Health Reports最新文献

Background: First Nations people were reported to have a shorter life expectancy and were more likely than their non-Indigenous counterparts to die prematurely from avoidable causes.

Methods: Using the 2006 Canadian Census Health and Environment Cohort (CanCHEC), the number and rates of deaths for a 10-year follow-up period for on- and off-reserve First Nations people and the non-Indigenous population were calculated by sex, age and region.

Results: According to the 2006 CanCHEC data, First Nations people showed higher age-standardized mortality rates (ASMRs) compared with the non-Indigenous population. On-reserve First Nations people showed higher ASMRs than off-reserve First Nations people. First Nations people's excess mortality, compared with their non-Indigenous counterparts, was caused by deaths from diabetes, heart diseases, chronic liver disease and cirrhosis, unintentional injuries, and intentional injuries (suicide and assault). The mortality differential between First Nations people and the non-Indigenous population was found to be more pronounced among younger age groups.

Interpretation: First Nations people's excess mortality can be better understood by examining specific causes for specific population groups, based on age, sex, being on- or off-reserve, and region.

Background: A comprehensive evaluation of progress in cancer survival for all cancer types combined has not previously been conducted for Canada. The cancer survival index (CSI) is superior to age standardization in measuring such progress.

Data and methods: Data are from the population-based Canadian Cancer Registry, record-linked to the Canadian Vital Statistics Death database. CSI estimates for both sexes combined were calculated as the weighted sum of the sex- and cancer-specific age-standardized net survival estimates. Sex-specific CSI estimates were calculated separately using sex-specific cancer type weights.

Results: From the 1992-to-1994 period to the 2015-to-2017 period, the five-year CSI increased 8.6 percentage points to 63.7%. It increased by 8.9 percentage points to 61.8% among males, and by 8.2 percentage points to 65.8% among females. The contribution of a cancer and sex combination to change in the CSI over time is a function of its assigned weight and changes in its age-standardized net survival. Female breast was the most influential cancer and sex combination, contributing 10.1% to the overall increase, followed by prostate (8.2%) and female lung (7.3%). The increase in the index since the 2005-to-2007 period was most impacted by lung cancer among both females (11.1%) and males (9.4%). While prostate cancer survival increased over the entire study period, it has recently decreased, resulting in a counterproductive 8.1% contribution since the 2005-to-2007 period.

Interpretation: Steady progress has been made in overall cancer survival in Canada since the early 1990s. Female breast cancer has contributed the most to this progress overall, but more recently female lung cancer has been the most influential.

Background: As Canadian immigration levels increase, knowledge concerning immigrant health becomes increasingly important for health system policy and planning. This study compares the rate of all-cause hospitalization among immigrants with that of their Canadian-born counterparts.

Data and methods: Using records from the Discharge Abstract Database (2004/2005 to 2016/2017) and the Ontario Mental Health Reporting System (2006/2007 to 2017/2018) linked to the 2016 Longitudinal Immigration Database, this study compared the age-standardized hospitalization rates (ASHRs) among immigrants with those of the Canadian-born population; the latter were obtained from a linkage based on the 2011 National Household Survey. Comparisons were made at the International Classification of Diseases chapter level by immigrant landing year, admission category and world region of birth. Quebec data were not available.

Results: Overall, ASHRs among immigrants were lower than for the Canadian-born population. Immigrants in the economic class had the lowest ASHR, followed by those in the family class and among refugees. After pregnancy was excluded, leading hospitalization causes were similar for immigrants and the Canadian-born population, where top causes included digestive system and circulatory diseases, injuries, and cancer. In male and female immigrants, the ASHRs were lowest among those from East Asia. By landing year, males arriving earlier had the highest ASHR compared with the most recent arrivals. When pregnancy was excluded and while the differential in ASHRs among females by landing year remained, the magnitude was smaller.

Interpretation: These results corroborate those from previous studies suggesting a healthy immigrant effect, but also reveal heterogeneity in ASHRs within the immigrant population. They provide a baseline for comparison of health status between populations, which enables further monitoring and informs health-system policy and planning.

Background: Public health measures related to the COVID-19 pandemic have upended the way Canadians eat and shop for food. Since the pandemic began, many Canadians have reported consuming food away from home (FAFH) less often. FAFH tends to be less healthful than food prepared at home. Little is known about patterns of Canadians' FAFH consumption before the pandemic. This study used 2015 national-level nutrition data, the most recent available, to characterize patterns of FAFH consumption and selected markers of dietary intake.

Data and methods: National-level food intake data came from the first 24-hour dietary recall provided by 20,475 respondents aged 1 or older to the 2015 Canadian Community Health Survey-Nutrition. Mean daily intakes of selected food subgroups and nutrients, adjusted for total energy intake, were compared between those who had consumed any food in a restaurant on the previous day and those who had not. Estimates were generated overall and for eight age and sex groups.

