scholarly journals Increasing concentration of COVID-19 by socioeconomic determinants and geography in Toronto, Canada: an observational study

2021 ◽  
Author(s):  
Sharmistha Mishra ◽  
Huiting Ma ◽  
Gary Moloney ◽  
Kristy CY Yiu ◽  
Dariya Darvin ◽  
...  
Keyword(s):  
Observational Study ◽  
Gini Coefficient ◽  
Pearson Correlation ◽  
Correlation Coefficients ◽  
Occupational Exposures ◽  
Individual Case ◽  
Population Based ◽  
Term Care ◽  
Lorenz Curves ◽  
Over Time

Background: Inequities in the burden of COVID-19 observed across Canada suggest heterogeneity within community transmission. Objectives: To quantify the magnitude of heterogeneity in the wider community (outside of long-term care homes) in Toronto, Canada and assess how the magnitude in concentration evolved over time (January 21 to November 21, 2020). Design: Retrospective, population-based observational study using surveillance data from Ontario's Case and Contact Management system. Setting: Toronto, Canada. Participants: Laboratory-confirmed cases of COVID-19 (N=33,992). Measurements: We generated epidemic curves by SDOH and crude Lorenz curves by neighbourhoods to visualize inequities in the distribution of COVID-19 cases by social determinants of health (SDOH) and estimated the crude Gini coefficient. We examined the correlation between SDOH using Pearson correlation coefficients. Results: The Gini coefficient of cumulative cases by population size was 0.41 (95% CI: 0.36-0.47) and were estimated for: household income (0.20, 95%CI: 0.14-0.28); visible minority (0.21, 95%CI: 0.16-0.28); recent immigration (0.12, 95%CI: 0.09-0.16); suitable housing (0.21, 95%CI: 0.14-0.30); multi-generational households (0.19, 95%CI: 0.15-0.23); and essential workers (0.28, 95% CI: 0.23-0.34). Most SDOH were highly correlated. Locally acquired cases were concentrated in higher income neighbourhoods in the early phase of the epidemic, and then concentrated in lower income neighbourhoods. Mirroring the trajectory of epidemic curves by income, the Lorenz curve shifted over time from below to above the line of equality with a similar pattern across SDOH. Limitations: Study relied on area-based measures of the SDOH and individual case counts of COVID-19. We cannot infer concentration of cases by specific occupational exposures given limitation to broad occupational categories. Conclusion: COVID-19 is increasingly concentrated by SDOH given socioeconomic inequities and structural racism. Primary Funding Source: Canadian Institutes of Health Research.

scholarly journals Development and validation of a food frequency questionnaire (FFQ-Porto Alegre) for adolescent, adult and elderly populations from Southern Brazil

2010 ◽  
Vol 26 (11) ◽  
pp. 2068-2079 ◽  
Author(s):  
Ruth Liane Henn ◽  
Sandra Costa Fuchs ◽  
Leila Beltrami Moreira ◽  
Flavio Danni Fuchs
Keyword(s):  
Food Frequency Questionnaire ◽  
Pearson Correlation ◽  
Correlation Coefficients ◽  
The Elderly ◽  
Population Based ◽  
Porto Alegre ◽  
Food Frequency ◽  
Dietary Recall ◽  
Epidemiological Surveys ◽  
Adolescents And Adults

This study assessed the validity of a food frequency questionnaire (FFQ-Porto Alegre), covering 135 food items, in comparison with the average of two consecutive 24-hour dietary recall questionnaires for adolescents, adults, and elderly who were randomly selected from a population-based survey. The Pearson correlation coefficients and cross-classification by quartiles of intake were used. The nutrients were log transformed and energy adjusted. The mean of adjusted de-attenuated correlation coefficient for adolescents was 0.44 and ranged from 0.18 (zinc) to 0.69 (folate) and for adult and elderly participants they were, respectively, 0.42, ranging from 0.16 (iron) to 0.73 (energy) and 0.52, ranging from 0.25 (vitamin E) to 0.84 (energy). The average classification percentage into the same or adjacent quartile for the two methods was 74.6% for adolescents, 74.9% for adults, and 81.2% for the elderly population. The FFQ showed fair relative validity for adolescents and adults, and may be used to study the dietary determinants of obesity and non-transmissible diseases in epidemiological surveys.

