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 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 Gender Disparities in Surgical Treatment of Axis Fractures in Older Adults

2019 ◽  
Vol 11 (1) ◽  
pp. 71-75
Author(s):  
Michael P. Catalino ◽  
Brice A. Kessler ◽  
Virginia Pate ◽  
Drew Cutshaw ◽  
Til Stürmer ◽  
...  
Keyword(s):  
Cohort Study ◽  
Surgical Treatment ◽  
Spine Surgery ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
International Classification Of Diseases ◽  
Population Based ◽  
Gender Disparity ◽  
Gender Disparities ◽  
Secondary Outcome

Study Design: Retrospective cohort study. Objectives: Gender appears to play in important role in surgical outcomes following acute cervical spine trauma, with current literature suggesting males have a significantly higher mortality following spine surgery. However, no well-adjusted population-based studies of gender disparities in incidence and outcomes of spine surgery following acute traumatic axis injuries exist to our knowledge. We hypothesized that females would receive surgery less often than males, but males would have a higher 1-year mortality following isolated traumatic axis fractures. Methods: We performed a retrospective cohort study using Medicare claims data that identified US citizens aged 65 and older with ICD-9 (International Classification of Diseases, Ninth Revision) code diagnosis corresponding to isolated acute traumatic axis fracture between 2007 and 2014. Our primary outcome was defined as cumulative incidence of surgical treatment, and our secondary outcome was 1-year mortality. Propensity weighted analysis was performed to balance covariates between genders. Our institutional review board approved the study (IRB #16-0533). Results: There was no difference in incidence of surgery between males and females following acute isolated traumatic axis fractures (7.4 and 7.5 per 100 fractures, respectively). Males had significantly higher 1-year weighted mortality overall (41.7 and 28.9 per 100 fractures, respectively, P < .001). Conclusion: Our well-adjusted data suggest there was no significant gender disparity in incidence of surgical treatment over the study period. The data also support previous observations that males have worse outcomes in comparison to females in the setting of axis fractures and spinal trauma regardless of surgical intervention.

scholarly journals Demographic predictors of active tuberculosis in people migrating to British Columbia, Canada: a retrospective cohort study

2018 ◽  
Vol 190 (8) ◽  
pp. E209-E216 ◽  
Author(s):  
Lisa A. Ronald ◽  
Jonathon R. Campbell ◽  
Robert F. Balshaw ◽  
Kamila Romanowski ◽  
David Z. Roth ◽  
...  
Keyword(s):  
British Columbia ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Active Tuberculosis ◽  
Demographic Predictors

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 Keloid risk in patients with atopic dermatitis: a nationwide retrospective cohort study in Taiwan

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e022865 ◽  
Author(s):  
Ying-Yi Lu ◽  
Chun-Ching Lu ◽  
Wei-Wen Yu ◽  
Li Zhang ◽  
Qing-Rui Wang ◽  
...  
Keyword(s):  
Atopic Dermatitis ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Population Based ◽  
Secondary Outcome ◽  
Severe Atopic Dermatitis ◽  
Secondary Outcome Measure ◽  
Research Database ◽  
Cox Proportional Hazard Regression

ObjectiveThe pathogenesis of keloid is largely unknown. Because keloid and atopic dermatitis have overlapping pathophysiological mechanisms, we aimed to evaluate keloid risk in patients with atopic dermatitis.Study designPopulation-based retrospective cohort study.SettingThe Taiwan National Health Insurance Research Database was used to analyse data for people who had been diagnosed with atopic dermatitis.ParticipantsWe identified 8371 patients with newly diagnosed atopic dermatitis during 1996–2010. An additional 33 484 controls without atopic dermatitis were randomly identified and frequency matched at a one-to-four ratio.Primary and secondary outcome measureThe association between atopic dermatitis and keloid risk was estimated using Cox proportional hazard regression models.ResultsAfter adjustment for covariates, the atopic dermatitis patients have a 3.19-fold greater risk of developing keloid compared with the non-atopic dermatitis group (3.19vs1.07 per 1000 person-years, respectively). During the study period, 163 patients with atopic dermatitis and 532 patients without atopic dermatitis developed keloid. Notably, keloid risk increased with severity of atopic dermatitis, particularly in patients with moderate to severe atopic dermatitis.ConclusionsOur results indicate that patients with atopic dermatitis had a higher than normal risk of developing keloid and suggest that atopic dermatitis may be an independent risk factor for keloid.

scholarly journals Outcomes associated with hospital admissions for accidental opioid overdose in British Columbia: a retrospective cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e025567
Author(s):  
Richard L Morrow ◽  
Ken Bassett ◽  
Malcolm Maclure ◽  
Colin R Dormuth
Keyword(s):  
British Columbia ◽  
Cohort Study ◽  
Adverse Events ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Secondary Analysis ◽  
Secondary Outcome ◽  
Opioid Overdose ◽  
Composite Outcome ◽  
Serious Adverse Events

