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de Oliveira C, Mason J, Luu L, Iwajomo T, Simbulan F, Kurdyak P, Pechlivanoglou P. The PSY-SIM Model: Using Real-World Data to Inform Health Care Policy for Individuals With Chronic Psychotic Disorders. Schizophr Bull 2024; 50:1094-1103. [PMID: 38104255 PMCID: PMC11349024 DOI: 10.1093/schbul/sbad175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
BACKGROUND AND HYPOTHESIS Few microsimulation models have been developed for chronic psychotic disorders, severe and disabling mental disorders associated with poor medical and psychiatric outcomes, and high costs of care. The objective of this work was to develop a microsimulation model for individuals with chronic psychotic disorders and to use the model to examine the impact of a smoking cessation initiative on patient outcomes. STUDY DESIGN Using health records and survey data from Ontario, Canada, the PSY-SIM model was developed to simulate health and cost outcomes of individuals with chronic psychotic disorders. The model was then used to examine the impact of the Smoking Treatment for Ontario Patients (STOP) program from Ontario on the development of chronic conditions, life expectancy, quality of life, and lifetime health care costs. STUDY RESULTS Individuals with chronic psychotic disorders had a lifetime risk of 63% for congestive heart failure and roughly 50% for respiratory disease, cancer and diabetes, and a life expectancy of 76 years. The model suggests the STOP program can reduce morbidity and lead to survival and quality of life gains with modest increases in health care costs. At a long-term quit rate of 4.4%, the incremental cost-effectiveness ratio of the STOP program was $41,936/QALY compared with status quo. CONCLUSIONS Smoking cessation initiatives among individuals with chronic psychotic disorders can be cost-effective. These findings will be relevant for decision-makers and clinicians looking to improving health outcomes among this patient population.
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Affiliation(s)
- Claire de Oliveira
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Joyce Mason
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Linda Luu
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tomisin Iwajomo
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Frances Simbulan
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Paul Kurdyak
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Petros Pechlivanoglou
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
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Richard L, Carter B, Nisenbaum R, Liu M, Hwang SW. Identification of homelessness using health administrative data in Ontario, Canada following a national coding mandate: a validation study. J Clin Epidemiol 2024; 172:111430. [PMID: 38880439 DOI: 10.1016/j.jclinepi.2024.111430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 06/04/2024] [Accepted: 06/10/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVES Conducting longitudinal health research about people experiencing homelessness poses unique challenges. Identification through administrative data permits large, cost-effective studies; however, case validity in Ontario is unknown after a 2018 Canada-wide policy change mandating homelessness coding in hospital databases. We validated case definitions for identifying homelessness using Ontario health administrative databases after introduction of this coding mandate. STUDY DESIGN AND SETTING We assessed 42 case definitions in a representative sample of people experiencing homelessness in Toronto (n = 640) from whom longitudinal housing history (ranging from 2018 to 2022) was obtained, and a randomly selected sample of presumably housed people (n = 128,000) in Toronto. We evaluated sensitivity, specificity, positive and negative predictive values, and positive likelihood ratios to select an optimal definition, and compared the resulting true positives against false positives and false negatives to identify potential causes of misclassification. RESULTS The optimal case definition included any homelessness indicator during a hospital-based encounter within 180 days of a period of homelessness (sensitivity = 52.9%; specificity = 99.5%). For periods of homelessness with ≥1 hospital-based healthcare encounter, the optimal case definition had greatly improved sensitivity (75.1%) while retaining excellent specificity (98.5%). Review of false positives suggested that homeless status is sometimes erroneously carried forward in healthcare databases after an individual transitioned out of homelessness. CONCLUSION Case definitions to identify homelessness using Ontario health administrative data exhibit moderate to good sensitivity and excellent specificity. Sensitivity has more than doubled since the implementation of a national coding mandate. Mandatory collection and reporting of homelessness information within administrative data present invaluable opportunities for advancing research on the health and healthcare needs of people experiencing homelessness.
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Affiliation(s)
- Lucie Richard
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada.
| | - Brooke Carter
- ICES Western, London Health Sciences Research Institute, London, Ontario, Canada
| | - Rosane Nisenbaum
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
| | | | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada
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Zhang K, Terebessy E, Zhu J, Birken C, Borkhoff CM, Gershon A, Moraes TJ, Kendzerska T, Pakhale S, To T. Uptake and cardiac events of COVID-19 vaccinations among Canadian youth and young adults. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003363. [PMID: 39083505 PMCID: PMC11290663 DOI: 10.1371/journal.pgph.0003363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 06/19/2024] [Indexed: 08/02/2024]
Abstract
Few studies have examined population-level data of the COVID-19 original and bivalent vaccine on its uptake and potential side effects. We used population-based health administrative data from Jan 2021-Feb 2023 to identify Ontario residents aged 12-35 years old to calculate their rates of COVID-19 vaccine uptake and vaccine-related cardiac events (myocarditis and pericarditis). Multivariable Cox, logistic, and negative binomial regression analyses were used to adjust for covariates. Hazard ratios (HR) were reported with 95% confidence intervals (CI). The study population included 5,012,721 individuals. Comparing to the general population, those with chronic diseases were associated with 13-37% higher rates of vaccine uptake and 1.39-2.27 times higher odds of receiving booster doses. Overall, post-vaccination cardiac event incidence rates ranged from 3-12 per 100,000 persons. Compared to the general population, the incidence rate of cardiac events among those with asthma and allergic diseases was significantly higher, 3.7 events per 100,000 persons. Compared to the general population, those with asthma and/or allergic diseases had significantly higher associated likelihoods of a cardiac event (HR = 1.31, 95% CI: 1.08-1.57). Females, adults, and those with prior COVID-19 infections had decreased odds of cardiac events after 2nd vaccine doses. No significant differences in post-vaccine cardiac events were detected between original and bivalent doses. This Canadian population-based study reported substantially higher rates of vaccine uptake and a very rare incidence of temporally associated post-vaccination cardiac events. While substantially smaller than the benefits of vaccination, our results indicated a continued small risk of cardiac side effects from bivalent COVID-19 vaccines in individuals with comorbidities.
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Affiliation(s)
- Kimball Zhang
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Emilie Terebessy
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jingqin Zhu
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Catherine Birken
- ICES, Toronto, Ontario, Canada
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cornelia M. Borkhoff
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Andrea Gershon
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Theo J. Moraes
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tetyana Kendzerska
- ICES, Toronto, Ontario, Canada
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Smita Pakhale
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Teresa To
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Guilcher SJT, Mayo AL, Swayze S, de Mestral C, Viana R, Payne MW, Dilkas S, Devlin M, MacKay C, Kayssi A, Hitzig SL. Patterns of inpatient acute care and emergency department utilization within one year post-initial amputation among individuals with dysvascular major lower extremity amputation in Ontario, Canada: A population-based retrospective cohort study. PLoS One 2024; 19:e0305381. [PMID: 38990832 PMCID: PMC11238985 DOI: 10.1371/journal.pone.0305381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/28/2024] [Indexed: 07/13/2024] Open
Abstract
INTRODUCTION Lower extremity amputation (LEA) is a life altering procedure, with significant negative impacts to patients, care partners, and the overall health system. There are gaps in knowledge with respect to patterns of healthcare utilization following LEA due to dysvascular etiology. OBJECTIVE To examine inpatient acute and emergency department (ED) healthcare utilization among an incident cohort of individuals with major dysvascular LEA 1 year post-initial amputation; and to identify factors associated with acute care readmissions and ED visits. DESIGN Retrospective cohort study using population-level administrative data. SETTING Ontario, Canada. POPULATION Adults individuals (18 years or older) with a major dysvascular LEA between April 1, 2004 and March 31, 2018. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Acute care hospitalizations and ED visits within one year post-initial discharge. RESULTS A total of 10,905 individuals with major dysvascular LEA were identified (67.7% male). There were 14,363 acute hospitalizations and 19,660 ED visits within one year post-discharge from initial amputation acute stay. The highest common risk factors across all the models included age of 65 years or older (versus less than 65 years), high comorbidity (versus low), and low and moderate continuity of care (versus high). Sex differences were identified for risk factors for hospitalizations, with differences in the types of comorbidities increasing risk and geographical setting. CONCLUSION Persons with LEA were generally more at risk for acute hospitalizations and ED visits if higher comorbidity and lower continuity of care. Clinical care efforts might focus on improving transitions from the acute setting such as coordinated and integrated care for sub-populations with LEA who are more at risk.
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Affiliation(s)
- Sara J. T. Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Amanda L. Mayo
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Charles de Mestral
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Division of Vascular Surgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Vascular Surgery, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Ricardo Viana
- Department of Physical Medicine & Rehabilitation, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Michael W. Payne
- Department of Physical Medicine & Rehabilitation, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Steven Dilkas
- Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- West Park Healthcare Centre, Toronto, Ontario, Canada
| | | | - Crystal MacKay
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Ahmed Kayssi
- Division of Vascular Surgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Schulich Heart Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Sander L. Hitzig
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Richard L, Holland A, Aghanya V, Campitelli MA, Hwang SW. Uptake of COVID-19 vaccination among community-dwelling individuals receiving healthcare for substance use disorder and major mental illness: a matched retrospective cohort study. Front Public Health 2024; 12:1426152. [PMID: 39035175 PMCID: PMC11257932 DOI: 10.3389/fpubh.2024.1426152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 06/24/2024] [Indexed: 07/23/2024] Open
Abstract
Introduction Patients with major mental illness (MMI) and substance use disorders (SUD) face barriers in accessing healthcare. In this population-based retrospective cohort study, we investigated the uptake of COVID-19 vaccination in Ontario, Canada among community-dwelling individuals receiving healthcare for major mental illness (MMI) and/or substance use disorders (SUD), comparing them to matched general population controls. Methods Using linked health administrative data, we identified 337,290 individuals receiving healthcare for MMI and/or SUD as of 14 December 2020, matched by age, sex, and residential geography to controls without such healthcare. Follow-up extended until 31 December 2022 to document vaccination events. Results Overall, individuals receiving healthcare for MMI and/or SUD (N = 337,290) had a slightly lower uptake of first (cumulative incidence 82.45% vs. 86.44%; hazard ratio [HR] 0.83 [95% CI 0.82-0.83]) and second dose (78.82% vs. 84.93%; HR 0.77 [95% CI 0.77-0.78]) compared to matched controls. Individuals receiving healthcare for MMI only (n = 146,399) had a similar uptake of first (87.96% vs. 87.59%; HR 0.97 [95% CI 0.96-0.98]) and second dose (86.09% vs. 86.05%, HR 0.94 [95% CI 0.93-0.95]). By contrast, individuals receiving healthcare for SUD only (n = 156,785) or MMI and SUD (n = 34,106) had significantly lower uptake of the first (SUD 78.14% vs. 85.74%; HR 0.73 [95% CI 0.72-0.73]; MMI & SUD 78.43% vs. 84.74%; HR 0.76 [95% CI 0.75-0.77]) and second doses (SUD 73.12% vs. 84.17%; HR 0.66 [95% CI 0.65-0.66]; MMI & SUD 73.48% vs. 82.93%; HR 0.68 [95% CI 0.67-0.69]). Discussion These findings suggest that effective strategies to increase vaccination uptake for future COVID-19 and other emerging infectious diseases among community-dwelling people with SUD are needed.
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Affiliation(s)
- Lucie Richard
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
| | - Anna Holland
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | | | | | - Stephen W. Hwang
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
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Mathews M, Lyons R, Harris S, Hedden L, Choi YH, Donnan J, Green ME, Harvey E, Reichert SM, Ryan B, Sibbald S, Meredith L. Evaluation of a unique and innovative diabetes care model in primary care in Ontario, Canada: protocol for a multiple-methods study with a convergent parallel design. BMJ Open 2024; 14:e088737. [PMID: 38858140 PMCID: PMC11168156 DOI: 10.1136/bmjopen-2024-088737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 05/30/2024] [Indexed: 06/12/2024] Open
Abstract
INTRODUCTION The growth and complexity of diabetes are exceeding the capacity of family physicians, resulting in the demand for community-based, interprofessional, primary care-led transition clinics. The Primary Care Diabetes Support Programme (PCDSP) in London, Ontario, is an innovative approach to diabetes care for high-risk populations, such as medically or socially complex and unattached patients. In this study, we will employ a quadruple-aim approach to evaluate the health system impacts of the PCDSP. METHODS AND ANALYSIS We will use multiple methods through a convergent parallel design in this project across five unique studies: a case study, a patient study, a provider study, a complications study and a cost-effectiveness study. The project will be conducted in a dedicated stand-alone clinic specialising in chronic disease management, specifically focusing on diabetes care. Participants will include clinic staff, administrators, family physicians, specialists and patients with type 1 or type 2 diabetes who received care at the clinic between 2011 and 2023. The project design will define the intervention, support replication at other sites or for other chronic diseases and address each of the quadruple aims and equity. Following the execution of the five individual studies, we will build a business case by integrating the results. Data will be analysed using both qualitative (content analysis and thematic analysis) and quantitative techniques (descriptive statistics and multiple logistic regression). ETHICS AND DISSEMINATION We received approval from the research ethics boards at Western University (reference ID: 2023-1 21 766; 2023-1 22 326) and Lawson Health Research Institute (reference ID: R-23-202). A privacy review was completed by St. Joseph's Healthcare Corporation. The findings will be shared among PCDSP staff and patients, stakeholders, academic researchers and the public through stakeholder sessions, conferences, peer-reviewed publications, infographics, posters, media interviews, social media and online discussions. For the patient and provider study, all participants will be asked to provide consent and are free to withdraw from the study, without penalty, until the data are combined. Participants will not be identified in any report or presentation except in the case study, for which, given the number of PCDSP providers, we will seek explicit consent to identify them.
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Affiliation(s)
- Maria Mathews
- Department of Family Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Rhiannon Lyons
- Department of Family Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Stewart Harris
- Department of Family Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
- Primary Care Diabetes Support Program, St. Joseph's Health Care London, London, Ontario, Canada
| | - Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Yun-Hee Choi
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Jennifer Donnan
- School of Pharmacy, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Michael E Green
- Departments of Family Medicine and Public Health Sciences, School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Elisabeth Harvey
- Primary Care Diabetes Support Program, St. Joseph's Health Care London, London, Ontario, Canada
- School of Nursing, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Sonja M Reichert
- Department of Family Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
- Primary Care Diabetes Support Program, St. Joseph's Health Care London, London, Ontario, Canada
| | - Bridget Ryan
- Department of Family Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Shannon Sibbald
- School of Health Studies, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Leslie Meredith
- Department of Family Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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Siu HYH, Hafid S, Kirkwood D, Elston D, Perez R, Jones A, Oliver J, Chidwick P, Nitti T, Costa A. Evaluating the Association between the Implementation of the PoET (Prevention of Error-Based Transfers) Southwest Spread Project and Palliative Care Provision: A Quasi-Experimental Matched Cohort Study Using Population-Level Health Administrative Data. J Am Med Dir Assoc 2024; 25:104956. [PMID: 38431263 DOI: 10.1016/j.jamda.2024.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES The PoET (Prevention of Error-based Transfers) project seeks to align long-term care (LTC) home informed consent practices to existing legislation, thereby reducing consent-related error-based transfers to acute care. We sought to measure changes in resident-level palliative care provision after participating in the PoET Southwest Spread Project (PSSP), and to identify patient and LTC home characteristics associated with palliative care provision. DESIGN Quasi-experimental matched (1:1 ratio) cohort study design using linked population-based health administrative data. SETTING Sixty LTC homes (PSSP = 30; Control = 30) in Ontario, Canada, from November 2019 to December 2021. METHODS We matched 30 PSSP to 30 control homes and described incidence rates for resident-level palliative care provision (ie, physician palliative care encounters and palliative medication prescriptions) during the 7-month postimplementation period. We used generalized linear mixed models to evaluate the association between PSSP implementation and palliative care provision during the postimplementation period. We adjusted for resident-level characteristics (ie, age, sex, comorbidity status) and home-level characteristics (ie, rurality status, profit model, COVID-19 impact). We identified a decedent subcohort to measure palliative care provision patterns during the last 2 months of life. RESULTS We captured a matched cohort of 8894 residents (PSSP = 4103; Control = 4791). Incidence rates of palliative care encounters increased during the postimplementation period for PSSP (82.6 to 85.4 per 100 person-months) but not for control residents (68.8 to 65.3 per 100 person-months). After adjusting for key covariates, PSSP exposure was associated increased palliative care provision (incidence rate ratio 2.47, 95% CI 2.31-2.64) and palliative care medication prescription (1.16, 95% CI 1.12-1.20). Larger home size, certain health regions, and higher number of comorbidities were associated with increased physician palliative care encounters. CONCLUSIONS AND IMPLICATIONS By promoting correct informed consent practices in LTC, PSSP participation increased palliative care provision for PSSP LTC residents across all settings.
