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Background Small area estimation refers to statistical modelling procedures that leverage information or "borrow strength" from other sources or variables. This is done to enhance the reliability of estimates of characteristics or outcomes for areas that do not contain sufficient sample sizes to provide disaggregated estimates of adequate precision and reliability. There is growing interest in secondary research applications for small area estimates (SAEs). However, it is crucial to assess the analytic value of these estimates when used as proxies for individual-level characteristics or as distinct measures that offer insights at the area level. This study assessed novel area-level community belonging measures derived using small area estimation and examined associations with individual-level measures of community belonging and self-rated health. Data and methods SAEs of community belonging within census tracts produced from the 2016-2019 cycles of the Canadian Community Health Survey (CCHS) were merged with respondent data from the 2020 CCHS. Multinomial logistic regression models were run between area-level SAEs, individual-level sense of community belonging, and self-rated health on the study sample of people aged 18 years and older. Results Area-level community belonging was associated with individual-level community belonging, even after adjusting for individual-level sociodemographic characteristics, despite limited agreement between individual- and area-level measures. Living in a neighbourhood with low community belonging was associated with higher odds of reporting being in fair or poor health, versus being in very good or excellent health (odds ratio: 1.53; 95% confidence interval: 1.22, 1.91), even after adjusting for other factors such as individual-level sense of community belonging, which was also associated with self-rated health. Interpretation Area-level and individual-level sense of community belonging were independently associated with self-rated health. The novel SAEs of community belonging can be used as distinct measures of neighbourhood-level community belonging and should be understood as complementary to, rather than proxies for, individual-level measures of community belonging. [ABSTRACT FROM AUTHOR]

This study aimed to determine whether higher intakes of Na, added sugars and saturated fat are prospectively associated with all-cause mortality and CVD incidence and mortality in a diverse population. The nationally representative Canadian Community Health Survey-Nutrition 2004 was linked with the Canadian Vital Statistics – Death Database and the Discharge Abstract Database (2004–2011). Outcomes were all-cause mortality and CVD incidence and mortality. There were 1722 mortality cases within 115 566 person-years of follow-up (median (interquartile range) of 7·48 (7·22–7·70) years). There was no statistically significant association between Na density or energy from saturated fat and all-cause mortality or CVD events for all models investigated. The association of usual percentage of energy from added sugars and all-cause mortality was significant in the base model with participants consuming 11·47 % of energy from added sugars having 1·34 (95 % CI 1·01, 1·77) times higher risk of all-cause mortality compared with those consuming 4·17 % of energy from added sugars. Overall, our results did not find statistically significant associations between the three nutrients and risk of all-cause mortality or CVD events at the population level in Canada. Large-scale linked national nutrition datasets may not have the discrimination to identify prospective impacts of nutrients on health measures. [ABSTRACT FROM AUTHOR]

Using 5 diet quality indexes, we estimated the mortality and life expectancy lost, at the national level, attributable to poor dietary patterns, which had previously been largely unknown. We used the Canadian Community Health Survey 2004, linked to vital statistics (n  = 16,212 adults; representing n  = 22,898,880). After a median follow-up of 7.5 years, 1,722 deaths were recorded. Population attributable fractions were calculated to estimate the mortality burden of poor dietary patterns (Dietary Guidelines for Americans Adherence Index 2015, Dietary Approaches to Stop Hypertension, Healthy Eating Index, Alternative Healthy Eating Index, and Mediterranean Style Dietary Pattern Score). Better diet quality was associated with a 32%–51% and 21%–43% reduction in all-cause mortality among adults aged 45–80 years and ≥20 years, respectively. Projected life expectancy at 45 years was longer for Canadians adhering to a healthy dietary pattern (average of 5.2–8.0 years (men) and 1.6–4.1 (women)). At the population level, 26.5%–38.9% (men) and 8.9%–22.9% (women) of deaths were attributable to poor dietary patterns. Survival benefit was greater for individuals with higher scores on all diet indexes, even with relatively small intake differences. The large attributable burden was likely from assessing overall dietary patterns instead of a limited range of foods and nutrients. [ABSTRACT FROM AUTHOR]

