Suchergebnisse

IntroductionAvoidable hospitalizations refer to acute care use for conditions that should normally be managed inprimary care settings. Lower socioeconomic status that is often measured using area-based indicators(e.g. median household income) has been shown to increase risk of avoidable hospitalizations.However, both area- and individual-level socioeconomic status can contribute to hospitalization risk,but previous data limitations have prevented separate analyses. Further, the joint effect of individualand neighbourhood socioeconomic status has not been established in the Canadian population. Toaddress this, this study links individual-level household income and neighbourhood-level materialdeprivation data within a population-based Canadian cohort.
ObjectivesTo determine the individual and joint effect of individual-level household income and neighbourhood-level material deprivation on risk of hospitalization for a set of chronic ambulatory care sensitiveconditions using linked health survey, hospital discharge, and census-derived data.
MethodsA pooled cohort was created by linking sociodemographic and health information from eight cycles ofthe Canadian Community Health Survey (2000/2001 - 2010) to hospital discharge records and Cana-dian Marginalization Indices (2001, 2006) (N = 354,595). The primary outcome variable was riskof index hospitalization with a primary diagnosis of angina, asthma, congestive heart failure, chronicobstructive pulmonary disease, diabetes, epilepsy, or hypertension. The primary exposure variablewas joint individual-level national household income quintile and neighbourhood-level material de-privation quintile. Relative risk (RR) was estimated by constructing modified Poisson regressionmodels with robust error variance.
ResultsIn fully adjusted models with income and deprivation considered separately, individuals in the lowesthousehold income quintile and highest material deprivation quintile were at increased risk of hospi-talization (Income RR: 1.82 (95% CI 1.56-2.13) Deprivation RR: 1.67 (1.44-1.95)). When incomeand deprivation were jointly considered, those with low individual income living in high deprivationneighbourhoods were at greatest risk of hospitalization (RR 1.83 (95% CI 1.63 - 2.05)).
ConclusionsBoth individual income and neighbourhood deprivation separately and jointly increase risk of avoid-able hospitalizations. Additional research is needed to understand their mechanisms of action.However, both levels should be considered when designing effective policies and interventions toreduce avoidable hospitalizations.

To prevent exponential spread of COVID-19, many governments restricted economic activity through lockdowns. We model these restrictions as shocks to productivity by sector and trace total equilibrium effects across the economy using techniques from production network economics. We combine this economic model with an epidemiological model of income shocks to long-term health. On both long-run health and economic grounds, it is better to keep upstream sectors such as transportation, manufacturing, and wholesale open than consumer-facing sectors such as retail and restaurants.

Funding This project was funded as an Applied Health Research Question (AHRQ), a process by which government-funded research organisations are funded to answer questions from relevant knowledge users. The Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC), was funded to carry out this AHRQ research question on behalf of Public Health Ontario, Ontario's expert technical and scientific public health organisation. ; Background: Historically, women have lower all-cause mortality than men. It is less understood that sex differences have been converging, particularly among certain subgroups and causes. This has implications for public health and health system planning. Our objective was to analyse contemporary sex differences over a 20-year period. Methods: We analysed data from a population-based death registry, the Ontario Registrar's General Death file, which includes all deaths recorded in Canada's most populous province, from 1992 to 2012 (N=1 710 080 deaths). We calculated absolute and relative mortality sex differences for all-cause and cause-specific mortality, age-adjusted and age-specific, including the following causes: circulatory, cancers, respiratory and injuries. We used negative-binomial regression of mortality on socioeconomic status with direct age adjustment for the overall population. Results: In the 20-year period, age-adjusted mortality dropped 39.2% and 29.8%, respectively, among men and women. The age-adjusted male-to-female mortality ratio dropped 41.4%, falling from 1.47 to 1.28. From 2000 onwards, all-cause mortality rates of high-income men were lower than those seen among low-income women. Relative mortality declines were greater among men than women for cancer, respiratory and injury-related deaths. The absolute decline in circulatory deaths was greater among men, although relative deciles were similar to women. The largest absolute mortality gains were seen among men over the age of 85 years. Conclusions: The large decline in mortality sex ratios in a Canadian province with universal healthcare over two decades signals an important population shift. These narrowing trends varied according to cause of death and age. In addition, persistent social inequalities in mortality exist and differentially affect men and women. The observed change in sex ratios has implications for healthcare and social systems. ; Publisher PDF ; Peer reviewed

