Incidence and Prevalence of Chronic Obstructive Pulmonary Disease among Aboriginal Peoples in Alberta, Canada

Background Chronic obstructive pulmonary disease (COPD) is a major respiratory disorder, largely caused by smoking that has been linked with large health inequalities worldwide. There are important gaps in our knowledge about how COPD affects Aboriginal peoples. This retrospective cohort study assessed the epidemiology of COPD in a cohort of Aboriginal peoples relative to a non-Aboriginal cohort. Methods We used linkage of administrative health databases in Alberta (Canada) from April 1, 2002 to March 31, 2010 to compare the annual prevalence, and the incidence rates of COPD between Aboriginal and non-Aboriginal cohorts aged 35 years and older. Poisson regression models adjusted the analysis for important sociodemographic factors. Results Compared to a non-Aboriginal cohort, prevalence estimates of COPD from 2002 to 2010 were 2.3 to 2.4 times greater among Registered First Nations peoples, followed by the Inuit (1.86 to 2.10 times higher) and the Métis (1.59 to 1.67 times higher). All Aboriginal peoples had significantly higher COPD incidence rates than the non-Aboriginal group (incidence rate ratio [IRR]: 2.1; 95% confidence interval [CI]: 1.97, 2.27). COPD incidence rates were higher in First Nation peoples (IRR: 2.37; 95% CI: 2.19, 2.56) followed by Inuit (IRR: 1.92; 95% CI: 1.64, 2.25) and Métis (IRR: 1.49; 95% CI: 1.32, 1.69) groups. Conclusions We found a high burden of COPD among Aboriginal peoples living in Alberta; a province with the third largest Aboriginal population in Canada. Altogether, the three Aboriginal peoples groups have higher prevalence and incidence of COPD compared to a non-Aboriginal cohort. The condition affects the three Aboriginal groups differently; Registered First Nations and Inuit have the highest burden of COPD. Reasons for these differences should be further explored within a framework of social determinants of health to help designing interventions that effectively influence modifiable COPD risk factors in each of the Aboriginal groups

Inflammatory Arthritis Prevalence and Health Services Use in the First Nations and non-First Nations Populations of Alberta, Canada

Objective: To estimate prevalence of rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic disease (PsD), and crystal-related arthritis and health care use for inflammatory arthritis in First Nations and non–First Nations patients in Alberta, Canada. Methods: Population-based cohorts of adults with RA, AS, PsD, and crystal-related arthritis were defined, with First Nations determination by premium payer status, to estimate prevalence rates. Rates of outpatient primary care, specialist visits, and hospitalizations (all-cause, inflammatory-arthritis specific) were estimated. Results: RA affected 3 times as many First Nations residents compared to non–First Nations residents (standardized rate ratio [SRR] 3.2, 95% confidence interval [95% CI] 2.9–3.4). AS and PsD were more prevalent in First Nations (AS 0.6 per 100 residents; SRR 2.7, 95% CI 2.3–3.2 and PsD 0.3 per 100 residents; SRR 1.5, 95% CI 1.3–1.9), whereas crystal-related arthritis was less prevalent (SRR 0.7, 95% CI 0.6–0.7). First Nations patients were more likely to have primary care visits (SRR 1.7, 95% CI 1.6–1.8) and less likely to have specialist visits (SRR 0.6, 95% CI 0.6–0.7) for RA relative to non–First Nations individuals. In PsD and crystal-related arthritis, First Nations people had higher rates of cause-specific hospitalizations. Conclusion: The estimated prevalence of RA, AS, and PsD was higher in the First Nations population, while crystal-related arthritis was less prevalent compared to the non–First Nations population. First Nations people were more likely to see primary care physicians and were less likely to see specialists for inflammatory arthritis care

The association between rurality and return to work for workers’ compensation claimants with work-related musculoskeletal injuries: An analysis of workers who failed to return to work within typical healing time frames

Objectives: The objectives of this study have been to: 1) describe and compare urban and rural injured worker populations in Alberta, Canada; 2) identify return-to-work outcomes in urban and rural populations; 3) examine the relationship between geographic location of residence and recovery from work-related musculoskeletal injury; and 4) investigate if this relationship is attenuated after controlling for other known risk factors. Material and Methods: This study was a secondary analysis utilizing data of a population of musculoskeletal injury claimants who underwent clinical/RTW (return to work) assessment between December 2009 and January 2011 collected by the Workers’ Compensation Board of Alberta. Descriptive statistics were computed for 32 variables and used for comparing urban and rural workers. The logistic regression analysis was performed to test the association between geographic location of residence and likelihood of return-to-work. Results: Data on 7843 claimants was included, 70.1% of them being urban and 29.9% – rural. Rural claimants tended to have spent less time in formal education, have a blue-collar job, have no modified work available, have a diagnosed comorbidity, and not been enrolled in a specialized rehabilitation program. They were 1.43 (1.12–1.84) times the odds more likely than urban claimants to be continuing to receive full disability benefits 90 days after their RTW assessment, and 1.68 (1.06–2.67) times the odds as likely to report a recurrence of receiving disability benefits. Conclusions: Rural residence was associated with prolonged work disability, even after controlling for age, job type, education level, health utilization and other potential confounders. Further research is required to explore why injured workers in rural settings experience prolonged reception of disability benefits and have greater rates of recurrence of receiving disability benefits. Int J Occup Med Environ Health 2017;30(5):715–72