Background: As Canada continues to experience an opioid crisis, it is important to understand the intersection between the demographic, socioeconomic and service use characteristics of those experiencing opioid overdoses to better inform prevention and treatment programs. Data and methods: The Statistics Canada British Columbia Opioid Overdose Analytical File (BCOOAF) represents people's opioid overdoses between January 2014 and December 2016 (n = 13,318). The BCOOAF contains administrative health data from British Columbia linked to Statistics Canada data, including on health, employment, social assistance and police contacts. Cluster analysis was conducted using the k-prototypes algorithm. Results: The results revealed a six-cluster solution, composed of three groups (A, B and C), each with two distinct clusters (1 and 2). Individuals in Group A were predominantly male, used non-opioid prescription medications and had varying levels of employment. Individuals in Cluster A1 were employed, worked mostly in construction, had high incomes and had a high rate of fatal overdoses, while individuals in Cluster A2 were precariously employed and had varying levels of income. Individuals in Group B were predominantly female; were mostly taking prescription opioids, with about one quarter or less receiving opioid agonist treatment (OAT); mostly had precarious to no employment; and had low to no income. People in Cluster B1 were primarily middle-aged (45 to 65 years) and on social assistance, while people in Cluster B2 were older, more frequently used health services and had no social assistance income. Individuals in Group C were primarily younger males aged 24 to 44 years, with higher prevalence of having experienced multiple overdoses, were medium to high users of health care services, were mostly unemployed and were recipients of social assistance. Most had multiple contacts with police. Those in Cluster C1 predominantly had no documented use of prescription opioid medications, and all had no documented OAT, while all individuals in Cluster C2 were on OAT. Interpretation: The application of machine learning techniques to a multidimensional database enables an intersectional approach to study those experiencing opioid overdoses. The results revealed distinct patient profiles that can be used to better target interventions and treatment. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To assess the influence of neighbourhood immigrant concentration on cardiovascular-disease-related hospitalizations in Canada (CVDH), while adjusting for individual-level immigrant status and socio-economic indicators at individual and neighbourhood levels. METHODS: Data were from the 2006 Canadian Census linked to the hospital Discharge Abstract Data (DAD) for the province of Ontario. Adults (n = 1,459,950) aged [greater than or equal to] 18 years at baseline and grouped by place of birth (Canada, China, South Asia, Europe, and other) were followed between Census Day May 16, 2006 and March 31, 2008. Information on CVDH was obtained from the DAD, while that on immigration and socio-economic indicators was obtained from the Census. The analysis used multilevel logistic regression. RESULTS: Unadjusted results showed that CVDH was significantly lower among people living in neighbourhoods with medium and high immigrant concentration. Neighbourhood immigrant concentration tended to have no independent effect on CVDH after adjustment for individual-level immigrant status. Immigrants were less likely to experience CVDH irrespective of their country of birth. However, cross-level interaction showed that neighbourhood immigrant concentration provided additional protection to individual-level immigrant status against CVDH for most female immigrant groups, but only for South Asian males. CONCLUSION: This study resulted from the first-ever linkage of census data to hospitalization data in Canada. It is also the first Canadian study to report on neighbourhood variation and the effect of immigrant concentration on CVDH. The study shows that understanding immigrant health requires both individual and neighbourhood approaches, and a consideration of country of origin. KEY WORDS: Hospitalization; immigrants; cardiovascular diseases; neighbourhoods; data linkage La traduction du resume se trouve a la fin de l'article. OBJECTIF : Evaluer l'influence de la concentration d'immigrants au niveau des quartiers sur les hospitalisations liees aux maladies cardiovasculaires (HLMCV) au Canada, tout en tenant compte du statut d'immigrant au niveau individuel et des indicateurs socioeconomiques aux niveaux individuel et du quartier. METHODE : Les donnees du Recensement du Canada 2006 ont ete liees a celles du registre des sorties des hopitaux (RSH) de la province de l'Ontario. Les adultes (n=1 459 950) de [greater than or equal to] 18 ans au depart, regroupes selon leur lieu de naissance (Canada, Chine, Asie du Sud, Europe et autre), ont ete suivis entre le jour du recensement (le 16 mai 2006) et le 31 mars 2008. L'information sur les HLMCV provient du RSH, tandis que celle sur l'immigration et les indicateurs socioeconomiques provient du Recensement. Les donnees ont ete analysees par regression logistique multiniveau. RESULTATS : Les resultats avant ajustement montrent que les HLMCV etaient significativement plus faibles chez les personnes vivant dans des quartiers a concentrations moyennes et elevees d'immigrants. La concentration d'immigrants dans les quartiers avait tendance a n'avoir aucun effet independant sur les HLMCV une fois pris en compte le statut d'immigrant individuel. Les immigrants etaient moins susceptibles de subir des HLMCV, peu importe leur pays de naissance. Toutefois, l'interaction transversale a montre que la concentration d'immigrants dans les quartiers offrait une protection supplementaire contre les HLMCV a la plupart des groupes de femmes immigrantes, mais chez les hommes, seulement aux immigrants d'Asie du Sud. CONCLUSION : Cette etude est le resultat du tout premier maillage entre les donnees du Recensement et des donnees sur les hospitalisations au Canada. C'est aussi la premiere etude canadienne a aborder les ecarts par quartier et l'effet de la concentration d'immigrants sur les HLMCV. L'etude montre que pour comprendre la sante des immigrants, il faut allier l'approche individuelle et l'approche par quartier et tenir compte du pays d'origine. MOTS CLES : hospitalisation; immigrants; maladies cardiovasculaires; quartiers; maillage de donnees, Although empirical studies generally show that compositional effects are relatively more important predictors of health, contextual effects (where people live) also matter. (1,2) More importantly, unlike human behaviour that puts [...]

