Health Reports最新文献

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.

Background: Income-related food insecurity is an important determinant of health. This study aimed to provide an update on the food security status of Canadian households using the most recent available data from a health-oriented national-level survey. This study also examined trends in food insecurity since 2017, and how these have tracked with changes in price inflation.

Data and methods: Data on household food security status in the 10 Canadian provinces came from five annual cycles of the population-representative cross-sectional Canadian Community Health Survey (CCHS): 2017, 2018, 2020 (September to December), 2021, and 2022. The Household Food Security Survey Module was used to categorize household food security status during the previous 12 months as food secure or marginally, moderately, or severely insecure.

Results: Before 2019, approximately 1 in 10 households had experienced some level of food insecurity in the previous 12 months (9.6% in 2017 and 11.6% in 2018). Household food insecurity prevalence was slightly lower and stable during the COVID-19 pandemic years (8.5% in fall 2020 and 9.1% in 2021) and increased to 15.6% in 2022. Levels of household food insecurity generally tracked with changes in consumer price inflation. Compared with 2021, there were notable increases in levels of moderate and severe food insecurity in 2022 among one-parent households with children, renters, and those reliant on government financial assistance.

Interpretation: The prevalence of household food insecurity in the CCHS was relatively stable from 2017 to 2021, increased in 2022, and generally tracked with changes in price inflation. Monitoring levels of household food insecurity will continue to be important as price inflation eases but the cost of living remains high.

Background: More than half (56%) of Canadian children aged 0 to 5 years are in non-parental child care, but data on child care attendance among children with disabilities is limited. This study examines child care participation among young children with disabilities in Canada, with a focus on different disability types.

Data and methods: Analyses were conducted on 1,189 children aged 0 to 5 years identified with disabilities from Statistics Canada's 2023 Survey on Early Learning and Child Care Arrangements - Children with Long-term Conditions and Disabilities. Rates of child care participation, difficulties finding child care, difficulties within child care, and whether parents reported that their child had ever been denied a child care space because of their condition were examined. Logistic regression models tested for differences in the main child care arrangement and difficulty finding child care based on the child's disability while controlling for sociodemographic variables.

Results: Among children aged 0 to 5 years with disabilities, 45% attended a daycare centre, preschool, centre de la petite enfance, or before or after school care as their main child care arrangement; 17% attended another type of child care, such as a family child care home or care by a relative; and 38% did not regularly attend non-parental child care. The parents of nearly half of children with disabilities reported difficulty finding a child care arrangement, particularly for children with emotional conditions. Close to 1 in 10 parents of children with disabilities who were using child care reported that their child had been denied a child care space because of their condition.

Interpretation: These findings highlight the need for information to support inclusive policies, practices, and resources for children with disabilities within the Canada-wide early learning and child care system.

Background: In Cycle 7 (2022), the Canadian Health Measures Survey (CHMS) introduced the OMRON (OM) IntelliSense HEM-907XL blood pressure (BP) monitor after using the BpTRU (BT) BPM-300 BP monitor for six cycles. This study assessed differences between adult BP values measured by both devices 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 hypertension prevalence were compared for 1,072 adults aged 18 to 79 years. Sex, age, body mass index (BMI), and the use of antihypertensive medication were examined in linear regression models to predict SBP and DBP values measured with OM based on those measured with BT.

Results: Average SBP measured with OM was 6 millimetres of mercury (mmHg) higher than average SBP measured with BT, and average DBP measured with OM was 2 mmHg lower than DBP measured with BT. Hypertension prevalence based on OM readings was 35.4%, compared with 34.0% based on BT readings. Between-device BP differences varied in magnitude by sex, age group, and BMI category. Average model-predicted estimates of BP were comparable to measured estimates, but predicted values were lower at higher levels of BP.

Interpretation: Switching BP monitors will substantively affect population estimates of adult SBP and DBP but may have less impact on estimates of adult hypertension prevalence. The prediction equations proposed in this study can be applied to adult BP data from cycles 1 to 6 of the CHMS for comparison with BP measurements taken in Cycle 7, with some caveats. The impact of changing to the OM monitor in Cycle 7 should be acknowledged when reporting estimates of adult BP based on the CHMS.

