized people and immigrants to these countries. This study investigates the factors that influence subjective well-being among a large national cohort study of 8,063 adults from the Canadian Alliance of Healthy Hearts and Minds cohort study recruited between 2014 and 2018, including a subset of 2,142 immigrants. Measures of demographic, socioeconomic, health, healthcare access, and self-reported ethnicity, from which racialized status was derived, were investigated in relation to self-reported life satisfaction as measured by the validated Cantril ladder score. Among 8,063 adults average age of 58 years, approximately half were women, 18.6% were racialized, and 26.6% were immigrants. Racialized immigrants had significantly lower life satisfaction compared to non-racialized immigrants and Canadian-born persons, whether racialized or not. Multivariable analysis showed that factors associated with higher life satisfaction included older age, male sex, having trusted neighbours, and having a language-concordant family doctor. Factors associated with lower life satisfaction included being racialized, having a higher social disadvantage, poorer cardiovascular health, and being unable to afford prescription medications. Amongst immigrants, those racialized were more likely to report experiencing discrimination based on skin colour and reported lower life satisfaction. Although high income countries like Canada have amongst the highest life satisfaction scores in the world, racialized people, especially immigrants, have lower life satisfaction compared to non-racialized people. Key Messages This study examines associations of demographic, socioeconomic, health, healthcare access that influence self-reported life satisfaction among adults in Canada, particularly among racialized individuals and immigrants. Using data from the Canadian Alliance of Healthy Hearts and Minds cohort study, we found racialized immigrants report significantly lower life satisfaction compared to non-racialized immigrants and Canadian-born individuals. Despite Canada’s high average life satisfaction, the data suggests there is still a need for equity-focused and culturally tailored healthcare to improve well-being among structurally marginalized groups. Introduction Social determinants such as employment, income, education, housing, and experiences of racism shape health outcomes ( 1 ). Although Canada’s 1984 Canada Health Act strives for equal healthcare access, challenges persist due to limited primary care, cultural and language barriers, complex system navigation, and institutional racism ( 2 , 3 ). Research indicates that racialized immigrants are more likely to experience a decline in self-reported health than non-racialized immigrants—a disparity that robust social networks can mitigate ( 4 , 5 ). Furthermore, the traditional "healthy immigrant effect" has weakened, reflecting evolving immigration patterns and an increase in arrivals from conflict zones ( 6 ). Life satisfaction, a global measure linked to self-rated health ( 7 – 9 ), is effectively gauged by the validated Cantril Ladder Score, which captures respondents’ current satisfaction and temporal projections ( 10 ). Notably, reduced Cantril scores have been associated with chronic diseases, including cardiovascular disease, particularly among immigrant populations ( 11 – 14 ). In this study, we used the Cantril Ladder to assess life satisfaction among participants of the Canadian Alliance for Healthy Hearts and Minds (CAHHM), aiming to elucidate the determinants of life satisfaction among Canadian adults and testing the hypothesis that socially disadvantaged racialized immigrants experience the lowest levels ( 15 ). Materials and Methods Study Design and Participants This is a cross-sectional analysis of data which were obtained from the CAHHM cohort study, previously described ( 15 ). Briefly, the CAHHM recruited adults from the general population between 2014 to 2018 and investigated health behaviours, contextual and socio-cultural factors, chronic disease risk factors and completed a brain and cardiac MRI in all participants. The cohort is currently undergoing repeat examinations 8 years from the baseline assessment. All participants provided written informed consent. Questionnaires were self-administered. The cohort comprises 8,580 individuals (54% women) aged 30 to 78 years from communities across Canada. Ethics approval was obtained from the Hamilton Integrated Research Ethics Board (HiREB #13-255) and all relevant local ethics boards. Measurement of Life Satisfaction The primary outcome variable in this analysis: life satisfaction, was measured using the Cantril ladder score. This psychometrically validated scale offers a quantitative measure of subjective well-being, ranging from 0 (worst possible life) to 10 (best possible life) ( 10 ). Cantril Ladder has displayed reliability and validity in diverse adult populations. In a sample of U.S. adults, the ladder had a test-retest correlation of 0.71 over a one month period.