Health Reports最新文献

Background: The prevalence of mood and anxiety disorders has risen in Canada over the past decade, and a large proportion of affected individuals do not receive professional help. This study aimed to understand how sociodemographic factors, including age, gender, immigrant status, population group, and household income, were associated with mental health care service use among people with mood or anxiety disorders.

Data and methods: Data from the 2022 Mental Health and Access to Care Survey were used to assess how many of the people who met the criteria for selected mood and anxiety disorders had (1) talked to a health professional about their mental health and (2) received counselling or therapy services in the 12 months before completing the survey. Chi-squared tests and logistic regression models were used to examine demographic differences in mental health service use among those with mood or anxiety disorders.

Results: Mental health service use among those with a mood or anxiety disorder was lower for youth aged 15 to 24, adults aged 45 and older, men, recent immigrants, and those with household income from $40,000 to $79,999, when controlling for other sociodemographic factors. The most frequently cited reasons for not having received counselling or therapy services included both attitudinal and structural barriers.

Interpretation: Disparities in the use of mental health care services exist beyond differences in the underlying prevalence of mental disorders. Different sociodemographic groups may face attitudinal and structural barriers that can contribute to difficulties in accessing care.

Background: Canadians' positive mental health (PMH) decreased during the early and mid stages of the COVID-19 pandemic. Less is known about whether PMH recovered as the pandemic transitioned away from being a global health emergency. The aim of the current study was to compare PMH estimates during the late stage of the pandemic with earlier stages.

Data and methods: Population-based, cross-sectional data from adults in the 10 Canadian provinces from all three cycles of the Survey on COVID-19 and Mental Health were analyzed. Data were collected in the early (September to December 2020; N=11,324), mid (February to May 2021; N=5,742), and late (February to May 2023; N=11,526) stages of the pandemic. Estimates for three PMH outcomes (high self-rated mental health [SRMH], high community belonging, and mean life satisfaction) in the late stage of the pandemic were compared with estimates from the early and mid stages, overall and for various subgroups.

Results: Overall, mean life satisfaction and the prevalence of high SRMH and community belonging were higher in 2023 compared with 2021. Compared with 2020, mean life satisfaction was higher in 2023. However, the prevalence of high SRMH and community belonging remained lower in 2023. Similar patterns were observed among many subgroups; however, the specific groups to which they applied varied by PMH outcome. Younger adults displayed relatively low estimates at all timepoints.

Interpretation: Despite some indication of recovery in the well-being of adults in Canada in the late stage of the pandemic, there remains room for improvement, especially among certain sociodemographic groups (e.g., younger adults).

Background: An increasing number of Canadians are living with mental health problems, including mood disorders. However, few studies have examined the prevalence of, and factors associated with, mood disorders among older Canadians (65 years or older).

Data and methods: A pooled sample of 172,524 community-dwelling older Canadians from nine cycles of the annual Canadian Community Health Survey - 2015 to 2023 - was used to examine mood disorders and associated correlates. Multivariable logistic regression, stratified by sex, was implemented to identify factors associated with mood disorders.

Results: From 2015 to 2023, on average, 7.0% of older Canadians reported a diagnosis of a mood disorder, with females (8.3%) more likely than males (5.5%) to do so. In a multivariable analysis that adjusted for demographic, socioeconomic, geographic, and health-related factors, Indigenous people (males and females) had higher odds of having a mood disorder than non-Indigenous, non-racialized populations. South Asian and Chinese males, as well as females belonging to Black and Other racialized groups, had significantly lower odds compared with their non-Indigenous, non-racialized counterparts. Living alone, being a male immigrant, and having lower household income were associated with a higher likelihood of experiencing mood disorders among older Canadians.

Interpretation: The results of this study highlight the importance of considering racialized population groups, as well as socioeconomic, geographic, and health-related factors - separately for males and females - when examining mood disorders among older Canadians to inform screening and intervention programs.

Background: The prevalence of household food insecurity in the 10 provinces rose from 16.8% in 2019 to 18.4% in 2022 and 22.9% in 2023. This study examines whether and how the sociodemographic and economic patterning of households' vulnerability to food insecurity changed across these years.

Data and methods: Using data from the master files for households in the 10 provinces from the 2018, 2021, and 2022 cycles of the Canadian Income Survey, year-specific logistic regression models were conducted to estimate the predicted probability of household food insecurity by sociodemographic and economic characteristics. The predicted probability of food insecurity was also charted in relation to household income from the prior tax year, expressed in 2022 constant dollars and adjusted for household size, for each survey year.

