Health Reports最新文献

Background: Multimorbidity is a significant challenge for health care systems worldwide. There are limited data, particularly in a Canadian context, on multimorbidity prevalence and incidence, and how these differ by multimorbidity complexity, sex, age, and neighbourhood income quintile.

Methods: This study included administrative data from residents of British Columbia, Canada, from 2001/2002 to 2019/2020. This study analyzed trends in the prevalence and incidence of multimorbidity (two or more conditions) and complex multimorbidity (five or more conditions) by sex, age, and neighbourhood income quintile. This study also identified the most prevalent disease combinations.

Results: More than 25% of adults and 60% of seniors met criteria for multimorbidity in 2019/2020. From 2001/2002 to 2019/2020, age-standardized multimorbidity prevalence increased annually by an average of 1.5% in females and 2.9% in males, and incidence decreased by 3.3% in females and 1.1% in males. Complex multimorbidity prevalence increased annually by an average of 4.8% in females and 5.7% in males, and incidence increased by 1.1% in females and 2.2% in males. Younger age groups had higher average annual increases in multimorbidity prevalence and incidence. Multimorbidity risk was higher in lower income quintiles, relative to higher income quintiles, and these disparities were larger for complex, relative to standard, multimorbidity. Highly prevalent single diseases tended to form the most prevalent disease combinations, and the most prevalent disease combinations varied by income quintile.

Interpretation: These findings suggest that the burden and complexity of multimorbidity continue to rise in British Columbia. Population trends in multimorbidity have important implications for projecting future disease burden and health care planning.

Background: Ambulatory care sensitive conditions (ACSCs) are illnesses that can be effectively treated and managed in primary care settings. Hospitalizations for ACSCs are therefore considered avoidable and may indicate poor access to quality primary care. This study examined trends in avoidable hospitalizations in Canada among racialized groups.

Data and methods: The 2016 Canadian Census Health and Environment Cohort was used to estimate annual age-standardized hospitalization rates (ASHRs) for ACSCs among people aged 10 to 74 from 2016/2017 to 2021/2022. ASHRs were disaggregated by sex and racialized group. Rate ratios (RRs) and 95% confidence intervals (CIs) were calculated to assess relative inequality. Logistic regression models were run, adjusting for age, sex, immigrant status, household income, and education.

Results: Across all study years, the odds of avoidable hospitalizations were significantly higher among males, Black people, and non-immigrants, and significantly lower among Chinese people and people in the category "other racialized groups not included elsewhere." In 2020/2021, during the COVID-19 pandemic, RRs for Black females compared with non-racialized females decreased (2019/2020: RR=1.12, 95% CI=1.07 to 1.61; 2020/2021: RR=0.99, 95% CI=0.94 to 1.04), while they significantly increased for Black males compared with non-racialized males (2019/2020: RR=1.30, 95% CI=1.25 to 1.35; 2020/2021: RR=1.63, 95% CI=1.41 to 1.88).

Interpretation: This study reveals inequalities in avoidable hospitalizations in Canada, pronounced for the Black population compared with the non-racialized population, especially during the pandemic (2020/2021 and 2021/2022). Future studies examining the factors driving these inequalities (e.g., access to primary care, most prevalent conditions, geography) may inform targeted interventions.

Background: The prevalence of Canadians living with obesity has increased over the past four decades. Disease and mortality risk increase as the number of years lived with obesity increases.

Methods: This study used self-reported weight history and health data collected from 2007 to 2011 via the Canadian Health Measures Survey (n = 5,761) to examine whether increased exposure to obesity during adulthood increases the odds of having poor health outcomes.

Results: The percentage of respondents with an obesity-related chronic condition was lower among those who did not have obesity at the time of survey or report having obesity in the past (50.6%) compared with those who did not have obesity at the time of the survey but did in the past (65.9%) or who had obesity at the time of the survey and in the past (71.1%). Relative to never having obesity, having obesity in the past but not at present or having obesity in the past and at present were associated with increased odds of having a range of chronic conditions. The highest odds were observed for type 2 diabetes (odd ratio (OR) = 3.26, 95% confidence interval (CI): 2.40 to 4.43 and OR = 5.36, 95% CI: 3.88 to 7.41), hypertension (OR = 2.41, 95% CI: 1.69 to 3.44 and OR = 3.76, 95% CI: 2.84 to 4.97), and poor or fair self-rated general health (OR = 2.04, 95% CI: 1.51 to 2.76 and OR = 2.68, 95% CI: 2.11 to 3.40).

Interpretation: Having had obesity in the past, regardless of current obesity status, was associated with increased odds of poor health outcomes. Obesity history information should be considered when estimating the population burden of obesity.

Background: Studies have shown that excess all-cause mortality during the COVID-19 pandemic caused declines of life expectancy at birth (LE₀) in most countries around the world, after decades of improvement prior to the pandemic. However, those studies rarely examined the contributions from specific causes of death other than COVID-19.