( 16 ) The ladder has shown a correlation of 0.68 across five studies of 762 adults with the Satisfaction with Life Scale.( 17 ) Categories of life satisfaction were also examined using predefined cut-offs, including suffering (0 to 4), satisfactory (5 to 6), and thriving (7 to 10). Measurement of Sociodemographic Variables/Covariates Demographic and lifestyle data were collected through standardized questionnaires. The information included demographic variables, cardiovascular risk factors (CVRFs), health behaviours, access to health care, and socioeconomic factors as previously described ( 15 ). Ethnicity was self-reported, and from this information, racialized status (referring to non-white individuals) was derived. Physical activity [assessed by short form International Physical Activity Questionnaire (IPAQ-S)], psychological stress, income, employment, and education levels were also self-reported ( 15 ). Social disadvantage was derived using an index predictive of CVD ( 18 ). Healthcare access was assessed by the Health Services Questionnaire (HSR), which includes questions on access to care, health behaviours, CV risk factors, cardiac diagnostic testing, and information to calculate the non-lab INTERHEART risk score—a validated score for myocardial infarction risk ( 19 , 20 ). Social support was defined as measured using questions about neighbours’ trust and neighbours helping to solve problems ( 15 ). Participants in CAHHM who were immigrants completed the Vancouver Index of Acculturation (VIA) ( 21 ), which enables scoring to determine an individual’s affinity to their heritage culture and North American culture, years since immigration, and a specific immigrant questionnaire using questions from the Longitudinal Survey of Immigrants to Canada ( 22 ). Statistical Considerations All analyses were conducted using SAS (version 9.4), with a statistical significance level set at p < 0.05. Results were reported with corresponding 95% confidence intervals to provide a comprehensive understanding of the precision of estimates. Factors defined above were tested for their association with life satisfaction in univariate analyses, and those with a P <0.20 were entered into a forward stepwise multivariable regression model. Stratified subgroup analyses were conducted to explore potential variations in the impact of determinants on life satisfaction across demographic categories. Interaction terms were incorporated to assess effect modification. For the immigrant subset, additional analyses were conducted to include questions on discrimination. Results Overall We stratified participants into four groups based on racialized and immigrant status. The demographic characteristics of all four groups are presented in Table 1 . Briefly, we observed the greatest differences in socio-demographic characteristics between non-racialized Canadian-born participants and RI. For example, education level was higher amongst RI compared to non-racialized Canadian-born participants, whereas age, annual income >$100K and CV risk scores were lower among RI compared to non-racialized Canadian-born participants, as were factors such as language-concordance with family doctor, ease of seeing a medical specialist, and neighbourhood support (trust, collective problem solving, and willingness to help each other). Furthermore, there was a higher percentage of RI reported being unable to fill prescriptions due to cost compared to the other groups ( Table 1 and Table 2 ). View this table: View inline View popup Download powerpoint Table 1. Baseline Demographic Characteristics of Participants Stratified by Immigration and Racialized Status View this table: View inline View popup Table 2. Baseline Social Characteristics of Participants Stratified by Immigration and Racialized Status The life satisfaction scores were lowest among RI compared