Results: The probability of food insecurity increased significantly for most households, irrespective of the sociodemographic or economic characteristics considered. In 2019 and 2022, households receiving 50% or more of their income from employment or self-employment had a lower probability of food insecurity than those with a smaller proportion of their income from employment, but there was no difference between these groups in 2023. The probability of food insecurity was significantly higher in 2022 than 2019 at all household income levels above $20,000 and higher along the entire household income continuum in 2023 than 2022.

Interpretation: The probability of food insecurity is highest for low-income households, but food insecurity is becoming more prevalent among moderate- and higher-income households, and reliance on employment income is no longer protective against food insecurity.

Background: There is mounting evidence about the negative dietary, health, and environmental impacts associated with high consumption of ultra-processed food and drink products (UPF) and low consumption of unprocessed or minimally processed foods and drinks (MPF). Eating context, including eating location and occasion, can influence food intake. This cross-sectional study used the most recent available national-level data for Canada to describe how consumption of UPF and MPF varied according to eating location and occasion.

Data and methods: The 2015 Canadian Community Health Survey - Nutrition provided 24-hour dietary recall data for Canadians aged 2 and older residing in the 10 Canadian provinces (n=20,080). Food and drink items were categorized using the NOVA classification. Descriptive statistics were used to characterize UPF and MPF consumption, as a percentage of energy intake, across four common eating locations (home, institution, restaurant, and other) and eating occasions (breakfast, lunch, dinner, and snack), overall and by age group.

Results: In 2015, overall, Canadians consumed most of their total daily energy at home (70.1%), and dinner accounted for 33.1% of energy intake. Meals consumed at home and in institutions (e.g., school, work) generally provided lower proportions of energy from UPF and higher proportions of energy from MPF compared with restaurants and "other" locations, with some variation by eating occasion and age group. Dinner consumed at home had the most favourable profile in terms of type of processing (overall, 30.6% of energy from UPF and 53.9% from MPF relative to total at-home dinner energy content). UPF intake in restaurants, as a proportion of energy consumed in restaurants, was high for all age groups (over 50% of energy), particularly for children and adolescents (over 65% of energy).

Interpretation: Eating location and occasion matter in terms of UPF and MPF energy intakes. These findings can inform the design of policies and programs aiming to encourage and support healthy eating environments.

Background: The COVID-19 pandemic changed how Canadians accessed health care, increasing their use of virtual services. While virtual care use decreased after the pandemic lockdowns, it continues to play an important role in health care delivery. More information is needed about variations in virtual care use by sociodemographic and health characteristics.

Data and methods: Data from the 2023 Canadian Social Survey - Quality of Life, Virtual Health Care and Trust were used. Descriptive statistics estimated the types of health care appointments individuals had in the past 12 months, access to virtual care, the types of health care providers consulted virtually, and the reasons individuals declined virtual appointments. Multivariate analyses examined whether sociodemographic and health characteristics were associated with patients' virtual care use.

Results: Over half of patients (57.5%) had in-person appointments only, 5.3% had virtual appointments only, and over one-third (37.2%) had both types of appointments. Of individuals who sought or were offered virtual care, 78.5% had a virtual appointment. Most virtual care users consulted a family doctor, general practitioner, or nurse practitioner only (62.1%). Higher education, not having a regular health care provider, and multimorbidity were positively associated with virtual care use. Greater comfort with in-person appointments was the most common reason for declining virtual care.

Interpretation: While many individuals in Canada accessed virtual care, only a small proportion had virtual appointments only. Virtual care use varied by some sociodemographic and health factors, such as education and multimorbidity. Technological barriers were not a common reason for declining virtual appointments.

Background: Globally, cervical cancer is one of the most common cancers, yet it is largely preventable. Switching methods for primary screening from cytology testing, via Pap test, to human papillomavirus (HPV) testing is a component of that prevention. OncoSim-Cervix, a Canadian cervical cancer microsimulation model, assesses the long-term effects of HPV vaccination and screening interventions. This study projects the impact of differing roll-out strategies for HPV primary testing for cervical cancer screening in Canada.

Data and methods: OncoSim-Cervix simulates the progression from HPV infection to cervical cancer, incorporating Canadian data on incidence, mortality, HPV vaccination, screening, and costs. This analysis compared the effect of different roll-out strategies for switching from current practice to HPV primary screening every five years. Using OncoSim-Cervix, the study simulated one status quo scenario (cytology primary screening every three years) and three quinquennial HPV primary screening scenarios: (1) one-time roll-out, (2) population-based roll-out over two years, and (3) age-based roll-out over three years.

Results: All HPV screening roll-out strategies were found to improve clinical outcomes, with reductions of approximately 20% in cervical cancer cases and 18% in deaths, while screening less frequently, compared with cytology screening. The one-time roll-out scenario initially spiked colposcopy referrals by 60%, while phased implementation produced smaller peaks (35% to 40%) followed by declining referrals, compared with cytology screening.