Introduction: The Canadian Community Health Survey (CCHS) - Nutrition 2004 (n=35,107; interview dates from January 2004 to January 2005) linked to the Canadian Vital Statistics - Death Database (CVSD) (2011) represents a novel linkage of a population-based, nationally representative nutrition survey with routinely collected mortality records (including date and cause of death). The linkage was done through individual tax data in Canada, and contains longitudinal records for 29,897 Canadians aged 0 years and older--1,753 of whom died--in the 10 provinces of Canada. The median follow-up time was 7.49 years, with 102,953 personyears among males and 114,876 person-years among females (unweighted), and included a special sampling survey weight (for linked data) to account for those who did not agree to share and link their information. The CCHS - Nutrition 2004 linked to CVSD has been used to evaluate associations between lifestyle and sociodemographic characteristics and mortality. Using these data, statistical methods have been developed and tested to control random and systematic measurement errors when evaluating the relationship between different dietary exposures (evaluated using repeated 24-hour dietary recalls) and health outcomes. The linked data are available through Statistics Canada's Research Data Centres. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To address the issue of comparative risk of cancer in Canada's immigrant population, an area-based methodology was applied to examine whether or not estimated cancer incidence rates among individuals living in given areas vary systematically according to the concentration of foreign-born individuals living in the same area. This method provides an alternative, accessible surveillance method in the absence of linked individual-level information to extend the work of others by providing both national and subnational standardized, hence comparable, results to address this issue. METHODS: Canadian Cancer Registry data (2001 to 2006) and 2006 Census data provided dissemination area information regarding the concentration of the foreign-born population and population estimates for rate denominators. Cancer (all cause and cause-specific) incidence rate ratios (age-standardized and by age/sex) were calculated by foreign-born concentration areas at both national and regional levels. RESULTS: An inverse gradient was identified between cancer incidence rates and area concentration of foreign-born, with the all-sites cancer rate ranging from a low of 388 per 100,000 among individuals living in areas with a high concentration of foreign-born to a high of 493 per 100,000 among individuals living in areas with a low concentration of foreign-born. This pattern occurred nationally for lung, colorectal, prostate and female breast cancers. However, for liver, nasopharynx, and thyroid cancers, higher cancer rates were observed in areas with a higher versus lower concentration of foreign-born populations. CONCLUSION: The study findings provide suggestive evidence of decreased cancer risk among foreign-born populations for most cancers except nasopharynx, liver and thyroid for which risks were higher. The results of this study demonstrate the value of ecological-based methods for disease surveillance in the absence of individual-level information on immigrant status in the national cancer registry. KEY WORDS: Immigrants; cancer incidence; vital statistics OBJECTIFS: Pour aborder la question du risque comparatif de cancer dans la population immigrante du Canada, nous avons applique une methode regionale pour determiner si les taux d'incidence estimatifs du cancer chez les residents de certaines regions varient systematiquement selon la concentration de personnes nees a l'etranger vivant dans la meme region. En l'absence de donnees individuelles maillees, une telle methode offre une solution de surveillance accessible pour completer le travail d'autres chercheurs; elle offre des resultats a la fois nationaux et sousnationaux standardises, et donc comparables, pour aborder la question. METHODE: Les donnees du Registre canadien du cancer (2001 a 2006) et celles du Recensement de 2006 ont fourni de l'information par aire de diffusion sur la concentration de personnes nees a l'etranger et des estimations demographiques pour les denominateurs des taux. Les ratios des taux d'incidence (standardises pour l'age et pour l'age/le sexe) du cancer (toutes causes confondues et par cause) ont ete calcules pour chaque zone de concentration de personnes nees a l'etranger a l'echelle nationale et regionale. RESULTATS: Nous avons observe un gradient inverse entre les taux d'incidence du cancer et la concentration regionale de personnes nees a l'etranger: les taux de cancer tous sites confondus variaient de 388 p. 100 000 (chez les residents des regions a forte concentration de personnes nees a l'etranger) a 493 p. 100 000 (chez les residents des regions a faible concentration de personnes nees a l'etranger). Cette tendance se manifestait a l'echelle nationale pour les cancers du poumon, colorectal et de la prostate et pour le cancer du sein feminin. Toutefois, pour les cancers du foie, du nasopharynx et de la thyroide, nous avons observe des taux de cancer superieurs dans les regions a forte plutot qu'a faible concentration de personnes nees a l'etranger. CONCLUSION: Les constatations de l'etude donnent a penser que le risque de cancer est reduit au sein des populations nees a l'etranger pour la plupart des cancers sauf ceux du nasopharynx, du foie et de la thyroide, pour lesquels les risques sont superieurs. Ces resultats demontrent la valeur des methodes ecologiques pour la surveillance des maladies en l'absence de donnees individuelles sur le statut d'immigrant dans le registre national du cancer. MOTS CLES: immigrants; incidence du cancer; statistiques de l'etat civil La traduction du resume se trouve a la fin de l'article., Understanding the potential impact of immigration trends on Canada's public health program needs is increasingly important. In 2006, an estimated 6.2 million immigrants comprised 19.8% of Canada's population, (1) and [...]