to all other groups, using non-racialized Canadian-born participants as the reference group (6.6 ± 1.6 vs. 7.2 ± 1.4), P<0.0001). These differences between RI and non-racialized Canadian-born participants persisted after adjustment for years of living in Canada [6.8 (95% CI: 6.7-6.9) vs. 7.2 (95% CI: 7.1-7.2)] ( Figure 1 ). RI compared to non-racialized Canadian-born participants were less likely to report a ladder score in the thriving range of 7 to 10 (57.3 vs. 73.0%), and more likely to report scores in the struggling range of 5 to 6 (33.9 vs. 22.6%) or in the suffering range of 0 to 4 (8.8 vs. 4.3%), respectively ( Table 2 ). Download figure Open in new tab Figure 1. Life satisfaction scores across demographic groups (adjusted for years in Canada). P for differences between groups <0.0001. The factors associated with life satisfaction in all participants are shown in Figure 2a . Briefly, in order of magnitude, factors associated with lower life satisfaction included not being able to fill a prescription due to cost, social disadvantage, being an RI, female sex, the presence of CVRFs, and having had an emergency room visit in the last 12 months. Factors associated with improved life satisfaction included having trusted neighbours, having a language-concordant primary care doctor, having neighbours to help solve problems, and increasing age ( Figure 2a and Table 3a ). Download figure Open in new tab Figure 2. (a) Determinants of life satisfaction scores in the overall cohort. *SDI = Social Disadvantage; IHRS = INTERHEART Risk Score; Discrim = Discrimination Download figure Open in new tab Figure 2. (b) Determinants of life satisfaction scores in the immigrant cohort. *SDI = Social Disadvantage; IHRS = INTERHEART Risk Score; Discrim = Discrimination View this table: View inline View popup Download powerpoint Table 3a. Predictors of the Cantril Score (continuous) in all participants using a Multivariable Model (N=7970) View this table: View inline View popup Download powerpoint Table 3b. Predictors of Cantril Score (continuous) in Immigrant Subpopulation using a Multivariable Model (N=2013) Immigrant subset Amongst immigrants, questions regarding discrimination were collected as part of the acculturation questionnaire ( Table 4 ). Among 2,142 who completed these questions, RI reported experiencing more discrimination compared to non-racialized immigrants (64 vs. 27%, respectively). The discrimination based on skin colour (as a proportion of the ethnic group) was largely driven by the experience of Black participants (i.e., 67% in Black people vs. 37% South Asians, 34% Chinese, and 30% in the other immigrant category). The most reported reasons for discrimination for both racialized and non-racialized are shown in Figure 3 . Download figure Open in new tab Figure 3. Commonly reported reasons for discrimination among Immigrants. View this table: View inline View popup Download powerpoint Table 4. Baseline Characteristics for Immigrant Subpopulation Specific Measures Other differences between RI vs. non-RI included their lower affinity to North American culture and their shorter duration of time living in Canada, which was, on average 10 years less. ( Figure 4 ) Download figure Open in new tab Figure 4. Immigrant years in Canada by racialized status. Amongst immigrants in the multivariate regression model, factors associated with lower life satisfaction in order of magnitude included: not being able to fill a prescription due to cost, high social disadvantage, experiencing discrimination, being racialized (even if they did not report discrimination), female sex, and having CVRFs. Factors associated with higher life satisfaction included years lived in Canada, having a language-concordant primary care doctor, having trusted neighbours and older age ( Figure 2b and Table 3b ). Discussion Our cross-sectional study of 8,063 adults finds racialized immigrants (RI) have significantly lower life satisfaction scores than other groups, particularly those experiencing discrimination. Low life satisfaction correlates with factors including inability to afford prescriptions, higher social disadvantage, being female, and more cardiovascular (CV) risk factors. Protective factors include social support, access to a language-concordant family doctor, and longer duration of residence in Canada. The strongest determinant of lower life satisfaction was the inability to afford prescriptions, reflecting