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Introduction: This aim of this study is to provide updated estimates on the prevalence of dementia, heart disease, and stroke in Canadian communities. Targeting all three conditions together, at the community level, may be key to disease prevention and health aging in the Canadian population. Methods: Using nationwide health survey data, we calculated the age-standardized prevalence of self-reported dementia, heart disease and stroke in adults aged 18 years and over residing in Canadian communities from 2016 to 2021. Poisson regression models were used to detect statistically significant changes in the prevalence of all three conditions from 2016 to 2021. Results: Less than 1% (~ 175,000 individuals) of adults residing in Canadian communities reported dementia, 5% (~ 1.5 million individuals) reported heart disease, and more than 1% (~ 370,000 individuals) reported stroke annually from 2016 to 2021. Overall, the age-standardized prevalence for stroke decreased minimally from 2016 to 2021 (p = 0.0004). Although the age-standardized prevalence of heart disease and dementia decreased from 2016 to 2018, subsequent increases in prevalence from 2018 to 2021 led to a lack of overall statistically significant changes from 2016 to 2021 (p = 0.10 for heart disease and p = 0.37 for dementia). Conclusion: Recent increases in the prevalence of dementia, heart disease and stroke in Canadian communities threaten to reverse any gains in vascular disease prevention over the past six years. Findings reveal the urgent need for intensified prevention efforts that are community-based with a focus on joint reduction in the shared risk factors contributing to all three diseases.

•Despite strong evidence, participation in cardiac rehab remains very low.•Myriad system-level and patient-level barriers persist.•Anxiety sensitivity is separate from anxiety and depression and can be treated.•There is a likely link between anxiety sensitivity, exercise, and cardiac rehab.•Significant gaps remain in our understanding of possible sex-based differences.

BACKGROUND Perfluorooctanoic acid (PFOA) and perfluorooctanesulfonate (PFOS) are man-made compounds with widespread presence in human sera. In previous occupational and adult studies, PFOA and PFOS were positively associated with serum lipid levels. OBJECTIVE To interrogate associations between PFOA and PFOS and serum lipids in children and adolescents. DESIGN Cross-sectional community-based study. SETTING Mid–Ohio River Valley. PARTICIPANTS A total of 12 476 children and adolescents included in the C8 Health Project, which resulted from the pretrial settlement of a class action lawsuit pursuant to PFOA contamination of the drinking water supply. MAIN OUTCOME MEASURES Serum lipids (total, high-density lipoprotein [HDL-C], and low-density lipoprotein [LDL-C] cholesterol and fasting triglycerides). RESULTS Mean (SD) serum PFOA and PFOS concentrations were 69.2 (111.9) ng/mL and 22.7 (12.6) ng/mL, respectively. In linear regression after adjustment for covariables, PFOA was significantly associated with increased total cholesterol and LDL-C, and PFOS was significantly associated with increased total cholesterol, HDL-C, and LDL-C. Using general linear model analysis of covariance, between the first and fifth quintiles of PFOA there was a 4.6-mg/dL and a 3.8-mg/dL increase in the adjusted mean levels of total cholesterol and LDL-C levels, respectively, and an 8.5-mg/dL and a 5.8-mg/dL increase in the adjusted mean levels of total cholesterol and LDL-C, respectively, between the first and fifth quintiles of PFOS. Increases were 10 mg/dL for some age- and sex-group strata. Observed effects were nonlinear, with larger increases in total cholesterol and LDL-C levels occurring at the lowest range, particularly of PFOA. CONCLUSION Although the epidemiologic and cross-sectional natures of this study limit causal inferences, the consistently observed associations between increasing PFOA and PFOS and elevated total cholesterol and LDL-C levels warrant further study.Arch Pediatr Adolesc Med. 2010;164(9):860-869--

To survey academic pediatric emergency medicine (PEM) programs for information on financial compensation and patient care activities of PEM faculty and compare the results to the financial data published by the AAEM, AAAP, and MGMA.

