Health Reports最新文献

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.

Background: Low staffing levels and high turnover rates are longstanding issues in long-term care (LTC) facilities that were further exacerbated by the COVID-19 pandemic. Consequently, residents and staff were disproportionately affected, with high morbidity and mortality rates. This study examines changes in staffing levels, overall and by direct care worker category, across the LTC facilities sector by ownership status in Canada before and during the pandemic. It also explores differences in facility expenditures allocated towards employee wages, benefits, and subcontracts across homes by ownership status.

Data and methods: Data were from the 2020 and 2021 Nursing and Residential Care Facility Survey, which collected information on facility characteristics, including expenses, revenue, ownership status, and staffing levels. Summary statistics and multivariate linear regression models were used to examine the association between staffing levels and ownership status, with analyses stratified by direct care worker category.

Results: On average, public LTC facilities had higher staffing levels and spent a greater proportion of their total costs on employee wages and benefits before and during the pandemic, compared with for-profit and non-profit private facilities. While the total hours of care per resident day (HPRD) increased during the pandemic, there were notable variations by region, ownership status, and direct care worker category. For example, Ontario public nursing homes provided 10% more HPRD from registered nurses during the pandemic, compared with the period before.

Interpretation: Staffing levels of direct care workers in LTC facilities, overall and separately, are associated with ownership status. Allocation of employee-related expenses also differed by ownership. Further research is needed to explore interactions between ownership status, staffing levels, and quality of care for residents.

Background: Most older Canadians would prefer to stay in their own homes and communities rather than move to long-term care (LTC) facilities. A growing older population, limited LTC capacity, and costs have increased demand for initiatives that enable people to age in their communities for as long as possible.

Methods: Data from the 2019/2020 Canadian Health Survey on Seniors were used to estimate the prevalence of four types of supports and services (SSs) that assist with living in the community: home adaptations, informal care, home care, and community support services. Separate multivariable logistic regressions for each SS, stratified by age group (65 to 79 years and 80 years or older), examined associations with need-related factors, enabling resources, and predisposing characteristics.

Results: At 25.0% of 65- to 79-year-olds and 51.9% of those aged 80 years or older, home adaptations were the most prevalent SS used in Canada. Use of home care, community support services and informal care was less common, ranging from 5.5% to 11.6% among Canadians aged 65 to 79 and 17.2% to 33.2% among those aged 80 or older. Nonetheless, substantial proportions of the younger (65.4%) and older (31.8%) age groups reported no SS use. In general, having a poor health status, having impairment, not driving, being older, living alone, having a regular health care provider, and being a woman increased the odds of using SSs.

Interpretation: Understanding the factors associated with SS use can help inform policies and programs aimed at assisting older Canadians with aging in the community.

Background: The OncoSim-Breast model, developed by the Canadian Partnership Against Cancer and Statistics Canada, represents breast cancer-related events in the Canadian female population. This study aimed to compare OncoSim-Breast with recent results from the United States' National Cancer Institute's Cancer Intervention and Surveillance Modeling Network (CISNET) breast cancer models. The primary focus was on the impact of extending breast cancer screening to women aged 40 to 49.

Data and methods: The OncoSim-Breast model used Canadian demographics, competing mortality, and test performance, while the CISNET models used comparable United States data to analyze 10 different mammography screening scenarios. Lifetime outcomes were calculated for a cohort of 40-year-old women born in 1980, assuming perfect adherence to digital mammography screening. OncoSim-Breast's estimates were compared with the median and range of estimates from the five CISNET models. The primary outcomes were breast cancer deaths averted and life years gained per 1,000 40-year-old women.

Results: OncoSim-Breast projected that starting screening at age 40 would lead to 1.7 breast cancer deaths averted and 53 life years gained per 1,000 women, compared with starting screening at age 50. CISNET models projected a median of 1.3 breast cancer deaths averted (range 0.8 to 3.2) and 43 life years gained (range 31 to 103) per 1,000 women for the same scenario. Secondary outcomes estimated by OncoSim-Breast and CISNET models were similarly consistent and comparable.