a broader issue of financial hardship and uneven access to healthcare. Canada’s fragmented medication coverage further exacerbates this issue. Structural inequalities persist, particularly for racialized groups, where both financial constraints and healthcare access contribute to lower satisfaction. Addressing these disparities through national pharmacare and improving language-concordant care may help mitigate these issues. Social disadvantage, including employment and housing instability, remains a powerful determinant in life satisfaction, emphasizing the need for targeted policy interventions. Strengths of our study include a large, diverse sample and the use of the validated Cantril Ladder to assess life satisfaction. Limitations include the cross-sectional nature of the analysis, preventing causal conclusions. Future prospective analyses could further elucidate the relationship between life satisfaction and long-term health outcomes. This cross-sectional analysis of 8,063 Canadian adults reveals that while overall life satisfaction is high, racialized immigrants (RI) report significantly lower scores—especially when facing discrimination. Key factors linked to lower life satisfaction include financial hardship (notably, the inability to pay for prescription medications), higher social disadvantage, female gender, and increased cardiovascular risk factors. In contrast, protective factors such as trustworthy neighbors, a language-concordant primary care physician, older age, and longer residence in Canada for immigrants buffer these negative effects. Health status and access play a critical role; the inability to afford prescription medications— indicative of financial strain leading to medication rationing—was the strongest determinant of lower life satisfaction ( 23 ). This issue is compounded by provincial disparities in prescription coverage and Canada’s lack of a national pharmacare plan, despite being the only G7 country without one ( 24 , 25 ). Additional adverse factors include recent emergency room visits and cardiovascular risk burdens, while language-concordant care is associated with improved outcomes. Social disadvantage—a composite of employment, income, and marital status—underscores the influence of structural racism on health. Our findings, consistent with prior studies ( 26 – 28 ), indicate that racialized individuals experience higher levels of discrimination in healthcare, contributing to their lower life satisfaction. There is some evidence that perceived racial discrimination is associated with measurable brain changes on MRI—particularly in regions involved in stress, vigilance, and threat detection ( 29 ). This will be the focus of future analyses. Moreover, our analysis shows that immigrants tend to have a stronger affinity for their heritage culture, whereas Canadian-born individuals exhibit a greater affinity for Canadian culture. This cultural alignment may further influence their overall well-being. Strengths of this study include its large, multi-ethnic sample and the use of the validated Cantril Ladder to assess life satisfaction. However, the cross-sectional design limits causal interpretations, and the CAHHM cohort’s demographic profile—older, more highly educated, and with fewer cardiovascular risk factors—might underestimate the broader impact of these determinants. Future longitudinal analyses will be essential to better understand the temporal relationships between factors such as perceived discrimination, brain MRI changes, and life satisfaction. Conclusions Our comprehensive analysis of the determinants of life satisfaction in Canada shows the complex interactions between various social, demographic and healthcare factors, which offers valuable insights into the immigrant experience in Canada. Our findings contribute to the evidence base necessary for informed policy formulation aimed at enhancing the overall life satisfaction of diverse communities in Canada. Ethics approval Ethics approval was obtained from the Hamilton Integrated Research Ethics Board (HiREB #13-255) and all relevant local ethics boards. All participants provided written informed consent. Data availability The data underlying this article will be shared on reasonable request to the corresponding author. Author contributions SSA developed the idea and drafted the manuscript, KS led the statistical analysis, DD coordinated the study, SP assisted with writing, editing, and