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Affiliation(s)
- Henry Yu-Hin Siu
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.
| | - Shuaib Hafid
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Dawn Elston
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Aaron Jones
- ICES McMaster University, Hamilton, Ontario, Canada; Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jill Oliver
- William Osler Health System, Brampton, Ontario, Canada
| | | | - Theresa Nitti
- William Osler Health System, Brampton, Ontario, Canada
| | - Andrew Costa
- ICES McMaster University, Hamilton, Ontario, Canada; Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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To T, Zhu J, Terebessy E, Borkhoff CM, Gershon AS, Kendzerska T, Pakhale SS, Vozoris NT, Zhang K, Licskai C. Mode of delivery and birth outcomes before and during COVID-19 -A population-based study in Ontario, Canada. PLoS One 2024; 19:e0303175. [PMID: 38728292 PMCID: PMC11086824 DOI: 10.1371/journal.pone.0303175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 04/21/2024] [Indexed: 05/12/2024] Open
Abstract
There is lack of clarity on whether pregnancies during COVID-19 resulted in poorer mode of delivery and birth outcomes in Ontario, Canada. We aimed to compare mode of delivery (C-section), birth (low birthweight, preterm birth, NICU admission), and health services use (HSU, hospitalizations, ED visits, physician visits) outcomes in pregnant Ontario women before and during COVID-19 (pandemic periods). We further stratified for pre-existing chronic diseases (asthma, eczema, allergic rhinitis, diabetes, hypertension). Deliveries before (Jun 2018-Feb 2020) and during (Jul 2020-Mar 2022) pandemic were from health administrative data. We used multivariable logistic regression analyses to estimate adjusted odds ratios (aOR) of delivery and birth outcomes, and negative binomial regression for adjusted rate ratios (aRR) of HSU. We compared outcomes between pre-pandemic and pandemic periods. Possible interactions between study periods and covariates were also examined. 323,359 deliveries were included (50% during pandemic). One in 5 (18.3%) women who delivered during the pandemic had not received any COVID-19 vaccine, while one in 20 women (5.2%) lab-tested positive for COVID-19. The odds of C-section delivery during the pandemic was 9% higher (aOR = 1.09, 95% CI: 1.08-1.11) than pre-pandemic. The odds of preterm birth and NICU admission were 15% (aOR = 0.85, 95% CI: 0.82-0.87) and 10% lower (aOR = 0.90, 95% CI: 0.88-0.92), respectively, during COVID-19. There was a 17% reduction in ED visits but a 16% increase in physician visits during the pandemic (aRR = 0.83, 95% CI: 0.81-0.84 and aRR = 1.16, 95% CI: 1.16-1.17, respectively). These aORs and aRRs were significantly higher in women with pre-existing chronic conditions. During the pandemic, healthcare utilization, especially ED visits (aRR = 0.83), in pregnant women was lower compared to before. Ensuring ongoing prenatal care during the pandemic may reduce risks of adverse mode of delivery and the need for acute care during pregnancy.
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Affiliation(s)
- Teresa To
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Ontario, Canada
| | - Jingqin Zhu
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Ontario, Canada
| | - Emilie Terebessy
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cornelia M. Borkhoff
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Andrea S. Gershon
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Tetyana Kendzerska
- ICES, Ontario, Canada
- Department of Medicine, The Ottawa Hospital and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- Faculty of Medicine, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Smita S. Pakhale
- Department of Medicine, The Ottawa Hospital and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- Faculty of Medicine, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Nicholas T. Vozoris
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Kimball Zhang
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Ontario, Canada
| | - Christopher Licskai
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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9
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Antoniou T, McCormack D, Tadrous M, Gomes T. Alpha-1 adrenergic antagonists and the risk of hospitalization or death in non-hospitalized patients with COVID-19: A population-based study. Fundam Clin Pharmacol 2024. [PMID: 38575851 DOI: 10.1111/fcp.13004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 01/29/2024] [Accepted: 03/07/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Alpha-1 receptor antagonists may interfere with IL-6 signaling and could therefore be a potential treatment for COVID-19. However, the effectiveness of these drugs in mitigating the risk of clinical deterioration among non-hospitalized patients with COVID-19 is unknown. OBJECTIVES The aim of this study is to examine the association between alpha-1 antagonist exposure and the 30-day risk of a hospital encounter or death in nonhospitalized patients with COVID-19. METHODS We conducted a population-based cohort study of Ontario residents aged 35 years and older who were eligible for public drug coverage and who had a positive test for SARS-CoV-2 between January 1, 2020, and March 1, 2021. We matched each individual receiving an alpha-1 antagonist at the time of their positive test with two non-exposed individuals using propensity scores. Our outcome was a composite of a hospital admission, emergency department visit, or death, 1 to 30 days following the positive test. RESULTS We matched 3289 alpha-1 antagonist exposed patients to 6189 unexposed patients. Overall, there was no difference in the 30-day risk of the primary outcome among patients exposed to alpha-1 antagonists at the time of their diagnosis relative to unexposed individuals (28.8% vs. 28.0%; OR 1.00, 95% CI 0.91 to 1.11). In a secondary analysis, individuals exposed to alpha-1 antagonists had a lower risk of death in the 30 days following a COVID diagnosis (OR 0.79; 95% CI 0.66 to 0.93). CONCLUSION Alpha-1 antagonists did not mitigate the 30-day risk of clinical deterioration in non-hospitalized patients with COVID-19. Our findings do not support the general repurposing of alpha-1 antagonists as a treatment for such patients, although there may be subgroups of patients in whom further research is warranted.
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Affiliation(s)
- Tony Antoniou
- Department of Family and Community Medicine, Unity Health Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Daniel McCormack
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Mina Tadrous
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Toronto, Ontario, Canada
| | - Tara Gomes
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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10
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Zhang L, Brennan K, Flemming JA, Nanji S, Djerboua M, Merchant SJ, Caycedo-Marulanda A, Patel SV. Emergency Colorectal Surgery in Those with Cirrhosis: A Population-based Study Assessing Practice Patterns, Outcomes and Predictors of Mortality. J Can Assoc Gastroenterol 2024; 7:160-168. [PMID: 38596800 PMCID: PMC10999774 DOI: 10.1093/jcag/gwad040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
Background Those with cirrhosis who require emergency colorectal surgery are at risk for poor outcomes. Although risk predictions models exists, these tools are not specific to colorectal surgery, nor were they developed in a contemporary setting. Thus, the objective of this study was to assess the outcomes in this population and determine whether cirrhosis etiology and/or the Model for End Stage Liver Disease (MELD-Na) is associated with mortality. Methods This population-based study included those with cirrhosis undergoing emergent colorectal surgery between 2009 and 2017. All eligible individuals in Ontario were identified using administrative databases. The primary outcome was 90-day mortality. Results Nine hundred and twenty-seven individuals (57%) (male) were included. The most common cirrhosis etiology was non-alcoholic fatty liver disease (NAFLD) (50%) and alcohol related (32%). Overall 90-day mortality was 32%. Multivariable survival analysis demonstrated those with alcohol-related disease were at increased risk of 90-day mortality (hazards ratio [HR] 1.53, 95% confidence interval [CI] 1.2-2.0 vs. NAFLD [ref]). Surgery for colorectal cancer was associated with better survival (HR 0.27, 95%CI 0.16-0.47). In the subgroup analysis of those with an available MELD-Na score (n = 348/927, 38%), there was a strong association between increasing MELD-Na and mortality (score 20+ HR 6.6, 95%CI 3.9-10.9; score 10-19 HR 1.8, 95%CI 1.1-3.0; score <10 [ref]). Conclusion Individuals with cirrhosis who require emergent colorectal surgery have a high risk of postoperative complications, including mortality. Increasing MELD-Na score is associated with mortality and can be used to risk stratify individuals.
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Affiliation(s)
- Lisa Zhang
- Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Kelly Brennan
- Department of Surgery, Queen’s University, Kingston, ON, Canada
| | | | - Sulaiman Nanji
- Department of Surgery, Queen’s University, Kingston, ON, Canada
| | - Maya Djerboua
- Department of Surgery, Queen’s University, Kingston, ON, Canada
| | | | | | - Sunil V Patel
- Department of Surgery, Queen’s University, Kingston, ON, Canada
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11
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Etherington C, Boet S, Chen I, Duffy M, Mamas MA, Bader Eddeen A, Bateman BT, Sun LY. Association Between Surgeon/Anesthesiologist Sex Discordance and 1-year Mortality Among Adults Undergoing Noncardiac Surgery: A Population-based Retrospective Cohort Study. Ann Surg 2024; 279:563-568. [PMID: 37791498 DOI: 10.1097/sla.0000000000006111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
OBJECTIVE To investigate the association between surgeon-anesthesiologist sex discordance and patient mortality after noncardiac surgery. BACKGROUND Evidence suggests different practice patterns exist among female and male physicians. However, the influence of physician sex on team-based practices in the operating room and subsequent patient outcomes remains unclear in the context of noncardiac surgery. METHODS We conducted a population-based, retrospective cohort study of adult Ontario residents who underwent index, inpatient noncardiac surgery between January 2007 and December 2017. The primary exposure was physician sex discordance (ie, the surgeon and anesthesiologist were of the opposite sex). The primary outcome was 1-year mortality. The association between physician sex discordance and patient outcomes was modeled using multivariable Cox proportional hazard regression with adjustment for relevant physician, patient, and hospital characteristics. RESULTS Of 541,209 patients, 158,084 (29.2%) were treated by sex-discordant physician teams. Physician sex discordance was associated with a lower rate of mortality at 1 year [5.2% vs. 5.7%; adjusted HR: 0.95 (0.91-0.99)]. Patients treated by teams composed of female surgeons and male anesthesiologists were more likely to be alive at 1 year than those treated by all-male physician teams [adjusted HR: 0.90 (0.81-0.99)]. CONCLUSIONS Noncardiac surgery patients had a lower likelihood of 1-year mortality when treated by sex-discordant surgeon-anesthesiologist teams. The likelihood of mortality was further reduced if the surgeon was female. Further research is needed to explore the underlying mechanisms of these observations and design strategies to diversify operating room teams to optimize performance and patient outcomes.
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Affiliation(s)
- Cole Etherington
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sylvain Boet
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Innie Chen
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Melissa Duffy
- Department of Educational Studies, University of South Carolina, Columbia, SC
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, Staffordshire, UK
| | | | - Brian T Bateman
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA
| | - Louise Y Sun
- Institute for Clinical Evaluative Sciences, ON, Canada
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA
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12
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Rousseau MC, Parent ME, Corsenac P, Salmon C, Mésidor M, Fantodji C, Conus F, Richard H, Jantchou P, Benedetti A. Cohort Profile Update: The Québec Birth Cohort on Immunity and Health (CO·MMUNITY). Int J Epidemiol 2024; 53:dyae014. [PMID: 38365966 PMCID: PMC10873493 DOI: 10.1093/ije/dyae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 01/18/2024] [Indexed: 02/18/2024] Open
Affiliation(s)
- Marie-Claude Rousseau
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut National de la Recherche Scientifique (INRS), Laval, QC, Canada
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, QC, Canada
- Carrefour de l’innovation, Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Marie-Elise Parent
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut National de la Recherche Scientifique (INRS), Laval, QC, Canada
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, QC, Canada
- Carrefour de l’innovation, Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Philippe Corsenac
- Department of Nursing Sciences, Population Health, Université du Québec en Outaouais, Saint-Jérôme, QC, Canada
| | - Charlotte Salmon
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut National de la Recherche Scientifique (INRS), Laval, QC, Canada
| | - Miceline Mésidor
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut National de la Recherche Scientifique (INRS), Laval, QC, Canada
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, QC, Canada
- Carrefour de l’innovation, Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Canisius Fantodji
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut National de la Recherche Scientifique (INRS), Laval, QC, Canada
- Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC, Canada
| | - Florence Conus
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut National de la Recherche Scientifique (INRS), Laval, QC, Canada
| | - Hugues Richard
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut National de la Recherche Scientifique (INRS), Laval, QC, Canada
| | - Prévost Jantchou
- Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC, Canada
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Centre Hospitalier Universitaire Sainte-Justine, and Université de Montréal, Montréal, QC, Canada
| | - Andrea Benedetti
- Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montréal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montréal, QC, Canada
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13
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Brown HK, Fung K, Cohen E, Dennis CL, Grandi SM, Rosella LC, Varner C, Vigod SN, Wodchis WP, Ray JG. Patterns of multiple chronic conditions in pregnancy: Population-based study using latent class analysis. Paediatr Perinat Epidemiol 2024; 38:111-120. [PMID: 37864500 DOI: 10.1111/ppe.13016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Adults with multiple chronic conditions (MCC) are a heterogeneous population with elevated risk of future adverse health outcomes. Yet, despite the increasing prevalence of MCC globally, data about MCC in pregnancy are scarce. OBJECTIVES To estimate the population prevalence of MCC in pregnancy and determine whether certain types of chronic conditions cluster together among pregnant women with MCC. METHODS We conducted a population-based cohort study in Ontario, Canada, of all 15-55-year-old women with a recognised pregnancy, from 2007 to 2020. MCC was assessed from a list of 22 conditions, identified using validated algorithms. We estimated the prevalence of MCC. Next, we used latent class analysis to identify classes of co-occurring chronic conditions in women with MCC, with model selection based on parsimony, clinical interpretability and statistical fit. RESULTS Among 2,014,508 pregnancies, 324,735 had MCC (161.2 per 1000, 95% confidence interval [CI] 160.6, 161.8). Latent class analysis resulted in a five-class solution. In four classes, mood and anxiety disorders were prominent and clustered with one additional condition, as follows: Class 1 (22.4% of women with MCC), osteoarthritis; Class 2 (23.7%), obesity; Class 3 (15.8%), substance use disorders; and Class 4 (22.1%), asthma. In Class 5 (16.1%), four physical conditions clustered together: obesity, asthma, chronic hypertension and diabetes mellitus. CONCLUSIONS MCC is common in pregnancy, with sub-types dominated by co-occurring mental and physical health conditions. These data show the importance of preconception and perinatal interventions, particularly integrated care strategies, to optimise treatment and stabilisation of chronic conditions in women with MCC.
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Affiliation(s)
- Hilary K Brown
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | | | - Eyal Cohen
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
- Edwin S.H. Leong Centre for Healthy Children, Toronto, Ontario, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
- Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Sonia M Grandi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
- Edwin S.H. Leong Centre for Healthy Children, Toronto, Ontario, Canada
| | - Laura C Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Department of Laboratory, Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Catherine Varner
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Simone N Vigod
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Walter P Wodchis
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Joel G Ray
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
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14
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Johnson KM, Cheng L, Yin Y, Carter R, Chow S, Brigham E, Law MR. Impact of income-based public drug coverage deductibles on adherence to asthma medications. Ann Allergy Asthma Immunol 2024; 132:223-228.e8. [PMID: 37871771 DOI: 10.1016/j.anai.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/15/2023] [Accepted: 10/13/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Cost-related nonadherence to medications can be a barrier to asthma management. OBJECTIVE To quantify the impact of public drug plan deductibles on adherence to asthma medications. METHODS We used a quasi-experimental regression discontinuity analysis to determine whether thresholds in deductibles for public drug coverage, determined on the basis of annual household income, decreased medication use among lower-income children and adults with asthma in British Columbia from 2013 to 2018. Using dispensed medication records, we evaluated deductible thresholds at annual household incomes of $15,000 (a deductible increase from 0% to 2% of annual household income), and $30,000 (a deductible increase from 2% to 3% annual household income). We evaluated medication costs, use, the ratio of inhaled corticosteroids-containing controller medications to total medications, excessive use of short-acting β-agonists, and the proportion of days covered by controller therapies. All costs are reported in 2020 Canadian dollars. RESULTS Overall, 88,935 individuals contributed 443,847 person-years of follow-up (57% of female sex, mean age 31 years). Public drug subsidy decreased by -$41.74 (95% CI, -$28.34 to -$55.13) at the $15,000-deductible threshold, a 28% reduction, and patient costs increased by $48.45 (95% CI, $35.37-$61.53). The $30,000 deductible threshold did not affect public drug costs (P = .31), but patient costs increased by $27.65 (95% CI, $15.22-$40.09), which is an 11% increase. Asthma-related medication use, inhaled corticosteroids-to-total medication ratio, excessive use of short-acting β-agonists, and proportion of days covered by controller therapies were not impacted by deductible thresholds. CONCLUSION Income-based deductibles reduced public drug costs with no effect on asthma-related medication use, adherence to controller therapies, or excessive reliever therapy use in lower-income individuals with asthma.
