In Sickness and In Health: Effects of Cardiovascular Health Shocks on Spouses’ Work and Earnings

Introduction A severe health shock can threaten a patient’s life and alter the lives of their family. Spouses often provide care, and may change their work situation, affecting family income. This could mean less work to allow for more caregiving, or more work to make up for the patient’s lower income. Objectives and Approach We used the Canadian Hospital and Taxation Database to quantify the impact on workforce participation and changes in earnings among spouses of working-age Canadians who survived a heart attack, cardiac arrest, or stroke. All 40-61 year-olds who experienced a health shock between 2005 and 2010, and survived for at least 3 years, were included, along with their spouses. We use 15 variables to match case spouses with up to 5 (weighted) potential control spouses. The main outcome was Total earnings, which included the sum of wages and salaries, net self-employment income and other employment income, normalized to 2012 Cdn dollars. Results Our analysis included 11,208 spouses of heart attack patients, 622 spouses of cardiac arrest patients, and 2,228 spouses of stroke patients, matched with spouses in the control group. For all three health shocks, we found no significant difference in the distribution of changes in earnings between cases and matched controls (p=0.30 for heart attack; p=0.72 for cardiac arrest and p=0.27 for stroke). We also found no difference in levels of working status (ie being employed). We found mixed impacts by spouses’ sex, age, and pre-event earnings for heart attack and stroke patients. These results are consistent with previous findings, but drill deeper by analyzing the distributions of changes in earnings among spouses of patients experiencing health shocks. Conclusion/Implications Despite known decreases in work and earnings among patients experiencing heart attack, cardiac arrest, or stroke, the proportion of spouses whose work and earnings were increased, decreased, or unchanged was the same as for control spouses. This combination implies a significant reduction in family income after serious health events

Academic and Social Outcomes for High‐Risk Youths in Manitoba

This study examined academic and social outcomes for high‐risk youths in Manitoba, using longitudinal, population‐based data. All children born in Manitoba in 1984‐1985 who resided in Winnipeg the year they turned 18 were included in analyses (N = 11,703). High risk youths were defined as those involved with child welfare services, living in poverty, and/or having a mother who was a teen at first childbirth. Of youths with one risk factor, 41 to 57 per cent failed to complete high school, and 84 per cent of those with all three risk factors did not complete high school, compared with only 18 per cent of youths with none of the risk factors. Multiple risk factors put youths at an even greater disadvantage. Similar poor outcomes for high risk youths were observed for performance in grade 9, unemployment in early adulthood, and teen births. The findings suggest an intractable cycle of risk and disadvantage with farreaching social and economic implications

THE COMPLETE STORY: A POPULATION‐ BASED PERSPECTIVE ON SCHOOL PERFORMANCE AND EDUCATIONAL TESTING

All children born in Manitoba in 1984 were tracked for 18 years to assess their grade‐ 12 performance on a provincial examination according to a student’s socio‐economic status. The proportion of youths in families receiving social assistance judged to have passed their language arts exam dropped from 80 per cent to 12 per cent, depending on whether one counts only those in the cohort who took the test on time in 2002 or all youths born in 1984 who should have taken the test in 2002. Getting better data on performance and doing something about the discrepancies should become a Canadian priority. Key words: educational opportunity, exam performance, socio‐economic status, testing, longitudinal studies Tous les enfants nés au Manitoba en 1984 ont été suivis sur une période de 18 ans en vue d’évaluer leur rendement en 12e année lors d’un examen provincial, tenant compte de leur statut socioéconomique. La proportion de jeunes issus des familles recevant de l’aide sociale et considérés comme ayant réussi leur examen au plan des compétences linguistiques passe de 80 % à 12 %, selon que l’on compte seulement ceux qui, dans la cohorte, ont subi l’examen à temps en 2002 ou tous les jeunes nés en 1984 qui auraient dû subir l’examen. En matière d’égalité des chances, la performance du système scolaire actuel au Canada laisse à désirer. Mots clés: possibilités éducatives, résultats d’examen, statut socioéconomique, analyse longitudinale.

Integrated KT 2.0: The next generation of teamwork

ABSTRACT Objective The goal of this study was to engage members of a long-standing Integrated KT collaborative in a process to revitalize team goals and processes. “The Need to Know” Team started in 2001 in Manitoba, to engage knowledge users in the conceptualization, creation, and application of population health research. The team has garnered numerous national awards and citations for its approach. We conducted a survey of team members (N=27), representing all Health Authorities in the province, plus provincial government reps. Questions included frequency of data use and medium (print vs online), how well the team is meeting is goals, open-ended questions about how the team could be more useful to members and their organizations, and their top 3 suggestions to ensure the ongoing success and increase the impact of the team. Method Twenty-two of 27 members responded to the survey (81.5%) within one week. Responses to questions about how well the team is meeting its existing goals revealed high scores – especially among those goals which lay entirely within the scope of the team’s control (91% extremely or moderately well). Objectives relating to larger-scale impacts on the healthcare system had lower ratings (72% extremely or moderately well), as might have been expected. Results Over 75% reported that the team’s work had impacted their organization’s work moderately or a lot. The most commonly cited examples were that the work of the team increased capacity for data analysis/interpretation and research (18%), provided results that were used in staff and/or board meetings (15%), influenced decisions and the discussions leading up to them (15%), influenced the development and use of region-relevant quality indicators (13%), and were used in the ongoing education of health professionals (13%). The open-ended questions regarding optimal next steps solicited a variety of suggestions ranging from developing even richer relationships with existing partners, to including a wider variety of partner organizations (e.g. Indigenous groups); aligning team priorities with those of the provincial government (where feasible); and moving to occasional electronic meetings for appropriate content issues and to increase impact in partner organizations. Conclusion This exercise in reflection and strategic planning has shown that the team has done an exceptional job in achieving its initial goals, most of which remain relevant, but some of which need revision. More importantly, several creative approaches have been suggested which may increase future impact and enhance both the breadth and depth of the team’s reach