creation of the figure. All others edited the manuscript. Funding CAHHM was funded by the Canadian Partnership Against Cancer (CPAC), Heart and Stroke Foundation of Canada (HSF-Canada), and the Canadian Institutes of Health Research (CIHR). Financial contributions were also received from the Population Health Research Institute and CIHR Foundation Grant no. FDN-143255 to S.S.A.; FDN-143313 to J.V.T.; and FDN 154317 to E.E.S. In-kind contributions from A.R.M. and S.E.B. from Sunnybrook Hospital, Toronto for MRI reading costs, and Bayer AG for provision of IV contrast. The Canadian Partnership for Tomorrow’s Health is supported by the Canadian Partnership Against Cancer, BC Cancer, Genome Quebec, Centre de recherche CHU Sainte-Justine, Ontario Institute for Cancer Research, Alberta Health, Alberta Cancer Foundation, Alberta Health Services, and Dalhousie University. The PURE Study was funded by multiple sources. The Montreal Heart Institute Biobank is funded by Mr André Desmarais and Mrs France Chrétien-Desmarais and the Montreal Heart Institute Foundation. S.S.A. was supported by the Heart and Stroke Foundation Chair in Population Health. S.A.L is supported by the Pfizer/Heart & Stroke Foundation Chair in Cardiovascular Prevention Research at St. Paul’s Hospital. P.A. was supported by a Ministry of Research and Innovation of Ontario Investigator Award. S.E.B. was supported by the Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, and the Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto. E.L. was supported by the Laval University Chair of Research & Innovation in Cardiovascular Imaging and the Fonds de recherche du Québec—Santé. J.-C.T. holds the Tier 1 Canada Research Chair in translational and personalized medicine and the Université de Montréal Pfizer endowed research chair in atherosclerosis. CG is supported by grants from the Swiss National Science Foundation (SNSF, # PP00P3_163892 and # PP00P3_190074), the Olga Mayenfisch Foundation, Switzerland, the OPO Foundation, Switzerland, the Novartis Foundation, Switzerland, the Swissheart Foundation, the Helmut Horten Foundation, Switzerland, the University Hospital Zurich (USZ) Foundation, the Iten-Kohaut Foundation, Switzerland, and the EMDO Foundation, Switzerland. Some of the data used in this research were made available by the Canadian Partnership for Tomorrow’s Health along with BC Generations Project, Alberta’s Tomorrow Project, Ontario Health Study, CARTaGENE, and the Atlantic PATH. Data were harmonized by Maelstrom Research and access policies and procedures were developed by the Centre of Genomics and Policy in collaboration with the Cohorts. MRI Working Group and Core Lab Investigators/Staff Chair: M.G. Friedrich; Brain Core Lab: E. Smith, C. McCreary, S. E. Black, C. Scott, S. Batool, F. Gao; Carotid Core Lab: A. Moody, V. Thayalasuthan; Abdomen: E. Larose, K. Bibeau, Cardiac: F. Marcotte, F. Henriques, T. Teixeira. Contextual Working Group: R. de Souza, S. Anand, G. Booth, J. Brook, D. Corsi, L. Gauvin, S. Lear, F. Razak, S.V. Subramanian, J. Tu. CAHHM Founding Advisory Group: Jean Rouleau, Pierre Boyle, Caroline Wong, Eldon Smith Some of the data used in this research were made available by the Canadian Partnership for Tomorrow’s Health along with BC Generations Project, Alberta’s Tomorrow Project, Ontario Health Study, CARTaGENE, and the Atlantic PATH. Data were harmonized by Maelstrom Research and access policies and procedures were developed by the Centre of Genomics and Policy in collaboration with the Cohorts. Conflicts of Interest The authors have no conflicts of interest to disclose. Figures Download figure Open in new tab Supplemental Figure 1. Graphical Abstract. Acknowledgements Steering Committee of CAHHM: S. Anand (Chair)*, M.G. Friedrich (Co-Chair), J. Tu (Co-Chair), P Awadalla (OHS), T. Dummer (BCGP), J. Vena (ATP), G. Lettre, V. Ho (CaG), J. Hicks (APATH), J-C. Tardif (MHI Biobank), K. Teo, S. Yusuf (PURE-Central), B-M. Knoppers (ELSI). Project Office Staff at Population Health Research Institute (PHRI): D. Desai Statistics/Biometrics Programmers Team at PHRI: K. Schulze, S. Bangdiwala, C. Ramasundarahettige, K. Ramakrishnana Central Operations Leads: D. Desai (PHRI), Sherry Zafar, Andrea Rogge Cohort Operations Research Personnel: K. McDonald (OHS), N. Noisel (CaG), J. Chu (BCGP), J. Hicks (APATH), H. Whelan (ATP), S. Rangarajan (PURE), D. Busseuil (MHI Biobank) Site Investigators and