Validity and Reliability of the Computer-Administered Routine Opioid Outcome Monitoring (ROOM) Tool

Pain Medicine ◽  
2020 ◽  
Vol 21 (12) ◽  
pp. 3645-3654
Author(s):  
Louisa Picco ◽  
Melissa Middleton ◽  
Raimondo Bruno ◽  
Michala Kowalski ◽  
Suzanne Nielsen
Keyword(s):  
Alcohol Use ◽  
Pearson Correlation ◽  
Correlation Coefficients ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Chronic Noncancer Pain ◽  
Retest Reliability ◽  
Outcome Monitoring ◽  
Test Retest Reliability ◽  
Over Time

Abstract Objective The Routine Opioid Outcome Monitoring (ROOM) tool measures outcomes with opioids using an established framework which includes domains such as pain, mood, opioid use disorder, alcohol use, and constipation. This study aims to validate and establish the test-retest reliability of the computer-administered ROOM tool. Design and Setting Cross-sectional analysis of an online sample. Subjects Participants comprised those with chronic noncancer pain who regularly used prescription opioids. Methods Participants self-completed the online ROOM tool along with other validated measures (validation questionnaire), and those who were agreeable also completed the online test-retest questionnaire approximately two weeks later. Subcomponents of the ROOM tool (i.e., pain, mood, alcohol use, opioid use disorder, and constipation) were validated against longer measures of the same construct using Pearson correlation coefficients. Intraclass correlation coefficients were used to assess the stability of the ROOM tool over time. Results A total of 324 participants completed the validation questionnaire, of whom 260 also completed the test-retest questionnaire. The opioid use disorder domain showed good sensitivity (73.6) and specificity (75.8) against the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, any opioid use disorder. All ROOM components showed moderate correlation (r = 0.55–0.73) with their longer counterparts. Test-retest reliability was fair (0.58–0.75), indicating that responses were relatively stable over time. Reliability did vary, however, based on the components being measured and how certain tools were scored. Conclusion The computer-administered ROOM tool is a valid approach for brief monitoring of outcomes with prescribed opioids in primary care settings and appears to be acceptable to people who are using prescribed opioids for chronic pain.

scholarly journals COVID-19 Demographics, Acute Care Resource Use and Mortality by Age and Sex in Ontario, Canada: Population-based Retrospective Cohort Analysis

2020 ◽  
Author(s):  
Stephen Mac ◽  
Kali Barrett ◽  
Yasin A. Khan ◽  
David MJ Naimark ◽  
Laura Rosella ◽  
...  
Keyword(s):  
Acute Care ◽  
Resource Use ◽  
Cohort Analysis ◽  
Invasive Mechanical Ventilation ◽  
Temporal Trends ◽  
Age Groups ◽  
Population Based ◽  
Term Care ◽  
Over Time ◽  
Age And Sex

AbstractBackgroundUnderstanding resource use for COVID-19 is critical. We conducted a population-based cohort study using public health data to describe COVID-19 associated age- and sex-specific acute care use, length of stay (LOS), and mortality.MethodsWe used Ontario’s Case and Contact Management (CCM) Plus database of individuals who tested positive for COVID-19 in Ontario from March 1 to September 30, 2020 to determine age- and sex-specific hospitalizations, intensive care unit (ICU) admissions, invasive mechanical ventilation (IMV) use, LOS, and mortality. We stratified analyses by month of infection to study temporal trends and conducted subgroup analyses by long-term care residency.ResultsDuring the observation period, 56,476 COVID-19 cases were reported (72% < 60 years, 52% female). The proportion of cases shifted from older populations (> 60 years) to younger populations (10-39 years) over time. Overall, 10% of individuals were hospitalized, of those 22% were admitted to ICU, and 60% of those used IMV. Mean LOS for individuals in the ward, ICU without IMV, and ICU with IMV was 12.8, 8.5, 20.5 days, respectively. Mortality for individuals receiving care in the ward, ICU without IMV, and ICU with IMV was 24%, 30%, and 45%, respectively. All outcomes varied by age and decreased over time, overall and within age groups.InterpretationThis descriptive study shows acute care use and mortality varying by age, and decreasing between March and September in Ontario. Improvements in clinical practice and changing risk distributions among those infected may contribute to fewer severe outcomes among those infected with COVID-19.

scholarly journals Trends in prevalence, incidence, health system use and cost by persons with dementia in Ontario from 2004 and 2013: a population-based study

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Susan Bronskill ◽  
Jun Guan ◽  
Marian Vermeulen ◽  
Erika Yates ◽  
Ryan Ng ◽  
...  
Keyword(s):  
Health System ◽  
Service Use ◽  
Long Term Care ◽  
Population Based ◽  
P Value ◽  
Term Care ◽  
Health Administrative Data ◽  
System Use ◽  
Over Time

