Cognitive testing of the Colon Cancer Screening Behaviours Survey with South Asian immigrants in Canada

The purpose of this study was to cognitively test the Urdu and English language versions of a survey to assess colon cancer screening behaviours among South Asian immigrants in Canada.Brock University Library Open Access Publishing Fun

Evidence generation and reproducibility in cell and gene therapy research: A call to action.

Editoria

Averting an impending storm: can we reengineer health systems to meet the needs of aging populations?

Arlene Bierman discusses new research findings from a randomized trial evaluating community-based nursing interventions in older adults, and and comments on how we need to to re-engineer health systems to provide greater quality of care

Performance measurement and equity

To maximise benefits and minimise harm, equity must be built in from the star

Neighborhood walkability and pre-diabetes incidence in a multiethnic population

Introduction We examined whether adults living in highly walkable areas are less likely to develop pre-diabetes and if so, whether this association is consistent according to immigration status and ethnicity.Research design and methods Population-level health, immigration, and administrative databases were used to identify adults aged 20–64 (n=1 128 181) who had normoglycemia between January 2011 and December 2011 and lived in one of 15 cities in Southern Ontario, Canada. Individuals were assigned to one of ten deciles (D) of neighborhood walkability (from lowest (D1) to highest (D10)) and followed until December 2013 for the development of pre-diabetes.Results Overall, 220 225 individuals in our sample developed pre-diabetes during a median follow-up of 8.4 years. Pre-diabetes incidence was 20% higher among immigrants living in the least (D1) (adjusted HR 1.20, 95% CI 1.15 to 1.25, p<0.0001) versus most (D10, referent) walkable neighborhoods after accounting for age, sex, and area income. Findings were similar among long-term residents and across sexes. However, susceptibility to walkability varied by ethnicity where D1 versus D10 adjusted HRs ranged from 1.17 (95% CI 1.02 to 1.35, p=0.03) among West Asian and Arab immigrants to 1.32 (95% CI 1.19 to 1.47, p<0.0001) in Southeast Asians. Ethnic variation in pre-diabetes incidence was more marked in low walkability settings. Relative to Western Europeans, the adjusted HR for pre-diabetes incidence was 2.11 (95% CI 1.81 to 2.46, p<0.0001) and 1.50 (95% CI 1.27 to 1.77, p<0.0001) among Sub-Saharan African and the Carribean and Latin American immigrants, respectively, living in the least walkable (D1) neighborhoods, but only 1.24 (95% CI 1.08 to 1.42, p=0.002) and 1.00 (95% CI 0.87 to 1.15, p=0.99) for these same groups living in the most walkable (D10) neighborhoods.Conclusions Pre-diabetes incidence was reduced in highly walkable areas for most groups living in Southern Ontario cities. These findings suggest a potential role for walkable urban design in diabetes prevention

Ethnic variation in the conversion of prediabetes to diabetes among immigrant populations relative to Canadian-born residents: a population-based cohort study

ObjectiveThe aim of this study was to compare absolute and relative rates of conversion from prediabetes to diabetes among non-European immigrants to Europeans and Canadian-born residents, overall, and by age and level of glycemia.Research design and methodsWe conducted a retrospective cohort population-based study using administrative health databases from Ontario, Canada, to identify immigrants (n=23 465) and Canadian born (n=1 11 085) aged ≥20 years with prediabetes based on laboratory tests conducted between 2002 and 2011. Individuals were followed until 31 December 2013 for the development of diabetes using a validated algorithm. Immigration data was used to assign ethnicity based on country of origin, mother tongue, and surname. Fine and Gray’s survival models were used to compare diabetes incidence across ethnic groups overall and by age and glucose category.ResultsOver a median follow-up of 5.2 years, 8186 immigrants and 39 722 Canadian-born residents developed diabetes (7.1 vs 6.1 per 100 person-years, respectively). High-risk immigrant populations such as South Asians (HR: 1.72, 95% CI 1.55 to 1.99) and Southeast Asians (HR: 1.65, 95% CI 1.46 to 1.86) had highest risk of converting to diabetes compared with Western Europeans (referent). Among immigrants aged 20–34 years, the adjusted cumulative incidence ranged from 18.4% among Eastern Europeans to 52.3% among Southeast Asians. Conversion rates increased with age in all groups but were consistently high among South Asians, Southeast Asians and Sub-Saharan African/Caribbeans after the age of 35 years. On average, South Asians converted to diabetes 3.1–4.6 years earlier than Western Europeans and at an equivalent rate of conversion to Western Europeans who had a 0.5 mmol/L higher baseline fasting glucose value.ConclusionsHigh-risk ethnic groups converted to diabetes more rapidly, at younger ages, and at lower fasting glucose values than European populations, leading to a shorter window for diabetes prevention

Using decision trees for measuring gender equity in the timing of angiography in patients with acute coronary syndrome: a novel approach to equity analysis

Abstract Background Methods to measure or quantify equity in health care remain scarce, if not difficult to interpret. A novel method to measure health equity is presented, applied to gender health equity, and illustrated with an example of timing of angiography in patients following a hospital admission for an acute coronary syndrome. Methods Linked administrative hospital discharge and survey data was used to identify a retrospective cohort of patients hospitalized with Acute Coronary Syndrome (ACS) between 2002 and 2008 who also responded to the Canadian Community Health Survey (CCHS), was analyzed using decision trees to determine whether gender impacted the delay to angiography following an ACS. Results Defining a delay to angiography as 1 day or more, resulted in a non-significant difference in an equity score of 0.14 for women and 0.12 for men, where 0 and 1 represents perfect equity and inequity respectively. Using 2 and 3 day delays as a secondary outcome resulted in women and men producing scores of 0.19 and 0.17 for a 2 day delay and 0.22 and 0.23 for a 3 day delay. Conclusions A technique developed expressly for measuring equity suggests that men and women in Ontario receive equitable care in access to angiography with respect to timeliness following an ACS