scholarly journals Access to cancer care in northwestern Ontario—a population-based study using administrative data

2020 ◽  
Vol 27 (3) ◽  
Author(s):  
M. Febbraro ◽  
M. Conlon ◽  
J. Caswell ◽  
N. Laferriere
Keyword(s):  
Administrative Data ◽  
Urban Areas ◽  
Access To Health Care ◽  
Universal Access ◽  
Population Based ◽  
Ontario Health Insurance Plan ◽  
Cancer Data ◽  
Factors Associated ◽  
Specialist Consultation ◽  
Northwestern Ontario

Background: Despite universal access to health care in Canada, disparities exist relating to social determinants of health, which contribute to discrepancies in cancer incidence and outcomes between rural and urban areas. Given that Canada has one of the highest-quality national population-based cancer registry systems in the world and there is little information regarding cancer statistics specific to northwestern Ontario, the purpose of this study was to estimate the percentage of cancer patients without documentation of a specialist consultation (medical or radiation oncology consultation) and to determine factors that affect access to specialist consultation in northwestern Ontario. Methods: This was a population-based retrospective study using administrative data. Administration data was obtained through the Ontario Cancer Data Linkage Project. For each index case, a timeline was constructed of all Ontario Health Insurance Plan billing codes and associated service dates starting with primary cancer diagnosis and ending with death. Specific factors affecting access to specialist consultation were assessed. Results: Within the 6 year study period (2010-2016), 2583 index cases were identified. Most (n=2007, 78%) received a specialist consultation. Factors associated with not receiving a specialist consultation included older age (p<0.0001, OR 0.29; 95% CI 0.19-0.44) and rural residence (p<0.0001, OR 0.48; 95% CI 0.48-0.72). Factors associated with receiving a specialist consultation included increased duration of disease (p< 0.0001, OR 1.32; 95% CI 1.19-1.46), a diagnosis of breast cancer (p < 0.0001, OR 2.51; 95% CI 1.43-4.42), and a diagnosis of lung cancer (p< 0.0001, OR 1.77; 95% CI 1.38-2.26).   Conclusions: These findings are consistent with the other studies assessing access to care barriers, but is the first to look at care access in northwestern Ontario. Further research is needed to examine gaps in care relating to access to primary referral services, symptom recognition, cancer screening, and travel associated burdens specific to northwestern Ontario.

scholarly journals Prevalence and factors associated with intimate partner violence among the adolescent girls and young women in South Africa: findings the 2017 population based cross-sectional survey

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jacqueline Mthembu ◽  
Musawenkosi Mabaso ◽  
Sarah Reis ◽  
Khangelani Zuma ◽  
Nompumelelo Zungu
Keyword(s):  
South African ◽  
Adolescent Girls ◽  
Young Women ◽  
Partner Violence ◽  
Urban Areas ◽  
Population Based ◽  
Intimate Partner ◽  
Low Ses ◽  
Cross Sectional ◽  
Factors Associated

Abstract Background Evidence indicate that intimate partner violence (IPV) is disturbingly high among South African adolescent girls and young women (AGYW). Understanding prevalence and risk factors for IPV among these emerging adults is critical for developing appropriate interventions to prevent adverse health outcomes later in life. This study investigates the prevalence and factors associated with lifetime physical IPV experience among AGYW, aged 15–24 years, using the South African national HIV prevalence, incidence, behaviour and communication survey conducted in 2017. Methods The data used in this secondary analysis was obtained from a cross-sectional, population-based household survey data, conducted using a multi-stage stratified random cluster sampling approach. Multivariate stepwise backward logistic regression modelling was used to determine factors associated with IPV. Results Of 716 AGYW that responded to the two commonly answered questions on IPV, 13.1% (95% CI: 9.6–17.6) indicated that they experienced IPV. The odds of reporting experiences of IPV were significantly lower among AGYW residing in high SES households [AOR = 0.09 (95% CI: 0.02–0.47), p = 0.004] than low SES households, and those residing in rural informal/tribal areas [AOR = 0.01 (95% CI: 0.00–0.22), p = 0.004] than urban areas. AGYW experiencing IPV had higher odds of reporting psychological distress compared to their counterparts [AOR = 4.37 (95% CI, 0.97–19.72), p = 0.054]. Conclusion The findings highlight the need for targeted structural and psychosocial interventions in low SES households and especially in urban areas.