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Affiliation(s)
- Kate M Johnson
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada; Division of Respiratory Medicine, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.
| | - Lucy Cheng
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Yiwei Yin
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Rachel Carter
- Patient Partner, Community Partner Committee, Legacy for Airway Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Santa Chow
- Patient Partner, Community Partner Committee, Legacy for Airway Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Emily Brigham
- Division of Respiratory Medicine, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael R Law
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
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Iskander C, Stukel TA, Diong C, Guan J, Saunders N, Cohen E, Brownell M, Mahar A, Shulman R, Gandhi S, Guttmann A. Acute health care use among children during the first 2.5 years of the COVID-19 pandemic in Ontario, Canada: a population-based repeated cross-sectional study. CMAJ 2024; 196:E1-E13. [PMID: 38228342 PMCID: PMC10802996 DOI: 10.1503/cmaj.221726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND The effects of the decline in health care use at the start of the COVID-19 pandemic on the health of children are unclear. We sought to estimate changes in rates of severe and potentially preventable health outcomes among children during the pandemic. METHODS We conducted a repeated cross-sectional study of children aged 0-17 years using linked population health administrative and disease registry data from January 2017 through August 2022 in Ontario, Canada. We compared observed rates of emergency department visits and hospital admissions during the pandemic to predicted rates based on the 3 years preceding the pandemic. We evaluated outcomes among children and neonates overall, among children with chronic health conditions and among children with specific diseases sensitive to delays in care. RESULTS All acute care use for children decreased immediately at the onset of the pandemic, reaching its lowest rate in April 2020 for emergency department visits (adjusted relative rate [RR] 0.28, 95% confidence interval [CI] 0.28-0.29) and hospital admissions (adjusted RR 0.43, 95% CI 0.42-0.44). These decreases were sustained until September 2021 and May 2022, respectively. During the pandemic overall, rates of all-cause mortality, admissions for ambulatory care-sensitive conditions, newborn readmissions or emergency department visits or hospital admissions among children with chronic health conditions did not exceed predicted rates. However, after declining significantly between March and May 2020, new presentations of diabetes mellitus increased significantly during most of 2021 (peak adjusted RR 1.49, 95% CI 1.28-1.74 in July 2021) and much of 2022. Among these children, presentations for diabetic ketoacidosis were significantly higher than expected during the pandemic overall (adjusted RR 1.14, 95% CI 1.00-1.30). We observed similar time trends for new presentations of cancer, but we observed no excess presentations of severe cancer overall (adjusted RR 0.91, 95% CI 0.62-1.34). INTERPRETATION In the first 30 months of the pandemic, disruptions to care were associated with important delays in new diagnoses of diabetes but not with other acute presentations of select preventable conditions or with mortality. Mitigation strategies in future pandemics or other health system disruptions should include education campaigns around important symptoms in children that require medical attention.
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Affiliation(s)
- Carina Iskander
- ICES (Iskander, Stukel, Diong, Guan, Saunders, Cohen, Mahar, Shulman, Gandhi, Guttmann); Institute of Health Policy, Management and Evaluation (Stukel, Shulman), University of Toronto; Department of Paediatrics (Saunders, Cohen, Guttmann), Hospital for Sick Children, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar), University of Manitoba; Manitoba Centre for Health Policy (Brownell), Winnipeg, Man
| | - Therese A Stukel
- ICES (Iskander, Stukel, Diong, Guan, Saunders, Cohen, Mahar, Shulman, Gandhi, Guttmann); Institute of Health Policy, Management and Evaluation (Stukel, Shulman), University of Toronto; Department of Paediatrics (Saunders, Cohen, Guttmann), Hospital for Sick Children, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar), University of Manitoba; Manitoba Centre for Health Policy (Brownell), Winnipeg, Man
| | - Christina Diong
- ICES (Iskander, Stukel, Diong, Guan, Saunders, Cohen, Mahar, Shulman, Gandhi, Guttmann); Institute of Health Policy, Management and Evaluation (Stukel, Shulman), University of Toronto; Department of Paediatrics (Saunders, Cohen, Guttmann), Hospital for Sick Children, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar), University of Manitoba; Manitoba Centre for Health Policy (Brownell), Winnipeg, Man
| | - Jun Guan
- ICES (Iskander, Stukel, Diong, Guan, Saunders, Cohen, Mahar, Shulman, Gandhi, Guttmann); Institute of Health Policy, Management and Evaluation (Stukel, Shulman), University of Toronto; Department of Paediatrics (Saunders, Cohen, Guttmann), Hospital for Sick Children, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar), University of Manitoba; Manitoba Centre for Health Policy (Brownell), Winnipeg, Man
| | - Natasha Saunders
- ICES (Iskander, Stukel, Diong, Guan, Saunders, Cohen, Mahar, Shulman, Gandhi, Guttmann); Institute of Health Policy, Management and Evaluation (Stukel, Shulman), University of Toronto; Department of Paediatrics (Saunders, Cohen, Guttmann), Hospital for Sick Children, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar), University of Manitoba; Manitoba Centre for Health Policy (Brownell), Winnipeg, Man
| | - Eyal Cohen
- ICES (Iskander, Stukel, Diong, Guan, Saunders, Cohen, Mahar, Shulman, Gandhi, Guttmann); Institute of Health Policy, Management and Evaluation (Stukel, Shulman), University of Toronto; Department of Paediatrics (Saunders, Cohen, Guttmann), Hospital for Sick Children, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar), University of Manitoba; Manitoba Centre for Health Policy (Brownell), Winnipeg, Man
| | - Marni Brownell
- ICES (Iskander, Stukel, Diong, Guan, Saunders, Cohen, Mahar, Shulman, Gandhi, Guttmann); Institute of Health Policy, Management and Evaluation (Stukel, Shulman), University of Toronto; Department of Paediatrics (Saunders, Cohen, Guttmann), Hospital for Sick Children, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar), University of Manitoba; Manitoba Centre for Health Policy (Brownell), Winnipeg, Man
| | - Alyson Mahar
- ICES (Iskander, Stukel, Diong, Guan, Saunders, Cohen, Mahar, Shulman, Gandhi, Guttmann); Institute of Health Policy, Management and Evaluation (Stukel, Shulman), University of Toronto; Department of Paediatrics (Saunders, Cohen, Guttmann), Hospital for Sick Children, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar), University of Manitoba; Manitoba Centre for Health Policy (Brownell), Winnipeg, Man
| | - Rayzel Shulman
- ICES (Iskander, Stukel, Diong, Guan, Saunders, Cohen, Mahar, Shulman, Gandhi, Guttmann); Institute of Health Policy, Management and Evaluation (Stukel, Shulman), University of Toronto; Department of Paediatrics (Saunders, Cohen, Guttmann), Hospital for Sick Children, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar), University of Manitoba; Manitoba Centre for Health Policy (Brownell), Winnipeg, Man
| | - Sima Gandhi
- ICES (Iskander, Stukel, Diong, Guan, Saunders, Cohen, Mahar, Shulman, Gandhi, Guttmann); Institute of Health Policy, Management and Evaluation (Stukel, Shulman), University of Toronto; Department of Paediatrics (Saunders, Cohen, Guttmann), Hospital for Sick Children, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar), University of Manitoba; Manitoba Centre for Health Policy (Brownell), Winnipeg, Man
| | - Astrid Guttmann
- ICES (Iskander, Stukel, Diong, Guan, Saunders, Cohen, Mahar, Shulman, Gandhi, Guttmann); Institute of Health Policy, Management and Evaluation (Stukel, Shulman), University of Toronto; Department of Paediatrics (Saunders, Cohen, Guttmann), Hospital for Sick Children, Toronto, Ont.; Department of Community Health Sciences (Brownell, Mahar), University of Manitoba; Manitoba Centre for Health Policy (Brownell), Winnipeg, Man.
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Lun R, Cerasuolo JO, Carrier M, Gross PL, Kapral MK, Shamy M, Dowlatshahi D, Sutradhar R, Siegal DM. Previous Ischemic Stroke Significantly Alters Stroke Risk in Newly Diagnosed Cancer Patients. Stroke 2023; 54:3064-3073. [PMID: 37850360 DOI: 10.1161/strokeaha.123.042993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 09/20/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Previous ischemic stroke (IS) is a risk factor for subsequent IS in the general population; it is unclear if this relationship remains true in patients with cancer. Our objective was to examine the association between previous IS and risk for future IS in individuals newly diagnosed with cancer. METHODS We conducted a retrospective population-based matched cohort study of newly diagnosed adult cancer patients (excluding nonmelanoma skin cancers and primary central nervous system tumors) in Ontario, Canada from 2010 to 2020; those with prior IS were matched (1:4) by age, sex, year of cancer diagnosis, cancer stage, and cancer site to those without a history of stroke. Cumulative incidence function curves were created to estimate the incidence of IS. Subdistribution adjusted hazard ratios (aHRs) and 95% CIs were calculated, where death was treated as a competing event. Multivariable analysis was adjusted for imbalanced baseline characteristics. RESULTS We examined 65 525 individuals with cancer, including 13 070 with a history of IS. The median follow-up duration was 743 days (interquartile range, 177-1729 days). The incidence of IS following cancer diagnosis was 261.3/10 000 person-years in the cohort with prior IS and 75.3/10 000 person-years in those without prior IS. Individuals with prior IS had an increased risk for IS after cancer diagnosis compared with those without a history (aHR, 2.68 [95% CI, 2.41-2.98]); they also had more prevalent cardiovascular risk factors. The highest risk for stroke compared with those without a history of IS was observed in the gynecologic cancer (aHR, 3.84 [95% CI, 2.15-6.85]) and lung cancer (aHR, 3.18 [95% CI, 2.52-4.02]) subgroups. The risk of IS was inversely correlated with lag time of previous stroke; those with IS 1 year before their cancer diagnosis had the highest risk (aHR, 3.68 [95% CI, 3.22-4.22]). CONCLUSIONS Among individuals with newly diagnosed cancer, those with IS history were almost 3× more likely to experience a stroke after cancer diagnosis, especially if the prediagnosis stroke occurred within 1 year preceding cancer diagnosis.
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Affiliation(s)
- Ronda Lun
- Division of Neurology, Department of Medicine, The Ottawa Hospital Research Institute, ON, Canada (R.L., M.S., D.D.)
- Division of Vascular Neurology, Stanford Healthcare, Palo Alto CA (R.L.)
- University of Ottawa, School of Epidemiology, Ontario, Canada (R.L.)
| | - Joshua O Cerasuolo
- ICES McMaster, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada (J.O.C.)
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada (J.O.C.)
| | - Marc Carrier
- Division of Hematology, Department of Medicine, University of Ottawa, ON, Canada (M.C., D.M.S.)
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, ON, Canada (M.C., D.M.S.)
| | - Peter L Gross
- Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, Ontario, Canada (P.L.G.)
| | | | - Michel Shamy
- Division of Neurology, Department of Medicine, The Ottawa Hospital Research Institute, ON, Canada (R.L., M.S., D.D.)
| | - Dar Dowlatshahi
- Division of Neurology, Department of Medicine, The Ottawa Hospital Research Institute, ON, Canada (R.L., M.S., D.D.)
| | | | - Deborah M Siegal
- Division of Hematology, Department of Medicine, University of Ottawa, ON, Canada (M.C., D.M.S.)
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, ON, Canada (M.C., D.M.S.)
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Hafid S, Kirkwood D, Elston D, Perez R, Jones A, Costa A, Oliver J, Chidwick P, Nitti T, Siu HYH. Evaluating the Association between the Implementation of the PoET Southwest Spread Project and Reductions in Acute Care Transfers from Long-Term Care: A Quasi-Experimental Matched Cohort Study Using Population-Level Health Administrative Data. J Am Med Dir Assoc 2023; 24:1888-1897. [PMID: 37777186 DOI: 10.1016/j.jamda.2023.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVES To measure changes in resident-level acute care transfer rates after the PoET Southwest Spread Project (PSSP), and to identify patient and long-term care (LTC) home characteristics associated with acute care transfers after program launch. DESIGN Quasi-experimental matched (1:1 ratio) cohort study design using linked population-based health administrative data. SETTING Sixty publicly funded LTC homes (PSSP = 30; control = 30) in Ontario, Canada, from November 2019 to December 2021. METHODS We matched 30 PSSP homes to 30 control homes with similar characteristics and described incidence rates for resident-level acute care transfers during the 7-month post-implementation period. We used generalized linear mixed models to evaluate the association between PSSP implementation and acute care transfers during the post-implementation period. We adjusted resident-level characteristics (ie, age, sex, comorbidity status) and home-level characteristics (ie, rurality status, profit model, COVID-19 impact). We identified a decedent sub-cohort to measure transfer patterns during the last 2 months of life. RESULTS A matched cohort of 8894 residents (PSSP = 4103; control = 4791) was captured. Incidence rates of transfers increased during the post-implementation period for both PSSP (78.8 to 80.9 transfers per 1000 person-months) and control residents (66.9 to 67.9 transfers per 1000 person-months). After adjusting for covariates of interest, PSSP exposure was associated with a reduction in acute care transfers during the post-implementation period after adjusting for covariates (incidence rate ratio, 0.73; 95% CI, 0.62-0.87; P = .0002). Older age and select health regions were associated with reduced transfers, whereas higher comorbidity status and higher COVID-19 outbreak days were associated with increases. Similar patterns persisted for transfers during the last 2 months of life. CONCLUSIONS AND IMPLICATIONS This study systematically evaluated the impact of an ethics-based health care intervention in LTC using health care utilization databases. PoET implementation is associated with reduced acute care transfer rates, especially in the last 2 months of life in LTC.
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Affiliation(s)
- Shuaib Hafid
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Dawn Elston
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Aaron Jones
- ICES McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Andrew Costa
- ICES McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jill Oliver
- William Osler Health System, Brampton, Ontario, Canada
| | | | - Theresa Nitti
- William Osler Health System, Brampton, Ontario, Canada
| | - Henry Yu-Hin Siu
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.
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18
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de Oliveira C, Tanner B. Estimating Cumulative Health Care Costs of Childhood and Adolescence Autism Spectrum Disorder in Ontario, Canada: A Population-Based Incident Cohort Study. PHARMACOECONOMICS - OPEN 2023; 7:987-995. [PMID: 37755688 PMCID: PMC10721567 DOI: 10.1007/s41669-023-00441-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Few studies have estimated cumulative health care costs post-diagnosis for individuals with autism spectrum disorder (ASD). OBJECTIVES Using an incidence-based approach, the objective of this analysis was to estimate cumulative costs of ASD to the Ontario health care system of children and adolescents. METHODS Using administrative health records from Ontario, Canada's most populous province, a retrospective, population-based, incident cohort study of children and adolescents aged 0-19 years old diagnosed with ASD was undertaken to estimate cumulative health care costs of ASD to the health care system from 2010 to 2019. Cumulative health care costs in 2021 Canadian dollars (CAD) from diagnosis to death or end of observation period were estimated using a consistent estimator based on the inverse probability weighting technique. Cumulative health care costs (and respective 95% confidence intervals [CI]) were estimated for 1, 5 and 10 years post-diagnosis by sex, age group and health service. RESULTS In 2010, there were 2867 diagnosed cases of ASD; in 2019, the number of incident cases had risen to 6072. The first year (i.e., 1-year) post-diagnosis cost of ASD was $4710.18 CAD (95% CI 4560.28-4860.08); just under a third of costs were for physician services. Total cumulative 5- and 10-year discounted costs were $16,025.95 CAD (15,371.64-16,680.26) and $32,635.76 CAD (28,906.94-36,364.58), respectively. Mean costs were higher for females and older age groups. CONCLUSIONS These results suggest that costs of ASD are high in the year of diagnosis and then increase at a steady rate thereafter. This information will help with future resource planning within the health care sector to ensure individuals with ASD are supported once their diagnosis is established.