Background:Poor cardiovascular health (CVH), characterized by clinical risk and unhealthy lifestyle habits, is a leading cause of death and disease worldwide. Despite advances in healthcare and policy, there remains an inequitable burden of poor CVH among Canadian sub-populations based on socioeconomic status and geographic region. Using recently published data and a national toolkit, this study aimed to quantify inequalities in poor CVH across the Canadian population.Methods:We conducted a cross-sectional study on Canadian adults, ≥20 years, from the nationally representative Canadian Community Health Survey 2017. Using the American Heart Association’s CVH Index, CVH was defined for each individual as a summed score of 7 components, where 1 point was awarded for achieving ideal health in each component. A total score of 0-2 points indicated poor overall CVH. The Canadian Institute for Health Information (CIHI) Measuring Health Inequalities Toolkit, a standardized methodological approach to analyzing health inequalities in population-based data using pre-defined stratifications and second-level interactions, was used to quantify inequalities in poor CVH based on Toolkit-defined stratifications in sex, income, urban/rural status, and region of residence. The regional distribution of CVH was mapped using ArcGIS software.Results:Approximately 7% of Canadians had poor CVH, representing 2 million Canadians. Poor dietary habits were noted in 99.0% of the population, with poor body mass index and poor physical activity noted in 58.1% and 42.3%, respectively. The eastern provinces of Newfoundland and Labrador and New Brunswick had the greatest proportion of health regions with poor CVH. An examination of the largest CVH inequalities across provinces revealed that females in the lowest income tercile residing in Prince Edward Island were 8-times more likely to experience poor CVH than females in the highest income tercile (RR 8.43, 95%CI 7.09-10.04). Additionally, females in New Brunswick residing in rural regions were almost 3-times more likely to experience poor CVH than females residing in urban regions (RR 3.07, 95%CI 1.07-4.87). In most provinces, income and urban/rural inequalities among males were observed but were of smaller magnitude than the inequalities among females.Conclusion:The greatest inequalities in poor CVH were experienced by females in the lowest income groups. Urban/rural inequalities in CVH were complex and varied by geographic region. The CIHI toolkit is a robust and systematic approach to understanding health inequalities that will enable comparison between studies and health/disease states, and thus facilitate comparative policy evaluation and population health priority setting.

Background:While existing literature has established individual risk factors for early death post-hospitalization in patients with cardiovascular and cardiometabolic disease (CVD/CMD), few studies to date have examined whether the known effects of these risk factors are maintained at the population level. The aim of this study was to determine whether traditional CVD risk factors and socioeconomic factors at the population level impacted CVD/CMD post-hospitalization mortality rates in Canada over time.Methodology:We conducted an ecological, cross-sectional analysis using merged data from two sources: 1) the Canadian Community Health Survey 2000-2011 and, 2) the Canadian Vital Statistics Death Database linked to the Discharge Abstract Database 2000-2012. The study outcome was 1-year mortality rate after hospital discharge for CVD/CMD, calculated by census division (CD) using ICD-9-CA codes for hospitalizations and deaths. The first stage of the statistical analysis reported age- and sex-standardized 1-year mortality rates after hospital discharge for CVD/CMD, across CDs in Canada. The second stage utilized Poisson regression to model associations between traditional CVD risk factors and socioeconomic factors at the CD level and CVD/CMD post-hospitalization mortality rates in Canada over time.Results:National 1-year mortality rates in patients with CVD/CMD increased from 146.5 per 100,000 in 2000 to 150.4 in 2012, peaking at 202.4 in 2006, with no significant trend observed over time. Maps of average 1-year mortality rates over the time period (2000-2012) show wide variations in rates across census divisions (CDs) in Canada. Nova Scotia and Ontario had the highest proportion of CDs with worsening rates of mortality over time (3% and 7% respectively) that remained below the national average. Traditional CVD risk factors, demographic factors and socioeconomic factors at the census division level were not associated with 1-year mortality rates after hospital discharge for CVD/CMD over time.Potential implication:Reductions in the CVD/CMD post-hospitalization mortality burden at the individual level may benefit from treatment targeted towards traditional risk factors and socioeconomic factors however; reduction in post-hospitalization burden at the population level can benefit from policy focused towards other societal elements such as healthcare and community care resources.

Background:Negative psychosocial factors, such as high stress and poor social support, are strongly associated with disease outcomes, including CVD. Conceptually, it is plausible that better cardiovascular health (CVH) may blunt the association between psychosocial factors and incident CVD. However, few studies have investigated whether CVH, which includes biological and behavioral factors, is a potential pathway between psychosocial factors and CVD.Objective:To investigate whether the association between CVD and psychosocial factors is fully or partially mediated by CVH.Setting:This study was carried out in a nationally representative sample of Canadian adults aged 20 years and older.Data and Methods:This study is a cross-sectional design using data from the Canadian Community Health Survey (CCHS) 2015-2016 database. The CCHS is a nationwide, nationally representative survey that collects information on the health status, health care utilization and health determinants of the Canadian population. The study outcome was CVD, as measured by the self-reported presence of physician-diagnosed heart disease. The potential mediator was individual CVH, defined using the AHA CVH Index (CVHI) and determined using self-reported responses in CCHS. Psychosocial factors included self-reported responses to questions on life stress, work stress, sleep, social support and alcohol and drug use. A structural equation modeling (SEM) approach was then used to explore the mediational role of CVH in the association of CVD with psychosocial factors. Analyses were conducted in MPlus Version 8 software.Results:The majority of the population were males (51%), aged 40-60 (37%), with tertiary education (64%) and of the White race (79%). Overall, the mean CVH of the population was 4.5. Results suggested that CVH and all psychosocial factors, except for life stress predicted, CVD. Additionally, all psychosocial factors, except for life stress and drug use, predicted CVH. Standardized coefficients demonstrated that, of all psychosocial factors, work stress had the highest impact on both CVH (std coeff -0.22, p<0.001) and CVD (std coeff -0.07, p<0.0001). Further analyses demonstrated that CVHI partially mediated the association between CVD and work stress (std coeff -0.02, p<0.001), sleep (std coeff -0.002, p<0.001), alcohol use (std coeff -0.009, p<0.001) and social support (std coeff -0.001, p=0.003). None of the associations were fully mediated by CVH.Conclusion:Results indicated that the association between psychosocial factors and CVD was partially mediated by CVH. That is, while better CVH weakened the association between psychosocial factors and CVD, the direct association between psychosocial factors and CVD remained. Further analyses should investigate whether accounting for individual characteristics such as age, sex and race may reveal full mediation through CVH.

