Suchergebnisse

AbstractObjectivesThe goals of this study were to examine and compare (a) the annual adult mortality rates and (b) the most commonly reported underlying causes of death between a cohort of Manitobans with intellectual and developmental disabilities (IDD) and a matched comparison group without IDD.MethodsUsing linked health and nonhealth administrative data, a cohort of Manitoba adults with IDD, aged 25–99 years in 2012, was identified. Each person in the study cohort was matched with three persons without IDD based on age, sex, region of residence, and morbidity level. The two groups were followed for three years (2013–2015). Crude annual adult mortality rates and avoidable premature mortality rates were calculated. The leading causes of death over the 3‐year study period were tabulated by ICD‐10 chapter. Coding of the underlying causes of death was reviewed.ResultsThe crude annual mortality rates for Manitoba adults with IDD were 1.8–2.4 times higher than those for the matched comparison group and remained stable over time. Disparities in mortality rates for the IDD cohort relative to the matched comparison group decreased with increasing age. No significant sex differences were found. The leading causes of death among the IDD cohort were diseases of the circulatory system, cancer, and diseases of the respiratory system. Avoidable premature deaths were 2.3–3.3 times more prevalent among Manitoba adults with IDD compared to the matched comparison group. An IDD diagnostic code was reported as cause of death in 2.11% of cases.ConclusionsThe excess mortality among adults with IDD should be monitored in Manitoba and all other jurisdictions and attention paid to the causes of death and their coding.

OBJECTIVES: We investigated the effect of drug coverage on viral suppression (sVL) in Ontario, Canada, where there is no universal coverage of prescription drugs, including antiretroviral therapy (ART). METHODS: Ontarians without employment coverage may be eligible for varying degrees of coverage through government-sponsored programs. Remaining individuals pay all expenses entirely out of pocket. Among participants on ART enrolled in the Ontario HIV Treatment Network Cohort Study (OCS) who were interviewed in 2008–2013 with known or imputable drug coverage, we estimated the prevalence with sVL (< 200 copies/mL) as of their last viral load each year. We calculated prevalence ratios (PR) according to time-updated socio-economic and behavioural factors using multivariable generalized estimating equations with a log-link function. Multiple imputation was used to assess the sensitivity of these findings to different assumed missing data models. RESULTS: One thousand two hundred forty-seven participants were included (3463 person-years). Compared to study participants with employer coverage, individuals covered through the Ontario Drug Benefit (ODB) were less likely to be suppressed (PR, 95% confidence interval (CI) 0.96, 0.93–0.98). After multivariable adjustment, ODB remained independently associated with less success in achieving sVL (adjusted PR, 95% CI 0.98, 0.95–0.99). These findings were robust to different assumptions about the missing data. CONCLUSION: Our findings suggest that drug coverage can affect viral suppression in our setting. Further research is needed to identify the mechanisms by which coverage interacts with individual patient factors to affect viral suppression. Mechanisms to improve access and coverage for ART are needed. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.17269/s41997-018-0104-z) contains supplementary material, which is available to authorized users.