Understanding the social determinants of opioid related hospitalizations

Introduction The current opioid crisis is recognized by governments at many levels as an urgent priority. While there is basic demographic information on who experiences opioid related adverse events, there is little information to provide a more fulsome profile of those experiencing these events for targeted intervention and forward projection estimation. Objectives and Approach This study is the first to use a nationally-representative Census of Population linked with health administrative data to examine opioid-related hospitalization patterns across income and Aboriginal status. Results Preliminary analyses using 2006 Census-hospital linked database found cohort rates of opioid-related hospitalizations are up to 7 times higher among Aboriginal youth, and also for young adults (12-19/ 20-24) compared with non-Aboriginal youth or young adults. Rates among these youth living on reserves were 8.4 times higher; among those off reserve 8.7 times higher. Rate among all youth living in lower income households was 5 times higher compared with those living in highest income households, For Aboriginal persons in lowest income quintile, the rate was 3 times higher relative to non-Aboriginal persons in same quintille. Conclusion/Implications New linked health data reveal new information regarding the profile of those who experienced opioid-related adverse events. This information will serve to inform targeted intervention strategies, models for forward estimation of events

Childbirth-Related Hospital Burden by Socioeconomic Status in a Universal Health Care Setting

Introduction Hospital utilization varies across socioeconomic and demographic strata in Canada, which has a universal health care system that grants essential services to everyone. Rates of adverse birth outcomes are known to differ among high and low SES women, but less is known of the excess burden attached to those outcomes across Canadian provinces. Objective To examine length of stay for childbirth relative to women’s socio-demographic characteristics, in the context of the Canadian universal health care system. Methods A population-based record linkage between the Canadian Community Health Survey (CCHS) cycles 3.1 (2005) and 4.1 (2007/8), and the Discharge Abstract Database (DAD) allowed the tracking of hospital utilization for linked survey respondents between 2005 and 2009. Hourly length of stay for delivery was modeled by socio-demographic factors, controlling for other clinical and individual-level characteristics. Results There were 7,166 complete delivery records from 5,570 female CCHS respondents who agreed to link and share their information. Women with the lowest income had on average, four-hour longer stays for vaginal delivery as compared to high-income women (IRR 1.07, 95% CI 1.02-1.13, p=0.01), and eight-hour longer stays for Caesarian delivery (IRR 1.08, 95% CI 0.95-1.22, p=0.23). A greater proportion of teenage pregnancy was seen for Aboriginal girls. Aboriginal status and rural area of residence were co-determinants of elevated length of stay. Conclusion The absence of egregious socio-demographic differences regarding childbirth is reassuring for the Canadian health care system. However, the persistence of marginally longer, and in turn, costlier visits for low-income and rural Aboriginal women is suggestive that policies of cash transfers during the prenatal period might be highly cost-effective if they achieve population-wide reductions in length of stay

Neighbourhood built environments as correlates of hospital burden and premature mortality in Canada

Introduction The built environment can shape modifiable risk factors such as obesity, poor diet, and physical inactivity, and could be a policy lever for the reduction of chronic disease. In Canada, the health care costs related to chronic disease continue to rise and there have been few policy options offered. Objectives and Approach We examine the role of the built environment in hospital burden and premature mortality, with an emphasis on one of the highest burden diseases, Type 2 Diabetes (T2D). Neighbourhood built environment measures for active living were derived using geographic information systems for respondents of the Canadian Community Health Survey, for whom we have linked hospitalization and mortality records. A combination of ICD codes, self-reported diabetes status, as well as a population-based algorithm identifying those at higher risk of developing diabetes were used to identify cases. Differences in hospitalization frequency, cumulative length of stay, and mortality are investigated. Results Over half a million hospitalization records were identified in our cohort of roughly 450,000 survey respondents. Key factors such as age, gender, race, and socioeconomic status are accounted for in modelling the association between neighborhood environment and hospitalization. Hospital burden and mortality in T2D patients are much higher than that of patients who do not report having the condition, and those at elevated risk of T2D display intermediate levels of hospitalization. Two-part hurdle models show evidence of an association between more walkable neighborhoods and lower hospitalization risk in non-T2D patients as well as those at elevated risk of developing T2D. The relationship between neighborhoods and the volume of chronic-disease related episodes as well as mortality is unclear, and under further investigation. Conclusion/Implications Elucidating the role of neighbourhood built environments on hospital burden and premature mortality for individuals with diabetes will provide insight as to the full range of clinical and non-clinical interventions that could feasibly address the needs of some the highest health care system users

A pan-Canadian dataset of neighbourhood retail food environment measures using Statistics Canada's Business Register.