Methods: This study used the Chiang method to estimate LE₀ for each year in British Columbia from 2000 to 2022 and the changes from 2019 to 2020, 2021, and 2022. Each death case was classified into 1 of 23 categories, including COVID-19, unregulated drug toxicity, cardiovascular diseases, and injuries, according to the International Classification of Diseases, 10th Revision (ICD-10). The changes in LE₀ were decomposed into age and causes of death using the Arriaga method.

Results: Compared with 2019, male LE₀ decreased by 1.16 years in 2020, 1.81 years in 2021, and 1.62 years in 2022; female LE₀ did not change in 2020, but decreased by 0.65 years in 2021, and by 0.56 years in 2022. COVID-19 and unregulated drug toxicity were the top two causes of deaths contributing to the LE₀ declines in males and females, with COVID-19 being the number one contributor in females and unregulated drug toxicity deaths as the number one contributor in males.

Interpretation: The COVID-19 pandemic impacted population health not only through its direct effects but also through indirect impacts on other health outcomes, including the unregulated drug toxicity crisis, the combination of which were driving factors in the decline in life expectancy at birth.

Background: Statistics Canada routinely collects information on functional health and related concepts. Recently, the Washington Group on Disability Statistics (WG) measure of disability has been introduced to the Canadian Community Health Survey (CCHS). The WG measure is used as a tool for developing internationally comparable data on disability. In alternate cycles of the CCHS, it replaces the Health Utilities Index Mark 3 (HUI3), a generic preference-based measure of health-related quality of life. The HUI3 is used to derive evaluative health measures common in population health and economic evaluations. Since the WG measure is not preference-based, it is unable to derive these measures. To address resulting data gaps, this study empirically maps the health state utility values of the HUI3 score from the WG measure.

Data and methods: Empirical mapping used a "head-to-head" subsample of the 2017 CCHS where WG and HUI3 measures were collected from the same respondents aged 40 and over. Empirical mapping used regression models to estimate the statistical relationship between WG and HUI3 measures in addition to health and demographic variables. Out-of-sample predictive performance was assessed through descriptive statistics, mean absolute error, and other measures of predictive accuracy.

Results: The preferred estimation strategy resulted in reasonably precise estimates of the HUI3 score corresponding to trends across health and demographic characteristics and reflecting distributional properties of the HUI3 score. Inclusion of different components of the WG measure influenced predictive accuracy.

Interpretation: Empirical mapping offers a potential method to estimate health state utility scores from the WG measure and addresses data gaps in health-related quality of life measures in the CCHS when HUI3 is not collected.

Background: Adolescents who engage in physical activity experience positive mental health outcomes. However, the increasing prevalence of physical inactivity combined with high screen time use among adolescents is a growing concern. Parents play an important role in shaping adolescents' physical activity and screen time levels through active participation and involvement.

Data and methods: This nationally representative cross-sectional study used self-reported data from the 2019 Canadian Health Survey on Children and Youth. The frequency of family physical activity included five categories from "never" to "daily." Outcome measures included achieving the physical activity (60 minutes or more of moderate-to-vigorous physical activity per day) and recreational screen time (two hours or less per day) recommendations, as well as mental health indicators. Logistic regression analyses examined the associations between family physical activity frequency and adolescents' physical activity, screen time, and mental health, with adjustments for relevant covariates.

Results: In adjusted models, across all outcomes, results showed that a higher frequency of family physical activity was associated with better outcomes in a dose-response relationship when compared with never engaging in family physical activity. The strongest associations for daily frequency of family physical activity (compared with never engaging in it) were with high life satisfaction (odd ratio [OR]: 4.25, 95% confidence interval [CI]: 3.16 to 5.72) and with high perceived mental health (OR: 3.60, 95% CI: 2.62 to 4.96). Subgroup analyses stratified by gender were generally consistent with the main results.

Interpretation: A higher frequency of family physical activity was associated with a greater likelihood of adhering to the physical activity and recreational screen time recommendations and better mental health in Canadian adolescents. Family physical activity may be an important way to promote adolescents' physical activity and positively influence their mental health.

Background: After six cycles of using the BpTRU (BT) BPM-300 blood pressure (BP) monitor, the Canadian Health Measures Survey (CHMS) introduced the OMRON (OM) IntelliSense HEM-907XL BP monitor in Cycle 7. This study assesses differences between BP values measured by both devices in children and youth aged 6 to 17 years and whether equations could be developed to compare BP measurements taken using the two devices.

Data and methods: In Cycle 6 (2018 to 2019) of the CHMS, BP was measured using BT and OM devices. Between-device estimates of systolic BP (SBP), diastolic BP (DBP), and BP categories were compared for 233 children and youth aged 6 to 17 years. Sex, age, body mass index (BMI), and central obesity categories were examined in linear regression models to predict SBP and DBP values measured with OM based on those measured with BT.