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Affiliation(s)
- Claire de Oliveira
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
- ICES, Toronto, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
| | - Bryan Tanner
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Canada
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19
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Patel S, Brennan K, Zhang L, Djerboua M, Nanji S, Merchant S, Flemming J. Colorectal Cancer in Individuals with Cirrhosis: A Population-Based Study Assessing Practice Patterns, Outcomes, and Predictors of Survival. Curr Oncol 2023; 30:9530-9541. [PMID: 37999110 PMCID: PMC10670829 DOI: 10.3390/curroncol30110690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/28/2023] [Accepted: 10/28/2023] [Indexed: 11/25/2023] Open
Abstract
Those with cirrhosis who develop colorectal cancer (CRC) are an understudied group who may tolerate treatments poorly and are at risk of worse outcomes. This is a retrospective cohort study of 842 individuals from Ontario, Canada, with a pre-existing diagnosis of cirrhosis who underwent surgery for CRC between 2009 and 2017. Practice patterns, overall survival, and short-term morbidity and mortality were assessed. The most common cirrhosis etiology was non-alcoholic fatty liver disease (NAFLD) (52%) and alcohol-associated liver disease (29%). The model for end-stage liver disease score (MELD-Na) was available in 42% (median score of 9, IQR7-11). Preoperative radiation was used in 62% of Stage II/III rectal cancer patients, while postoperative chemotherapy was used in 42% of Stage III colon cancer patients and 38% of Stage II/III rectal cancer patients. Ninety-day mortality following surgery was 12%. Five-year overall survival was 53% (by Stages I-IV, 66%, 55%, 50%, and 11%, respectively). Those with alcohol-associated cirrhosis (HR 1.8, 95% CI 1.5-2.2) had lower survival than those with NAFLD. Those with a MELD-Na of 10+ did worse than those with a lower MELD-Na score (HR 1.9, 95% CI 1.4-2.6). This study reports poor survival in those with cirrhosis who undergo treatment for CRC. Caution should be taken when considering aggressive treatment.
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Affiliation(s)
- Sunil Patel
- Department of Surgery, Queen’s University, Kingston, ON K7L 2V7, Canada
- Cancer Care and Epidemiology, Queens Cancer Research Institute, Kingston, ON K7L 3N6, Canada
| | - Kelly Brennan
- Department of Surgery, Queen’s University, Kingston, ON K7L 2V7, Canada
| | - Lisa Zhang
- Department of Surgery, Ottawa University, Ottawa, ON K1H 8L6, Canada
| | | | - Sulaiman Nanji
- Department of Surgery, Queen’s University, Kingston, ON K7L 2V7, Canada
| | - Shaila Merchant
- Department of Surgery, Queen’s University, Kingston, ON K7L 2V7, Canada
- Cancer Care and Epidemiology, Queens Cancer Research Institute, Kingston, ON K7L 3N6, Canada
| | - Jennifer Flemming
- Cancer Care and Epidemiology, Queens Cancer Research Institute, Kingston, ON K7L 3N6, Canada
- Department of Medicine, Queen’s University, Kingston, ON K7L 3N6, Canada
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20
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Mayers I, Randhawa A, Qian C, Talukdar M, Soliman M, Jayasingh P, Johnston K, Bhutani M. Asthma-related emergency admissions and associated healthcare resource use in Alberta, Canada. BMJ Open Respir Res 2023; 10:e001934. [PMID: 37914234 PMCID: PMC10668303 DOI: 10.1136/bmjresp-2023-001934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/06/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND There is a lack of real-world research assessing asthma management following asthma-related emergency department (ED) discharges. The objective of this study was to characterise follow-up care, healthcare resource use (HCRU) and medical costs following ED admissions in Alberta, Canada. METHODS A retrospective cohort study was conducted on adults with asthma using longitudinal population-based administrative data from Alberta Health Services. Adult patients with asthma and ≥1 ED admission from 1 April 2015 to 31 March 2020 were included. ED admissions, outpatient visits, hospitalisations and asthma-specific medication use were measured in the 30 days before and up to 90 days after each asthma-related ED admission. Mean medical costs attributable to each type of HCRU were summarised. All outcomes were stratified by patient baseline disease severity. RESULTS Among 128 063 patients incurring a total of 20 142 asthma-related ED visits, a substantial rate of ED readmission was observed, with 10% resulting in readmissions within 7 days and 35% within 90 days. Rates increased with baseline asthma severity. Despite recommendations for patients to be followed up with an outpatient visit within 2-7 days of ED discharge, only 6% were followed up within 7 days. The mean total medical cost per patient was $C8143 in the 30 days prior to and $C5407 in the 30 days after an ED admission. CONCLUSIONS Despite recommendations regarding follow-up care for patients after asthma-related ED admissions, there are still low rates of outpatient follow-up visits and high ED readmission rates. New or improved multidimensional approaches must be integrated into follow-up care to optimise asthma control and prevent readmissions.
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Affiliation(s)
- Irvin Mayers
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Arsh Randhawa
- AstraZeneca Canada Inc, Mississauga, Ontario, Canada
| | | | | | - Mena Soliman
- AstraZeneca Canada Inc, Mississauga, Ontario, Canada
| | | | | | - Mohit Bhutani
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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21
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St Cyr K, Aiken AB, Cramm H, Whitehead M, Kurdyak P, Mahar AL. Sex-specific differences in physical health and health services use among Canadian Veterans: a retrospective cohort study using healthcare administrative data. BMJ Mil Health 2023; 169:430-435. [PMID: 34635494 PMCID: PMC10579508 DOI: 10.1136/bmjmilitary-2021-001915] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/23/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Military occupations have historically been, and continue to be, male dominated. As such, female military Veteran populations tend to be understudied, and comparisons of the physical health status and patterns of health services use between male and female Veterans are limited outside of US samples. This study aimed to compare the physical health and health services use between male and female Veterans residing in Ontario, Canada. METHODS A retrospective cohort of 27 058 male and 4701 female Veterans residing in Ontario whose military service ended between 1990 and 2019 was identified using routinely collected administrative healthcare data. Logistic and Poisson regression models were used to assess sex-specific differences in the prevalence of select physical health conditions and rates of health services use, after multivariable adjustment for age, region of residence, rurality, neighbourhood median income quintile, length of service in years and number of comorbidities. RESULTS The risk of rheumatoid arthritis and asthma was higher for female Veterans compared with male Veterans. Female Veterans had a lower risk of myocardial infarction, hypertension and diabetes. No sex-specific differences were noted for chronic obstructive pulmonary disease. Female Veterans were also more likely to access all types of health services than male Veterans. Further, female Veterans accessed primary, specialist and emergency department care at greater rates than male Veterans. No significant differences were found in the sex-specific rates of hospitalisations or home care use. CONCLUSIONS Female Veterans residing in Ontario, Canada have different chronic health risks and engage in health services use more frequently than their male counterparts. These findings have important healthcare policy and programme planning implications, in order to ensure female Veterans have access to appropriate health services.
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Affiliation(s)
- Kate St Cyr
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - A B Aiken
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - H Cramm
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | | | - P Kurdyak
- ICES, Toronto, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - A L Mahar
- ICES, Toronto, Ontario, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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22
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Rousseau MC, Conus F, El-Zein M, Benedetti A, Parent ME. Ascertaining asthma status in epidemiologic studies: a comparison between administrative health data and self-report. BMC Med Res Methodol 2023; 23:201. [PMID: 37679673 PMCID: PMC10486089 DOI: 10.1186/s12874-023-02011-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 08/07/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Studies have suggested that agreement between administrative health data and self-report for asthma status ranges from fair to good, but few studies benefited from administrative health data over a long period. We aimed to (1) evaluate agreement between asthma status ascertained in administrative health data covering a period of 30 years and from self-report, and (2) identify determinants of agreement between the two sources. METHODS We used administrative health data (1983-2012) from the Quebec Birth Cohort on Immunity and Health, which included 81,496 individuals born in the province of Quebec, Canada, in 1974. Additional information, including self-reported asthma, was collected by telephone interview with 1643 participants in 2012. By design, half of them had childhood asthma based on health services utilization. Results were weighted according to the inverse of the sampling probabilities. Five algorithms were applied to administrative health data (having ≥ 2 physician claims over a 1-, 2-, 3-, 5-, or 30-year interval or ≥ 1 hospitalization), to enable comparisons with previous studies. We estimated the proportion of overall agreement and Kappa, between asthma status derived from algorithms and self-reports. We used logistic regression to identify factors associated with agreement. RESULTS Applying the five algorithms, the prevalence of asthma ranged from 49 to 55% among the 1643 participants. At interview (mean age = 37 years), 49% and 47% of participants respectively reported ever having asthma and asthma diagnosed by a physician. Proportions of agreement between administrative health data and self-report ranged from 88 to 91%, with Kappas ranging from 0.57 (95% CI: 0.52-0.63) to 0.67 (95% CI: 0.62-0.72); the highest values were obtained with the [≥ 2 physician claims over a 30-year interval or ≥ 1 hospitalization] algorithm. Having sought health services for allergic diseases other than asthma was related to lower agreement (Odds ratio = 0.41; 95% CI: 0.25-0.65 comparing ≥ 1 health services to none). CONCLUSIONS These findings indicate good agreement between asthma status defined from administrative health data and self-report. Agreement was higher than previously observed, which may be due to the 30-year lookback window in administrative data. Our findings support using both administrative health data and self-report in population-based epidemiological studies.
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Affiliation(s)
- Marie-Claude Rousseau
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut national de la recherche scientifique (INRS), Laval, QC, Canada.
- School of Public Health, Université de Montréal, Montréal, QC, Canada.
| | - Florence Conus
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut national de la recherche scientifique (INRS), Laval, QC, Canada
- Direction des enquêtes de santé, Direction principale des statistiques sociales et de santé, Institut de la statistique du Québec, Montréal, QC, Canada
| | - Mariam El-Zein
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut national de la recherche scientifique (INRS), Laval, QC, Canada
- Division of Cancer Epidemiology, McGill University, Montréal, QC, Canada
| | - Andrea Benedetti
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montréal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - Marie-Elise Parent
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut national de la recherche scientifique (INRS), Laval, QC, Canada
- School of Public Health, Université de Montréal, Montréal, QC, Canada
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23
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Matthewman J, Tadrous M, Mansfield KE, Thiruchelvam D, Redelmeier DA, Cheung AM, Lega IC, Prieto-Alhambra D, Cunliffe LA, Mulick A, Henderson A, Langan SM, Drucker AM. Association of Different Prescribing Patterns for Oral Corticosteroids With Fracture Preventive Care Among Older Adults in the UK and Ontario. JAMA Dermatol 2023; 159:961-969. [PMID: 37556153 PMCID: PMC10413212 DOI: 10.1001/jamadermatol.2023.2495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/09/2023] [Indexed: 08/10/2023]
Abstract
Importance Identifying and mitigating modifiable gaps in fracture preventive care for people with relapsing-remitting conditions such as eczema, asthma, and chronic obstructive pulmonary disease who are prescribed high cumulative oral corticosteroid doses may decrease fracture-associated morbidity and mortality. Objective To estimate the association between different oral corticosteroid prescribing patterns and appropriate fracture preventive care, including treatment with fracture preventive care medications, among older adults with high cumulative oral corticosteroid exposure. Design, Setting, and Participants This cohort study included 65 195 participants with UK electronic medical record data from the Clinical Practice Research Datalink (January 2, 1998, to January 31, 2020) and 28 674 participants with Ontario, Canada, health administrative data from ICES (April 1, 2002, to September 30, 2020). Participants were adults 66 years or older with eczema, asthma, or chronic obstructive pulmonary disease receiving prescriptions for oral corticosteroids with cumulative prednisolone equivalent doses of 450 mg or higher within 6 months. Data were analyzed October 22, 2020, to September 6, 2022. Exposures Participants with prescriptions crossing the 450-mg cumulative oral corticosteroid threshold in less than 90 days were classified as having high-intensity prescriptions, and participants crossing the threshold in 90 days or more as having low-intensity prescriptions. Multiple alternative exposure definitions were used in sensitivity analyses. Main Outcomes and Measures The primary outcome was prescribed fracture preventive care. A secondary outcome was major osteoporotic fracture. Individuals were followed up from the date they crossed the cumulative oral corticosteroid threshold until their outcome or the end of follow-up (up to 1 year after index date). Rates were calculated for fracture preventive care and fractures, and hazard ratios (HRs) were estimated from Cox proportional hazards regression models comparing high- vs low-intensity oral corticosteroid prescriptions. Results In both the UK cohort of 65 195 participants (mean [IQR] age, 75 [71-81] years; 32 981 [50.6%] male) and the Ontario cohort of 28 674 participants (mean [IQR] age, 73 [69-79] years; 17 071 [59.5%] male), individuals with high-intensity oral corticosteroid prescriptions had substantially higher rates of fracture preventive care than individuals with low-intensity prescriptions (UK: 134 vs 57 per 1000 person-years; crude HR, 2.34; 95% CI, 2.19-2.51, and Ontario: 73 vs 48 per 1000 person-years; crude HR, 1.49; 95% CI, 1.29-1.72). People with high- and low-intensity oral corticosteroid prescriptions had similar rates of major osteoporotic fractures (UK: crude rates, 14 vs 13 per 1000 person-years; crude HR, 1.07; 95% CI, 0.98-1.15 and Ontario: crude rates, 20 vs 23 per 1000 person-years; crude HR, 0.87; 95% CI, 0.79-0.96). Results from sensitivity analyses suggested that reaching a high cumulative oral corticosteroid dose within a shorter time, with fewer prescriptions, or with fewer or shorter gaps between prescriptions, increased fracture preventive care prescribing. Conclusions The results of this cohort study suggest that older adults prescribed high cumulative oral corticosteroids across multiple prescriptions, or with many or long gaps between prescriptions, may be missing opportunities for fracture preventive care.
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Affiliation(s)
- Julian Matthewman
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mina Tadrous
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
- Leslie Dan School of Pharmacy, University of Toronto, Toronto, Canada
- ICES (previously known as Institute for Clinical Evaluative Sciences), Toronto, Canada
| | - Kathryn E. Mansfield
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Deva Thiruchelvam
- ICES (previously known as Institute for Clinical Evaluative Sciences), Toronto, Canada
| | - Donald A. Redelmeier
- ICES (previously known as Institute for Clinical Evaluative Sciences), Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | | | - Iliana C. Lega
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
- ICES (previously known as Institute for Clinical Evaluative Sciences), Toronto, Canada
| | - Daniel Prieto-Alhambra
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Amy Mulick
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Alasdair Henderson
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sinéad M. Langan
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Aaron M. Drucker
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
- ICES (previously known as Institute for Clinical Evaluative Sciences), Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
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24
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Moore LE, Serrano-Lomelin J, Rosychuk RJ, Kozyrskyj AL, Chari R, Crawford S, Bakal J, Hicks A, Ducharme FM, Ospina MB. Perinatal and early life factors and asthma control among preschoolers: a population-based retrospective cohort study. BMJ Open Respir Res 2023; 10:e001928. [PMID: 37748808 PMCID: PMC10533801 DOI: 10.1136/bmjresp-2023-001928] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/30/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Preventing poor childhood asthma control is crucial for short-term and long-term respiratory health. This study evaluated associations between perinatal and early-life factors and early childhood asthma control. METHODS This retrospective study used administrative health data from mothers and children born 2010-2012 with a diagnosis of asthma before age 5 years, in Alberta, Canada. The outcome was asthma control within 2 years after diagnosis. Associations between perinatal and early-life factors and risk of partly and uncontrolled asthma were evaluated by multinomial logistic regression. RESULTS Of 7206 preschoolers with asthma, 52% had controlled, 37% partly controlled and 12% uncontrolled asthma 2 years after diagnosis. Compared with controlled asthma, prenatal antibiotics (adjusted risk ratio (aRR): 1.19; 95% CI 1.06 to 1.33) and smoking (aRR: 1.18; 95% CI 1.02 to 1.37), C-section delivery (aRR: 1.11; 95% CI 1.00 to 1.25), summer birth (aRR: 1.16; 95% CI 1.00 to 1.34) and early-life hospitalisation for respiratory illness (aRR: 2.24; 95% CI 1.81 to 2.76) increased the risk of partly controlled asthma. Gestational diabetes (aRR: 1.41; 95% CI 1.06 to 1.87), C-section delivery (aRR: 1.18; 95% CI 1.00 to 1.39), antibiotics (aRR: 1.32; 95% CI 1.08 to 1.61) and hospitalisation for early-life respiratory illness (aRR: 1.65; 95% CI 1.19 to 2.27) were associated with uncontrolled asthma. CONCLUSION Maternal perinatal and early-life factors including antibiotics in pregnancy and childhood, gestational diabetes, prenatal smoking, C-section and summertime birth, and hospitalisations for respiratory illness are associated with partly or uncontrolled childhood asthma. These results underline the significance of perinatal health and the lasting effects of early-life experiences on lung development and disease programming.