Child drowning on farms in Canada and associated demographic and risk factors

Objectives: This study aimed to examine the occurrence and characteristics of child drowning deaths on farms compared with other child injury deaths on farms. Methods: This study uses cross-sectional data from the Canadian Agricultural Injury Reporting Program for the years 1990 through 2012. Using χ2 tests and regression, it compares the occurrence of demographics and potential risk factors between drowning deaths and all other injury deaths among children (< 19 years of age) on farms. Results: There were 44 drowning deaths and 306 non-drowning deaths identified. Drowning deaths were at younger age (mean age of 5.4 versus 8.8 years old), non-work-related (25% versus 79%), and less likely to occur during adult supervision (36.4% versus 53.5%). Conclusions: Drowning disproportionately affects the very young. Improving supervision of young children may prevent some farm drowning deaths, but installing effective barriers to water hazards is likely more effective

Strengthening Medicare: will increasing the bulk-billing rate and supply of general practitioners increase access to Medicare-funded general practitioner services and does rurality matter?

Recent increases in the bulk-billing rate have been taken as an indication that the federal government\u27s Strengthening Medicare initiative, and particularly the bulk-billing incentives, are working. Given the enduring geographic differences in the supply of general practitioners, Susan E. Day, Katrina Alford, David Dunt, Stuart Peacock, Lyle Gurrin and Don Voaklander reconsider the impact that this increase in the provision of \u27free care\u27 will have on access to Medicare-funded GP services in rural and urban areas of Australia

Cancer incidence and mortality among the Métis population of Alberta, Canada

Background: Cancer has been identified as a major cause of morbidity and mortality in Canada over the last decade. However, there is a paucity of information about cancer patterns in Aboriginal people, particularly for Métis. This study aims to explore cancer incidence and mortality burden among Métis and to compare disease estimates with non-Métis population. Methods: This population-based descriptive epidemiological study used cancer incidence and mortality data from 2007 to 2012 obtained from Alberta Health Care Insurance Plan (AHCIP) – Central Stakeholder Registry – and Alberta Cancer Registry (ACR). To identify cancer cases in Métis, the ACR was linked with the Métis Nation of Alberta (MNA) Identification Registry. In Métis and non-Métis people, age-standardized cancer incidence and mortality rates were estimated and subsequently compared between both groups. Results: A higher incidence of bronchus/lung cancer was found among Métis men compared with their non-Métis counterparts (RR=1.69, CI 1.28–2.09; p=0.01). No other statistically significant differences in cancer incidence or mortality were found between Métis and non-Métis people living in Alberta over the course of the 6 years studied. Conclusions: Overall incidence and mortality associated with cancer were not higher among Métis people compared with non-Métis people. However, special efforts should be considered to decrease the higher incidence of bronchus/lung cancer in Métis men. Further development and maintenance of new and existing institutional collaborations are necessary to continue cancer research and health status surveillance in Métis population

Predicting falls-related admissions in older adults in Alberta, Canada: a machine-learning falls prevention tool developed using population administrative health data

Objective To construct a machine-learning (ML) model for health systems with organised falls prevention programmes to identify older adults at risk for fall-related admissions.Design This prognostic study used population-level administrative health data to develop an ML prediction model.Setting This study took place in Alberta, Canada during 2018–2019.Participants Albertans aged 65 and older with at least one prior admission. Those with palliative conditions or emigrated out of Alberta were excluded.Exposure Unit of analysis was the individual person.Main outcomes/measures We identified fall-related admissions. A CatBoost model was developed on 2018 data to predict risk of fall-related emergency department visits or hospitalisations. Temporal validation was done using 2019 data to evaluate model performance. We reported discrimination, calibration and other relevant metrics measured at the end of 2019 on both ranked predictions and predicted probability thresholds. A cost-savings simulation was performed using 2019 data.Results Final number of study participants was 224 445. The validation set had 203 584 participants with 19 389 fall-related events (9.5% pretest probability) and an ML model c-statistic of 0.70. The highest ranked predictions had post-test probabilities ranging from 40% to 50%. Net benefit analysis presented mixed results with some net benefit using the ML model in the 6%–30% range. The top 50 percentile of predicted risks represented nearly $C60 million in health system costs related to falls. Intervening on the top 25 or 50 percentiles of predicted risk could realise substantial (up to$C16 million) savings.Conclusion ML prediction models based on population-level administrative data can assist health systems with fall prevention programmes identify older adults at risk of fall-related admissions and reduce costs. ML predictions based on ranked predictions or probability thresholds could guide subsequent interventions to mitigate fall risks. Increased access to diverse forms of data could improve ML performance and further reduce costs