Staff: (112) J. Leipsic, S. Lear, V. de Jong; (306) M. Noseworthy, K. Teo, E. Ramezani, N. Konyer; (402) P. Poirier, A-S. Bourlaud, E. Larose, K. Bibeau; (512) J. Leipsic, S. Lear, V. de Jong; (609) E. Smith, R. Frayne, A. Charlton, R Sekhon; (703) A. Moody, V. Thayalasuthan; (704) A. Kripalani, G Leung; (706) M. Noseworthy, S. Anand, R. de Souza, N. Konyer, S. Zafar; (707) G. Paraga, L. Reid; (714) A. Dick, F. Ahmad; (799) D. Kelton, H. Shah; (801) F. Marcotte, H. Poiffaut; (802) M. Friedrich, J. Lebel; (817) E. Larose, K. Bibeau; (913) L. Parker, D. Thompson, J. Hicks; (1001) J-C. Tardif, H. Poiffaut; (1103) J. Tu, K. Chan, A. Moody, V. Thayalasuthan; Footnotes ↵ ^ Membership to Canadian Alliance for Healthy Hearts and Minds is provided in the Acknowledgments. References 1. ↵ Public Health Agency of Canada . Social determinants of health and health inequalities [Internet] . 2024 [cited 2024 Jun 12 ]. Available from: https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html 2. ↵ Kalich A , Heinemann L , Ghahari S . A Scoping Review of Immigrant Experience of Health Care Access Barriers in Canada . J Immigrant Minority Health [Internet ]. 2016 Jun 1 [cited 2024 Jan 30 ]; 18 ( 3 ): 697 – 709 . Available from : doi: 10.1007/s10903-015-0237-6 OpenUrl CrossRef 3. ↵ Tsai PL , Ghahari S . Immigrants’ Experience of Health Care Access in Canada: A Recent Scoping Review . J Immigr Minor Health [Internet] . 2023 Jun ; 25 ( 3 ): 712 – 27 . Available from : doi: 10.1007/s10903-023-01461-w OpenUrl CrossRef 4. ↵ De Maio FG , Kemp E . The deterioration of health status among immigrants to Canada . Global Public Health [Internet] . 2010 Sep 1 [cited 2024 Jan 30 ]; 5 ( 5 ): 462 – 78 . Available from : doi: 10.1080/17441690902942480 OpenUrl CrossRef PubMed Web of Science 5. ↵ Pascoe EA , Richman LS . Perceived Discrimination and Health: A Meta-Analytic Review . Psychol Bull [Internet] . 2009 Jul [cited 2024 Jun 24 ]; 135 ( 4 ): 531 – 54 . Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2747726/ OpenUrl 6. ↵ Agyemang C , van der Linden EL , Chilunga F , van den Born BH . International Migration and Cardiovascular Health: Unraveling the Disease Burden Among Migrants to North America and Europe . Journal of the American Heart Association [Internet] . 2024 May 7 [cited 2024 Aug 27 ]; 13 ( 9 ): e030228 . Available from: https://www.ahajournals.org/doi/10.1161/JAHA.123.030228 OpenUrl 7. ↵ Melin R , Fugl-Meyer KS , Fugl-Meyer AR . Life satisfaction in 18- to 64-year-old Swedes: in relation to education, employment situation, health and physical activity . J Rehabil Med [Internet] . 2003 Mar ; 35 ( 2 ): 84 – 90 . Available from : doi: 10.1080/16501970306119 OpenUrl CrossRef PubMed Web of Science 8. Safi M . Immigrants’ Life Satisfaction in Europe: Between Assimilation and Discrimination . European Sociological Review [Internet] . 2010 Apr 1 [cited 2024 Jan 30 ]; 26 ( 2 ): 159 – 76 . Available from : doi: 10.1093/esr/jcp013 OpenUrl CrossRef 9. ↵ Strine TW , Chapman DP , Balluz LS , Moriarty DG , Mokdad AH . The Associations Between Life Satisfaction and Health-related Quality of Life, Chronic Illness, and Health Behaviors among U.S. Community-dwelling Adults . J Community Health [Internet] . 2008 Feb 1 [cited 2024 Jan 30 ]; 33 ( 1 ): 40 – 50 . Available from : doi: 10.1007/s10900-007-9066-4 OpenUrl CrossRef PubMed Web of Science 10. ↵ Cantril H . The pattern of human concerns . New Brunswick : Rutgers University Press ; 1965 . 11. ↵ Łopuszańska M , Szklarska A , Lipowicz A , Jankowska EA , Kozieł S . Life satisfaction and cardiovascular disease risk in Poland . Arch Med Sci [Internet] . 2013 Aug 30 [cited 2024 Jan 30 ]; 9 ( 4 ): 629 – 34 . Available from : doi: 10.5114/aoms.2013.36909 OpenUrl CrossRef 12. Regensteiner JG , Hiatt WR , Coll JR , Criqui MH , Treat-Jacobson D , McDermott MM , et al. The impact of peripheral arterial disease on health-related quality of life in the Peripheral Arterial Disease Awareness, Risk, and Treatment: New Resources for Survival (PARTNERS) Program . Vasc Med [Internet] . 2008 Feb 1 [cited 2024 Jan 30 ]; 13 ( 1 ): 15 – 24 . Available from : doi: 10.1177/1358863X07084911 OpenUrl CrossRef PubMed Web of Science 13. Martín-María N , Caballero FF , Moreno-Agostino D , Olaya B , Haro JM , Ayuso-Mateos JL , et al. Relationship between subjective well-being and healthy lifestyle behaviours in older adults: a longitudinal study . Aging & Mental Health [Internet] . 