Background Canadian immigrants from countries where the hepatitis B virus (HBV) and hepatitis C virus (HCV) are endemic may be at higher risk of liver-related disease than Canadian-born residents. This study compared HBV- and HCV-related hospitalizations in Canadian immigrants (arriving from 1980 to 2013) and longterm residents (Canadian-born population and pre-1980 immigrants) and aimed to describe the burden of disease in both groups. Methods Based on the 2004/2005-to-2013/2014 hospital Discharge Abstract Database linked to the 1980-to-2013 Longitudinal Immigration Database, this descriptive cross-sectional study examined the distribution of HBV- and HCV-related hospitalizations, lengths of stay, comorbidities, and sequelae incurred by immigrants and long-term residents in Canada. With a linkage rate of 85%, 5,854,949 immigrants were included in the study. Proportions of HBV- and HCV-related hospitalizations attributable to immigrants were calculated. Results By birth country risk level, 22% of HBV-related hospital events among recent immigrants, and 20% of those related to HCV, were among people from high-risk countries. Proportionally, fewer immigrants had comorbidities than long-term residents. The top two hospital-related sequelae in both groups were cirrhosis and ascites, and liver cancer. While immigrants made up 16% of the Canadian population, they incurred 37% of HBV-related hospitalizations and 9% of HCVrelated hospitalizations, giving ratios of hepatitis-related hospitalizations relative to the population share of 2.3 (95% confidence interval [CI]: 2.2 to 2.5) and 0.5 (95% CI: 0.5 to 0.6) respectively. These ratios were higher among seniors, at 4.4 (95% CI: 3.9 to 4.9) and 2.3 (95% CI: 1.9 to 2.6), respectively. Interpretation Immigrants can require hospitalization for hepatitis in Canada, especially for HBV. These results may inform health screening for HBV or HCV in the Canadian immigration context. [ABSTRACT FROM AUTHOR]