scholarly journals Validation of Carotid Artery Revascularization Coding in Ontario Health Administrative Databases

2016 ◽  
Vol 39 (2) ◽  
pp. 73 ◽  
Author(s):  
Mohamad A Hussain ◽  
Muhammad Mamdani ◽  
Gustavo Saposnik ◽  
Jack V Tu ◽  
David Turkel-Parrella ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Administrative Data ◽  
High Volume ◽  
Population Based ◽  
Administrative Databases ◽  
Ontario Health Insurance Plan ◽  
Stroke Registry ◽  
Administrative Records ◽  
Ischemic Attack ◽  
Procedure Codes

Purpose: The positive predictive value (PPV) of carotid endarterectomy (CEA) and carotid artery stenting (CAS) procedure and post-operative complication coding were assessed in Ontario health administrative databases. Methods: Between 1 April 2002 and 31 March 2014, a random sample of 428 patients were identified using Canadian Classification of Health Intervention (CCI) procedure codes and Ontario Health Insurance Plan (OHIP) billing codes from administrative data. A blinded chart review was conducted at two high-volume vascular centers to assess the level of agreement between the administrative records and the corresponding patients’ hospital charts. PPV was calculated with 95% confidence intervals (CIs) to estimate the validity of CEA and CAS coding, utilizing hospital charts as the gold standard. Sensitivity of CEA and CAS coding were also assessed by linking two independent databases of 540 CEA-treated patients (Ontario Stroke Registry) and 140 CAS-treated patients (single-center CAS database) to administrative records. Results: PPV for CEA ranged from 99% to 100% and sensitivity ranged from 81.5% to 89.6% using CCI and OHIP codes. A CCI code with a PPV of 87% (95% CI, 78.8-92.9) and sensitivity of 92.9% (95% CI, 87.4-96.1) in identifying CAS was also identified. PPV for post-admission complication diagnosis coding was 71.4% (95% CI, 53.7-85.4) for stroke/transient ischemic attack, and 82.4% (95% CI, 56.6-96.2) for myocardial infarction. Conclusions: Our analysis demonstrated that the codes used in administrative databases accurately identify CEA and CAS-treated patients. Researchers can confidently use administrative data to conduct population-based studies of CEA and CAS.

scholarly journals Validation of endovascular and open thoracoabdominal aortic aneurysm repair in Ontario health administrative databases

2019 ◽  
Vol 42 (2) ◽  
pp. E19-25 ◽  
Author(s):  
Rodolfo V. Rocha ◽  
Mohammed Al-Omran ◽  
Mohamad A. Hussain ◽  
Douglas S. Lee ◽  
Thomas L. Forbes ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Administrative Data ◽  
Thoracoabdominal Aortic Aneurysm ◽  
Population Based ◽  
Administrative Databases ◽  
Ontario Health Insurance Plan ◽  
Administrative Records ◽  
Thoracoabdominal Aortic Aneurysm Repair ◽  
Aneurysm Repair ◽  
Procedure Codes