Results: In 2015, overall, 21.8% of Canadians had consumed FAFH in a restaurant on the previous day. Eating out was most common among males aged 19 to 54 (27.7%) and least common among young children aged 1 to 5 (8.4%). Compared with Canadians who had not eaten out on the previous day, those who had eaten out had consumed, on that day, fewer servings of whole fruit; whole grains; dark green and orange vegetables; other vegetables (excluding potatoes); milk and fortified soy-based beverages; and legumes, nuts and seeds, on average. Those who had eaten out had consumed, on average, less fibre and total sugar, and more total fat, saturated fat and sodium on that day. There were few differences for meat and poultry, fish and seafood, and protein intake.

Discussion: On the day that Canadians ate out in a restaurant, their dietary intake was generally less favourable than that of Canadians who did not eat out. If Canadians continue to eat at home more and to consume less FAFH, as early pandemic-period reports suggest, then results can be used to gauge the potential dietary implications of these shifts.

Background: Cancer incidence rates have been shown to vary by ethnicity, and the increasing awareness of and interest in reporting ethnic health inequalities have been growing internationally. The objective of this study was to assess cancer incidence and mortality rates by ethnicity in Canada.

Data and methods: The study used the 2006 Canadian Census Health and Environment Cohort, linked to the Canadian Cancer Registry and the Canadian Vital Statistics-Death Database, to determine cancer cases and mortality from 2006 to 2016. Ethnicity was categorized as non-Indigenous North American (NINA); European; Caribbean; Latin, Central and South American (LCSA); African; East Asian; South Asian; and West Central Asian and Middle Eastern.

Results: Europeans had the highest standardized incidence rates, while NINA had the highest mortality rates. Rates varied substantially by ethnicity and immigrant status. The top three cancers accounted for 46.5% to 61.9% of all new cancers, while the top three cancer deaths accounted for 36.1% to 61.9% of all deaths. The distribution of cancers within the top 10 cancers and the top 10 cancer deaths also differed; e.g., stomach cancer was found to be more prevalent in the East Asian, LCSA, African and Caribbean groups. Non-immigrant African males had the highest cancer incidence rates, and non-immigrant South Asian females had the highest mortality rates.

Discussion: There is considerable variability in cancer incidence and cancer mortality rates by ethnicity, and this study addresses the knowledge gap in Canada in this area. Establishing baseline indicators, such as cancer rates by ethnicity, is essential to understanding the differences within the diverse Canadian population and to informing targeted interventions that may help reduce health inequalities.

Background: This study assessed the use of and exposure to handheld laser devices by Canadians and the potential associated health risks.

Data and methods: The 2019 Canadian Community Health Survey collected data from 12,397 Canadians on the prevalence of handheld laser exposure or use, and associated eye or skin injuries.

Results: In 2019, an estimated 12.4% (95% CI: 11.4% to 13.4%) of Canadians reported using a handheld laser device or being exposed to its beam in the previous year, and those between the ages of 12 and 17 represented 30.5% (95% CI: 26.6% to 34.4%) of users. The highest laser device use or exposure was among those with a university education (13.8%; 95% CI: 11.8% to 15.8%), and a significant trend was found over income categories (p < 0.0001). The highest prevalence of exposure or use involved laser pointers (69.4%; 95% CI: 65.4% to 73.4%), followed by laser toys (38.5%; 95% CI: 34.6% to 42.5%), laser torches (8.2%; 95% CI: 6.1% to 10.4%) and-lastly-search-and-rescue lasers (0.8%E; 95% CI: 0.3% to 1.2%). Overall, 0.7%E (95% CI: 0.2% to 1.2%) of Canadians reported discomfort or injury in the past 12 months. One-quarter (27.9%; 95% CI: 23.8% to 31.9%) of users had a laser beam intentionally directed toward their eyes or skin. Most users did not buy the device (56.3%; 95% CI: 52.1% to 60.5%), while 40.5% (95% CI: 36.2% to 44.7%) purchased it at a Canadian retail store or online (3.8%E; 95% CI: 2.6% to 5.0%).

Discussion: The prevalence of handheld laser device use and beam exposure was 12.4% (95% CI: 11.4% to 13.4%), representing approximately 3.9 million Canadians. While the number of reported injuries was low, ongoing surveillance helps assess the effectiveness of current risk management approaches for laser products.

Background: The objective of this study was to describe sex-specific hospitalization rates among Indigenous people in Canada (excluding Quebec), separately for First Nations people living on and off reserve, Inuit living in Inuit Nunangat (excluding Nunavik), Métis, and the non-Indigenous population.

Data and methods: The 2006 and 2011 Canadian Census Health and Environment Cohorts (CanCHECs) were used, allowing hospital records to be examined by Indigenous identity as reported on the census. Five years of hospitalization data were used for each CanCHEC. Causes of hospitalization were based on the most responsible diagnosis and coded at the chapter level according to the International Classification of Diseases (ICD-10-CA). Age-standardized hospitalization rates (ASHRs) were calculated per 100,000 population, and rate ratios (RRs) were calculated for each Indigenous group relative to non-Indigenous people.