BACKGROUND: The objective of this study was to create the Canadian Food Environment Dataset (Can-FED) and to demonstrate its validity. DATA AND METHODS: Food outlet data were extracted from Statistics Canada's Business Register (BR) in 2018. Retail food environment access measures (both absolute and relative measures) were calculated using network buffers around the centroid of 56,589 dissemination areas in Canada. A k-medians clustering approach was used to create categorical food environment variables that were easy to use and amenable to dissemination. Validity of the measures was assessed by comparing the food environment measures from Can-FED with measures created using Enhanced Points of Interest data by DMTI Spatial Inc. and data from a municipal health inspection list. Validity was also assessed by calculating the geographic variability in food environments across census metropolitan areas (CMAs) and assessing associations between CMA-level food environments and CMA-level health indicators. RESULTS: Two versions of Can-FED were created: a researcher file that must be accessed within a secure Statistics Canada environment and a general-use file available online. Agreement between Can-FED food environment measures and those derived from a proprietary dataset and a municipal health inspection list ranged from rs=0.28 for convenience store density and rs=0.53 for restaurant density. At the CMA level, there is wide geographic variation in the food environment with evidence of patterning by health indicators. INTERPRETATION: Can-FED is a valid and accessible dataset of pan-Canadian food environment measures that was created from the BR, a data source that has not been explored fully for health research

Comparison of mortality hazard ratios associated with health behaviours in Canada and the United States:a population-based linked health survey study

Background Modern health surveillance and planning requires an understanding of how preventable risk factors impact population health, and how these effects vary between populations. In this study, we compare how smoking, alcohol consumption, diet and physical activity are associated with all-cause mortality in Canada and the United States using comparable individual-level, linked population health survey data and identical model specifications. Methods The Canadian Community Health Survey (CCHS) (2003–2007) and the United States National Health Interview Survey (NHIS) (2000, 2005) linked to individual-level mortality outcomes with follow up to December 31, 2011 were used. Consistent variable definitions were used to estimate country-specific mortality hazard ratios with sex-specific Cox proportional hazard models, including smoking, alcohol, diet and physical activity, sociodemographic indicators and proximal factors including disease history. Results A total of 296,407 respondents and 1,813,884 million person-years of follow-up from the CCHS and 58,232 respondents and 497,909 person-years from the NHIS were included. Absolute mortality risk among those with a ‘healthy profile’ was higher in the United States compared to Canada, especially among women. Adjusted mortality hazard ratios associated with health behaviours were generally of similar magnitude and direction but often stronger in Canada. Conclusion Even when methodological and population differences are minimal, the association of health behaviours and mortality can vary across populations. It is therefore important to be cautious of between-study variation when aggregating relative effect estimates from differing populations, and when using external effect estimates for population health research and policy development

Comparison of Health Behaviour Mortality Hazards in Canada and the United States

Introduction National health surveys, available in over 100 countries, are the most common data used for health behaviour surveillance and are increasingly being linked to individual-level health outcomes. We propose that improved health behaviour hazard estimates can be obtained from pooled international population health surveys linked to outcome data. Objectives and Approach The objective of this study was to compare smoking, alcohol, diet and physical activity all-cause mortality hazards in Canada and the United States using individual-level, linked population health survey data and common model specifications. The Canadian Community Health Survey (CCHS) (2003-2007) and the United States National Health Interview Survey (NHIS) (2000, 2005) linked to individual-level mortality outcomes with follow up to December 31, 2011 were used. Variable definitions consistent across the CCHS and NHIS were developed and used to estimate country-specific mortality hazards with sex-specific Cox proportional hazard models, including health behaviours, sociodemographic indicators and proximal factors including disease history. Results A total of 296,407 respondents and 1,813,884 million person-years of follow-up from the CCHS and 62,226 respondents and 497,909 person-years from the NHIS were included. Hazards of smoking, alcohol consumption, diet and physical activity in Canada and the United States are of similar magnitude and direction, with similar dose response relationships. The largest health behaviour mortality hazards were associated with female heavy smokers in both Canada (HR: 3.36, 95% CI: 2.86, 3.95) and the United States (Female HR: 2.63, 95% CI: 2.11, 3.27), compared to non-smokers. Conclusion/Implications Health behaviour mortality hazards are comparable in Canada and the United States, supporting the use of hazards obtained from pooled analyses for population heath. These hazards can replace those obtained from independent epidemiology studies that are often incompletely adjusted, rarely population-based and often not generalizable to the population of interest