Purpose: The positive predictive value (PPV) of endovascular and open thoracoabdominal aortic aneurysm (TAAA) repair coding was assessed in Ontario health administrative databases. Methods: Between 1 January 2006 and 31 March 2016, a random sample of 192 patients was identified using Canadian Classification of Health Intervention (CCI) procedure codes and Ontario Health Insurance Plan (OHIP) billing codes from administrative data. Blinded chart reviews were conducted at two cardiovascular centers to assess the level of agreement between the administrative records and the corresponding patients’ hospital charts. The PPV was calculated with 95% confidence intervals using hospital charts as the gold standard. Results: The PPV for the single endovascular TAAA repair code, 1ID80GQNRN, was 0.90 (0.78, 0.97). A combination of all nine CCI open TAAA repair codes was performed, with a PPV of 0.62 (0.47, 0.76). The combination of any one of the nine CCI codes AND the single OHIP code for open TAAA repair (R803) rendered a PPV of 0.98 (0.90, 1.00). Conclusions: Endovascular TAAA repair may be identified using a single CCI code (1ID80GQNRN). Open TAAA repair may be identified using a combination of CCI and OHIP codes. Researchers may therefore use administrative data to conduct population-based studies of endovascular and open repair of TAAA.

scholarly journals Access to prenatal care: inequalities in a region with high maternal mortality in southeastern Brazil

2016 ◽  
Vol 21 (5) ◽  
pp. 1647-1658 ◽  
Author(s):  
Katrini Guidolini Martinelli ◽  
Edson Theodoro dos Santos Neto ◽  
Silvana Granado Nogueira da Gama ◽  
Adauto Emmerich Oliveira
Keyword(s):  
Health Care ◽  
Prenatal Care ◽  
Health Services ◽  
Pregnant Women ◽  
Minimum Wage ◽  
Urban Areas ◽  
Access To Health Care ◽  
Universal Access ◽  
Southeastern Brazil ◽  
Cross Sectional

Abstract Aim This article aims to evaluate access to prenatal care according to the dimensions of availability, affordability and acceptability in the SUS microregion of southeastern Brazil. Methods A cross-sectional study conducted in 2012-2013 that selected 742 postpartum women in seven hospitals in the region chosen for the research. The information was collected, processed and submitted to the chi-square test and the nonparametric Spearman’s test, with p-values less than 5% (p < 0.05). Results Although the SUS constitutionally guarantees universal access to health care, there are still inequalities between pregnant women from rural and urban areas in terms of the availability of health care and among families earning up to minimum wage and more than one minimum wage per month in terms of affordability; however, the acceptability of health care was equal, regardless of the modality of the health services. Conclusion The location, transport resources and financing of health services should be reorganised, and the training of health professionals should be enhanced to provide more equitable health care access to pregnant women.

scholarly journals Access to oncology consultation in a cancer cohort in northeastern Ontario

2015 ◽  
Vol 22 (2) ◽  
pp. 69 ◽  
Author(s):  
M. Conlon ◽  
M. Hartman ◽  
B. Ballantyne ◽  
N. Aubin ◽  
M. Meigs ◽  
...  
Keyword(s):  
Cancer Diagnosis ◽  
Radiation Oncology ◽  
Population Based ◽  
Primary Cancer ◽  
Ontario Health Insurance Plan ◽  
Cancer Data ◽  
Disease Trajectory ◽  
Area Of Interest ◽  
Cancer Symptom Management ◽  
Rural Patients

BackgroundTo enhance cancer symptom management for residents of Sudbury–Manitoulin District, an ambulatory palliative clinic (pac) was established at the Northeast Cancer Centre of Health Sciences North. The pac is accessed from a medical or radiation oncology consultation. The primary purpose of the present population-based retrospective study was to estimate the percentage of cancer patients who died without ever having a medical or radiation oncology consultation. A secondary purpose was to determine factors associated with never having received one of those specialized consultations.MethodsAdministrative data was obtained through the Ontario Cancer Data Linkage Project. For each index case, we constructed a timeline, in days, of all Ontario Health Insurance Plan billing codes and associated service dates starting with the primary cancer diagnosis and ending with death.ResultsWithin the 5-year study period (2004–2008), 6683 people in the area of interest with a valid record of primary cancer diagnosis died from any cause. Most (n = 5988, 89.6%) had 1 primary cancer diagnosis. For that subgroup, excluding those with a disease duration of 0 days (n = 67), about 18.4% (n = 1088) never had a consultation with a medical or radiation oncologist throughout their disease trajectory. Patients who were older or who resided in a rural area were significantly less likely to have had a consultation.ConclusionsSpecific strategies directed toward older and rural patients might help to address this important access-to-care issue.