ABSTRACTObjectiveEfforts to enable persons with dementia to remain at home longer, and to reduce use of costly acute care resources, are at the forefront of policy agendas internationally. Foundational to planning appropriate health system supports is the ongoing, comparable and accurate estimation of the prevalence and incidence of dementia across regions, as well as associated patterns of health services use and cost. Our objective was to explore emerging approaches to using population data in dementia research and demonstrate the policy contribution of the resulting new knowledge. ApproachUsing population-based health administrative data and an algorithm that was validated using electronic medical records, we developed a series of repeated, cross-sectional cohort studies to examine trends in dementia prevalence, incidence and publicly-funded health service use and costs between 2004/05 and 2013/14 among adults aged 65 years and older in Ontario, Canada. Trends in yearly rates of health service use were assessed using regression models for serially correlated data and compared to a 1:1 matched control group based on age, sex, geographic region and comorbidity level. ResultsOver time, age- and sex-adjusted prevalence of dementia increased by 18.2% (from 63.0 to 74.5 per 1,000 persons; p-value < 0.001) and age- and sex-adjusted incidence decreased slightly (from 18.2 to 17.0 per 1,000 persons; p-value = 0.05). Community-dwelling persons with dementia were more likely than matched controls to be placed in long-term care (11.8% vs. 1.5% in 2013; p<0.001) and use home care (45.8% vs 23.2%; p<0.001) but equally likely to visit family physicians (93.9% vs. 94.8% in 2013) and specialists (87.1% vs. 89.4%). Median costs associated with one year of health system use were $19,468 (interquartile range (IQR) $4,490 to $47,726) for prevalent cases in 2012/13 and $16,549 (IQR $5,070 to $47,899) for incident cases. Long-term care and hospital care accounted for the largest portion of total costs in both groups. ConclusionThe prevalence of dementia has increased in Ontario, Canada over time and, given slightly declining incidence rates, is likely attributable to improved survival. Surveillance of dementia with health administrative data is a cost-effective tool for describing and monitoring trends in incidence and prevalence over time, and for supporting health system capacity planning. This comparative information is critical to understanding the impact of policy decisions designed to address dementia-related health care needs at a population level.

scholarly journals Surveillance of COVID-19 vaccination in US nursing homes, December 2020-April 2021

2021 ◽  
Author(s):  
Andrew I Geller ◽  
Daniel S Budnitz ◽  
Heather Dubendris ◽  
Radhika Gharpure ◽  
Minn Minn Soe ◽  
...  
Keyword(s):  
Vaccination Coverage ◽  
Long Term Care ◽  
Pearson Correlation ◽  
Vaccine Dose ◽  
Correlation Coefficients ◽  
Care Program ◽  
High Coverage ◽  
Term Care ◽  
National Healthcare Safety Network

Monitoring COVID-19 vaccination coverage among nursing home (NH) residents and staff is important to ensure high coverage and guide patient-safety policies. With the termination of the federal Pharmacy Partnership for Long-Term Care Program, another source of facility-based vaccination data is needed. We compared numbers of COVID-19 vaccinations administered to NH residents and staff reported by pharmacies participating in the temporary federal Pharmacy Partnership for Long-Term Care Program with those reported by NHs participating in new COVID-19 vaccination modules of CDC's National Healthcare Safety Network (NHSN). Pearson correlation coefficients comparing the number vaccinated between the two approaches were 0.89, 0.96, and 0.97 for residents and 0.74, 0.90, and 0.90 for staff, in the weeks ending January 3, 10, and 17, respectively. Based on subsequent NHSN reporting, vaccination coverage with ≥1 vaccine dose reached 77% for residents and 50% for staff the week ending January 31 and plateaued through April 2021.

scholarly journals Incidence of aplastic anemia in metropolitan Baltimore: a population- based study

Blood ◽  
1985 ◽  
Vol 66 (1) ◽  
pp. 115-119 ◽  
Author(s):  
M Szklo ◽  
L Sensenbrenner ◽  
J Markowitz ◽  
S Weida ◽  
S Warm ◽  
...  
Keyword(s):  
Aplastic Anemia ◽  
Occupational Exposures ◽  
The United States ◽  
Population Based ◽  
Incidence Rates ◽  
Metropolitan Statistical Area ◽  
Population Based Study ◽  
Etiologic Agents ◽  
Adjusted Incidence ◽  
Over Time

