Health Reports最新文献

Background: Body mass index (BMI) is commonly used to estimate obesity prevalence; however, reliance on BMI alone can lead to an incomplete understanding of obesity's impact on health. In line with the 2025 recommendations of the Lancet Diabetes & Endocrinology Commission, this study combines population-level measures of excess adiposity with indicators of physiological dysfunction and activity limitation across eight body system domains to characterize clinical and preclinical obesity among Canadian adults.

Data and methods: Measured and self-reported data from the 2016 to 2019 Canadian Health Measures Survey were used to define excess adiposity as measured BMI in the obese range plus elevated waist circumference. A three-tier system was used to capture progressive obesity-related impairment. At each tier, clinical obesity was defined by excess adiposity and indicators of impairment in one or more domains (Tier 1), two or more domains (Tier 2), or three or more domains (Tier 3). Preclinical obesity at each tier was characterized by excess adiposity with fewer indicators of impairment than the corresponding clinical thresholds. Prevalence estimates for these indicators and characterizations of obesity were calculated by sex and age group.

Results: Just over one in four Canadian adults had excess adiposity. Prevalence of physiological dysfunction and activity limitation indicators varied across domains and sex and age groups. Clinical and preclinical obesity prevalences were 19% and 8% at Tier 1, 12% and 15% at Tier 2, and 7% and 20% at Tier 3, respectively. Preclinical obesity - especially at tiers 1 and 2 - was more common in younger adults and females.

Interpretation: Younger adults and females with excess adiposity were less likely to present with obesity-related physiological dysfunction or activity limitation, indicating early stage impairment and highlighting opportunities for targeted prevention. Integrating measures of impairment when assessing obesity can refine population surveillance efforts.

Background: The accurate monitoring of population mental health requires repeated assessments using valid and reliable measures. The Warwick-Edinburgh Mental Well-being Scale (WEMWBS) and its short form (SWEMWBS) are widely used positive mental health (PMH) measures ([S]WEMWBS is used hereafter to refer to both). This study tested their validity among Canadian adults using representative health survey data.

Data and methods: Cross-sectional data from the 2024 Canadian Community Health Survey - Rapid Response on Sleep Quality and Positive Mental Health of adults (18 years and older) living in the provinces were used. The distributions of (S)WEMWBS responses and scores were examined. Confirmatory factor analysis (CFA) and bifactor exploratory structural equation modelling (ESEM) were conducted to assess factorial validity. Measurement invariance was tested across gender and age. Differences in (S)WEMWBS scores by gender, age, and other mental health indicators were examined. Cronbach's alphas were used to investigate internal consistency.

Results: (S)WEMWBS scores had relatively normal distributions, with no floor and minimal ceiling effects. A bifactor ESEM and bifactor CFA model for the WEMWBS and SWEMWBS, respectively, fit the data best, with indices suggesting that they were essentially unidimensional. Evidence was found for measurement invariance across gender and age. Older adults had higher (S)WEMWBS scores on average, as did men on the WEMWBS. The (S)WEMWBS had acceptable internal consistency and were associated with other mental health indicators.

Interpretation: The (S)WEMWBS appear to be valid and reliable PMH measures for Canadian adults. The (S)WEMWBS could be regularly included in health surveys to support the surveillance of population-level changes in PMH.

Background: Canada's drug toxicity crisis has burdened some populations disproportionately. This study identifies populations facing higher (or lower) rates of acute toxicity death (ATD) relative to a comparison group, using integrated Canadian Census Health and Environment Cohort data.

Methods: This national prospective cohort study linked census long-form questionnaire respondents to Canadian Vital Statistics Deaths to identify ATDs occurring within five years of the 2016 Census (from May 10, 2016, to May 9, 2021). Age-standardized mortality rates (ASMRs) and ratios relative to a reference population group were compiled for Canada overall, by sex, and by select socioeconomic characteristics.

Results: Approximately 0.05% of Canada's household population experienced an ATD during the follow-up period. The national ASMR of 10.7 per 100,000 person-years varied by population group. The highest ASMRs related to lowest educational attainment, household income quintile, and unemployment. Among employed people, highest ASMRs occurred for workers in trades, transport, equipment operators, and related occupations (19.0 per 100,000 person-years) or in occupations in manufacturing and utilities (15.3 per 100,000 person-years). People who spent between 50% to under 100% of their household total income on housing had the highest ASMR (27.9) compared with people spending less than 15% of their total household income on housing. Lower ASMRs also occurred for racialized people and immigrants.

Interpretation: This study's results generally align with previous studies, while also identifying new details about which disaggregated population groups experienced higher ATD rates. These findings can support intervention programs and policies tailored for populations facing greater ATD risk and enable future monitoring of progress towards equitable outcomes.

Background: Accurate and ongoing assessments of physical activity (PA) and sedentary time (SED) are needed to support public health surveillance, evaluate interventions, and advance the understanding of how movement behaviours relate to health. After six cycles of data collection (2007 to 2019) using the Actical (AC) accelerometer, the Canadian Health Measures Survey (CHMS) transitioned to the ActiGraph wGT3X-BT (AG). To understand how estimates from the AC accelerometer may compare with those from the AG in the context of the CHMS, this study compares AC and AG accelerometer estimates of PA, step counts, and SED using CHMS protocols.

Methods: A convenience sample of 47 adults (aged 18 to 79 years) and 36 children and youth (aged 3 to 17 years) wore both AC and AG accelerometers on their waist for seven consecutive days. Estimates of PA and SED, step counts, and the percentage of those meeting PA recommendations were compared between the devices using descriptive, correlation, and agreement statistics.

Results: Agreement ranged from poor to excellent, with variability across PA intensities and age groups. Significant absolute differences in SED and light PA (LPA) were observed across all age groups, and in step counts among children and youth. Agreement was good to excellent across most age groups for moderate-to-vigorous PA (MVPA), and among adults for step counts. While the percentage of those meeting PA recommendations was higher with the AG, results were not statistically different. Similar comparisons could be made with the AG device when using the normal and low frequency extension filters.

Interpretation: The results of the present study provide data users and researchers with an indication of the expected differences between the devices across various movement behaviour outcomes in the context of the CHMS. Results suggest that comparisons between cycles 1 to 6 and Cycle 7 onward of the CHMS for MVPA are acceptable, but they should be carried out with caution. Comparisons of SED, LPA, vigorous PA, and step counts are not recommended.

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.