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Affiliation(s)
- Linn E Moore
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | | | - Rhonda J Rosychuk
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Anita L Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Radha Chari
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Anne Hicks
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | | | - Maria B Ospina
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
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Mac S, Shi S, Millson B, Tehrani A, Eberg M, Myageri V, Langley JM, Simpson S. Burden of illness associated with Respiratory Syncytial Virus (RSV)-related hospitalizations among adults in Ontario, Canada: A retrospective population-based study. Vaccine 2023; 41:5141-5149. [PMID: 37422377 DOI: 10.1016/j.vaccine.2023.06.071] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/22/2023] [Accepted: 06/22/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Globally, RSV is a common viral pathogen that causes 64 million acute respiratory infections annually. Our objective was to determine the incidence of hospitalization, healthcare resource use and associated costs of adults hospitalized with RSV in Ontario, Canada. METHODS To describe the epidemiology of adults hospitalized with RSV, we used a validated algorithm applied to a population-based healthcare utilization administrative dataset in Ontario, Canada. We created a retrospective cohort of incident hospitalized adults with RSV between September 2010 and August 2017 and followed each person for up to two years. To determine the burden of illness associated with hospitalization and post-discharge healthcare encounters each RSV-admitted patient was matched to two unexposed controls based on demographics and risk factors. Patient demographics were described and mean attributable 6-month and 2-year healthcare costs (2019 Canadian dollars) were estimated. RESULTS There were 7,091 adults with RSV-associated hospitalizations between 2010 and 2019 with a mean age of 74.6 years; 60.4 % were female. RSV-coded hospitalization rates increased from 1.4 to 14.6 per 100,000 adults between 2010-2011 and 2018-2019. The mean difference in healthcare costs between RSV-admitted patients and matched controls was $28,260 (95 % CI: $27,728 - $28,793) in the first 6 months and $43,721 over 2 years (95 % CI: $40,383 - $47,059) post-hospitalization. CONCLUSIONS RSV hospitalizations among adults increased in Ontario between 2010/11 to 2018/19 RSV seasons. RSV hospitalizations in adults were associated with increased attributable short-term and long-term healthcare costs compared to matched controls. Interventions that could prevent RSV in adults may reduce healthcare burden.
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Affiliation(s)
| | | | | | | | | | | | - Joanne M Langley
- Canadian Center for Vaccinology (Dalhousie University, IWK Health and Nova Scotia Health) Halifax, Nova Scotia, Canada
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Baliunas D, Voci S, Selby P, de Oliveira C, Kurdyak P, Rosella L, Zawertailo L, Fu L, Sutradhar R. Incidence of chronic disease following smoking cessation treatment: A matched cohort study using linked administrative healthcare data in Ontario, Canada. PLoS One 2023; 18:e0288759. [PMID: 37494345 PMCID: PMC10370896 DOI: 10.1371/journal.pone.0288759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 07/04/2023] [Indexed: 07/28/2023] Open
Abstract
Scarce evidence is available on the impact of real-world smoking cessation treatment on subsequent health outcomes, such as incidence of chronic disease. This study compared two cohorts of people that smoke-those that enrolled in a smoking cessation program, and a matched control that had not accessed the program-to assess the incidence of cancer, chronic obstructive pulmonary disease, diabetes, hypertension, and major cardiovascular events over a 5-year follow-up period. We selected five sub-cohorts with matched treatment-control pairs in which both individuals were at risk of the five chronic diseases. Incident chronic disease from index date until December 31, 2017, was determined through linkage with routinely collected healthcare data. The cumulative incidence of each chronic disease was estimated using the cumulative incidence function with death as a competing risk. Gray's test was used to test for a difference between matched treatment and control groups in the chronic disease-specific cumulative incidence function over follow-up. Analyses were stratified by sex. Among females, cumulative incidence of diabetes was higher over follow-up for the treatment group (5-year cumulative incidence 5.8% vs 4.2%, p = 0.004), but did not differ for the four other chronic diseases. Among males, cumulative incidence of chronic obstructive pulmonary disease (12.2% vs 9.1%, p < 0.001) and diabetes (6.7% vs 4.8%, p < 0.001) both had higher 5-year cumulative incidence for the treated versus control groups but did not differ for the other three chronic diseases. We conclude that accessing primary-care based smoking cessation treatment is associated with increased incidence of diabetes for both sexes, and chronic obstructive pulmonary disease for males (possibly due to under diagnosis prior to treatment), within 5 years of treatment. The associations detected require further research to understand causal relationships.
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Affiliation(s)
- Dolly Baliunas
- School of Health and Medical Sciences, University of Southern Queensland, Ipswich, Queensland, Australia
- Clinical Research - Addictions, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- School of Public Health, University of Queensland, Herston, Queensland, Australia
| | - Sabrina Voci
- Nicotine Dependence Service, INTREPID Lab, Addictions Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Peter Selby
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Nicotine Dependence Service, INTREPID Lab, Addictions Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Claire de Oliveira
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Centre for Health Economics and Hull York Medical School, University of York, Heslington, York, United Kingdom
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Paul Kurdyak
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Laura Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Laurie Zawertailo
- Nicotine Dependence Service, INTREPID Lab, Addictions Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | | | - Rinku Sutradhar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
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Butler SJ, Louie AV, Sutradhar R, Paszat L, Brooks D, Gershon AS. Association between COPD and Stage of Lung Cancer Diagnosis: A Population-Based Study. Curr Oncol 2023; 30:6397-6410. [PMID: 37504331 PMCID: PMC10377848 DOI: 10.3390/curroncol30070471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/26/2023] [Accepted: 07/01/2023] [Indexed: 07/29/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is associated with an increased risk of lung cancer; however, the association between COPD and stage of lung cancer diagnosis is unclear. We conducted a population-based cross-sectional analysis of lung cancer patients (2008-2020) in Ontario, Canada. Using estimated propensity scores and inverse probability weighting, logistic regression models were developed to assess the association between COPD and lung cancer stage at diagnosis (early: I/II, advanced: III/IV), accounting for prior chest imaging. We further examined associations in subgroups with previously diagnosed and undiagnosed COPD. Over half (55%) of all lung cancer patients in Ontario had coexisting COPD (previously diagnosed: 45%, undiagnosed at time of cancer diagnosis: 10%). Compared to people without COPD, people with COPD had 30% lower odds of being diagnosed with lung cancer in the advanced stages (OR = 0.70, 95% CI: 0.68 to 0.72). Prior chest imaging only slightly attenuated this association (OR = 0.77, 95% CI: 0.75 to 0.80). The association with lower odds of advanced-stage diagnosis remained, regardless of whether COPD was previously diagnosed (OR = 0.68, 95% CI: 0.66 to 0.70) or undiagnosed (OR = 0.77, 95% CI: 0.73 to 0.82). Although most lung cancers are detected in the advanced stages, underlying COPD was associated with early-stage detection. Lung cancer diagnostics may benefit from enhanced partnership with COPD healthcare providers.
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Affiliation(s)
- Stacey J Butler
- Institute of Medical Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada
- ICES, Toronto, ON M4N 3M5, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Alexander V Louie
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Rinku Sutradhar
- ICES, Toronto, ON M4N 3M5, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
| | - Lawrence Paszat
- ICES, Toronto, ON M4N 3M5, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
| | - Dina Brooks
- School of Rehabilitation Sciences, McMaster University, Hamilton, ON L8S 1C7, Canada
| | - Andrea S Gershon
- Institute of Medical Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada
- ICES, Toronto, ON M4N 3M5, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
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Guilcher SJT, Bai YQ, Wodchis WP, Bronskill SE, Kuluski K. An interrupted time series study using administrative health data to examine the impact of the COVID-19 pandemic on alternate care level acute hospitalizations in Ontario, Canada. CMAJ Open 2023; 11:E621-E629. [PMID: 37437954 PMCID: PMC10356004 DOI: 10.9778/cmajo.20220086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Many health systems struggle with delayed discharges (known as alternate level of care [ALC] in Canada). Our objectives were to describe and compare patient and hospitalization characteristics by ALC status, and to examine the impact of the initial period of the COVID-19 pandemic on ALC rates in Ontario, Canada. METHODS We conducted an interrupted time series using linked administrative data for acute care hospital discharges in Ontario between Feb. 28, 2018, and Nov. 30, 2020. We measured the monthly ALC rate among discharges before and after the onset of the COVID-19 pandemic (Mar. 1, 2020). We used interrupted time series regressions to examine the association between the onset of the pandemic and average ALC monthly rates. RESULTS We identified no meaningful differences in patient and admission characteristics, irrespective of time; however, differences were identified by ALC status. The overall average monthly rate of ALC discharges before the COVID-19 pandemic was 4.9% and after the onset of the pandemic was 5.0%. These discharges dropped to 4.3% (n = 3558) in March 2020 but then rebounded to their peak of 5.8% (n = 3915). There was no significant change in the average level of ALC rates per month after the onset of the pandemic (increase of 0.36% average per month, 95% confidence interval [CI] -0.11% to 0.83%) or monthly rate of change (slope) after the onset of the pandemic (-0.08%, 95% CI -0.15 to 0). INTERPRETATION We identified a continued high rate of hospital discharges with an ALC component despite the considerable efforts in hospital to reduce hospital occupancy during the COVID-19 pandemic. Future research should examine why ALC rates remain high despite hospital efforts.
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Affiliation(s)
- Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy (Guilcher), University of Toronto; ICES UofT (Guilcher, Bai, Wodchis); ICES Central (Bronskill); Institute of Health Policy, Management and Evaluation (Guilcher, Bai, Wodchis, Bronskill, Kuluski), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Institute for Better Health (Wodchis, Kuluski), Trillium Health Partners, Mississauga, Ont.
| | - Yu Qing Bai
- Leslie Dan Faculty of Pharmacy (Guilcher), University of Toronto; ICES UofT (Guilcher, Bai, Wodchis); ICES Central (Bronskill); Institute of Health Policy, Management and Evaluation (Guilcher, Bai, Wodchis, Bronskill, Kuluski), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Institute for Better Health (Wodchis, Kuluski), Trillium Health Partners, Mississauga, Ont
| | - Walter P Wodchis
- Leslie Dan Faculty of Pharmacy (Guilcher), University of Toronto; ICES UofT (Guilcher, Bai, Wodchis); ICES Central (Bronskill); Institute of Health Policy, Management and Evaluation (Guilcher, Bai, Wodchis, Bronskill, Kuluski), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Institute for Better Health (Wodchis, Kuluski), Trillium Health Partners, Mississauga, Ont
| | - Susan E Bronskill
- Leslie Dan Faculty of Pharmacy (Guilcher), University of Toronto; ICES UofT (Guilcher, Bai, Wodchis); ICES Central (Bronskill); Institute of Health Policy, Management and Evaluation (Guilcher, Bai, Wodchis, Bronskill, Kuluski), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Institute for Better Health (Wodchis, Kuluski), Trillium Health Partners, Mississauga, Ont
| | - Kerry Kuluski
- Leslie Dan Faculty of Pharmacy (Guilcher), University of Toronto; ICES UofT (Guilcher, Bai, Wodchis); ICES Central (Bronskill); Institute of Health Policy, Management and Evaluation (Guilcher, Bai, Wodchis, Bronskill, Kuluski), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Institute for Better Health (Wodchis, Kuluski), Trillium Health Partners, Mississauga, Ont
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Rosella LC, Negatu E, Kornas K, Chu C, Zhou L, Buajitti E. Multimorbidity at time of death among persons with type 2 diabetes: a population-based study in Ontario, Canada. BMC Endocr Disord 2023; 23:127. [PMID: 37264336 DOI: 10.1186/s12902-023-01362-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 05/04/2023] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVE Individuals with Type 2 Diabetes are likely to experience multimorbidity and accumulate multiple chronic conditions over their life. We aimed to identify causes of death and chronic conditions at the time of death in a population-based cohort, and to analyze variations in the presence of diabetes at the time of death overall and across income and immigrant status. RESEARCH DESIGN AND METHODS We conducted a retrospective cohort study of 2,199,801 adult deaths from 1992 to 2017 in Ontario, Canada. We calculated the proportion of decedents with chronic conditions at time of death and causes of death. The risk of diabetes at the time of death was modeled across sociodemographic variables with a log binomial regression adjusting for sex, age, immigrant status, area-level income. comorbiditiesand time. RESULTS The leading causes of death in the cohort were cardiovascular and cancer. Decedents with diabetes had a higher prevalence of most chronic conditions than decedents without diabetes, including hypertension, osteo and other arthritis, chronic coronary syndrome, mood disorder, and congestive heart failure. The risk of diabetes at the time of death was 19% higher in immigrants (95%CI 1.18-1.20) and 15% higher in refugees (95%CI 1.12-1.18) compared to long-term residents, and 19% higher in the lowest income quintile (95%CI 1.18-1.20) relative to the highest income quintile, after adjusting for other covariates. CONCLUSIONS Individuals with diabetes have a greater multimorbidity burden at the time of death, underscoring the importance of multiple chronic disease management among those living with diabetes and further considerations of the social determinants of health.
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Affiliation(s)
- Laura C Rosella
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 6th floor, 155 College Street, Toronto, ON, M5T 3M7, Canada.
- ICES, Toronto, ON, Canada.
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.
- Temerty Faculty of Medicine, Toronto, Canada.
| | - Ednah Negatu
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 6th floor, 155 College Street, Toronto, ON, M5T 3M7, Canada
| | - Kathy Kornas
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 6th floor, 155 College Street, Toronto, ON, M5T 3M7, Canada
| | - Casey Chu
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | | | - Emmalin Buajitti
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 6th floor, 155 College Street, Toronto, ON, M5T 3M7, Canada
- ICES, Toronto, ON, Canada
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Siu SC, Lee DS, Fang J, Austin PC, Silversides CK. New Hypertension After Pregnancy in Patients With Heart Disease. J Am Heart Assoc 2023; 12:e029260. [PMID: 37158089 DOI: 10.1161/jaha.122.029260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Background After pregnancy, patients with preexisting heart disease are at high risk for cardiovascular complications. The primary objective was to compare the incidence of new hypertension after pregnancy in patients with and without heart disease. Methods and Results This was a retrospective matched-cohort study comparing the incidence of new hypertension after pregnancy in 832 patients who are pregnant with congenital or acquired heart disease to a comparison group of 1664 patients who are pregnant without heart disease; matching was by demographics and baseline risk for hypertension at the time of the index pregnancy. We also examined whether new hypertension was associated with subsequent death or cardiovascular events. The 20-year cumulative incidence of hypertension was 24% in patients with heart disease, compared with 14% in patients without heart disease (hazard ratio [HR], 1.81 [95% CI, 1.44-2.27]). The median follow-up time at hypertension diagnosis in the heart disease group was 8.1 years (interquartile range, 4.2-11.9 years). The elevated rate of new hypertension was observed not only in patients with ischemic heart disease, but also in those with left-sided valve disease, cardiomyopathy, and congenital heart disease. Pregnancy risk prediction methods can further stratify risk of new hypertension. New hypertension was associated with an increased rate of subsequent death or cardiovascular events (HR, 1.54 [95% CI, 1.05-2.25]). Conclusions Patients with heart disease are at higher risk for developing hypertension in the decades after pregnancy when compared with those without heart disease. New hypertension in this young cohort is associated with adverse cardiovascular events highlighting the importance of systematic and lifelong surveillance.