ObjectivesTo study the association between accidental opioid overdose and neurological, respiratory, cardiac and other serious adverse events and whether risk of these adverse events was elevated during hospital readmissions compared with initial admissions.DesignRetrospective cohort study.SettingPopulation-based study using linked administrative data in British Columbia, Canada.ParticipantsThe primary analysis included 2433 patients with 2554 admissions for accidental opioid overdose between 2006 and 2015, including 121 readmissions within 1 year of initial admission. The secondary analysis included 538 patients discharged following a total of 552 accidental opioid overdose hospitalizations and 11 040 matched controls from a cohort of patients with ≥180 days of prescription opioid use.Outcome measuresThe primary outcome was encephalopathy; secondary outcomes were adult respiratory distress syndrome, respiratory failure, pulmonary haemorrhage, aspiration pneumonia, cardiac arrest, ventricular arrhythmia, heart failure, rhabdomyolysis, paraplegia or tetraplegia, acute renal failure, death, a composite outcome of encephalopathy or any secondary outcome and total serious adverse events (all-cause hospitalisation or death). We analysed these outcomes using generalised linear models with a logistic link function.Results3% of accidental opioid overdose admissions included encephalopathy and 25% included one or more adverse events (composite outcome). We found no evidence of increased risk of encephalopathy (OR 0.57; 95% CI 0.13 to 2.49) or other outcomes during readmissions versus initial admissions. In the secondary analysis, <5 patients in each cohort experienced encephalopathy. Risk of the composite outcome (OR 2.15; 95% CI 1.48 to 3.12) and all-cause mortality (OR 2.13; 95% CI 1.18 to 3.86) were higher for patients in the year following overdose relative to controls.ConclusionsWe found no evidence that risk of encephalopathy or other adverse events was higher in readmissions compared with initial admissions for accidental opioid overdose. Risk of serious morbidity and mortality may be elevated in the year following an accidental opioid overdose.

scholarly journals Prevalence of multimorbidity in adults with cancer, and associated health service utilization in Ontario, Canada: a population-based retrospective cohort study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anna Péfoyo Koné ◽  
Deborah Scharf
Keyword(s):  
Cohort Study ◽  
Health Service ◽  
Service Utilization ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Health Service Utilization ◽  
Premature Death ◽  
Population Based ◽  
Chronic Medical Condition ◽  
Cancer Type

Abstract Background The majority of people with cancer have at least one other chronic health condition. With each additional chronic disease, the complexity of their care increases, as does the potential for negative outcomes including premature death. In this paper, we describe cancer patients’ clinical complexity (i.e., multimorbidity; MMB) in order to inform strategic efforts to improve care and outcomes for people with cancer of all types and commonly occurring chronic diseases. Methods We conducted a population-based, retrospective cohort study of adults diagnosed with cancer between 2003 and 2013 (N = 601,331) identified in Ontario, Canada healthcare administrative data. During a five to 15-year follow-up period (through March 2018), we identified up to 16 co-occurring conditions and patient outcomes for the cohort, including health service utilization and death. Results MMB was extremely common, affecting more than 91% of people with cancer. Nearly one quarter (23%) of the population had five or more co-occurring conditions. While we saw no differences in MMB between sexes, MMB prevalence and level increased with age. MMB prevalence and type of co-occurring conditions also varied by cancer type. Overall, MMB was associated with higher rates of health service utilization and mortality, regardless of other patient characteristics, and specific conditions differentially impacted these rates. Conclusions People with cancer are likely to have at least one other chronic medical condition and the presence of MMB negatively affects health service utilization and risk of premature death. These findings can help motivate and inform health system advances to improve care quality and outcomes for people with cancer and MMB.

scholarly journals Prevalence of Multimorbidity in Adults with Cancer, and Associated Health Service Utilization in Ontario, Canada: A Population-based Retrospective Cohort Study

2021 ◽  
Author(s):  
Anna Kone ◽  
Deborah Scharf
Keyword(s):  
Cohort Study ◽  
Health Service ◽  
Service Utilization ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Health Service Utilization ◽  
Premature Death ◽  
Population Based ◽  
Chronic Medical Condition ◽  
Cancer Type

Abstract Background: The majority of people with cancer have at least one other chronic health condition. With each additional chronic disease, the complexity of their care increases, as does the potential for negative outcomes including premature death. In this paper, we describe cancer patients’ clinical complexity (i.e., multimorbidity; MMB) in order to inform strategic efforts to improve care and outcomes for people with cancer of all types and commonly occurring chronic diseases. Methods: We conducted a population-based, retrospective cohort study of adults diagnosed with cancer between 2003 and 2013 (N=601,331) identified in Ontario, Canada healthcare administrative data. During a five to 15-year follow-up period (through March 2018), we identified up to 16 co-occurring conditions and patient outcomes including health service utilization and death. Results: MMB was extremely common, affecting more than 91% of people with cancer. Nearly one quarter (23%) of the population had five or more co-occurring conditions. While we saw no differences in MMB between sexes, MMB prevalence and level increased with age. MMB prevalence and type of co-occurring conditions also varied by cancer type. Overall, MMB was associated with higher rates of health service utilization and mortality, regardless of other patient characteristics, and specific conditions differentially impacted these rates.Conclusions: People with cancer are likely to have at least one other chronic medical condition and the presence of MMB negatively affects health service utilization and risk of premature death. These finds can help motivate and inform health system advances to improve care quality and outcomes for people with cancer and MMB due to commonly occurring chronic conditions.

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