Interpretation: Switching from three-year cytology to five-year HPV testing improves outcomes, with phased strategies mitigating the initial colposcopy surge. Modelling can help programs anticipate and manage colposcopy demand during the transition.

Background: The association between oral health and general health is not yet fully understood. This study examines the association between missing teeth, mortality, and hospitalization outcomes.

Data and methods: This cohort study utilized time-to-event data from the Canadian Health Measures Survey Cycle 1 (2007 to 2009) linked to death and hospital discharge records. Participants with clinically assessed tooth counts were followed up to 2019. Cox proportional hazards models were used, treating missing teeth as either categorical or continuous exposures, adjusting for socioeconomic and health-related factors.

Results: In participants aged 20 to 79 years, 3,450 records were linked to mortality data (n=300 deaths) and 2,250 to hospitalization data (n=650 with at least one hospital stay). Missing teeth were associated with elevated all-cause and cancer mortality in unadjusted models, but not after covariate adjustment. After adjusting for key risk factors, including age and sex, participants with five or more missing teeth had a 76% higher risk of all-cause hospitalization (hazard ratio [HR] 1.76, 95% confidence interval [CI]: 1.41 to 2.20) and a 120% higher risk of circulatory-related hospitalization (HR 2.20, 95% CI: 1.09 to 4.45). Respiratory hospitalizations were also linked to missing teeth. No significant links were found with hospitalizations for digestive diseases or cancer.

Interpretation: Missing teeth is associated with hospitalization in Canadian adults. These findings highlight that oral health may play a role or serve as an indicator of overall health and health service use among Canadian adults.

Background: To better understand the interplay between adiposity and metabolic health, joint phenotypes have been used to categorize people as being metabolically healthy (MH) or metabolically unhealthy (MU) while having a body mass index (BMI) indicative of obesity, overweight, or normal weight. This study examines the prevalence of these phenotypes in adults, the factors associated with them, and their relationship with adverse health outcomes.

Data and methods: Three cycles of the Canadian Health Measures Survey (from 2014 to 2019) were combined to characterize adults aged 20 to 79 years as MU if they had at least three out of five measures of elevated waist circumference, elevated triglycerides, reduced high-density lipoprotein cholesterol, elevated blood pressure, or elevated fasting glucose. Measured BMI, categorized as indicative of normal weight, overweight, or obesity, was combined with MH or MU to produce six joint phenotypes. Phenotype prevalence was examined across selected characteristics and separate multivariable logistic regression models estimated the association with self-reported health status and morbidity indicators.

Results: One in four Canadian adults was either MU with obesity or MU with overweight. These phenotypes were more prevalent at older ages. Among MH adults, higher BMI was associated with worse self-rated general health. MU adults with obesity were 1.8 times more likely to report worse general health than MH adults with obesity. MU adults with obesity or with overweight were 1.2 times more likely to have higher levels of systemic inflammation than MH adults with obesity or overweight. Higher BMI, regardless of metabolic health, was associated with higher levels of systemic inflammation.

Interpretation: Gaining insight into the population prevalence of metabolic health and BMI phenotypes and their association with health risks can help improve awareness and inform health promotion strategies.

Background: Metabolic syndrome (MetS) is a major cause of cardiovascular morbidity and mortality. This study provides an updated prevalence of MetS and its components among Canadian adults aged 18 to 79 years in the period from 2016 to 2019 by age group and sex. It also examines trends in the prevalence of MetS and its components over time in this population from 2007 to 2019.

Data and methods: This study used direct health measures data from cycles 1 to 6 (2007 to 2019) of the Canadian Health Measures Survey. MetS was defined as the presence of at least three of the following components: elevated waist circumference, elevated triglycerides, reduced high-density lipoprotein (HDL) cholesterol, high blood pressure, and elevated fasting blood glucose.

Results: In the period from 2016 to 2019, 26.1% of Canadian adults aged 18 to 79 years had MetS. The prevalence of MetS was similar among females (25.2%) and males (27.0%) and increased with age, from 11.1% for those aged 18 to 39 years to 44.3% for those aged 60 to 79 years. The prevalence of MetS remained stable from the 2007-to-2011 period to the 2016-to-2019 period. Among individuals with MetS in the period from 2016 to 2019, high waist circumference was the most common component (90.0%), followed by high fasting blood glucose (70.6%) and low HDL cholesterol (65.8%). The prevalence of all components of MetS increased with age, except for low HDL cholesterol, which significantly decreased with age.

Interpretation: The prevalence of MetS among adults has remained stable over time in Canada. Low HDL cholesterol seems to be the leading component of MetS among young adults.