Background: People experiencing homelessness have diverse patterns of healthcare use. This study examined the distribution and determinants of healthcare encounters among adults with a history of homelessness. Methods: Administrative healthcare records were linked with survey data for a general cohort of adults with a history of homelessness and a cohort of homeless adults with mental illness. Binary and count models were used to identify factors associated with hospital admissions, emergency department visits and physician visits for comparison across the 2 cohorts. Results: During the 1-year follow-up period, a higher proportion of people in the cohort with a mental illness used any inpatient (27% vs 14%), emergency (63% vs 53%), or physician services (90% vs 76%) compared to the general homeless cohort. People from racialized groups were less likely use nearly all health services, most notably physician services. Other factors, such as reporting of a regular source of care, poor perceived general health, and diagnosed chronic conditions were associated with higher use of all health services except psychiatric inpatient care Conclusion: When implementing interventions for patients with the greatest health needs, we must consider the unique factors that contribute to higher healthcare use, as well as the barriers to healthcare access.

INTRODUCTION: Aspects of the built environment that support physical activity are associated with better population health outcomes. Few experimental data exist to support these observations. This protocol describes the study of the creation of urban trials on cardiovascular disease (CVD)-related morbidity and mortality in a large urban centre. METHODS AND ANALYSIS: Between 2008 and 2010, the city of Winnipeg, Canada, built four, paved, multiuse (eg, cycling, walking and running), two-lane trails that are 5–8 km long and span ~60 neighbourhoods. Linking a population-based health data with census and environmental data, we will perform an interrupted time series analysis to assess the impact of this natural experiment on CVD-related morbidity and mortality among individuals 30–65 years of age residing within 400–1200 m of the trail. The primary outcome of interest is a composite measure of incident major adverse CVD events (ie, CVD-related mortality, ischaemic heart disease, stroke and congestive heart failure). The secondary outcome of interest is a composite measure of incident CVD-related risk factors (ie, diabetes, hypertension and dyslipidaemia). Outcomes will be assessed quarterly in the 10 years before the intervention and 5 years following the intervention, with a 4-year interruption. We will adjust analyses for differences in age, sex, ethnicity, immigration status, income, gentrification and other aspects of the built environment (ie, greenspace, fitness/recreation centres and walkability). We will also assess trail use and trail user profiles using field data collection methods. ETHICS AND DISSEMINATION: Ethical approvals for the study have been granted by the Health Research Ethics Board at the University of Manitoba and the Health Information Privacy Committee within the Winnipeg Regional Health Authority. We have adopted an integrated knowledge translation approach. Information will be disseminated with public and government partners. TRIAL REGISTRATION NUMBER: NCT04057417.

Objective and ApproachSedative-hypnotic medications are associated with harms such as delirium and falls, and may be overprescribed in hospitals. Measuring potentially inappropriate in-hospital sedative-hypnotic prescriptions requires distinguishing new initiations from pre-hospital prescriptions, but pre-hospital medications may not be captured in hospital data. To quantify physician- and hospital-level variation in sedative-hypnotic prescribing, we use linked data between GEMINI (which includes EMR data from >1.8 million admissions across 30 hospitals, approximately 60% of medical inpatient beds in Ontario) and ICES (which houses administrative healthcare databases, including outpatient prescriptions for adults ≥65 years). We will validate whether data in hospital clinical notes or pharmacy records can reliably identify pre-hospital prescriptions.
ResultsUsing provincial health insurance number, 98.1% of GEMINI records could successfully be linked deterministically to ICES. Our exploratory sedative-hypnotic cohort included 90,806 general medicine patients treated by 437 physicians from 17 hospitals across Ontario from 2021-2022. Median age was 72 years and 48.7% were female. The proportion of patients receiving a new sedative-hypnotic prescription varied markedly across hospitals (median 0.21, range 0.04-0.41) and across physicians within hospitals (median within-hospital difference between lowest and highest prescriber: 0.18, range of within-hospital differences 0.07-0.67). Validation of new rather than continued prescriptions is underway. Full results will be ready for presentation at the conference.
ConclusionSedative-hypnotic prescribing is common and highly variable in hospitals across Ontario, indicating an opportunity to improve patient safety.
Implications Based on these analyses, the province of Ontario has made reducing in-hospital sedative-hypnotic prescribing a provincial priority for 2023-2024.