scholarly journals Changing roles of population-based cancer registries in Australia

2015 ◽  
Vol 39 (4) ◽  
pp. 425 ◽  
Author(s):  
David Roder ◽  
Nicola Creighton ◽  
Deborah Baker ◽  
Richard Walton ◽  
Sanchia Aranda ◽  
...  
Keyword(s):  
Health System ◽  
Administrative Data ◽  
Cancer Incidence ◽  
Interval Cancer ◽  
Cancer Registries ◽  
Population Based ◽  
Registry Data ◽  
Multiple Primary Cancers ◽  
Clinical Quality ◽  
Cancer Data

Registries have key roles in cancer incidence, mortality and survival monitoring and in showing disparities across the population. Incidence monitoring began in New South Wales in 1972 and other jurisdictions soon followed. Registry data are used to evaluate outcomes of preventive, screening, treatment and support services. They have shown decreases in cancer incidence following interventions and have been used for workforce and other infrastructure planning. Crude markers of optimal radiotherapy and chemotherapy exist and registry data are used to show shortfalls against these markers. The data are also used to investigate cancer clusters and environmental concerns. Survival data are used to assess service performance and interval cancer data are used in screening accreditation. Registries enable determination of risk of multiple primary cancers. Clinical quality registries are used for clinical quality improvement. Population-based cancer registries and linked administrative data complement clinical registries by providing high-level system-wide data. The USA Commission on Cancer has long used registries for quality assurance and service accreditation. Increasingly population-based registry data in Australia are linked with administrative data on service delivery to assess system performance. Addition of tumour stage and other prognostic indicators is important for these analyses and is facilitated by the roll-out of structured pathology reporting. Data linkage with administrative data, following checks on the quality of these data, enables assessment of patterns of care and other performance indicators for health-system monitoring. Australian cancer registries have evolved and increasingly are contributing to broader information networks for health system management.

scholarly journals Incidence of ESKD and Mortality among Children with Congenital Heart Disease after Cardiac Surgery

2019 ◽  
Vol 14 (10) ◽  
pp. 1450-1457 ◽  
Author(s):  
Chirag R. Parikh ◽  
Jason H. Greenberg ◽  
Eric McArthur ◽  
Heather Thiessen-Philbrook ◽  
Allen D. Everett ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
General Population ◽  
Access To Health Care ◽  
Health Care Services ◽  
Congenital Heart ◽  
Surgical Repair ◽  
Universal Access ◽  
Population Based ◽  
Interquartile Range

Background and objectivesSurvival after surgical repair for congenital heart disease has markedly improved; however, there are limited data on long-term ESKD and mortality during childhood.Design, setting, participants, & measurementsWe conducted an observational, population-based cohort study of children who had their first surgery for congenital heart disease within 10 years of birth. The study was conducted in Ontario, Canada, where residents have universal access to health care services. Each child who underwent surgical repair was matched to ten children from the general population who were similar in age, sex, index date, rurality, and neighborhood income. Primary outcomes of all-cause mortality and ESKD were reported until March 2015.ResultsWe followed 3600 children with congenital heart disease for a median of 5.9 (interquartile range, 2.9–9.0) years after their surgical repair. Median age at first surgery was 150 (interquartile range, 40–252) days and 22% were low birth weight (<2500 g). During follow-up, 140 (4%) children who had surgery for congenital heart disease died and 52 (1%) reached ESKD. The cumulative incidence of death and ESKD at 1, 5, and 10 years was higher in children with surgical repair of congenital heart disease (death: 3%, 4%, and 5%, respectively; ESKD: 1%, 2%, and 2%, respectively) compared with the matched control population without any congenital heart disease (death: 0.06%, 0.10%, and 0.13%, respectively; ESKD: 0.00%, 0.02%, and 0.02%, respectively). The risk of ESKD and death increased with severity of congenital heart disease, with the highest risk in children with hypoplastic left heart syndrome and increased in children who had surgical repair of congenital heart disease compared with those without surgical repair.ConclusionsThe risk of mortality and ESKD is high in children who undergo surgical repair for congenital heart disease compared to the general population.

