Alcohol Sales and Risk of Serious Assault

In a population-based case-crossover analysis, Joel Ray and colleagues find that the risk of being a victim of serious assault increases with retail alcohol sales, especially among young urban men

The Epidemiology of Diabetes among Immigrants to Ontario

Type 2 Diabetes Mellitus (T2DM) prevalence is increasing globally with roughly 2.4 million people currently living with this condition in Canada. T2DM occurs more commonly in non-European ethnoracial groups, however the distribution of risk by age, sex, ethnicity and immigration status in Canada are not completely understood. The purpose of this thesis is to investigate the epidemiology of diabetes in an immigrant, multi-ethnic population using linked immigration and health data for the province of Ontario. The ultimate goal of this work is to generate information that can be used to design appropriate and effective targeted programs for diabetes prevention, management and control in order to reduce inequities in health. The principal findings of this work indicate that: 1) South Asians had a three-fold higher risk for developing diabetes as compared with people of European ethnicity and this disparity in risk was evident at a very young age; 2) The young age at diabetes onset experienced by many of our high-risk ethnic groups, including South Asians and people of African and Middle Eastern descent, suggest that in order to capture an equivalent risk of disease, screening may be recommended up to 15 years earlier in these groups – which is not reflected in current screening guidelines; 3) Contrary to patterns seen in Western European populations, women belonging to many high–risk ethnicities had equivalent or, in some cases, higher risk than men; 4) Risk varied substantially across country and region of birth making broad definitions of race or ethnicity (eg. ‘Asian’ or ‘Black’) inappropriate. These findings emphasize the heterogeneity of risk experienced by different ethnoracial populations in Canada and suggest that targeted primary prevention programs aimed at young adults and adolescents belonging to high-risk ethnic groups may be warranted. In addition, screening guidelines may need to be updated to reflect the younger age at onset in these populations. Further research is necessary to identify culturally appropriate and effective programs to reduce diabetes risk and associated health problems in these populations.Ph

Urban neighborhoods, chronic stress, gender and depression

Using multilevel analysis we find that residents of "stressed" neighborhoods have higher levels of depression than residents of less "stressed" neighborhoods. Data for individuals are from two cycles of the Canadian Community Health Survey, a national probability sample of 56,428 adults living in 25 Census Metropolitan Areas in Canada, with linked information about the respondents' census tracts. Depression is measured with the Center for Epidemiologic Studies-Depression Scale Short Form and is based on a cutoff of 4+ symptoms. Factor analysis of census tract characteristics identified two measures of neighborhood chronic stress--residential mobility and material deprivation--and two measures of population structure--ethnic diversity and dependency. After adjustment for individual-level gender, age, education, marital and visible minority status and neighborhood-level ethnic diversity and dependency, a significant contextual effect of neighborhood chronic stress survives. As such, the daily stress of living in a neighborhood where residential mobility and material deprivation prevail is associated with depression. Since gender frames access to personal and social resources, we explored the possibility that women might be more reactive to chronic stressors manifested in higher risk of depression. However, we did not find random variation in depression by gender across neighborhoods.Canada Depression Gender Neighborhood Chronic stress

Assessing the Origin of and Potential for International Spread of Chikungunya Virus from the Caribbean

Background: For the first time, an outbreak of chikungunya has been reported in the Americas. Locally acquired infections have been confirmed in fourteen Caribbean countries and dependent territories, Guyana and French Guiana, in which a large number of North American travelers vacation. Should some travelers become infected with chikungunya virus, they could potentially introduce it into the United States, where there are competent Aedes mosquito vectors, with the possibility of local transmission. Methods: We analyzed historical data on airline travelers departing areas of the Caribbean and South America, where locally acquired cases of chikungunya have been confirmed as of May 12th, 2014. The final destinations of travelers departing these areas between May and July 2012 were determined and overlaid on maps of the reported distribution of Aedes aeygpti and albopictus mosquitoes in the United States, to identify potential areas at risk of autochthonous transmission. Results: The United States alone accounted for 52.1% of the final destinations of all international travelers departing chikungunya indigenous areas of the Caribbean between May and July 2012. Cities in the United States with the highest volume of air travelers were New York City, Miami and San Juan (Puerto Rico). Miami and San Juan were high travel-volume cities where Aedes aeygpti or albopictus are reported and where climatic conditions could be suitable for autochthonous transmission. Conclusion: The rapidly evolving outbreak of chikungunya in the Caribbean poses a growing risk to countries and areas linked by air travel, including the United States where competent Aedes mosquitoes exist. The risk of chikungunya importation into the United States may be elevated following key travel periods in the spring, when large numbers of North American travelers typically vacation in the Caribbean

Mean Alcohol Sales (Blue) and Weekly Number of Hospitalized Assaults (Dashed Red)

<p>Mean Alcohol Sales (Blue) and Weekly Number of Hospitalized Assaults (Dashed Red)</p

Risk of Hospitalization for Assault per 1,000 l Increase in Daily Alcohol Sales, According to Alcohol Type and Patient Variables

<p>Risk of Hospitalization for Assault per 1,000 l Increase in Daily Alcohol Sales, According to Alcohol Type and Patient Variables</p

Geographic Methods for Understanding and Responding to Disparities in Mammography Use in Toronto, Canada

OBJECTIVE: To use spatial and epidemiologic analyses to understand disparities in mammography use and to formulate interventions to increase its uptake in low-income, high–recent immigration areas in Toronto, Canada. DESIGN: We compared mammography rates in four income-immigration census tract groups. Data were obtained from the 1996 Canadian census and 2000 physician billing claims. Risk ratios, linear regression, multilayer maps, and spatial analysis were used to examine utilization by area for women age 45 to 64 years. SETTING: Residential population of inner city Toronto, Canada, with a 1996 population of 780,000. PARTICIPANTS: Women age 45 to 64 residing in Toronto's inner city in the year 2000. MEASUREMENTS AND MAIN RESULTS: Among 113,762 women age 45 to 64, 27,435 (24%) had received a mammogram during 2000 and 91,542 (80%) had seen a physician. Only 21% of women had a mammogram in the least advantaged group (low income–high immigration), compared with 27% in the most advantaged group (high income–low immigration) (risk ratio, 0.79; 95% confidence interval, 0.75 to 0.84). Multilayer maps demonstrated a low income–high immigration band running through Toronto's inner city and low mammography rates within that band. There was substantial geographic clustering of study variables. CONCLUSIONS: We found marked variation in mammography rates by area, with the lowest rates associated with low income and high immigration. Spatial patterns identified areas with low mammography and low physician visit rates appropriate for outreach and public education interventions. We also identified areas with low mammography and high physician visit rates appropriate for interventions targeted at physicians