International population-based health surveys linked to outcome data:A new resource for public health and epidemiology

Background: National health surveys linked to vital statistics and health care information provide a growing source of individual-level population health data. Pooling linked surveys across jurisdictions would create comprehensive datasets that are larger than most existing cohort studies, and that have a unique international and population perspective. This paper’s objectives are to examine the feasibility of pooling linked population health surveys from three countries, facilitate the examination of health behaviours, and present useful information to assist in the planning of international population health surveillance and research studies. Methods: The design, methodologies and content of the Canadian Community Health Survey (2003 to 2008), the United States National Health Interview Survey (2000, 2005) and the Scottish Health Survey (SHeS) (2003, 2008 to 2010) were examined for comparability and consistency. The feasibility of creating common variables for measuring smoking, alcohol consumption, physical activity and diet was assessed. Sample size and estimated mortality events were collected. Results: The surveys have comparable purposes, designs, sampling and administration methodologies, target populations, exclusions, and content. Similar health behaviour questions allow for comparable variables to be created across the surveys. However, the SHeS uses a more detailed risk factor evaluation for alcohol consumption and diet data. Therefore, comparisons of alcohol consumption and diet data between the SHeS and the other two surveys should be performed with caution. Pooling these linked surveys would create a dataset with over 350,000 participants, 28,424 deaths and over 2.4 million person-years of follow-up. Conclusions: Pooling linked national population health surveys could improve population health research and surveillance. Innovative methodologies must be used to account for survey dissimilarities, and further discussion is needed on how to best access and analyze data across jurisdictions

Observation of J/ψpJ/\psi p resonances consistent with pentaquark states in Λb0→J/ψK−p{\Lambda_b^0\to J/\psi K^-p} decays

Observations of exotic structures in the $J/\psi p$ channel, that we refer to as pentaquark-charmonium states, in $\Lambda_b^0\to J/\psi K^- p$ decays are presented. The data sample corresponds to an integrated luminosity of 3/fb acquired with the LHCb detector from 7 and 8 TeV pp collisions. An amplitude analysis is performed on the three-body final-state that reproduces the two-body mass and angular distributions. To obtain a satisfactory fit of the structures seen in the $J/\psi p$ mass spectrum, it is necessary to include two Breit-Wigner amplitudes that each describe a resonant state. The significance of each of these resonances is more than 9 standard deviations. One has a mass of $4380\pm 8\pm 29$ MeV and a width of $205\pm 18\pm 86$ MeV, while the second is narrower, with a mass of $4449.8\pm 1.7\pm 2.5$ MeV and a width of $39\pm 5\pm 19$ MeV. The preferred $J^P$ assignments are of opposite parity, with one state having spin 3/2 and the other 5/2.Comment: 48 pages, 18 figures including the supplementary material, v2 after referee's comments, now 19 figure

Quantum numbers of the X(3872)X(3872) state and orbital angular momentum in its ρ0Jψ\rho^0 J\psi decay

Angular correlations in $B^+\to X(3872) K^+$ decays, with $X(3872)\to \rho^0 J/\psi$, $\rho^0\to\pi^+\pi^-$ and $J/\psi \to\mu^+\mu^-$, are used to measure orbital angular momentum contributions and to determine the $J^{PC}$ value of the $X(3872)$ meson. The data correspond to an integrated luminosity of 3.0 fb$^{-1}$ of proton-proton collisions collected with the LHCb detector. This determination, for the first time performed without assuming a value for the orbital angular momentum, confirms the quantum numbers to be $J^{PC}=1^{++}$. The $X(3872)$ is found to decay predominantly through S wave and an upper limit of $4\%$ at $95\%$ C.L. is set on the fraction of D wave.Comment: 16 pages, 4 figure

Precise measurements of the properties of the B-1(5721)(0,+) and B-2*(5747)(0,+) states and observation of B-+,B-0 pi(-,+) mass structures

Invariant mass distributions of B+π− and B0π+ combinations are investigated in order to study excited B mesons. The analysis is based on a data sample corresponding to 3.0 fb−1 of pp collision data, recorded by the LHCb detector at centre-of-mass energies of 7 and 8 TeV. Precise measurements of the masses and widths of the B1(5721)0,+ and B2(5747)0,+ states are reported. Clear enhancements, particularly prominent at high pion transverse momentum, are seen over background in the mass range 5850-6000 MeV in both B+π− and B0π+ combinations. The structures are consistent with the presence of four excited B mesons, labelled BJ (5840)0,+ and BJ (5960)0,+, whose masses and widths are obtained under different hypotheses for their quantum numbers