Results: In the study sample, average SBP measured with OM was 9 millimetres of mercury (mmHg) higher than average SBP measured with BT, and average DBP measured with OM was 3 mmHg lower than DBP measured with BT. Normal BP prevalence based on OM measurements was 2.1 to 6.4 percentage points lower than the prevalence based on BT measurements, depending on which pediatric BP guidelines were applied. Between-device BP differences varied in magnitude by sex, age group, and BMI categories. Prediction equations developed using linear regression could not adequately account for the measurement differences between the two devices.

Interpretation: Switching to the OM device in Cycle 7 will substantively affect pediatric BP estimates, preventing comparability with BP data from previous cycles. The impact of changing the BP devices on BP measurement should be acknowledged when reporting estimates of pediatric BP based on the CHMS.

Background: Anxiety disorders are among the most common mental health problems. However, few studies have examined the prevalence of, and factors associated with, anxiety disorders among older Canadians (65 years or older), with a particular focus on Indigenous and racialized population groups.

Data and methods: Data from eight cycles of the annual Canadian Community Health Survey (CCHS) - 2015 to 2022 - were used to examine anxiety disorders among older Canadians. Multivariable logistic regression, stratified by sex, was carried out on a pooled sample of 151,755 respondents aged 65 years or older.

Results: From 2015 to 2022, on average, 6.0% of older Canadians reported a diagnosis of an anxiety disorder, with females (7.5%) more likely than males (4.2%) to have done so. Indigenous males had higher odds of having an anxiety disorder than non-Indigenous, non-racialized males, while Chinese and other racialized females had lower odds of having an anxiety disorder than non-Indigenous, non-racialized females.

Interpretation: Findings of this study highlight the importance of considering Indigenous and racialized population groups disaggregated by sex when examining anxiety disorders among older Canadians to inform screening and intervention programs.

Background: This study assessed health care system costs and resource utilization for adult women with breast cancer in Ontario, Canada. The goal was to update costs by stage, age, and phase of care from a health care system perspective.

Data and methods: A retrospective analysis was conducted using linked population-based administrative data. The study included women diagnosed with breast cancer from 2017 to 2021, with follow-up data until 2022. Cases were matched with controls in a 1:5 ratio using birth year, local health integrative network, income quintile, and resource utilization band at baseline. Incremental costs were estimated using linear regression. The modified income quintile was the neighbourhood- or area-level income quintile.

Results: Among the 37,133 cases matched with 185,665 controls, the average age at diagnosis was 62 years. For the entire study duration, cases incurred an additional cost of $27,485 per year, compared with controls. Costs rose with disease severity, ranging from $15,588 for stage I to $137,319 for stage IV. The highest incremental costs occurred during the first 12 months after diagnosis (initial: $43,408), followed by the last 12 months before death (terminal: $25,940), and then interim years (continuous: $9,533 per year). Additionally, the incremental cost of breast cancer was higher when diagnosis was before age 70 ($28,415), compared with diagnosis at age 70 and older ($25,254).

Interpretation: The findings align with previous studies on breast cancer costs for the health care system. Additionally, variations in costs based on disease severity, care phase, and age were emphasized, highlighting higher costs for metastatic breast cancer cases, women younger than 70 years, and the initial 12 months following diagnosis.

Background: Compared with their cisgender heterosexual peers, youth who are Two-Spirit, lesbian, gay, bisexual, transgender, and queer and those who use other terms related to gender or sexual diversity (2SLGBTQ+) are at elevated risk for mental health difficulties and suicidality. The social experiences of 2SLGBTQ+ youth, including the impact of minority stress, access to social support, and experiences of negative social interactions, may contribute to this disparity.

Data and methods: Participants were 2,047 youth aged 15 to 24 years who responded to the 2022 Mental Health and Access to Care Survey. The 2SLGBTQ+ population was derived from youth reports of their gender, sex at birth, and sexual orientation. Two dimensions of social experiences were assessed using the Social Provisions Scale and the Negative Social Interactions Scale. Symptoms of mental health and substance use disorders were assessed via computer-assisted diagnostic interview using a modified version of the World Health Organization Composite International Diagnostic Interview (CIDI). Use of formal and informal mental health supports was self-reported by youth.

Results: Results indicated significant group differences in the proportion of youth meeting criteria for any CIDI disorder, a major depressive episode, generalized anxiety disorder, and suicidal ideation in the past 12 months. For example, 56% (95% confidence interval [CI]: 49 to 63) of 2SLGBTQ+ youth met criteria for any CIDI disorder, compared with 29% (95% CI: 26 to 32) of cisgender heterosexual youth. Logistic regression models suggested that after adjusting for demographic covariates, 2SLGBTQ+ youth were at elevated risk of these mental health conditions compared with their cisgender heterosexual peers. These differences remained apparent after adjusting for social support and negative social interactions. Among those meeting criteria for any disorder, 2SLGBTQ+ youth were more likely to report receiving formal and informal mental health support.

Interpretation: 2SLGBTQ+ youth are at elevated risk of several indicators of poor mental health compared with their cisgender heterosexual peers - differences which are not fully explained by their access to social support and negative social interactions. Some of the remaining differences may potentially be explained by the impact of unmeasured aspects of minority stress on 2SLGBTQ+ youth.