Interpretation: This study demonstrates that OncoSim-Breast's estimates of the impact of starting breast cancer screening earlier align with those from CISNET models.

Background: Oral contraceptives (OCs) have been legally available in Canada since 1969. OCs remain the most common method of reversible contraception in Canada and are among the most commonly used medications by reproductive-aged women in Canada. The use of OCs offers protection against unplanned pregnancy, in addition to other non-contraceptive benefits. Detailed data about current and lifetime OC use in Canada are rarely available.

Methods: Data from four cycles (from the 2007-to-2009 cycle to the 2018-to-2019 cycle) of Statistics Canada's Canadian Health Measures Survey were combined to estimate current OC use (past 30 days) by sociodemographic characteristics and other factors and formulations by estrogen dose and progestin type. Logistic regression was used to examine the association between current OC use and sociodemographic characteristics and other factors. Combined data from 2016-to-2017 and 2018-to-2019 were used to estimate lifetime OC use and use duration.

Results: According to combined data from the 2007-to-2009 period to the 2018-to-2019 period, an average of 15.9% of non-pregnant women aged 15 to 49 had used OCs in the previous 30 days. Most (98.6%) used OCs containing estrogen and progestin, and 48.7% of them took lower-dose formulations with 10 to 25 micrograms of ethinylestradiol. Younger women aged 15 to 39 were more likely to have used OCs in the previous 30 days than those aged 40 to 49. Additionally, the adjusted odds of being an OC user were higher for women who had not had children, were non-racialized and non-Indigenous, and were currently sexually active. Another 53.9% of women aged 15 to 49 reported former use. A majority of both current (67.5%) and former (52.8%) OC users reported having used them for at least four years.

Interpretation: Substantial proportions of reproductive-aged women in Canada are current or former OC users.

Background: Girls and young women experience poorer mental health than boys and young men, although the reverse is true for substance use disorders. Few population-based studies examine girls' and young women's experiences accessing and receiving mental health and substance use (MHSU) health care support, particularly across sociodemographic groups.

Data and methods: Data from the 2022 Mental Health and Access to Care Survey were used to estimate the proportions of girls and young women who met the criteria for at least one MHSU disorder and who accessed formal MHSU health supports. The types of supports accessed, reasons for not accessing services, and associations between sociodemographic characteristics and the likelihood of indicating that the supports they accessed were helpful were examined. Girls and women aged 15 to 29 were studied, with an analytical sample of 1,254.

Results: Among girls and young women aged 15 to 29, 38.5% met the criteria for one or more MHSU disorders in 2022; of those, 54.6% had accessed formal MHSU health supports. Lesbian and bisexual girls and young women with an MHSU disorder were more likely to access formal supports and more likely to have found the supports helpful compared with their heterosexual peers. Racialized girls and young women were less likely than their non-racialized peers to report the care they received was helpful.

Interpretation: Some sociodemographic differences in the experiences of girls and young women accessing and receiving formal care for MHSU disorders were observed. Results indicated a need to improve the accessibility of formal MHSU supports for this population.

Background: The population aged 85 and older is one of the fastest-growing age groups. Identifying distinct health status and care-receiving profiles can improve the understanding of the heterogeneity in this age group. Unmet home care needs are associated with negative health consequences and can challenge the ability of those 85 and older to age in the community.

Data and methods: A representative sample of 4,083 community-dwelling Canadians aged 85 years and older from the 2019/2020 Canadian Health Survey on Seniors (CHSS) was used to identify health and care-receiving profiles applying latent class analysis. Multinomial logistic regression was used to examine factors associated with the profiles. Multivariable logistic regression was applied to evaluate the association between the profiles and unmet home care needs.

