We used linked clinical and administrative data to conduct a retrospective cohort study of adults seen in the emergency department or hospitalized with ischemic stroke or TIA between July 1, 2003 and April 1, 2013, and included in the provincial stroke registry. We ascertained immigration status using immigration records, and compared processes of stroke care delivery between immigrants (defined as those immigrating after 1985) and long-term residents. We calculated inverse probability treatment weight (IPTW)-adjusted risk ratios (aRR) for disability on discharge (modified Rankin score 2 to 5), adjusting for demographic characteristics and comorbid conditions to compare outcomes between immigrants and long-term residents.

We included 34,987 patients with ischemic stroke or TIA, of whom 2,649 (7.6%) were immigrants. Immigrants were younger than long-term residents at the time of stroke/TIA (median age 67 years vs. 76 years, P < 0.001). There were no differences in stroke care delivery, except that a higher proportion of immigrants received thrombolysis than long-term residents (21.2% vs. 15.5%, P < 0.001).  Immigrants had a higher adjusted risk of being disabled on discharge (aRR 1.18; 95% CI 1.13-1.22) compared to long-term residents.