Incidence rates for aplastic anemia (AA) so far have been unavailable for defined populations in the United States. A study was carried out in the Baltimore Standard Metropolitan Statistical Area (SMSA) to examine the incidence rates for aplastic anemia from 1970 through 1978. Cases of AA (N = 118) were identified through medical records (N = 77) in SMSA hospitals and death certificates (N = 41). All medical charts were reviewed by an oncologist-hematologist for validation purposes. Among whites, average annual age-adjusted incidence rates per million were higher in males (7.1) than in females (5.4), whereas in nonwhites, females had a higher rate (7.3) than males (4.7). None of the sex differences was statistically significant. Age-specific incidence rates were consistently low in young ages, with an exponential increase after age 40. Examination of time trends did not suggest changes in whites, although in blacks, mainly in males, there was a suggestion of a temporal increase. However, rates in blacks were based on small numbers, and trends were not statistically significant. An inconsistent sex differential, as well as the relative stability of rates over time at least in whites, suggests that although sexes may have different types of exposures, occupational exposures and changes in environmental factors over time cannot entirely explain the occurrence of AA in the population. In addition, the age pattern suggests that future studies should examine etiologic agents separately for the younger and the older subjects with AA.

COVID-19 Cases Among Facility-Staff by Neighbourhood of Residence and Social and Structural Determinants: An Observational Study (Preprint)

2021 ◽  
Author(s):  
Huiting Ma ◽  
Kristy C.Y. Yiu ◽  
Stefan D. Baral ◽  
Christine Fahim ◽  
Gary Moloney ◽  
...  
Keyword(s):  
Observational Study ◽  
Census Data ◽  
Structural Determinants ◽  
Term Care ◽  
Lorenz Curves ◽  
Gini Coefficients ◽  
Greater Toronto Area ◽  
Social Structural ◽  
Neighbourhood Level ◽  
Facility Staff

BACKGROUND Disproportionate risks of COVID-19 in congregate settings including long-term care homes, retirement homes, and shelters both affect and are affected by SARS-CoV-2 infections among facility-staff. In cities across Canada, there has been a consistent trend of geographic clustering of COVID-19 cases. However, there remain limited data on how COVID-19 among facility-staff reflect urban neighbourhood disparities, particularly stratified by the social and structural determinants of community-level transmission. OBJECTIVE To compare the concentration of cumulative cases by geography and social/structural determinants across three mutually exclusive subgroups in the Greater Toronto Area (population 7.1 million): community, facility-staff, and healthcare workers (HCW) in other settings. METHODS We conducted a retrospective, observational study using surveillance data on laboratory-confirmed COVID-19 cases (January 23 to December 13, 2020; prior to vaccination roll-out). We derived neighbourhood-level social/structural determinants from census data, and generated Lorenz curves and Gini coefficients to visualize and quantify inequalities in cases. RESULTS The hardest-hit neighbourhoods (comprising 20% of the population) accounted for 53.4% of community cases, 48.6% of facility-staff cases, and 42.3% of other HCW cases. Compared with other HCW, cases in facility-staff more closely reflected the distribution of community cases. Cases in facility-staff reflected greater social and structural inequalities (larger Gini coefficients) than other HCW across all determinants. Facility-staff cases were also more likely than community cases to be concentrated in lower income neighbourhoods (Gini 0.24[0.15-0.38] vs 0.14[0.08-0.21] with lower household density (Gini 0.23[0.17-0.29] vs 0.17[0.12-0.22]) and with a greater proportion working in other essential services (Gini 0.29 [0.21-0.40], 0.22[0.17-0.28]). CONCLUSIONS COVID-19 cases among facility-staff largely reflects neighbourhood-level heterogeneity and disparities; even more so than cases in other HCW. Findings signal the importance of interventions prioritized and tailored to home geographies of facility-staff in addition to workplace measures, including prioritization and reach of vaccination at home (neighbourhood-level) and at work.

scholarly journals Stability across time of the neutrophil-lymphocyte and lymphocyte-neutrophil ratios and associations with outcomes in cardiac surgery patients

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Jeremy Green ◽  
Syed Usman Bin Mahmood ◽  
Makoto Mori ◽  
Sameh Yousef ◽  
Abeel A. Mangi ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Pearson Correlation ◽  
Artery Bypass ◽  
Temporal Stability ◽  
Correlation Coefficients ◽  
Coronary Artery Bypass Grafts ◽  
Elective Cardiac Surgery ◽  
Cell Counts ◽  
White Blood Cell Counts ◽  
Over Time