2020 Apr 2 [cited 2024 Jan 30 ]; 24 ( 4 ): 611 – 9 . Available from : doi: 10.1080/13607863.2018.1548567 OpenUrl CrossRef 14. ↵ Borraccino A , Charrier L , Berchialla P , Lazzeri G , Vieno A , Dalmasso P , et al. Perceived well-being in adolescent immigrants: it matters where they come from . Int J Public Health [Internet] . 2018 Dec 1 [cited 2024 Jan 30 ]; 63 ( 9 ): 1037 – 45 . Available from : doi: 10.1007/s00038-018-1165-8 OpenUrl CrossRef 15. ↵ Anand SS , Tu JV , Awadalla P , Black S , Boileau C , Busseuil D , et al. Rationale, design, and methods for Canadian alliance for healthy hearts and minds cohort study (CAHHM) - a Pan Canadian cohort study . BMC public health [Internet] . 2016/07/29 ed. 2016 Jul 27 ; 16 : 650 . Available from : doi: 10.1186/s12889-016-3310-8 OpenUrl CrossRef PubMed 16. ↵ Kapteyn A , Lee J , Tassot C , Vonkova H , Zamarro G . Dimensions of Subjective Well-Being . Soc Indic Res [Internet] . 2015 [cited 2025 Mar 7 ]; 123 ( 3 ): 625 – 60 . Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4543406/ OpenUrl 17. ↵ Tov W , Keh JS , Tan YQ , Tan QYJ , Azuz IASB . Assessing subjective well-being: A review of common measures . Handbook of positive psychology assessment [Internet] . 2022 Dec 1 ; Available from: https://ink.library.smu.edu.sg/soss_research/3729 18. ↵ Anand SS , Razak F , Davis AD , Jacobs R , Vuksan V , Teo K , et al. Social disadvantage and cardiovascular disease: development of an index and analysis of age, sex, and ethnicity effects . Int J Epidemiol [Internet] . 2006 Oct ; 35 ( 5 ): 1239 – 45 . Available from : doi: 10.1093/ije/dyl163 OpenUrl CrossRef PubMed Web of Science 19. ↵ Hall RE , Tusevljak N , Wu CF , Ibrahim Q , Schulze K , Khan AM , et al. The Canadian Alliance for Healthy Hearts and Minds: How Well Does It Reflect the Canadian Population? CJC Open [Internet] . 2020/12/12 ed. 2020 Nov ; 2 ( 6 ): 599 – 609 . Available from : doi: 10.1016/j.cjco.2020.07.013 OpenUrl CrossRef 20. ↵ McGorrian C , Yusuf S , Islam S , Jung H , Rangarajan S , Avezum A , et al. Estimating modifiable coronary heart disease risk in multiple regions of the world: the INTERHEART Modifiable Risk Score . European Heart Journal [Internet] . 2011 Mar 1 [cited 2024 Jun 7 ]; 32 ( 5 ): 581 – 9 . Available from : doi: 10.1093/eurheartj/ehq448 OpenUrl CrossRef PubMed 21. ↵ Ryder AG , Alden LE , Paulhus DL . Is acculturation unidimensional or bidimensional? A head-to-head comparison in the prediction of personality, self-identity, and adjustment . Journal of Personality and Social Psychology [Internet] . 2000 ; 79 ( 1 ): 49 – 65 . Available from : doi: 10.1037/0022-3514.79.1.49 OpenUrl CrossRef PubMed Web of Science 22. ↵ Statistics Canada . Longitudinal Survey of Immigrants to Canada [Internet] . 2003 [cited 2024 Mar 21 ]. Available from: https://publications.gc.ca/Collection/Statcan/89-611-X/89-611-XIE2003001.pdf 23. ↵ Gupta S , McColl MA , Guilcher SJT , Smith K . Managing Medication Cost Burden: A Qualitative Study Exploring Experiences of People with Disabilities in Canada . Int J Environ Res Public Health [Internet] . 2019 Sep [cited 2024 Jun 5 ]; 16 ( 17 ): 3066 . Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6747197/ OpenUrl 24. ↵ Canada H . Government of Canada Introduces Legislation for First Phase of National Universal Pharmacare [Internet] . 2024 [cited 2024 Mar 25 ]. Available from: https://www.canada.ca/en/health-canada/news/2024/02/government-of-canada-introduces-legislation-for-first-phase-of-national-universal-pharmacar.html 25. ↵ Sheikh H . The Conversation . 2021 [cited 2024 Mar 21 ]. The federal government is out of excuses: It’s time to get serious about pharmacare . Available from: http://theconversation.com/the-federal-government-is-out-of-excuses-its-time-to-get-serious-about-pharmacare-168827 26. ↵ Vaswani M , Sutter A , Lapshina N , Esses VM . Discrimination Experienced by Immigrants, Racialized Individuals, and Indigenous Peoples in Small- and Mid-Sized Communities in Southwestern Ontario . Canadian Review of Sociology/Revue canadienne de sociologie [Internet] . 2023 [cited 2024 Mar 21 ]; 60 ( 1 ): 92 – 113 . Available from : doi: 10.1111/cars.12413 OpenUrl CrossRef 27. Weerasinghe S . Inequities in visible minority Immigrant Women’s Healthcare accessibility . Ethnicity and Inequalities in Health and Social Care [Internet] . 2012 Jan 1 [cited 2024 Mar 21 ]; 5 ( 1 ): 18 – 28 . Available from : doi: 10.1108/17570981211286750 OpenUrl CrossRef 28. ↵ Jones CP . Levels of racism: a theoretic framework and a gardener’s tale . Am J Public Health [Internet] . 