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Affiliation(s)
- Samuel C Siu
- Division of Cardiology University of Toronto Pregnancy and Heart Disease Program Toronto Canada
- Maternal Cardiology Program, Division of Cardiology Department of Medicine Schulich School of Medicine and Dentistry London Ontario Canada
- ICES Toronto Ontario Canada
- Division of Cardiology Department of Medicine Mount Sinai Hospital and University Health Network University of Toronto Ontario Canada
| | - Douglas S Lee
- ICES Toronto Ontario Canada
- Division of Cardiology Department of Medicine Mount Sinai Hospital and University Health Network University of Toronto Ontario Canada
- Institute of Health Policy, Management and Evaluation University of Toronto Ontario Canada
| | | | - Peter C Austin
- ICES Toronto Ontario Canada
- Institute of Health Policy, Management and Evaluation University of Toronto Ontario Canada
| | - Candice K Silversides
- Division of Cardiology University of Toronto Pregnancy and Heart Disease Program Toronto Canada
- Division of Cardiology Department of Medicine Mount Sinai Hospital and University Health Network University of Toronto Ontario Canada
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Rosella LC, Kornas K, Negatu E, Zhou L. Variations in all-cause mortality, premature mortality and cause-specific mortality among persons with diabetes in Ontario, Canada. BMJ Open Diabetes Res Care 2023; 11:11/3/e003378. [PMID: 37130629 PMCID: PMC10163552 DOI: 10.1136/bmjdrc-2023-003378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/15/2023] [Indexed: 05/04/2023] Open
Abstract
INTRODUCTION Patients with diabetes have a higher risk of mortality compared with the general population. Large population-based studies that quantify variations in mortality risk for patients with diabetes among subgroups in the population are lacking. This study aimed to examine the sociodemographic differences in the risk of all-cause mortality, premature mortality, and cause-specific mortality in persons diagnosed with diabetes. RESEARCH DESIGN AND METHODS We conducted a population-based cohort study of 1 741 098 adults diagnosed with diabetes between 1994 and 2017 in Ontario, Canada using linked population files, Canadian census, health administrative and death registry databases. We analyzed the association between sociodemographics and other covariates on all-cause mortality and premature mortality using Cox proportional hazards models. A competing risk analysis using Fine-Gray subdistribution hazards models was used to analyze cardiovascular and circular mortality, cancer mortality, respiratory mortality, and mortality from external causes of injury and poisoning. RESULTS After full adjustment, individuals with diabetes who lived in the lowest income neighborhoods had a 26% (HR 1.26, 95% CI 1.25 to 1.27) increased hazard of all-cause mortality and 44% (HR 1.44, 95% CI 1.42 to 1.46) increased risk of premature mortality, compared with individuals with diabetes living in the highest income neighborhoods. In fully adjusted models, immigrants with diabetes had reduced risk of all-cause mortality (HR 0.46, 95% CI 0.46 to 0.47) and premature mortality (HR 0.40, 95% CI 0.40 to 0.41), compared with long-term residents with diabetes. Similar HRs associated with income and immigrant status were observed for cause-specific mortality, except for cancer mortality, where we observed attenuation in the income gradient among persons with diabetes. CONCLUSIONS The observed mortality variations suggest a need to address inequality gaps in diabetes care for persons with diabetes living in the lowest income areas.
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Affiliation(s)
- Laura C Rosella
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Kathy Kornas
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ednah Negatu
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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de Oliveira C, Iwajomo T, Kurdyak P. Mental Health Care Use Among Children and Adolescents With High Health Care Costs in Ontario, Canada. JAMA Netw Open 2023; 6:e2313172. [PMID: 37171817 PMCID: PMC10182426 DOI: 10.1001/jamanetworkopen.2023.13172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
Importance Research on patients with high health care costs has examined mainly adults, with little focus on mental health care use. Objective To examine the characteristics and costs of children and adolescents with high health care costs who use mostly mental health care and whether and why they persist in the high-cost state. Design, Setting, and Participants This population-based, retrospective cohort study used health care records from Ontario, Canada, on all children and adolescents (age 0-17 years) covered under a universal health care system from January 1, 2012, to December 31, 2019. All children and adolescents in and above the 90th percentile of the cost distribution in 2012 for whom costs related to mental health care accounted for 50% or more of their costs were defined as patients with high mental health care costs. Data were analyzed from August 2019 to December 2022. Exposures High health care costs. Main Outcomes and Measures Patients with high mental health care costs were characterized in terms of their sociodemographic characteristics; chronic physical health, mental health, and behavioral conditions; and health care costs (in 2021 Canadian dollars) by health service and type of care (mental health care vs non-mental health care). Patients were followed up until 2019 to assess whether they persisted in the high-cost state and to examine factors associated with persisting in that state. Results In 2012, there were 273 490 children and adolescents with high health care costs (mean [SD] age, 6.43 [5.99] years; 55.8% male; mean cost, $7936.40; 95% CI, $7850.30-$8022.40). Of these, 20 463 (7.5%) were classified as having high mental health care costs (mean cost, $10 040.20; 95% CI, $9822.80-$10 257.50). Asthma (30.3%), attention-deficit/hyperactivity disorder (35.8%), and mood and/or anxiety disorders (94.9%) were the most common chronic physical, behavioral, or mental health conditions. Few patients with high mental health care costs persisted in the high-cost state beyond 3 years (19.0%). Mood and/or anxiety disorders (relative risk ratio [RRR], 6.17; 95% CI, 3.19-11.96) and schizophrenia spectrum disorders (RRR, 2.98; 95% CI, 2.14-4.14) were identified as the main factors associated with persistence in the high-cost state. Conclusions and Relevance In this cohort study of children and adolescents with high health care costs, some patients had high levels of mental health care use and high costs of care, but few of these persisted in the high-cost state for 3 or more years. These findings may help inform the development of care coordination interventions and service delivery models, such as youth integrated services, to reduce costs and improve outcomes for children and adolescents.
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Affiliation(s)
- Claire de Oliveira
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Tomisin Iwajomo
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Paul Kurdyak
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Mental Health and Addictions Centre of Excellence, Ontario Health, Toronto, Ontario, Canada
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Alcantara M, Koh M, Park AL, Bril V, Barnett C. Outcomes of COVID-19 Infection and Vaccination Among Individuals With Myasthenia Gravis. JAMA Netw Open 2023; 6:e239834. [PMID: 37097637 PMCID: PMC10130942 DOI: 10.1001/jamanetworkopen.2023.9834] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Abstract
Importance There are limited data regarding COVID-19 outcomes and vaccine uptake and safety among people with myasthenia gravis (MG). Objective To investigate COVID-19-related outcomes and vaccine uptake among a population-based sample of adults with MG. Design, Setting, and Participants This population-based, matched cohort study in Ontario, Canada, used administrative health data from January 15, 2020, and August 31, 2021. Adults with MG were identified using a validated algorithm. Each patient was matched by age, sex, and geographic area of residence to 5 controls from the general population and from a cohort of individuals with rheumatoid arthritis (RA). Exposure Patients with MG and matched controls. Main Outcomes and Measures Main outcomes were COVID-19 infection and related hospitalizations, intensive care unit admissions, and 30-day mortality among patients with MG vs controls. Secondary outcomes were uptake of COVID-19 vaccination among patients with MG vs controls. Results Among 11 365 233 eligible Ontario residents, 4411 patients with MG (mean [SD] age, 67.7 [15.6] years; 2274 women [51.6%]) were matched to 22 055 general population controls (mean [SD] age, 67.7 [15.6] years; 11 370 women [51.6%]) and 22 055 controls with RA (mean [SD] age, 67.7 [15.6] years; 11 370 women [51.6%]). In the matched cohort, 38 861 of 44 110 individuals (88.1%) were urban residents; in the MG cohort, 3901 (88.4%) were urban residents. Between January 15, 2020, and May 17, 2021, 164 patients with MG (3.7%), 669 general population controls (3.0%), and 668 controls with RA (3.0%) contracted COVID-19. Compared with general population controls and controls with RA, patients with MG had higher rates of COVID-19-associated emergency department visits (36.6% [60 of 164] vs 24.4% [163 of 669] vs 29.9% [200 of 668]), hospital admissions (30.5% [50 of 164] vs 15.1% [101 of 669] vs 20.7% [138 of 668]), and 30-day mortality (14.6% [24 of 164] vs 8.5% [57 of 669] vs 9.9% [66 of 668]). By August 2021, 3540 patients with MG (80.3%) vs 17 913 general population controls (81.2%) had received 2 COVID-19 vaccine doses, and 137 (3.1%) vs 628 (2.8%), respectively had received 1 dose. Of 3461 first vaccine doses for patients with MG, fewer than 6 individuals were hospitalized for MG worsening within 30 days of vaccination. Vaccinated patients with MG had a lower risk than unvaccinated patients with MG of contracting COVID-19 (hazard ratio, 0.43; 95% CI, 0.30-0.60). Conclusions and Relevance This study suggests that adults with MG who contracted COVID-19 had a higher risk of hospitalization and death compared with matched controls. Vaccine uptake was high, with negligible risk of severe MG exacerbations after vaccination, as well as evidence of effectiveness. The findings support public health policies prioritizing people with MG for vaccination and new COVID-19 therapeutics.
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Affiliation(s)
- Monica Alcantara
- Ellen & Martin Prosserman Centre for Neuromuscular Diseases, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Vera Bril
- Ellen & Martin Prosserman Centre for Neuromuscular Diseases, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Carolina Barnett
- Ellen & Martin Prosserman Centre for Neuromuscular Diseases, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Mofina A, Miller J, Tranmer J, Li W, Donnelly C. The association between receipt of home care rehabilitation services and acute care hospital utilization in clients with multimorbidity following an acute care unit discharge: a retrospective cohort study. BMC Health Serv Res 2023; 23:269. [PMID: 36934243 PMCID: PMC10024414 DOI: 10.1186/s12913-023-09116-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 01/27/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND Individuals experiencing multimorbidity have more complex healthcare needs, use more healthcare services, and access multiple service providers across the healthcare continuum. They also experience higher rates of functional decline. Rehabilitation therapists are well positioned to address these functional needs; however, little is known about the influence of rehabilitation therapy on patient outcomes, and subsequent unplanned healthcare utilization for people with multimorbidity. The aims of this study were to: 1) describe and compare the characteristics of people with multimorbidity receiving: home care rehabilitation therapy alone, other home care services without rehabilitation therapy, and the combination of home care rehabilitation therapy and other home care services, and 2) determine the association between home care rehabilitation therapy and subsequent healthcare utilization among those recently discharged from an acute care unit. METHODS This retrospective cohort study used linked health administrative data housed within ICES, Ontario, Canada. The cohort included long-stay home care clients experiencing multimorbidity who were discharged from acute care settings between 2007-2015 (N = 43,145). Descriptive statistics, ANOVA's, t-tests, and chi-square analyses were used to describe and compare cohort characteristics. Multivariable logistic regression was used to understand the association between receipt of rehabilitation therapy and healthcare utilization. RESULTS Of those with multimorbidity receiving long-stay home care services, 45.5% had five or more chronic conditions and 46.3% required some assistance with ADLs. Compared to people receiving other home care services, those receiving home care rehabilitation therapy only were less likely to be readmitted to the hospital (OR = 0.78; 95% CI: 0.73-0.83) and use emergency department services (OR = 0.73; 95% CI: 0.69-0.78) within the first 3-months following hospital discharge. CONCLUSIONS Receipt of rehabilitation therapy was associated with less unplanned healthcare service use when transitioning from hospital to home among persons with multimorbidity. These findings suggest rehabilitation therapy may help to reduce the healthcare burden for individuals and health systems. Future research should evaluate the potential cost savings and health outcomes associated with providing rehabilitation therapy services for people with multimorbidity.
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Affiliation(s)
- Amanda Mofina
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada.
| | - Jordan Miller
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Joan Tranmer
- School of Nursing, Queen's University, Kingston, ON, Canada
- ICES, Queen's, Kingston, ON, Canada
| | | | - Catherine Donnelly
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
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Brar S, Dixon SN, Paterson JM, Dirk J, Hahn E, Kim SJ, Ng V, Solomon M, Vasilevska-Ristovska J, Banh T, Nathan PC, Parekh RS, Chanchlani R. Incidence of cardiovascular disease and mortality in childhood solid organ transplant recipients: a population-based study. Pediatr Nephrol 2023; 38:801-810. [PMID: 35849223 DOI: 10.1007/s00467-022-05635-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/28/2022] [Accepted: 05/16/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND With improved survival among children after transplantation, our understanding of the risk for developing other comorbidities is improving, yet little is known about the long-term risk of cardiovascular events and mortality after solid organ transplantation. METHODS In a cohort study using health administrative data, we compared cardiovascular events in children (n = 615) with liver, lung, kidney, small bowel, or multi-organ transplant at the Hospital for Sick Children, Toronto, Canada, with asthmatic children (n = 481,697) between 1996 and 2014. Outcomes included non-fatal cardiovascular events, cardiovascular death, all-cause mortality, and a composite of non-fatal and fatal cardiovascular events. Time-stratified Cox proportional hazards models were used. RESULTS Among 615 children, 317 (52%) were recipients of kidneys, 253 (41%) of livers, and the remaining 45 (7%) had lung, small bowel, or multi-organ transplants. Median follow-up was 12.1 [7.2, 16.7] years. Non-fatal incident cardiovascular events were 34 times higher among solid organ transplant recipients than non-transplanted children (incidence rate ratio (IRR) 34.4, 95% CI: 25.5, 46.4). Among transplant recipients, the cumulative incidence of non-fatal and fatal cardiovascular events was 2.3% and 13.0%, 5 and 15 years after transplantation, respectively. CONCLUSIONS Increased rate of cardiovascular events in children after transplantation highlights the need for surveillance during transition into adulthood and beyond. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Sandeep Brar
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Stephanie N Dixon
- ICES Western, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - J Michael Paterson
- ICES Central, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jade Dirk
- ICES Western, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Emma Hahn
- ICES Western, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - S Joseph Kim
- ICES Western, London, ON, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Division of Nephrology and the Ajmera Transplant Centre, University Health Network, Toronto, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Vicky Ng
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Transplant and Regenerative Medicine Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Melinda Solomon
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Respiratory Medicine, Department of Paediatrics, Transplant and Regenerative Medicine Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | - Tonny Banh
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, ON, Canada
| | - Paul C Nathan
- ICES Central, Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Rulan S Parekh
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Division of Nephrology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
- Academics, Women's College Hospital, 76 Grenville St., Toronto, ON, M5S 1B2, Canada.
| | - Rahul Chanchlani
- Division of Pediatric Nephrology, Department of Pediatrics, McMaster Children's Hospital, Hamilton, ON, Canada
- Division of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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Moitra S, Fong A, Bhutani M. An inverse relationship between asthma prevalence and medication dispensation trend: a 12-year spatial analysis of electronic health record data in Alberta, Canada. ERJ Open Res 2023; 9:00489-2022. [PMID: 36891081 PMCID: PMC9986764 DOI: 10.1183/23120541.00489-2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/14/2022] [Indexed: 12/30/2022] Open
Abstract
Despite guideline-based asthma management in Alberta, an inverse trend between asthma prevalence and dispensation of asthma medications in the past 12 years possibly underscores the reason for a large number of emergency department visits https://bit.ly/3HQsBo8.
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Affiliation(s)
- Subhabrata Moitra
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Andrew Fong
- Alberta Health Services, Calgary, AB, Canada
| | - Mohit Bhutani
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada.,Alberta Health Services, Calgary, AB, Canada
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37
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de Oliveira C, Tanner B, Colton P, Kurdyak P. Understanding the scope of preventable acute care spending among patients with eating disorders. Int J Eat Disord 2023. [PMID: 36757092 DOI: 10.1002/eat.23910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/24/2023] [Accepted: 01/24/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE The economic burden of eating disorders is substantial. One potential way to reduce costs, without sacrificing care, may be to target preventable (i.e., potentially unnecessary) acute care. This study sought to determine the amount and proportion of preventable and non-preventable acute care spending among individuals with eating disorders. METHOD We undertook a population-based, cross-sectional study of all individuals over the age of 17 with eating disorders (diagnosed through hospitalization) in Ontario, Canada, to determine potentially preventable and non-preventable acute care spending. Preventable acute care (i.e., preventable emergency department visits and hospitalizations) was defined using previously validated algorithms. We undertook analyses for the full sample, by sex and by eating disorder diagnosis (anorexia nervosa, bulimia nervosa, eating disorder not otherwise specified, multiple). RESULTS Among 7547 individuals with eating disorders, 15% of all acute care spending (i.e., $1.33 million) was considered preventable; this figure was higher for females (14%) and those with bulimia nervosa (21%). Among emergency department visits, 25% of visits were considered preventable; the largest proportions were for non-emergent (11%) and primary care treatable (10%) conditions. Among hospitalizations, 9% were considered preventable; the highest proportions of preventable care spending were for short-term diabetes complications (1.8%) and urinary tract infections (1.8%). DISCUSSION Although the economic burden of eating disorders is substantial, there is some scope to decrease acute care spending among this patient population. Care coordination and improved access to primary care and disease prevention, particularly related to diabetes, may help prevent the occurrence of some acute care episodes. PUBLIC SIGNIFICANCE Many jurisdictions have implemented strategies to reduce costs and improve the quality of care among patients with high health care needs, such as those with eating disorders; however, it is unclear whether any costs can be reduced and, if so, which costs. Cost-savings resulting from the reduction of unnecessary care could provide further economic justification for increased investment in outpatient care for individuals with eating disorders.