Results: An estimated 201,000 Canadians aged 85 years and older (28.2%) were classified as "healthiest-low care receiving", 180,000 (25.3%) as "moderately healthy-moderate care receiving," 194,000 (27.2%) as "moderately unhealthy-low care receiving," and 137,000 (19.2%) as "poor health-high care receiving." Increasing age and being an immigrant were associated with poorer health status and a higher likelihood of receiving care. An estimated 46,000 Canadians aged 85 years and older (6.5%) reported having unmet home care needs. Individuals with the profiles characterized by poorer health and a higher likelihood of receiving care were more likely to have unmet home care needs.

Interpretation: The findings of this study highlight the importance of considering multiple health and care-receiving factors to better illuminate unmet home care needs among community-dwelling Canadians aged 85 years and older.

Background: It is not clear whether the increased mortality pattern observed in a prior analysis of the Canadian Census Health and Environment Cohorts for HIV/AIDS, diabetes, prostate cancer, and uterine cancer among Black adults is reflected in incident hospitalization (a marker of severity) or the diagnosis of these diseases, nor is it clear whether disparities exist regarding early screening and survivability.

Methods: To understand the paths that contribute to differential mortality patterns, standard Cox proportional hazard models were used to assess the incidence risk of diagnosis (uterine and prostate cancer) and incident hospitalization (HIV and diabetes) among 161,520 Black adults, compared with 6,866,070 White adults. Competing risk regression was used to evaluate the cumulative risk of death for the four disease outcomes since diagnosis or hospitalization. For the observed differential cancer mortality, mediation analysis was conducted to investigate the role of cancer diagnosis at follow-up (a proxy for delayed diagnosis that is not entirely indicative of late-stage cancer).

Results: Across all examined outcomes, except for uterine cancer, Black adults had elevated incident diagnoses or hospitalizations compared with White adults. Notably, Black males demonstrated a risk of incident prostate cancer and hospitalizations from HIV and diabetes twice as high relative to White males. For Black females, the risk of incident HIV hospitalization was 12 times as high. However, Black females were 15% less likely to be diagnosed with uterine cancer, compared with White females. Cumulative mortality risk analysis showed significantly lower survivability (two times lower) among Black females diagnosed with uterine cancer, relative to White females. Delayed diagnosis mediated a marginally higher proportion of the total differential uterine cancer mortality among Black females (14.9%; 95% confidence interval [CI]: 10.5% to 23.1%), compared with White females (8.9%; 95% CI: 6.3% to 13.9%).

Interpretation: This study unveils substantial parallels between heightened incidence risk and relative mortality for most of the four explored outcomes between Black and White adults in Canada. Notably, the study highlights a lower incident diagnosis of uterine cancer among Black females, despite a relatively higher uterine cancer mortality. Three in every 20 uterine cancer deaths were mediated through the time of uterine cancer diagnosis (relatively delayed in Black females), underscoring the need for targeted interventions and early detection strategies to address health disparities in this population.

Background: During the COVID-19 pandemic in Canada, there was a decrease in population positive mental health (PMH); however, many individuals still reported high levels of PMH. One potential protective factor could be a sense of control, which involves perceptions of personal mastery and minimal perceived constraints. Limited Canadian research has been conducted on the link between sense of control and PMH during the pandemic.

Data and methods: This study used cross-sectional data from the 2020 and 2021 Survey on COVID-19 and Mental Health, which included adults (18 years and older) living in the 3 territorial capitals and 10 provinces in Canada. Two facets of sense of control were measured with the Sense of Mastery Scale: personal mastery and perceived constraints. Three PMH outcomes were measured using single-item measures of self-rated mental health (SRMH), community belonging, and life satisfaction. Regression analyses were conducted to examine associations between the two sense of control facets and the three PMH outcomes.

Results: Higher personal mastery was associated with higher average life satisfaction and a greater likelihood of high SRMH and strong community belonging. In contrast, greater perceived constraints were associated with lower average life satisfaction and a lower likelihood of high SRMH and strong community belonging. Sociodemographic differences on the facets were observed.

Interpretation: Adults in Canada with a higher sense of control during the pandemic tended to have better PMH than those who felt like they had less control. Further research on mental health promotion efforts involving sense of control is needed.