Abstract Background Elevated white blood cell counts and leukocyte ratios are recognized markers of systemic inflammation associated with poor surgical outcomes. We analyzed the temporal stability and prognostic value of the preoperative Neutrophil-to-Lymphocyte ratio (NLR) and Lymphocyte-to-Neutrophil ratio (LNR) in patients undergoing coronary artery bypass grafts and/or valve surgery. Methods We retrospectively reviewed 558 patients who underwent elective cardiac surgery between July 2014 and December 2016, excluding patients with immunosuppressed status. The stability of NLR and LNR was evaluated using interclass correlation coefficients. The patients were dichotomized into two groups, high NLR and low NLR, based on the median value of preoperative NLR in our cohort. A logistic regression model compared preoperative NLR and LNR values to clinical outcomes, including a composite of perioperative events and mid-term mortality. Results We identified that NLR reliability over time was good (ICC = .592; R-squared = .351), and LNR reliability over time was excellent (ICC = .761; R-squared = .601). Furthermore, an increased duration between collection dates was not significantly correlated with increased variability in NLR (Pearson Correlation Coefficient: −.111, p = .117). On multivariate model, neither high NLR (OR = .879, p = .168) nor low LNR (OR = 3.30, p = .214) was significantly associated with a composite of perioperative events, but increased LNR was associated with lower mid-term mortality (HR .001, p = .026). Conclusions Both NLR and LNR were stable over time, up to 100 days, but LNR values were more consistent compared to NLR. High LNR was significantly associated with decreased risk of mid-term mortality, and LNR showed a stronger relationship with mid-term mortality than its NLR counterpart. Both of these findings indicate that LNR may be a more useful and valuable clinical marker.

scholarly journals Albuminuria: population epidemiology and concordance in Australian children aged 11–12 years and their parents

BMJ Open ◽  
2019 ◽  
Vol 9 (Suppl 3) ◽  
pp. 75-84 ◽  
Author(s):  
Nicholas G Larkins ◽  
Siah Kim ◽  
John B Carlin ◽  
Anneke C Grobler ◽  
David P Burgner ◽  
...  
Keyword(s):  
Pearson Correlation ◽  
Correlation Coefficients ◽  
Population Based ◽  
Cross Sectional Study ◽  
Linear Regression Models ◽  
Creatinine Concentration ◽  
Cross Sectional ◽  
Urine Albumin ◽  
Genetic Heritability ◽  
Parent Child

ObjectivesTo describe the distribution of albuminuria among Australian children aged 11–12 years and their parents, and assess its intergenerational concordance within parent–child dyads.DesignPopulation-based cross-sectional study (the Child Health CheckPoint), nested within the Longitudinal Study of Australian Children.SettingAssessment centres (seven Australian cities and eight regional towns) and home visits across Australia, February 2015 to March 2016.ParticipantsOf all participating CheckPoint families (n=1874), 1557 children (46.2% girls) and 1454 parents (85.5% mothers) provided random urine samples at the visit; samples from menstruating females were excluded.Outcome measuresUrine albumin-to-creatinine ratio (ACR) and its components (urine albumin and creatinine concentration); albuminuria was defined as an ACR ≥3.4 mg/mmol. Pearson’s correlation coefficients and multivariable linear regression models assessed parent–child concordance, using log-transformed data due to skewing. Survey weights and methods were applied to account for the complex sample design.ResultsThe median ACR for children was 1.03 mg/mmol (IQR 0.65–1.97) and 1.01 mg/mmol (IQR 0.60–2.09) for adults. The median ACR was higher in girls (1.20, IQR 0.71–2.65) than boys (0.90, IQR 0.61–1.65) and in mothers (1.13, IQR 0.63–2.33) than fathers (0.66, IQR 0.41–1.05). Albuminuria was detected in 15.1% of children (girls 20.8%, boys 10.1%) and 13.5% of adults (15.1% mothers, 4.0% fathers) had albuminuria. There was a small correlation between parent and child ACR (Pearson correlation coefficient 0.06, 95% CI 0.01 to 0.12).ConclusionsAlbuminuria is common among Australian children and adults, which is of concern because it predicts risk for kidney and cardiovascular disease, and mortality. The weak concordance among intergenerational pairs for urine ACR suggests either that genetic heritability is low or that it becomes evident only at later offspring life stages.

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