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Affiliation(s)
- Claire de Oliveira
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Bryan Tanner
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Patricia Colton
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University Health Network, Toronto, Ontario, Canada
| | - Paul Kurdyak
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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MacKinnon M, Barrick K, Lévesque LE, Liss G, Tarlo SM, Lougheed MD. Linkage of administrative and compensation databases for work-related asthma surveillance in Ontario: A proof of concept study. CANADIAN JOURNAL OF RESPIRATORY, CRITICAL CARE, AND SLEEP MEDICINE 2023. [DOI: 10.1080/24745332.2022.2161025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Madison MacKinnon
- Asthma Research Unit, Kingston Health Sciences Centre, Kingston, Ontario, Canada
- Department of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Kendra Barrick
- Department of Family Medicine, University of Calgary, Calgary, Alberta
| | - Linda E. Lévesque
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Gary Liss
- Department of Medicine, Dalla Lana School of Public Health, University of Toronto
| | - Susan M. Tarlo
- Department of Medicine, Dalla Lana School of Public Health, University of Toronto
- Respiratory Division, University Health Network, Toronto, Ontario, Canada
| | - M. Diane Lougheed
- Asthma Research Unit, Kingston Health Sciences Centre, Kingston, Ontario, Canada
- Department of Medicine, Queen’s University, Kingston, Ontario, Canada
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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Moloney M, Digby G, MacKinnon M, Morra A, Barber D, Queenan J, Gupta S, To T, Lougheed MD. Primary care asthma surveillance: a review of knowledge translation tools and strategies for quality improvement. Allergy Asthma Clin Immunol 2023; 19:3. [PMID: 36650578 PMCID: PMC9843861 DOI: 10.1186/s13223-022-00755-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 12/15/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Viable knowledge translation (KT) strategies are increasingly sought to improve asthma diagnosis, particularly in primary care. Despite this understanding, practical KT tools to support primary care practitioners are not widely available. Electronic medical records (EMRs) offer an opportunity to optimize the diagnosis and surveillance of chronic diseases such as asthma, and support quality improvement initiatives that increase adherence to guideline-recommended care. This review aims to describe the current state of electronic KT electronic tools (eTools) and surveillance systems for asthma and identify opportunities to increase adherence to asthma diagnostic guidelines by implementing digital KT eTools. METHODS Systematic literature searches were conducted on Ovid MEDLINE that included the search terms: asthma, asthma diagnosis, asthma surveillance, electronic health records, translational medical research, quality improvement, professional practice gaps, and primary health care published in the previous 10 years. In total, the searches returned 971 articles, 163 of which were considered relevant and read in full. An additional 28 articles were considered after reviewing the references from selected articles. 75 articles were included in this narrative review. RESULTS Established KT eTools for asthma such as electronic questionnaires, computerized clinical decision support systems (CDSS), chronic disease surveillance networks, and asthma registries have been effective in improving the quality of asthma diagnosis and care. As well, chronic disease surveillance systems, severe asthma registries, and workplace asthma surveillance systems have demonstrated success in monitoring asthma outcomes. However, lack of use and/or documentation of objective measures of lung function, challenges in identifying asthma cases in EMRs, and limitations of data sources have created barriers in the development of KT eTools. Existing digital KT eTools that overcome these data quality limitations could provide an opportunity to improve adherence to best-practice guidelines for asthma diagnosis and management. CONCLUSION Future initiatives in the development of KT eTools for asthma care should focus on strategies that assist healthcare providers in accurately diagnosing and documenting cases of asthma. A digital asthma surveillance system could support adherence to best-practice guidelines of asthma diagnosis and surveillance by prompting use of objective methods of confirmation to confirm an asthma diagnosis within the EMR.
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Affiliation(s)
- Max Moloney
- grid.511274.4Asthma Research Unit, Kingston Health Sciences Centre, Kingston, ON Canada ,grid.410356.50000 0004 1936 8331Division of Respirology, Department of Medicine, Queen’s University, Kingston, ON Canada
| | - Geneviève Digby
- grid.410356.50000 0004 1936 8331Division of Respirology, Department of Medicine, Queen’s University, Kingston, ON Canada
| | - Madison MacKinnon
- grid.511274.4Asthma Research Unit, Kingston Health Sciences Centre, Kingston, ON Canada ,grid.410356.50000 0004 1936 8331Division of Respirology, Department of Medicine, Queen’s University, Kingston, ON Canada
| | - Alison Morra
- grid.511274.4Asthma Research Unit, Kingston Health Sciences Centre, Kingston, ON Canada ,grid.410356.50000 0004 1936 8331Division of Respirology, Department of Medicine, Queen’s University, Kingston, ON Canada
| | - David Barber
- grid.410356.50000 0004 1936 8331Department of Family Medicine, Queen’s University, Kingston, ON Canada ,Canadian Primary Care Sentinel Surveillance Network (Eastern Ontario Network), Kingston, ON Canada
| | - John Queenan
- grid.410356.50000 0004 1936 8331Department of Family Medicine, Queen’s University, Kingston, ON Canada
| | - Samir Gupta
- grid.415502.7Division of Respirology, Department of Medicine, St. Michael’s Hospital, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, ON Canada
| | - Teresa To
- grid.42327.300000 0004 0473 9646Child Health Evaluative Science, Research Institute, The Hospital for Sick Children, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - M. Diane Lougheed
- grid.511274.4Asthma Research Unit, Kingston Health Sciences Centre, Kingston, ON Canada ,grid.410356.50000 0004 1936 8331Division of Respirology, Department of Medicine, Queen’s University, Kingston, ON Canada
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Tint A, Chung H, Lai MC, Balogh R, Lin E, Durbin A, Lunsky Y. Health conditions and service use of autistic women and men: A retrospective population-based case-control study. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023:13623613221144353. [PMID: 36588296 PMCID: PMC10374994 DOI: 10.1177/13623613221144353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
LAY ABSTRACT This study used administrative data from Ontario, Canada to compare the health conditions and service use of autistic women and men with adults with other developmental disabilities and with adults without developmental disabilities. Autistic women and men were more likely to have physical and mental health conditions compared to adults without developmental disabilities. Rates of health conditions were similar or lower among autistic adults compared to adults with other developmental disabilities, except more autistic adults had psychiatric conditions. Autistic women and men used higher rates of psychiatric services compared to all other groups. When comparing autistic women with same aged autistic men, sex differences were found for specific physical (Crohn's disease/colitis, rheumatoid arthritis) and psychiatric conditions (psychotic disorders, non-psychotic disorders), as well differences in service use (emergency department visits, hospitalizations, family doctor and neurologist visits). These results further highlight the high health needs and service use of autistic women and men, as well as adults with other developmental disabilities. It is critical for future research to focus on mental health support for autistic adults and to better understand how to tailor supports to best serve autistic women.
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Affiliation(s)
- Ami Tint
- Centre for Addiction and Mental Health, Canada
| | | | - Meng-Chuan Lai
- Centre for Addiction and Mental Health, Canada.,University of Toronto, Canada.,The Hospital for Sick Children, Canada.,University of Cambridge, United Kingdom.,National Taiwan University Hospital, Taiwan
| | | | - Elizabeth Lin
- Centre for Addiction and Mental Health, Canada.,University of Toronto, Canada
| | - Anna Durbin
- ICES, Canada.,University of Toronto, Canada.,Unity Health, Canada
| | - Yona Lunsky
- Centre for Addiction and Mental Health, Canada.,ICES, Canada.,University of Toronto, Canada
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Mathews M, Ouédraogo AM, Lam M, Gozdyra P, Green M. A cross-sectional study of community-level physician retention and hospitalization in rural Ontario, Canada. J Rural Health 2023; 39:69-78. [PMID: 35289453 PMCID: PMC10078748 DOI: 10.1111/jrh.12661] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE Many rural communities experience poor family physician retention. We examined the association between community-level physician retention and hospitalization for all causes and ambulatory care-sensitive conditions (ACSCs) in 2017 among residents of rural communities in Ontario, Canada. METHODS We conducted a population-based cross-sectional study by linking administrative data from the public health insurance program in Ontario. To create the physician retention measure for each rural community, we divided the number of family physicians who worked in the community in both 2016 and 2017 by the total number of unique family physicians in the community in either year. We grouped retention level by tertile and added a fourth category, "no physician" to include communities that did not have any residing physicians in either 2016 or 2017. Outcomes were all-cause hospitalization and ACSC hospitalization between April 1, 2017 and March 31, 2018. FINDINGS Among 1,436,794 rural residents, there were 93,752 all-cause hospitalizations and 8,691 ACSC hospitalizations in 2017. After controlling for other predictors, compared to residents in low-retention communities, residents of medium- and high-retention communities were 0.888 (95% CI: 0.868-0.909) and 0.937 (95% CI: 0.915-0.960) times as likely to have all-cause hospitalization, and residents of high-retention communities were 0.918 (95% CI: 0.858-0.981) times as likely to have ACSC hospitalization in 2017. CONCLUSIONS Community-level physician retention is significantly associated with all cause and ACSC hospitalization in rural communities in Ontario, and may serve as an alternate measure to assess the impact of disrupted continuity of care.
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Affiliation(s)
- Maria Mathews
- Department of Family Medicine, Western University, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, London, Ontario, Canada
| | | | - Melody Lam
- ICES Western, ICES, London, Ontario, Canada
| | | | - Michael Green
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
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Kim JH, Yi YY, Ha EK, Cha HR, Han MY, Baek HS. Neurodevelopment at 6 years of age in children with atopic dermatitis. Allergol Int 2023; 72:116-127. [PMID: 36058807 DOI: 10.1016/j.alit.2022.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 07/17/2022] [Accepted: 07/26/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Few studies have reported an association between atopic dermatitis and cognitive impairment in children. Therefore, we evaluated the association between atopic dermatitis (AD) and neurodevelopmental dysfunction in children. METHODS We analyzed 2,395,966 children born between 2008 and 2012 in Korea. All data were acquired from the databases of the Korean National Health Insurance System. AD was defined as five or more diagnoses before age 24 months. The outcome was suspected neurodevelopmental dysfunction in the gross motor skill, fine motor skill, cognition, language, sociality, and self-care domains of the Korean Developmental Screening Test for Infants and Children at age 6 years. The positive control outcome was defined as attention deficit hyperactive disorder (ADHD). The associations were assessed using ordinal logistic regression, adjusting for asthma and allergic rhinitis. RESULTS Among the eligible children, 89,452 and 30,557 were allocated to the control and AD groups, respectively. In the weighted data, the AD group showed a higher risk of suspected neurodevelopmental dysfunction in the total score (weighted adjusted odds ratio [95% CI] 1.10 [1.05-1.16]), gross motor skills (1.14 [1.04-1.25]), and fine motor skills (1.15 [1.06-1.25]) than the control group. The AD with steroids or hospitalization groups showed an increased risk of suspected neurodevelopmental dysfunction. In addition, the AD group showed a significant association with mental retardation, psychological development disorder, and behavioral and emotional disorders as well as ADHD. CONCLUSIONS AD before age 2 years may be associated with an increased risk of neurodevelopmental dysfunction including gross and fine motor skills in the young childhood period.
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Affiliation(s)
- Ju Hee Kim
- Department of Pediatrics, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Yoon Young Yi
- Department of Pediatrics, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Eun Kyo Ha
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, South Korea
| | - Hey Ryung Cha
- Department of Data Science, Sejong University College of Software Convergence, Seoul, South Korea
| | - Man Yong Han
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea.
| | - Hey-Sung Baek
- Department of Pediatrics, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea.
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To T, Zhang K, Terebessy E, Zhu J, Licskai C. Healthcare utilization in Canadian children and young adults with asthma during the COVID-19 pandemic. PLoS One 2023; 18:e0280362. [PMID: 36638144 PMCID: PMC9838850 DOI: 10.1371/journal.pone.0280362] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 12/28/2022] [Indexed: 01/14/2023] Open
Abstract
Literature is limited regarding the COVID-19 pandemic's impact on health services use in younger Canadian populations with asthma. We utilized health administrative databases from January 2019-December 2021 for a population-based cross-sectional study to identify Ontario residents 0-25 years old with physician-diagnosed asthma and calculate rates of healthcare use. Multivariable negative binomial regression analysis was used to adjust for confounders. We included 716,690 children and young adults ≤25 years. There was a sharp increase of ICS and SABA prescription rates at the start of the pandemic (March 2020) of 61.7% and 54.6%, respectively. Monthly virtual physician visit rates increased from zero to 0.23 per 100 asthma population during the pandemic. After adjusting for potential confounders, rate ratios (RR) with 95% confidence intervals (CI) showed that the pandemic was associated with significant decrease in hospital admissions (RR = 0.21, 95% CI: 0.18-0.24), emergency department visits (RR = 0.35, 95% CI: 0.34-0.37), and physician visits (RR = 0.61, 95% CI: 0.60-0.61). ICS and SABA prescriptions filled also significantly decreased during the pandemic (RR = 0.58, 95% CI: 0.57-0.60 and RR = 0.47, 95% CI: 0.46-0.48, respectively). This Canadian population-based asthma study demonstrated a dramatic decline in physician and emergency department visits, hospitalizations, and medication prescriptions filled during the COVID-19 pandemic. An extensive evaluation of the factors contributing to an 80% reduction in the risk of hospitalization may inform post-pandemic asthma management.
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Affiliation(s)
- Teresa To
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- * E-mail:
| | - Kimball Zhang
- The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | | | - Jingqin Zhu
- The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Christopher Licskai
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- London Health Sciences, Victoria Hospital, London, Ontario, Canada
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Hamada Y, Nakatani E, Nagahama T, Nagai K, Nagayama K, Tomita Y, Sekiya K, Taniguchi M, Fukutomi Y. Identification of asthma cases in Japan using health insurance claims data: Positive and negative predictive values of proposed discrimination criteria: A single-center study. Allergol Int 2023; 72:75-81. [PMID: 35965192 DOI: 10.1016/j.alit.2022.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/30/2022] [Accepted: 07/02/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Asthma cases have been increasingly investigated using claims data. However, the validity of defining asthma cases using health insurance claims in Japan is unclear. This study aims to assess the positive and negative predictive values of our proposed discrimination criteria for asthma. METHODS We developed discrimination criteria for asthma based on both the International Statistical Classification of Diseases and Related Health Problems (ICD)-10 disease codes for asthma and health insurance claims data for prescriptions and the treatment of asthma. Inclusion criteria were patients aged ≥16 years with at least one health insurance claim from April 2018 to March 2019 in all departments of our hospital. Physician-diagnosed asthma documented in the charts was used as the reference standard. Positive and negative predictive values of the discrimination criteria for physician-diagnosed asthma were estimated and compared with those estimated from discrimination criteria based solely on ICD-10 codes. RESULTS The new discrimination criteria had a high positive predictive value (PPV) of 86.0%, which was significantly higher than the PPV for the criteria defined solely by the ICD-10 codes (61.5%) (P < 0.01). The negative predictive values for both criteria were 100%. Allergic rhinitis and chronic cough were frequently misclassified as asthma using the discrimination criteria based solely on ICD-10 codes but were more likely to be appropriately classified using our proposed criteria. CONCLUSIONS Our proposed criteria adequately identified asthma subjects using health insurance claims data in Japan with a high PPV. Further studies are needed for external validation of these criteria.
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Affiliation(s)
- Yuto Hamada
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Eiji Nakatani
- Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan
| | | | | | - Kisako Nagayama
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Yasuhiro Tomita
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Kiyoshi Sekiya
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Masami Taniguchi
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan; Center for Immunology and Allergology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Yuma Fukutomi
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.
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45
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Kim JH, Ha EK, Lee SW, Cha HR, Baek HS, Han MY. Growth pattern during early infancy, body mass index during childhood and childhood asthma. Clin Exp Allergy 2023; 53:39-51. [PMID: 36032030 DOI: 10.1111/cea.14221] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 08/04/2022] [Accepted: 08/18/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is a lack of longitudinal studies of associations between growth from infancy to childhood and asthma development. OBJECTIVE The objective of the study was to investigate the effects of weight change during infancy, body mass index (BMI) and the interaction of these factors on the risk of childhood asthma. METHODS We enrolled children born in 2008 and 2009 at full-term and with normal birth weight. The weight change in infancy was grouped into slow, on-track and rapid. BMI status in childhood was stratified into low, normal and high groups and used as a time-varying variable. The outcome was asthma, defined as two or more diagnoses of asthma separated by at least 1 year after 2 years of age. The risk of asthma was assessed using Cox proportional hazard regression, with adjustment for sex, residence area at birth, economic status and feeding types in infancy. RESULTS Of 917,707 children born in Korea in 2008 and 2009, 271,871 were eligible for analysis. The risk of asthma was greater in groups with low birth weight (aHR 1.06, 95% CI 1.04 to 1.08), rapid body weight change during early infancy (aHR 1.08, 95% CI 1.07 to 1.10) and high BMI during childhood (aHR 1.06, 95% CI 1.04-1.08). The interaction of weight change during early infancy with BMI during childhood was significant for asthma (p < .01). Rapid weight gain in infancy was associated with lower risk of asthma in those with low BMI during childhood; had no association with asthma in those with normal BMI during childhood; and was associated increased asthma risk in those with high BMI during childhood-aHR 1.26 (95% CI 1.19 to 1.33) and aHR 1.33 (95% CI 1.12 to 1.56) compared with on-track and slow infant weight gain, respectively. CONCLUSION Low birth weight, high BMI during childhood and, in those with high childhood BMI, rapid weight gain during early infancy are associated with increased risk of childhood asthma.
