UK and Canadian Gulf War Veteran Mortality: Using A Fellow Military Cohort as a Comparison Population

Introduction To compare 1990-91 Gulf War Veterans (GWV) survival outcomes with a comparable cohort, UK’s Ministry of Defence and Canada’s Department of National Defence combined data from their respective cohorts. The survival estimates/comparisons emanating from this collaboration will be novel as they will control for healthy worker/soldier effect (HW/SE). Objectives and Approach GWV cohort building and record linkage methods used by Canada and the UK are described in more detail elsewhere. To ensure comparability in mortality outcomes between cohorts, the following steps will be conducted prior to analysis: • ICD-9 causes of death (COD) will be recoded to ICD-10; recoding by each country will be cross-validated by the other, to ensure high inter-coder reliability; • CODs will be analysed at the ICD-chapter level; Calculated age- and sex-specific rates will be directly standardized using the WHO 2012-2022 Standard Population. Cox proportional hazards will be used to compare survival between cohorts. Results We are currently in the process of completing this exciting cross-sectoral linkage study and expect to have preliminary results to present. To our knowledge, this will be the first time that mortality outcomes for two discrete Gulf War veteran cohorts (ascertained by record linkage) will be analytically compared, rather than comparing to the general population. These findings will not only provide a more recent evaluation of the health status of GWV in Canada, but will also be a rare opportunity to control for the HW/SE, using comparisons with non-equivalent cohorts (e.g., general population, other deployment) cannot achieve. Conclusion/Implications Beyond evidence of a strong inter-sectoral research relationship between military nations, these findings also represent a feasible solution to controlling for the HW/SE. The ability to control for this will mean more accurate UK and Canada GWV mortality/survival estimates than either country can generate on their own

The Canadian Chronic Disease Surveillance System: A model for collaborative surveillance

Chronic diseases have a major impact on populations and healthcare systems worldwide. Administrative health data are an ideal resource for chronic disease surveillance because they are population-based and routinely collected. For multi-jurisdictional surveillance, a distributed model is advantageous because it does not require individual-level data to be shared across jurisdictional boundaries. Our objective is to describe the process, structure, benefits, and challenges of a distributed model for chronic disease surveillance across all Canadian provinces and territories (P/Ts) using linked administrative data. The Public Health Agency of Canada (PHAC) established the Canadian Chronic Disease Surveillance System (CCDSS) in 2009 to facilitate standardized, national estimates of chronic disease prevalence, incidence, and outcomes. The CCDSS primarily relies on linked health insurance registration files, physician billing claims, and hospital discharge abstracts. Standardized case definitions and common analytic protocols are applied to the data for each P/T; aggregate data are shared with PHAC and summarized for reports and open access data initiatives. Advantages of this distributed model include: it uses the rich data resources available in all P/Ts; it supports chronic disease surveillance capacity building in all P/Ts; and changes in surveillance methodology can be easily developed by PHAC and implemented by the P/Ts. However, there are challenges: heterogeneity in administrative databases across jurisdictions and changes in data quality over time threaten the production of standardized disease estimates; a limited set of databases are common to all P/Ts, which hinders potential CCDSS expansion; and there is a need to balance comprehensive reporting with P/T disclosure requirements to protect privacy. The CCDSS distributed model for chronic disease surveillance has been successfully implemented and sustained by PHAC and its P/T partners. Many lessons have been learned about national surveillance involving jurisdictions that are heterogeneous with respect to healthcare databases, expertise and analytical capacity, population characteristics, and priorities

Pain in Canadian Veterans: Analysis of Data from the Survey on Transition to Civilian Life

BACKGROUND: Little is known about the prevalence of chronic pain among Veterans outside the United States