Prevalence and socio-cultural determinants of domestic violence among married women in Thimphu, Bhutan

2015 ◽  
Vol 1 (1) ◽  
pp. 39-48 ◽  
Author(s):  
Kencho Wangmo
Keyword(s):  
Domestic Violence ◽  
Rural Areas ◽  
Urban Areas ◽  
Public Health Problem ◽  
Population Based ◽  
Married Women ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Factors Associated ◽  
Adolescent Women

Introduction: Domestic violence is a public health problem all over the world, yet its prevalence is under-reported in a pervasive “culture of silence”. Bhutan is not likely to be an exception; however, data on the prevalence, forms and determinants of domestic violence are scant. The purpose of this study is to measure the prevalence and characterize factors associated with domestic violence among women in Thimphu, Bhutan’s capital. Methods: A population-based, household cross-sectional survey was conducted in January-May, 2012. A multistage sampling method was used to obtain a representative sample of 300 married women. The chi-square test was used to identify factors associated with increased likelihood of experiencing the four forms of domestic violence. Results: The overall prevalence of any domestic violence was 44%. By type of violence, the most common was emotional (36%), followed by control (30%), physical (20%) and sexual (14%). Sexual violence was reported more often by young adolescent women. Women from urban areas reported more emotional violence compared to women from rural areas. Women agreed with many situations in which force might be used by their husbands and with many of the traditional roles of women in society. Nonetheless, many women objected to the use of force in many situations and rejected certain constraining roles of women. Conclusions: This study supports the importance of advocacy for education and programs to prevent and mitigate harm from domestic abuse experienced by women in Bhutan.

scholarly journals STI epidemic re-emergence, socio-epidemiological clusters characterisation and HIV coinfection in Catalonia, Spain, during 2017–2019: a retrospective population-based cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e052817
Author(s):  
Alexis Sentís ◽  
Marcos Montoro-Fernandez ◽  
Evelin Lopez-Corbeto ◽  
Laia Egea-Cortés ◽  
Daniel K Nomah ◽  
...  
Keyword(s):  
Urban Areas ◽  
Descriptive Analysis ◽  
Population Based ◽  
Incidence Rates ◽  
Sexually Transmitted ◽  
Factors Associated ◽  
Health Area ◽  
Effective Interventions ◽  
Hiv Coinfection ◽  
Deprived Areas

