scholarly journals Effect of socio-demographic factors on the association between multimorbidity and healthcare costs: a population-based, retrospective cohort study

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e017264 ◽  
Author(s):  
Kednapa Thavorn ◽  
Colleen J Maxwell ◽  
Andrea Gruneir ◽  
Susan E Bronskill ◽  
YuQing Bai ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Healthcare Costs ◽  
Retrospective Cohort ◽  
Demographic Factors ◽  
Positive Association ◽  
Healthcare Services ◽  
Population Based ◽  
Administrative Databases ◽  
Socio Demographic Factors

ObjectivesTo estimate the attributable costs of multimorbidity and assess whether the association between the level of multimorbidity and health system costs varies by socio-demographic factors in young (<65 years) and older (≥65 years) adults living in Ontario, Canada.DesignA population-based, retrospective cohort studySettingThe province of Ontario, CanadaParticipants6 639 089 Ontarians who were diagnosed with at least one of 16 selected medical conditions on 1 April 2009.Main outcome measuresFrom the perspective of the publicly funded healthcare system, total annual healthcare costs were derived from linked provincial health administrative databases using a person-level costing method. We used generalised linear models to examine the association between the level of multimorbidity and healthcare costs and the extent to which socio-demographic variables modified this association.ResultsAttributable total costs of multimorbidity ranged from C$377 to C$2073 for young individuals and C$1026 to C$3831 for older adults. The association between the degree of multimorbidity and healthcare costs was significantly modified by age (p<0.001), sex (p<0.001) and neighbourhood income (p<0.001) in both age groups, and the positive association between healthcare costs and levels of multimorbidity was statistically stronger for older than younger adults. For individuals aged 65 years or younger, the increase in healthcare costs was more gradual in women than in their male counterparts, however, for those aged 65 years or older, the increase in healthcare costs was significantly greater among women than men. Lastly, we also observed that the positive association between the level of multimorbidity and healthcare costs was significantly greater at higher levels of marginalisation.ConclusionSocio-demographic factors are important effect modifiers of the relationship between multimorbidity and healthcare costs and should therefore be considered in any discussion of the implementation of healthcare policies and the organisation of healthcare services aimed at controlling healthcare costs associated with multimorbidity.

scholarly journals Suicide in Canadian veterans living in Ontario: a retrospective cohort study linking routinely collected data

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e027343
Author(s):  
Alyson L Mahar ◽  
Alice B Aiken ◽  
Marlo Whitehead ◽  
Homer Tien ◽  
Heidi Cramm ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Armed Forces ◽  
Time Frame ◽  
Population Based ◽  
Administrative Databases ◽  
Risk Of Death ◽  
Male Veterans ◽  
Similar Risk

ObjectivesTo compare the risk of death by suicide in male veterans with age-matched civilians.DesignRetrospective cohort study linking provincial administrative databases between 1990 and 2013 with follow-up complete until death or December 31, 2015.SettingPopulation-based study in Ontario, Canada.ParticipantsEx-serving Canadian Armed Forces and Royal Canadian Mounted Police veterans living in Ontario who registered for provincial health insurance were included. A civilian comparator group was matched 4:1 on age and sex.Main outcomeDeath by suicide was classified using standard cause of death diagnosis codes from a provincial registry of mandatory data collected from death certificates. Fine and Gray sub-distribution hazards regression compared the risk of death by suicide between veterans and civilians. Analyses were adjusted for age, residential region, income, rurality and major physical comorbidities.Results20 397 male veterans released to Ontario between 1990 and 2013 and 81 559 age–sex matched civilians were included. 4.2% of veterans died during the study time frame, compared with 6.5% of the civilian cohort. Death by suicide was rare in both cohorts, accounting for 4.6% and 3.6% of veteran and civilian deaths, respectively. After adjustment for confounders, veterans had an 18% lower risk of dying from causes other than suicide (HR 0.82, 95% CI 0.76 to 0.89) and a similar risk of dying by suicide (HR 1.01, 95% CI 0.71 to 1.43), compared with civilians.ConclusionsDeaths by suicide were rare in male veterans residing in Ontario. Our findings demonstrate that veterans had a similar risk of suicide-related mortality as an age-matched civilian population. A better understanding of effective suicide prevention as well as clarifying pathways to seeking and receiving mental health supports and services are important areas for future consideration.