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Affiliation(s)
- Ju Hee Kim
- Department of Pediatrics, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Eun Kyo Ha
- Department of Pediatrics, Kangnam Sacred Heart Hospital, Seoul, South Korea
| | - Seung Won Lee
- Department of Precision Medicine, Sunkyunkwan University School of Medicine, Suwon, South Korea
| | - Hye Ryeong Cha
- Department of Computer Science and Engineering, Sunkyunkwan University, Suwon, South Korea
| | - Hey-Sung Baek
- Department of Pediatrics, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Man Yong Han
- Department of Pediatrics, Bundang CHA Medical Center, CHA University School of Medicine, Seongnam, South Korea
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46
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Barber CEH, Lacaille D, Croxford R, Barnabe C, Marshall DA, Abrahamowicz M, Xie H, Avina-Zubieta JA, Esdaile JM, Hazlewood G, Faris P, Katz S, MacMullan P, Mosher D, Widdifield J. System-level performance measures of access to rheumatology care: a population-based retrospective study of trends over time and the impact of regional rheumatologist supply in Ontario, Canada, 2002-2019. BMC Rheumatol 2022; 6:86. [PMID: 36572934 PMCID: PMC9793576 DOI: 10.1186/s41927-022-00315-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 10/25/2022] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To determine whether there were improvements in rheumatology care for rheumatoid arthritis (RA) between 2002 and 2019 in Ontario, Canada, and to evaluate the impact of rheumatologist regional supply on access. METHODS We conducted a population-based retrospective study of all individuals diagnosed with RA between January 1, 2002 and December 31, 2019. Performance measures evaluated were: (i) percentage of RA patients seen by a rheumatologist within one year of diagnosis; and (ii) percentage of individuals with RA aged 66 years and older (whose prescription drugs are publicly funded) dispensed a disease modifying anti-rheumatic drug (DMARD) within 30 days after initial rheumatologist visit. Logistic regression was used to assess whether performance improved over time and whether the improvements differed by rheumatology supply, dichotomized as < 1 rheumatologist per 75,000 adults versus ≥1 per 75,000. RESULTS Among 112,494 incident RA patients, 84% saw a rheumatologist within one year: The percentage increased over time (adjusted odds ratio (OR) 2019 vs. 2002 = 1.43, p < 0.0001) and was consistently higher in regions with higher rheumatologist supply (OR = 1.73, 95% CI 1.67-1.80). Among seniors who were seen by a rheumatologist within 1 year of their diagnosis the likelihood of timely DMARD treatment was lower among individuals residing in regions with higher rheumatologist supply (OR = 0.90 95% CI 0.83-0.97). These trends persisted after adjusting for other covariates. CONCLUSION While access to rheumatologists and treatment improved over time, shortcomings remain, particularly for DMARD use. Patients residing in regions with higher rheumatology supply were more likely to access care but less likely to receive timely treatment.
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Affiliation(s)
- Claire E. H. Barber
- grid.22072.350000 0004 1936 7697Department of Medicine, University of Calgary, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Department of Community Health Sciences, University of Calgary, AB Calgary, Canada ,grid.22072.350000 0004 1936 7697McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB Canada ,Arthritis Research Canada, Vancouver, BC Canada
| | - Diane Lacaille
- Arthritis Research Canada, Vancouver, BC Canada ,grid.17091.3e0000 0001 2288 9830Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Ruth Croxford
- grid.418647.80000 0000 8849 1617ICES, Toronto, Canada
| | - Cheryl Barnabe
- grid.22072.350000 0004 1936 7697Department of Medicine, University of Calgary, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Department of Community Health Sciences, University of Calgary, AB Calgary, Canada ,grid.22072.350000 0004 1936 7697McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB Canada ,Arthritis Research Canada, Vancouver, BC Canada
| | - Deborah A. Marshall
- grid.22072.350000 0004 1936 7697Department of Medicine, University of Calgary, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Department of Community Health Sciences, University of Calgary, AB Calgary, Canada ,grid.22072.350000 0004 1936 7697McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB Canada ,Arthritis Research Canada, Vancouver, BC Canada
| | - Michal Abrahamowicz
- Arthritis Research Canada, Vancouver, BC Canada ,grid.14709.3b0000 0004 1936 8649Department of Epidemiology and Biostatistics, McGill University, Montreal, QC Canada
| | - Hui Xie
- Arthritis Research Canada, Vancouver, BC Canada ,grid.61971.380000 0004 1936 7494Faculty of Health Sciences, Simon Fraser University, Burnaby, BC Canada
| | - J. Antonio Avina-Zubieta
- Arthritis Research Canada, Vancouver, BC Canada ,grid.17091.3e0000 0001 2288 9830Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - John M. Esdaile
- Arthritis Research Canada, Vancouver, BC Canada ,grid.17091.3e0000 0001 2288 9830Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Glen Hazlewood
- grid.22072.350000 0004 1936 7697Department of Medicine, University of Calgary, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Department of Community Health Sciences, University of Calgary, AB Calgary, Canada ,grid.22072.350000 0004 1936 7697McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB Canada ,Arthritis Research Canada, Vancouver, BC Canada
| | - Peter Faris
- grid.413574.00000 0001 0693 8815Alberta Health Services, Calgary, AB Canada
| | - Steven Katz
- grid.17089.370000 0001 2190 316XDepartment of Medicine, University of Alberta, Edmonton, AB Canada
| | - Paul MacMullan
- grid.22072.350000 0004 1936 7697Department of Medicine, University of Calgary, Calgary, AB Canada
| | - Dianne Mosher
- grid.22072.350000 0004 1936 7697Department of Medicine, University of Calgary, Calgary, AB Canada
| | - Jessica Widdifield
- grid.418647.80000 0000 8849 1617ICES, Toronto, Canada ,grid.17063.330000 0001 2157 2938Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada ,grid.17063.330000 0001 2157 2938Holland Bone and Joint Program, Sunnybrook Research Institute, Toronto, Canada
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Jopling S, Wodchis WP, Rayner J, Rudoler D. Who gets access to an interprofessional team-based primary care programme for patients with complex health and social needs? A cross-sectional analysis. BMJ Open 2022; 12:e065362. [PMID: 36517102 PMCID: PMC9756166 DOI: 10.1136/bmjopen-2022-065362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To determine whether a voluntary referral-based interprofessional team-based primary care programme reached its target population and to assess the representativeness of referring primary care physicians. DESIGN Cross-sectional analysis of administrative health data. SETTING Ontario, Canada. INTERVENTION TeamCare provides access to Community Health Centre services for patients of non-team physicians with complex health and social needs. PARTICIPANTS All adult patients who participated in TeamCare between 1 April 2015 and 31 March 2017 (n=1148), and as comparators, all non-referred adult patients of the primary care providers who shared patients in TeamCare (n=546 989), and a 1% random sample of the adult Ontario population (n=117 753). RESULTS TeamCare patients were more likely to live in lower income neighbourhoods with a higher degree of marginalisation relative to comparison groups. TeamCare patients had a higher mean number of diagnoses, higher prevalence of all chronic conditions and had more frequent encounters with the healthcare system in the year prior to participation. CONCLUSIONS TeamCare reached a target population and fills an important gap in the Ontario primary care landscape, serving a population of patients with complex needs that did not previously have access to interprofessional team-based care. STRENGTHS AND LIMITATIONS This study used population-level administrative health data. Data constraints limited the ability to identify patients referred to the programme but did not receive services, and data could not capture all relevant patient characteristics.
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Affiliation(s)
- Sydney Jopling
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Rayner
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Alliance for Healthier Communities, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - David Rudoler
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada
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To T, Terebessy E, Zhu J, Zhang K, Lakey PS, Shiraiwa M, Hatzopoulou M, Minet L, Weichenthal S, Dell S, Stieb D. Does early life exposure to exogenous sources of reactive oxygen species (ROS) increase the risk of respiratory and allergic diseases in children? A longitudinal cohort study. Environ Health 2022; 21:90. [PMID: 36184638 PMCID: PMC9528154 DOI: 10.1186/s12940-022-00902-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 09/12/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND Excess reactive oxygen species (ROS) can cause oxidative stress damaging cells and tissues, leading to adverse health effects in the respiratory tract. Yet, few human epidemiological studies have quantified the adverse effect of early life exposure to ROS on child health. Thus, this study aimed to examine the association of levels of ROS exposure at birth and the subsequent risk of developing common respiratory and allergic diseases in children. METHODS 1,284 Toronto Child Health Evaluation Questionnaire (T-CHEQ) participants were followed from birth (born between 1996 and 2000) until outcome, March 31, 2016 or loss-to-follow-up. Using ROS data from air monitoring campaigns and land use data in Toronto, ROS concentrations generated in the human respiratory tract in response to inhaled pollutants were estimated using a kinetic multi-layer model. These ROS values were assigned to participants' postal codes at birth. Cox proportional hazards regression models, adjusted for confounders, were then used to estimate hazard ratios (HR) with 95% confidence intervals (CI) per unit increase in interquartile range (IQR). RESULTS After adjusting for confounders, iron (Fe) and copper (Cu) were not significantly associated with the risk of asthma, allergic rhinitis, nor eczema. However, ROS, a measure of the combined impacts of Fe and Cu in PM2.5, was associated with an increased risk of asthma (HR = 1.11, 95% CI: 1.02-1.21, p < 0.02) per IQR. There were no statistically significant associations of ROS with allergic rhinitis (HR = 0.96, 95% CI: 0.88-1.04, p = 0.35) and eczema (HR = 1.03, 95% CI: 0.98-1.09, p = 0.24). CONCLUSION These findings showed that ROS exposure in early life significantly increased the childhood risk of asthma, but not allergic rhinitis and eczema.
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Affiliation(s)
- Teresa To
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Canada.
- ICES, Ontario, Canada.
| | - Emilie Terebessy
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Jingqin Zhu
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Canada
- ICES, Ontario, Canada
| | - Kimball Zhang
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Canada
- ICES, Ontario, Canada
| | - Pascale Sj Lakey
- Department of Chemistry, University of California Irvine, Irvine, USA
| | - Manabu Shiraiwa
- Department of Chemistry, University of California Irvine, Irvine, USA
| | - Marianne Hatzopoulou
- Department of Civil and Mineral Engineering, University of Toronto, Toronto, Canada
| | - Laura Minet
- Department of Civil Engineering, University of Victoria, Victoria, Canada
| | - Scott Weichenthal
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- Water and Air Quality Bureau, Health Canada, Ottawa, Canada
| | - Sharon Dell
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Pediatric Respiratory Medicine, Provincial Health Services Authority, BC Children's Hospital, Vancouver, Canada
| | - Dave Stieb
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Canada
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Clemens KK, Ouédraogo AM, Le B, Voogt J, MacDonald M, Stranberg R, Yan JW, Krayenhoff ES, Gilliland J, Forchuk C, Van Uum R, Shariff SZ. Impact of Ontario's Harmonized Heat Warning and Information System on emergency department visits for heat-related illness in Ontario, Canada: a population-based time series analysis. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2022; 113:686-697. [PMID: 35982292 PMCID: PMC9481795 DOI: 10.17269/s41997-022-00665-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
INTERVENTION Ontario's Harmonized Heat Warning and Information System (HWIS) brings harmonized, regional heat warnings and standard heat-health messaging to provincial public health units prior to periods of extreme heat. RESEARCH QUESTION Was implementation of the harmonized HWIS in May 2016 associated with a reduction in emergency department (ED) visits for heat-related illness in urban locations across Ontario, Canada? METHODS We conducted a population-based interrupted time series analysis from April 30 to September 30, 2012-2018, using administrative health and outdoor temperature data. We used autoregressive integrated moving average models to examine whether ED rates changed following implementation of the harmonized HWIS, adjusted for maximum daily temperature. We also examined whether effects differed in heat-vulnerable groups (≥65 years or <18 years, those with comorbidities, those with a recent history of homelessness), and by heat warning region. RESULTS Over the study period, heat alerts became more frequent in urban areas (6 events triggered between 2013 and 2015 and 14 events between 2016 and 2018 in Toronto, for example). The mean rate of ED visits was 47.5 per 100,000 Ontarians (range 39.7-60.1) per 2-week study interval, with peaks from June to July each year. ED rates were particularly high in those with a recent history of homelessness (mean rate 337.0 per 100,000). Although rates appeared to decline following implementation of HWIS in some subpopulations, the change was not statistically significant at a population level (rate 0.04, 95% CI: -0.03 to 0.1, p=0.278). CONCLUSION In urban areas across Ontario, ED encounters for heat-related illness may have declined in some subpopulations following HWIS, but the change was not statistically significant. Efforts to continually improve HWIS processes are important given our changing Canadian climate.
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Affiliation(s)
- Kristin K Clemens
- Department of Medicine, Western University, London, Ontario, Canada.
- ICES, Toronto, Ontario, Canada.
- St. Joseph's Health Care London, 268 Grosvenor Street, London, Ontario, N6A 4V2, Canada.
| | | | | | - James Voogt
- Department of Geography and Environment, Western University, London, Ontario, Canada
| | - Melissa MacDonald
- Environment and Climate Change Canada, Dartmouth, Nova Scotia, Canada
| | - Rebecca Stranberg
- Consumer and Hazardous Products Safety Directorate, Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, Ontario, Canada
| | - Justin W Yan
- Division of Emergency Medicine, Western University, London, Ontario, Canada
| | - E Scott Krayenhoff
- School of Environmental Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Jason Gilliland
- Department of Geography and Environment, Western University, London, Ontario, Canada
- Department of Pediatrics, Western University, London, Ontario, Canada
| | - Cheryl Forchuk
- School of Health Studies, Western University, London, Ontario, Canada
| | - Rafique Van Uum
- Department of Science, University of Toronto, Toronto, Ontario, Canada
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50
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Joumaa H, Sigogne R, Maravic M, Perray L, Bourdin A, Roche N. Artificial intelligence to differentiate asthma from COPD in medico-administrative databases. BMC Pulm Med 2022; 22:357. [PMID: 36127649 PMCID: PMC9487098 DOI: 10.1186/s12890-022-02144-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 08/26/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Discriminating asthma from chronic obstructive pulmonary disease (COPD) using medico-administrative databases is challenging but necessary for medico-economic analyses focusing on respiratory diseases. Artificial intelligence (AI) may improve dedicated algorithms. OBJECTIVES To assess performance of different AI-based approaches to distinguish asthmatics from COPD patients in medico-administrative databases where the clinical diagnosis is absent. An "Asthma COPD Overlap" category was defined to further test whether AI can detect complexity. METHODS This study included 178,962 patients treated by two "R03" treatment prescriptions at least from January 2016 to December 2018 and managed by either a general practitioner and/or a pulmonologist participating in a permanent longitudinal observatory of prescription in ambulatory medicine (LPD). Clinical diagnoses are available in this database and were used as gold standards to develop diagnostic rules. Three types of AI approaches were explored using data restricted to demographics and treatment dispensations: multinomial regression, gradient boosting and recurrent neural networks (RNN). The best performing model (based on metric properties) was then applied to estimate the size of asthma and COPD populations based on a database (LRx) of treatment dispensations between July, 2018 and June, 2019. RESULTS The best models were obtained with the boosting approach and RNN, with an overall accuracy of 68%. Performance metrics were better for asthma than COPD. Based on LRx data, the extrapolated numbers of patients treated for asthma and COPD in France were 3.7 and 1.2 million, respectively. Asthma patients were younger than COPD patients (mean, 49.9 vs. 72.1 years); COPD occurred mostly in men (68%) compared to asthma (33%). CONCLUSION AI can provide models with acceptable accuracy to distinguish between asthma, ACO and COPD in medico-administrative databases where the clinical diagnosis is absent. Deep learning and machine learning (RNN) had similar performances in this regard.
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Affiliation(s)
- Hassan Joumaa
- Department of Respiratory Medicine, Cochin Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.
| | | | - Milka Maravic
- IQVIA, La Défense, France.,Hôpital Lariboisière, Rhumatologie, Paris, France
| | | | - Arnaud Bourdin
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier, Montpellier, France.,Department of Respiratory Medicine, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France
| | - Nicolas Roche
- Department of Respiratory Medicine, Cochin Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,University Paris Descartes (EA2511), Paris, France
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