Cohort study of medical cannabis authorization and motor vehicle crash-related healthcare visits in 2014–2017 in Ontario, Canada

Abstract Background With increasing numbers of countries/jurisdictions legalizing cannabis, cannabis impaired driving has become a serious public health concern. Despite substantive research linking cannabis use with higher rates of motor vehicle crashes (MVC), there is an absence of conclusive evidence linking MVC risk with medical cannabis use. In fact, there is no clear understanding of the impact of medical cannabis use on short- and long-term motor vehicle-related healthcare visits. This study assesses the impact of medical cannabis authorization on motor vehicle-related health utilization visits (hospitalizations, ambulatory care, emergency department visits, etc) between 2014 and 2017 in Ontario, Canada. Methods A matched cohort study was conducted on patients authorized to use medical cannabis and controls who did not receive authorization for medical cannabis – in Ontario, Canada. Overall, 29,153 adult patients were identified and subsequently linked to the administrative databases of the Ontario Ministry of Health, providing up to at least 6 months of longitudinal follow-up data following the initial medical cannabis consultation. Interrupted time series analyses was conducted to evaluate the change in rates of healthcare utilization as a result of MVC 6 months before and 6 months after medical cannabis authorization. Results Over the 6-month follow-up period, MVC-related visits in medical cannabis patients were 0.50 visits/10000 patients (p = 0.61) and − 0.31 visits/10000 patients (p = 0.64) for MVC-related visits in controls. Overall, authorization for medical cannabis was associated with an immediate decrease in MVC-related visits of − 2.42 visits/10000 patients (p = 0.014) followed by a statistically significant increased rate of MVC-related visits (+ 0.89 events/10,000 in those authorized medical cannabis) relative to controls in the period following their authorization(p = 0.0019). Overall, after accounting for both the immediate and trend effects, authorization for medical cannabis was associated with an increase of 2.92 events/10,000 (95%CI 0.64 to 5.19) over the entire follow-up period. This effect was largely driven by MVC-related emergency department visits (+ 0.80 events/10,000, p < 0.001). Conclusions Overall, there was an association between medical cannabis authorization and healthcare utilization, at the population level, in Ontario, Canada. These findings have public health importance and patients and clinicians should be fully educated on the potential risks. Continued follow-up of medically authorized cannabis patients is warranted to fully comprehend long-term impact on motor vehicle crash risk

Imbalance of Prevalence and Specialty Care for Osteoarthritis for First Nations People in Canada

Objective: Estimate the population-based prevalence and healthcare use for osteoarthritis (OA) by First Nations (FN) and non-First Nations (non-FN) in Alberta. Methods: A cohort of adults with OA (≥2 physician claims in 2 years or 1 hospitalization with ICD-9-CM code 715x or ICD-10-CA code M15-19, years 1993-2010) was defined, with FN determination by premium payer status. Prevalence rates (2007/8) were estimated from the cohort and the population registered with the Alberta Health Care Insurance Plan. Rates of outpatient primary care and specialist (orthopedics, rheumatology, internal medicine) visits; arthroplasty (hip and knee); and all-cause hospitalization were estimated. Results: OA prevalence in FN was twice that of the non-FN population (16.1 vs 7.8 cases/100 population; standardized rate ratio (SRR) adjusted for age and sex 2.06, 95%CI 2.00-2.12). The SRR (adjusted for age, sex and location of residence) for primary care visits for OA was nearly double in FN compared to non-FN (SRR 1.88, 95%CI 1.87-1.89), and internal medicine visits were increased (SRR 1.25, 95%CI 1.25-1.26). Visit rates with an orthopedic surgeon (SRR 0.49, 95%CI 0.48-0.50) or rheumatologist (SRR 0.62, 95%CI 0.62-0.63) were substantially lower in FN with OA. Hip and knee arthroplasties were performed less frequently in FN with OA (SRR 0.48, 95%CI 0.47-0.49), but all-cause hospitalization rates were higher (SRR 1.59, 95%CI 1.58-1.60). Conclusion: We estimate a 2-fold higher prevalence of OA in the FN population, with differential healthcare use. Reasons for higher use of primary care and lower use of specialty services and arthroplasty compared to the general population are not yet understood.Medicine, Faculty ofNon UBCPopulation and Public Health (SPPH), School ofReviewedFacult