Objectives. We examined income-related inequalities in self-reported health in the United States and Canada and the extent to which they are associated with individual-level risk factors and health care system characteristics. Methods. We estimated income inequalities with concentration indexes and curves derived from comparable survey data from the 2002 to 2003 Joint Canada--US Survey of Health. Inequalities were then decomposed by regression and decomposition analysis to distinguish the contributions of various factors. Results. The distribution of income accounted for close to half of income-related health inequalities in both the United States and Canada. Health care system factors (e.g., unmet needs and health insurance status) and risk factors (e.g., physical inactivity and obesity) contributed more to income-related health inequalities in the United States than to those in Canada. Conclusions. Individual-level health risk factors and health care system characteristics have similar associations with health status in both countries, but they both are far more prevalent and much more concentrated among lower-income groups in the United States than in Canada. (Am J Public Health. 2009;99: 1856-1863. doi:10.2105/AJPH.2007.129361)

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. [ABSTRACT FROM AUTHOR]

Background Reliance on the use of opioids to manage pain has increased over time, as have opioid-related morbidity and deaths. In 2018, 12.7% of Canadians reported having used opioid pain relief medications (OPRMs) in the previous year. Among these people, 9.6% had engaged in problematic use that could cause harm to their health. Though socioeconomic characteristics associated with opioid-related harms have previously been reported, population-level evidence based on administrative health data lacks important behavioural and psychosocial information. This analysis extends previous research by using modelling to report factors related to the problematic use of OPRMs for the household population aged 15 and older in Canada. Data and methods This analysis uses responses to the 2018 Canadian Community Health Survey to identify factors that are significantly associated, after adjustment using multivariate logistic regression models, with elevated odds of problematic use of OPRMs. Results The fully adjusted model confirmed that being male, being younger (ages 20 to 24), having fair or poor mental health, having unmet needs for help with mental or emotional health or substance problems, being a smoker, or being unattached and living with others were significantly related to problematic OPRM use. Interpretation Subjective perceptions significantly related to problematic OPRM use, independent of socioeconomic circumstances, were examined in this study. While previous research based on administrative health data has contributed much to knowledge about factors associated with opioid harms, modelled results revealed that self-reported experiential factors also warrant consideration as they are significantly associated with problematic use. Having fair or poor mental health, having unmet perceived needs for help, and being unattached in terms of household arrangement relationship were related to problematic use of OPRMs, even after adjustment for socioeconomic and other health covariates. This study suggests risk profiles that could be used to inform health care providers, and strategies to support safe pain management. [ABSTRACT FROM AUTHOR]

The transcription of the tir operon and the orf19 gene is mediated by Ler protein by overcoming the negative regulation of a repressor protein in Escherichia coli. Furthermore, cis-acting elements cesT and eae also regulate tir expression in response to environmental cues.