ObjectivesTo describe the epidemiology of sexually transmitted infections (STIs), identify and characterise socio-epidemiological clusters and determine factors associated with HIV coinfection.DesignRetrospective population-based cohort.SettingCatalonia, Spain.Participants42 283 confirmed syphilis, gonorrhoea, chlamydia and lymphogranuloma venereum cases, among 34 600 individuals, reported to the Catalan HIV/STI Registry in 2017–2019.Primary and secondary outcomesDescriptive analysis of confirmed STI cases and incidence rates. Factors associated with HIV coinfection were determined using logistic regression. We identified and characterized socio-epidemiological STI clusters by Basic Health Area (BHA) using K-means clustering.ResultsThe incidence rate of STIs increased by 91.3% from 128.2 to 248.9 cases per 100 000 population between 2017 and 2019 (p<0.001), primarily driven by increase among women (132%) and individuals below 30 years old (125%). During 2017–2019, 50.1% of STIs were chlamydia and 31.6% gonorrhoea. Reinfections accounted for 10.8% of all cases and 6% of cases affected HIV-positive individuals. Factors associated with the greatest likelihood of HIV coinfection were male sex (adjusted OR (aOR) 23.69; 95% CI 16.67 to 35.13), age 30–39 years (versus <20 years, aOR 18.58; 95% CI 8.56 to 52.13), having 5–7 STI episodes (vs 1 episode, aOR 5.96; 95% CI 4.26 to 8.24) and living in urban areas (aOR 1.32; 95% CI 1.04 to 1.69). Living in the most deprived BHAs (aOR 0.60; 95% CI 0.50 to 0.72) was associated with the least likelihood of HIV coinfection. K-means clustering identified three distinct clusters, showing that young women in rural and more deprived areas were more affected by chlamydia, while men who have sex with men in urban and less deprived areas showed higher rates of STI incidence, multiple STI episodes and HIV coinfection.ConclusionsWe recommend socio-epidemiological identification and characterisation of STI clusters and factors associated with HIV coinfection to identify at-risk populations at a small health area level to design effective interventions.

scholarly journals Risk factors, early presentations, and clinical markers of Parkinson's disease in Primary Care in a diverse UK population

2021 ◽  
Author(s):  
Cristina Simonet ◽  
Jonathan P Bestwick ◽  
Mark Jitlal ◽  
Aaron Ben-Joseph ◽  
Charles R Marshall ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Hearing Loss ◽  
Access To Health Care ◽  
Universal Access ◽  
Surrogate Marker ◽  
Final Diagnosis ◽  
Population Based ◽  
Clinical Markers ◽  
Health Care Design

Importance: Predictors of future Parkinson′s disease (PD) have been suggested through population-based studies, but these studies over–represent white, affluent groups and may not be generalisable. Objective: To investigate the association between risk factors and pre–diagnostic presentations of PD in a uniquely diverse UK population, with universal access to health care. Design, Setting, and Participants: A case–control study was conducted in East London, using primary care health records. Main outcomes and Measures: Logistic regression was used to determine associations between risk factors and pre–diagnostic presentations of PD with final diagnosis. Three periods (recorded <2 years, 2–5 years, and 5–10 years prior to diagnosis) were analysed. Results: Primary care records were available for 1,055 patients with PD and 1,009,523 controls. The strongest associations were found for tremor (OR, 181.69; 95% CI, 151.91–217.31) and ′memory complaints′ (OR, 9.84; 95% CI, 7.39–13.11), <2 years before PD diagnosis. However, associations for both complaints persisted up to 10 years prior to PD diagnosis. Shoulder pain was more common in those who developed PD, emerging 5 to 10 years prior to diagnosis (OR, 2.54; 95% CI, 1.77–3.65), and may be a surrogate marker for rigidity. Epilepsy showed a strongest association with subsequent PD (OR, 5.14; 95% CI, 1.26–21.0), and associations were also found for hypertension (OR, 1.71; 95% CI, 1.34–2.17) and type 2 diabetes (OR, 1.57; 95% CI, 1.31–1.87) 5 to 10 years before diagnosis. We replicated several known associations with early non motor features including hypotension, constipation, and depression. A weak but novel association was observed with prodromal hearing loss and subsequent PD, which appeared up to 10 years prior to diagnosis. No associations with future PD diagnosis were found for ethnicity or deprivation index. Conclusions and relevance: This study provides further evidence that a range of comorbidities and pre-diagnostic presentations are encountered in primary care prior to PD diagnosis, but for the first time in such a diverse and deprived population. Convincing temporal associations were observed for epilepsy and hearing loss with subsequent PD. The predominance of ′memory symptoms′ hints at an excess of cognitive dysfunction in early PD in this population or difficulty in correctly ascertaining symptoms in traditionally under–represented groups.

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