Background: An extensive literature documents substantial variations in life expectancy (LE) between countries and at various levels of subnational geography. These variations in LE are significantly correlated with socioeconomic covariates, though no analyses have been produced at the finest feasible census tract (CT) level of geographic disaggregation in Canada or designed to compare Canada with the United States.

Data and methods: Abridged life tables for each CT where robust estimates were feasible were estimated comparably with U.S. data. Cross-tabulations and graphical visualizations are used to explore patterns of LE across Canada, for Canada's 15 largest cities, and for the 6 largest U.S. cities.

Results: LE varies by as much as two decades across CTs in both countries' largest cities. There are notable differences in the strength of associations with socioeconomic status (SES) factors across Canada's largest cities, though these associations with income-poverty rates are noticeably weaker for Canada's largest cities than for the United States' largest cities.

Interpretation: Small area geographic variations in LE signal major health inequalities. The association of CT-level LE with SES factors supports and extends similar findings across many studies. The variability in these associations within Canada and compared with those in the United States reinforces the importance for population health of better understanding differences in social structures and public policies not only at the national and provincial or state levels, but also within municipalities to better inform interventions to ameliorate health inequalities.

Background: Income-related food insecurity is an important determinant of health. Persons with disabilities are at a higher risk of experiencing household food insecurity (HFI) than those without disabilities. The main objectives of this study were to estimate the prevalence of HFI for persons with different types, numbers, and severity of disabilities, and to examine sociodemographic correlates of HFI among this group.

Data and methods: Data from the 2021 Canadian Income Survey (CIS) were used. Disability status was assessed using the short version of the Disability Screening Questions module for one randomly selected household respondent. The Household Food Security Survey Module measured HFI as marginal, moderate, or severe. Weighted descriptive and multivariable analyses were conducted to estimate the prevalence of HFI and analyze the association between various socioeconomic factors and HFI among the study sample.

Results: Among CIS participants with disabilities (30% of the total CIS sample: 31 million persons), 26% reported some level of HFI, including 8% with severe HFI. The prevalence of HFI was 13% among those without disabilities. The prevalence of HFI was highest among those with learning, memory, cognition, and seeing disabilities (each at 36%). Levels of HFI were higher for those with more severe disabilities and with a greater number of disabilities. For persons with disabilities, the odds of HFI were two times higher, compared with persons without disabilities (adjusted odds ratio [AOR]: 2.5 [95% confidence interval (CI): 2.2, 2.7]), after adjustment for a range of sociodemographic covariates. Persons with disabilities who were in the lowest income quintile (AOR: 4.0 [95% CI: 3.2, 4.9]) and aged 45 to 54 (AOR: 2.9 [95% CI: 2.1, 4.1]) had the highest odds of HFI, compared with other persons with disabilities living in wealthier households and those aged 65 and older, respectively. Other risk factors included being in a one-parent household, living in the Prairies, and living in a dwelling not owned by the household.

Interpretation: HFI prevalence among CIS participants with disabilities was higher than for persons without disabilities, even after adjustment for well-documented sociodemographic risk factors. Consistent monitoring of HFI among persons with disabilities can help inform any ongoing or newly developed poverty reduction strategies for this population.

Background: Mental health disparity is associated with diverse characteristics, such as gender, socioeconomic status, Indigenous identity, immigrant status, race, disability, and sexual orientation. However, intersectional studies on women's mental health have been rare, particularly during the COVID-19 pandemic period.

Methods: Using data from two cycles of the Canadian Community Health Survey (2019 annual data and data from September to December 2020), self-reported mental health outcomes before the COVID-19 pandemic (sample size was 64,880) and during the second wave of the pandemic in the fall of 2020 (sample size of 27,246) were analyzed.

Results: After sociodemographic factors were controlled for, women and girls had higher odds of poorer self-perceived mental health and worsened mental health compared with before the COVID-19 pandemic than men and boys. Compared with 2019, the gender gap in negative self-perceived mental health increased during the pandemic. The number and type of intersections of specific socioeconomic characteristics also had an impact on mental health outcomes. During the pandemic, women and girls with the following characteristics were more likely to report low self-perceived mental health, compared with women and girls with no intersections: those with a disability (7.8 times); or who are lesbian, gay, or bisexual or have another sexual orientation than heterosexual (5.6); or who are Indigenous (3.6).

Interpretation: The intersections of gender and other sociodemographic characteristics increased the odds of negative self-perceived mental health.