Health Reports最新文献

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.

Background: Cost and lack of dental insurance coverage are major obstacles to accessing dental care in Canada. This study estimates the prevalence and explores the characteristics of cost-related avoidance of oral health services among a nationally representative sample of people in Canada aged 12 years and older who may qualify for coverage under the Canadian Dental Care Plan (CDCP).

Data and methods: Data from the 2023 to 2024 Canadian Oral Health Survey were used to construct a population-based cohort of CDCP-eligible individuals based on income and insurance status. The responses from 11,189 CDCP-eligible individuals in Canada who answered questions about avoiding visits to an oral health professional or avoiding recommended dental care because of the cost were analyzed. Generalized linear models were used to examine the association between sociodemographic characteristics and the outcomes of cost-related avoidance of oral health services.

Results: During the period from November 2023 to March 2024 - before the CDCP was available to help pay for care - 47% of CDCP-eligible individuals avoided visits to an oral health professional and 38% avoided recommended dental care in the past year because of the cost. Young and middle-aged adults, uninsured individuals (compared with those with public insurance), and individuals with an adjusted family net income of less than $38,800 reported greater cost-related avoidance of oral health services. After adjustments, dental insurance status (odds ratio [OR]: 5.78; 95% confidence interval [CI]: 3.74 to 8.94) and self-reported mouth problems (OR: 4.80; 95% CI: 3.87 to 5.96) had the strongest association with cost-related avoidance of dental visits in the past year. The same was true for cost-related avoidance of recommended dental care (OR: 3.15; 95% CI: 2.07 to 4.78 and OR: 5.11; 95% CI: 4.17 to 6.27, respectively).

Interpretation: This study identified cost as a significant barrier to accessing oral health care for nearly half of CDCP-eligible individuals. The findings suggest that the use of oral health services by CDCP-eligible individuals in Canada is largely influenced by their income and ability to pay out of pocket for dental care expenses, rather than their need for treatment, leaving many vulnerable to unmet oral health care needs. Establishing baseline estimates of cost-related avoidance before the CDCP became available to help pay for care is essential for gauging the success of easing financial barriers and facilitating effective program monitoring.

Background: Data measuring life expectancy (LE) and health-adjusted life expectancy (HALE) in Canada are available for large geographical areas, such as provinces, territories, and health regions. However, to date, no study has analyzed LE and HALE at the municipal level.

Data and methods: Death and population counts from January 1, 2019, to December 31, 2020, were retrieved for 1,227 census subdivisions (CSDs) in Canada. CSDs are municipalities or areas treated as municipal equivalents by provincial and territorial governments. Functional health status was operationalized via the Health Utilities Index Mark 3 (HUI3) and obtained from the 2019 and 2020 Canadian Community Health Survey. CSD mortality rates and HUI3 scores for sex and age groups were estimated via multilevel regression models and poststratification. LE and HALE were calculated using life table methods and compared with previously published data for a subset of CSDs. The variability of LE and HALE was described using population, income, and educational characteristics.

Results: The median CSD had estimates of LE at birth of 84.1 years for females and 79.6 years for males. The median CSD had estimates of HALE at birth of 70.8 years for females and 69.7 years for males. For both measures, the gaps between CSDs at the 95th and 5th percentiles of LE were approximately 13 years for females and 14 years for males. The differences between the model-based LE estimates and published data were typically less than one year. LE and HALE at birth were positively correlated with population size and the percentage of individuals aged 25 to 64 with a postsecondary education.

Interpretation: This study develops, validates, and describes the first set of LE and HALE estimates for municipalities in Canada. Municipal-level health indicators are important for research and policy focused on the health of local populations.