scholarly journals Risk of active tuberculosis in migrants diagnosed with cancer: a retrospective cohort study in British Columbia, Canada

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e037827
Author(s):  
Divjot S Kumar ◽  
Lisa A Ronald ◽  
Kamila Romanowski ◽  
Caren Rose ◽  
Hennady P Shulha ◽  
...  
Keyword(s):  
British Columbia ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Population Based ◽  
Active Tuberculosis ◽  
Administrative Databases ◽  
Secondary Outcome ◽  
Cancer Type ◽  
Ltbi Screening

ObjectivesTo describe the association between types of cancer and active tuberculosis (TB) risk in migrants. Additionally, in order to better inform latent TB infection (LTBI) screening protocols, we assessed proportion of active TB cases potentially preventable through LTBI screening and treatment in migrants with cancer.DesignPopulation-based, retrospective cohort study.SettingBritish Columbia (BC), Canada.Participants1 000 764 individuals who immigrated to Canada from 1985 to 2012 and established residency in BC at any point up to 2015.Primary and secondary outcome measuresUsing linked health administrative databases and disease registries, data on demographics, comorbidities, cancer type, TB exposure and active TB diagnosis were extracted. Primary outcomes included: time to first active TB diagnoses, and risks of active TB following cancer diagnoses which were estimated using Cox extended hazard regression models. Potentially preventable TB was defined as active TB diagnosed >6 months postcancer diagnoses.ResultsActive TB risk was increased in migrants with cancer ((HR (95% CI)) 2.5 (2.0 to 3.1)), after adjustment for age, sex, TB incidence in country of origin, immigration classification, contact status and comorbidities. Highest risk was observed with lung cancer (HR 11.2 (7.4 to 16.9)) and sarcoma (HR 8.1 (3.3 to 19.5)), followed by leukaemia (HR 5.6 (3.1 to 10.2)), lymphoma (HR 4.9 (2.7 to 8.7)) and gastrointestinal cancers (HR 2.7 (1.7 to 4.4)). The majority (65.9%) of active TB cases were diagnosed >6 months postcancer diagnosis.ConclusionSpecific cancers increase active TB risk to varying degrees in the migrant population of BC, with approximately two-thirds of active TB cases identified as potentially preventable.

scholarly journals Comparison of adverse perinatal outcomes between Asians and Caucasians: a population-based retrospective cohort study in Ontario

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Na Zeng ◽  
Erica Erwin ◽  
Wendy Wen ◽  
Daniel J. Corsi ◽  
Shi Wu Wen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Birth Weight ◽  
Preterm Birth ◽  
Cesarean Section ◽  
Gestational Age ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Perinatal Outcomes ◽  
Population Based ◽  
Adverse Perinatal Outcomes

Abstract Background Racial disparities in adverse perinatal outcomes have been studied in other countries, but little has been done for the Canadian population. In this study, we sought to examine the disparities in adverse perinatal outcomes between Asians and Caucasians in Ontario, Canada. Methods We conducted a population-based retrospective cohort study that included all Asian and Caucasian women who attended a prenatal screening and resulted in a singleton birth in an Ontario hospital (April 1st, 2015-March 31st, 2017). Generalized estimating equation models were used to estimate the independent adjusted relative risks and adjusted risk difference of adverse perinatal outcomes for Asians compared with Caucasians. Results Among 237,293 eligible women, 31% were Asian and 69% were Caucasian. Asians were at an increased risk of gestational diabetes mellitus, placental previa, early preterm birth (< 32 weeks), preterm birth, emergency cesarean section, 3rd and 4th degree perineal tears, low birth weight (< 2500 g, < 1500 g), small-for-gestational-age (<10th percentile, <3rd percentile), neonatal intensive care unit admission, and hyperbilirubinemia requiring treatment, but had lower risks of preeclampsia, macrosomia (birth weight > 4000 g), large-for-gestational-age neonates, 5-min Apgar score < 7, and arterial cord pH ≤7.1, as compared with Caucasians. No difference in risk of elective cesarean section was observed between Asians and Caucasians. Conclusion There are significant differences in several adverse perinatal outcomes between Asians and Caucasians. These differences should be taken into consideration for clinical practices due to the large Asian population in Canada.

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