External Validation of a Population-Based Prediction Model for High Healthcare Resource Use in Adults

Predicting high healthcare resource users is important for informing prevention strategies and healthcare decision-making. We aimed to cross-provincially validate the High Resource User Population Risk Tool (HRUPoRT), a predictive model that uses population survey data to estimate 5 year risk of becoming a high healthcare resource user. The model, originally derived and validated in Ontario, Canada, was applied to an external validation cohort. HRUPoRT model predictors included chronic conditions, socio-demographics, and health behavioural risk factors. The cohort consisted of 10,504 adults (≥18 years old) from the Canadian Community Health Survey in Manitoba, Canada (cycles 2007/08 and 2009/10). A person-centred costing algorithm was applied to linked health administrative databases to determine respondents’ healthcare utilization over 5 years. Model fit was assessed using the c-statistic for discrimination and calibration plots. In the external validation cohort, HRUPoRT demonstrated strong discrimination (c statistic = 0.83) and was well calibrated across the range of risk. HRUPoRT performed well in an external validation cohort, demonstrating transportability of the model in other jurisdictions. HRUPoRT’s use of population survey data enables a health equity focus to assist with decision-making on prevention of high healthcare resource use

Collateral benefits: Unintended consequences of the Roots of Empathy program

ABSTRACT Objectives Roots of Empathy is a school-based mental health program with demonstrated effectiveness in reducing bullying and aggression, and raising children’s social/emotional competence and empathy. This study examines the program’s impact on several longer-term health and social outcomes that are related to the program’s goals, but not specifically targeted by the program’s design or objectives. Approach This study used linked, de-identified administrative records of health, education, social service use and justice system involvement for children and youth in Manitoba who participated in the ROE program, along with a carefully matched comparison group. Propensity scores were used along with hard matching on key variables to ensure comparability of groups. Outcome measures encompass a broad array of health, educational, and social indicators including hospitalization for injury, teen pregnancy, high school graduation, involvement with the criminal justice system, and suicide attempts. Analyses were performed at the Manitoba Centre for Health Policy (MCHP), using SAS 9.4. Results Findings from analyses of data from the pilot study (N=688) reveal several ‘collateral benefits’ that may be related to the program, though most differences did not reach statistical significance in this initial sample. (Results from the full sample will be available May 2016; N ~ 8000.) Compared to matched counterparts who did not receive the program, ROE participants had lower rates of teen pregnancy (6.6% vs 9.6%; p=0.19), and school grade repetition (2.4% vs 3.8%, p=0.09), and higher rates of high school graduation (77.7% vs 73.5%, p=.36). However, they also had higher rates of injury-related hospitalization (6.4% vs 5.0%, p=0.14). Even in this small pilot, sub-group analyses for some outcomes showed significant differences for some strata but not others. Analyses of the full study group (underway) will provide more robust results. Conclusion These findings provide intriguing evidence suggesting beneficial impacts in several longer-term health and social outcomes that could feasibly be related to participation in the Roots of Empathy program. The multi-variable propensity scores and hard-matching algorithms used on this large group provide considerable confidence in attributing group differences to program participation. Results from the full sample will provide more conclusive results, and allow sub-group analyses. The linkage of databases from health, education, social service and justice systems provides a unique opportunity to examine the truly multi-dimensional long-term impacts of a program already proven to provide dramatic improvements in short and medium-term outcomes

Linking Hospital and Tax data to support research on the economic impacts of hospitalization

ABSTRACT Objectives This project links data on acute inpatient hospitalizations from the Canadian Discharge Abstract Database (DAD) with data on income and employment from various taxation- and employment-based administrative files. The goal was to create a linked database that will support research on the labour market and financial outcomes experienced by individuals and families following acute illness requiring hospitalization. Approach Data from the 1999/00 to 2014/15 Discharge Abstract Database (DAD) were linked to the 1981-2013/14 T1 Tax filer data and the Canadian Child Tax Benefit data. We sought to create a unique association between Health Insurance Numbers (HIN) available in the DAD and Social Insurance Numbers (SIN) available in the tax data by using variables common to both data sets – date of birth, postal code and sex. Both transactional data sets were “individualized” such that unique combinations of the linkage variables were identified and eligible for linkage. The linkage was conducted using deterministic methods. Results Approximately 97% of combinations involving date of birth, postal code and sex in the hospitalization data were uniquely related to a single valid HIN (n=18.8 million). Similarly, approximately 96% of the keys on the Tax data file were associated with a unique person. Approximately 86% of HINs were associated with a unique identifier in the tax file and these HINs account for approximately 83% of the hospital records. The linkage was consistent over time, with linkage rates between 85% and 88% of HINs for all years. Some variation in linkage rates were observed by jurisdiction and by age. (Error estimates to be reported) Conclusion This project has created a unique linked database that will support research on the economic consequences of ‘health shocks’ for individuals and their families, and the implications for income, labour and health policies. This database represents a new and unique resource that will fill an important national data gap, and enable a wide range of relevant research