Results: ASHRs were higher among Indigenous people than among non-Indigenous people; this was true for females and males from both the 2006 and the 2011 cohorts. Hospitalization patterns varied by sex and Indigenous group. The greatest disparities with the non-Indigenous population were observed among on-reserve First Nations females and males from both cohorts. Elevated RRs were observed for diseases of the endocrine, nutritional and metabolic system among First Nations females and males living on reserve; hospitalizations for mental health among First Nations females and males living off reserve and Inuit males; and diseases of the respiratory system among Inuit females. For Métis females and males, equally elevated RRs were observed for diseases of the endocrine system and mental health. ASHRs for most causes decreased between the 2006 and 2011 cohorts, with the exception of ASHRs for mental health among First Nations females and males living on reserve, which increased.

Discussion: Findings are consistent with recognized health disparities between Indigenous and non-Indigenous people. Further research is warranted to understand reported differences in hospitalization patterns.

The family environment is an important influence on the health and behaviours of children. Few large-scale datasets include detailed and objectively measured health data about multiple individuals from the same family who are living in the same household. The Canadian Health Measures Survey (CHMS) is a repeating, cross-sectional survey that selects two members of a household-a child and a randomly selected older member of the household aged 12 to 79 years-with at least one child aged 3 to 11 years in residence. These paired respondent records, available in the CHMS relationship files, provide unique opportunities to researchers interested in examining associations between two members of the same household for health behaviours and outcomes. A range of pairings are captured in the relationship files (e.g., parent and child, siblings, grandchild and grandparent) with birth parent-child pairs being the most common. These paired respondent data are an important analytical asset of the CHMS and enhance the research potential of the survey significantly.

Background: Few quantitative studies have used national-level data to examine access to mental health consultation (MHC) by immigrants in Canada, and even fewer studies investigate MHCs using the following variables: immigrant admission category, duration in Canada since landing and world source regions. This study examines MHCs by immigrants and refugees-compared with those of Canadian-born respondents-while controlling for self-reported mental health (SRMH) and immigrant characteristics, using a population-based survey linked to immigrant landing information. This study, which is based on a linked database, allows for much richer insight into immigrant populations than most previous studies.

Data and methods: Based on data from four cycles (2011 to 2014) of the Canadian Community Health Survey linked to data from the Longitudinal Immigration Database, the odds ratios of having had MHCs are compared between the Canadian-born population and immigrants by immigration dimensions, while controlling for SRMH. Results are hierarchically adjusted for age, sex, socioeconomic factors and sense of belonging.

Results: After the above-mentioned factors were controlled for, immigrants were much less likely than Canadian-born respondents to access MHCs. Specifically, compared with the Canadian-born population that had high levels of SRMH, immigrants with high levels of SRMH were statistically less likely to have had an MHC (odds ratio [OR]=0.5, 95% confidence interval [CI] from 0.4 to 0.5), while those with low SRMH levels were more likely to report an MHC (OR=4.8, 95% CI from 4.5 to 5.1, for the Canadian-born population but OR=1.8, 95% CI from 1.5 to 2.1, for immigrants). Most Asian immigrants with low SRMH levels were only as likely to report MHCs as Canadian-born respondents with high SRMH levels. Refugees with low SRMH levels also had only a slightly elevated MHC level (OR=1.6, 95% CI from 1.1 to 2.3) compared with Canadian-born individuals with high SRMH levels. Overall, refugees were not more likely than immigrants of other admission categories to report having had an MHC, even though previous findings have shown that refugees report low levels of SRMH.

Discussion: This study provides new evidence on the differences in access to MHC between Canadian-born individuals and immigrants by various characteristics, while controlling for SRMH. Results probably reflect the structural or cultural barriers to MHC and point to a possible pathway to either maintain or improve mental health among immigrants.

Background: This study aims to measure cancer incidence and mortality rates of Registered First Nations people in Ontario and compare them with those of other people in Ontario from 1991 to 2010.

Data and methods: The federal Indian Register, the Ontario Cancer Registry and the Registered Persons Database were linked to develop a cohort of First Nations people diagnosed with cancer in Ontario. Sex-and site-specific age-standardized cancer incidence and mortality rates, and selected trends over time, were calculated. Rate ratios (RRs) were used to compare rates in First Nations peoples with those of other people in Ontario.

Results: The First Nations cohort comprised 194,392 people, with 6,859 cancer diagnoses. First Nations people had higher rates for certain cancers than others in Ontario: lung (males RR 1.19; females RR 1.47), colorectal (males RR 1.36; females RR 1.34) and kidney (males RR1.95; females RR 2.23). While lung cancer rates rose in First Nations females (annual percent change [APC] +2.67), they fell at a similar rate (APC -2.28) in males. Cervical cancer rates fell (APC -9.53) and approached the rate among other females in Ontario. Kidney cancer rates increased in First Nations people.

Discussion: First Nations people in Ontario have higher incidence and mortality for certain cancers compared with other people in Ontario. However, the declines in cervical cancer rates in First Nations females and lung cancer rates in First Nations males illustrate the likely impact of Pap test uptake and smoking cessation programs. Community-led efforts to develop culturally appropriate prevention and screening programs are essential to further reduce cancer rates in First Nations people.