2000 Aug [cited 2024 Mar 21 ]; 90 ( 8 ): 1212 – 5 . Available from : doi: 10.2105/ajph.90.8.1212 OpenUrl CrossRef 29. ↵ Elbasheir A , Katrinli S , Kearney BE , Lanius RA , Harnett NG , Carter SE , et al. Racial Discrimination, Neural Connectivity, and Epigenetic Aging Among Black Women . JAMA Network Open [Internet] . 2024 Jun 13 [cited 2025 May 30 ]; 7 ( 6 ): e2416588 . Available from : doi: 10.1001/jamanetworkopen.2024.16588 OpenUrl CrossRef View the discussion thread. Back to top Previous Next Posted June 03, 2025. Download PDF Data/Code Email Thank you for your interest in spreading the word about medRxiv. NOTE: Your email address is requested solely to identify you as the sender of this article. Your Email * Your Name * Send To * Enter multiple addresses on separate lines or separate them with commas. You are going to email the following Life Satisfaction in Canada and the Immigrant Experience Message Subject (Your Name) has forwarded a page to you from medRxiv Message Body (Your Name) thought you would like to see this page from the medRxiv website. Your Personal Message CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Share Life Satisfaction in Canada and the Immigrant Experience Sonia S. Anand , Shreni Patel , Scott A. Lear , Trevor J.B. Dummer , Vikki Ho , Jean-Claude Tardif , Jennifer E. Vena , Karleen Schulze , Paul Poirier , Dipika Desai , Matthias G. Friedrich medRxiv 2025.06.02.25328814; doi: https://doi.org/10.1101/2025.06.02.25328814 Share This Article: Copy Citation Tools Life Satisfaction in Canada and the Immigrant Experience Sonia S. Anand , Shreni Patel , Scott A. Lear , Trevor J.B. Dummer , Vikki Ho , Jean-Claude Tardif , Jennifer E. Vena , Karleen Schulze , Paul Poirier , Dipika Desai , Matthias G. Friedrich medRxiv 2025.06.02.25328814; doi: https://doi.org/10.1101/2025.06.02.25328814 Citation Manager Formats BibTeX Bookends EasyBib EndNote (tagged) EndNote 8 (xml) Medlars Mendeley Papers RefWorks Tagged Ref Manager RIS Zotero Tweet Widget Facebook Like Google Plus One Subject Area Public and Global Health Subject Areas All Articles Addiction Medicine (568) Allergy and Immunology (863) Anesthesia (300) Cardiovascular Medicine (4435) Dentistry and Oral Medicine (444) Dermatology (382) Emergency Medicine (608) Endocrinology (including Diabetes Mellitus and Metabolic Disease) (1509) Epidemiology (15229) Forensic Medicine (30) Gastroenterology (1124) Genetic and Genomic Medicine (6600) Geriatric Medicine (668) Health Economics (997) Health Informatics (4536) Health Policy (1368) Health Systems and Quality Improvement (1613) Hematology (541) HIV/AIDS (1264) Infectious Diseases (except HIV/AIDS) (15916) Intensive Care and Critical Care Medicine (1103) Medical Education (623) Medical Ethics (146) Nephrology (667) Neurology (6599) Nursing (346) Nutrition (998) Obstetrics and Gynecology (1144) Occupational and Environmental Health (957) Oncology (3332) Ophthalmology (974) Orthopedics (369) Otolaryngology (420) Pain Medicine (436) Palliative Medicine (130) Pathology (663) Pediatrics (1693) Pharmacology and Therapeutics (691) Primary Care Research (711) Psychiatry and Clinical Psychology (5447) Public and Global Health (9232) Radiology and Imaging (2198) Rehabilitation Medicine and Physical Therapy (1370) Respiratory Medicine (1196) Rheumatology (593) Sexual and Reproductive Health (712) Sports Medicine (530) Surgery (712) Toxicology (99) Transplantation (289) Urology (265) (function(){function c(){var b=a.contentDocument||a.contentWindow.document;if(b){var d=b.createElement('script');d.innerHTML="window.__CF$cv$params={r:'a00b479dfd974ed4',t:'MTc3OTYxNTAwNg=='};var a=document.createElement('script');a.src='/cdn-cgi/challenge-platform/scripts/jsd/main.js';document.getElementsByTagName('head')[0].appendChild(a);";b.getElementsByTagName('head')[0].appendChild(d)}}if(document.body){var a=document.createElement('iframe');a.height=1;a.width=1;a.style.position='absolute';a.style.top=0;a.style.left=0;a.style.border='none';a.style.visibility='hidden';document.body.appendChild(a);if('loading'!==document.readyState)c();else if(window.addEventListener)document.addEventListener('DOMContentLoaded',c);else{var e=document.onreadystatechange||function(){};document.onreadystatechange=function(b){e(b);'loading'!==document.readyState&&(document.onreadystatechange=e,c())}}}})();