Background Behaviours such as smoking, poor diet, physical inactivity, and unhealthy alcohol consumption are leading risk factors for death. We assessed the Canadian burden attributable to these behaviours by developing, validating, and applying a multivariable predictive model for risk of all-cause death. Methods A predictive algorithm for 5 y risk of death-the Mortality Population Risk Tool (MPoRT)-was developed and validated using the 2001 to 2008 Canadian Community Health Surveys. There were approximately 1 million person-years of follow-up and 9,900 deaths in the development and validation datasets. After validation, MPoRT was used to predict future mortality and estimate the burden of smoking, alcohol, physical inactivity, and poor diet in the presence of sociodemographic and other risk factors using the 2010 national survey (approximately 90,000 respondents). Canadian period life tables were generated using predicted risk of death from MPoRT. The burden of behavioural risk factors attributable to life expectancy was estimated using hazard ratios from the MPoRT risk model. Findings The MPoRT 5 y mortality risk algorithms were discriminating (C-statistic: males 0.874 [95% CI: 0.867-0.881]; females 0.875 [0.868-0.882]) and well calibrated in all 58 predefined subgroups. Discrimination was maintained or improved in the validation cohorts. For the 2010 Canadian population, unhealthy behaviour attributable life expectancy lost was 6.0 years for both men and women (for men 95% CI: 5.8 to 6.3 for women 5.8 to 6.2). The Canadian life expectancy associated with health behaviour recommendations was 17.9 years (95% CI: 17.7 to 18.1) greater for people with the most favourable risk profile compared to those with the least favourable risk profile (88.2 years versus 70.3 years). Smoking, by itself, was associated with 32% to 39% of the difference in life expectancy across social groups (by education achieved or neighbourhood deprivation). Conclusions Multivariable predictive algorithms such as MPoRT can be used to assess health burdens for sociodemographic groups or for small changes in population exposure to risks, thereby addressing some limitations of more commonly used measurement approaches. Unhealthy behaviours have a substantial collective burden on the life expectancy of the Canadian population., Author(s): Douglas G. Manuel 1,2,3,4,5,6,7,*, Richard Perez 1,2,5, Claudia Sanmartin 3, Monica Taljaard 1,5, Deirdre Hennessy 1,3, Kumanan Wilson 1, Peter Tanuseputro 1,2,6, Heather Manson 7, Carol Bennett 1,2, Meltem [...]

Background Following the 2016 opioid overdose emergency declaration in British Columbia (B.C.), provincial stakeholders collaborated to link data that resulted in the B.C. Provincial Overdose Cohort. This database provides information about people who have experienced opioid overdoses to inform policy and intervention developments. Subsequently, Statistics Canada likewise constructed a cohort and integrated federal data to broaden the scope of the B.C. initiative. This provided federally sourced information about people's circumstances that was not otherwise available. Methods The Statistics Canada British Columbia Opioid Overdose Analytical File further characterizes the socioeconomic circumstances of 13,318 people who experienced illicit drug toxicity deaths and non-fatal opioid overdoses in B.C. between January 1, 2014, and December 31, 2016. Statistics Canada linked federal data on immigration, employment, the justice system and social assistance receipt in the year of, and prior to, people's first overdose. Results During the observation period, most people (78%) had one overdose episode, rather than several. Seven percent were immigrants or temporary residents, 41% of whom arrived in Canada more than 20 years before their index overdose. Half (49.6%) had not received social assistance, and one-third (33.8%) were employed--primarily within construction (21% of those employed)--in the year prior to their index overdose. Most employed people (65.5%) experienced periods of unemployment within five years prior to their index overdose. Employment was more prevalent among people who experienced illicit-drug toxicity death (36.1%). About 60% of people had not had any formal police contact within the two years prior to the index overdose. Interpretation This project demonstrated further added value to existing data by using this linkage approach and aligned with strategies underway by BC public health partners to provide cross-sectoral evidence to inform efforts to prevent and manage opioid overdoses. [ABSTRACT FROM AUTHOR]