Background:Cardiovascular health (CVH) and CVD prevention remains a top public health priority across North America. The health of Canadians is largely accredited to the publicly funded healthcare system, which affords “free” healthcare to all its citizens. However, there is little evidence demonstrating whether the characteristics of and access to primary care by Canadians directly impacts their likelihood of ideal CVH.Objective:To examine the association between ideal CVH and the characteristics of and access to primary care in Canadians.Data and Methods:This study is a cross-sectional design using adult data from the Canadian Community Health Survey (CCHS) 2015-2016 database. The CCHS is a nationwide, nationally representative survey that collects information on the health status, health care access and utilization, and health determinants of the Canadian population. CVH, defined using the AHA CVH Index (CVHI), was determined using self-reported responses in CCHS. Weighted logistic regression was performed to examine the association between ideal CVH and the characteristics of and access to primary care, including having regular care, receiving coordinated care, ER use and access to routine care. Models were also adjusted for individual characteristics known to affect CVH.Results:The majority of the population were females (51%), aged 40-60 (37%), with tertiary education (64%) and of the White race (79%). Overall, 19% of the population had ideal CVH (ideal status in 6-7 CVHI factors), representing approximately 6 million individuals nationwide. Individuals reported having a regular primary healthcare provider (82%), insurance for prescription medication (76%), high coordination in their healthcare between health professionals (10%), difficulties in accessing routine care in the past 12 months (3%). The likelihood of ideal CVH were highest in those who reported having: a regular provider (OR 1.11, 95% CI 1.05-1.17), higher coordination of care (OR 1.10, 95% CI 1.01-1.20) and using the ER less frequently (OR 0.90, 95% CI 0.80-0.95). After controlling for age, sex and race, only having a regular provider (OR 1.11, 95% CI 1.02-1.20) and not reporting difficulties in accessing routine care in the past 12 months (OR 1.02, 95% CI 1.01-1.04) were significantly associated with ideal CVH.Conclusion:Findings from this study suggest that individuals experiencing better primary healthcare, including having a regular primary care physician or having less difficulty accessing care, are more likely to have ideal CVH than those experiencing poor primary healthcare. Further studies should investigate policies that promote better primary healthcare as interventions for preventing CVD and improving CVH.

Background:Result from many studies support that the associations between income, income inequality, and mortality, including CVD mortality, are very complex. Given the urgent need for greater CVD prevention in populations, it is essential to understand how income inequality and income, both in individuals and the regions in which they live, can affect cardiovascular health (CVH).Objective:To examine the associations between regional income and income inequality and individual relative income and individual CVH.Setting:This study was carried out in a nationally representative sample of Canadian adults aged 20 years and older residing in 113 health regions (HR) across Canada.Data and Methods:This study is a cross-sectional design using data from the Canadian Community Health Survey (CCHS) 2015-2016 database. The CCHS is a nationwide, nationally representative survey that collects information on the health status, health care utilization, and health determinants of the Canadian population. The study outcome was individual CVH, defined using the AHA CVH Index (CVHI) and determined using self-reported responses in CCHS. Regional income inequality was measured as the Gini coefficient of the HR. Regional income was measured as the median household income in the HR. Individual income was measured as relative, not absolute, income representing the individual’s household income compared to those in the HR. Multilevel models were used to examine the associations between regional income and income inequality and individual relative income and individual CVH, controlling for individual age, sex, race and education. Analyses were conducted using SAS 9.4 software.Results:The majority of the population were males (51%), aged 40-60 (37%), with tertiary education (64%) and of the White race (79%). Overall, mean CVH for individuals was 4.5. The national average Gini coefficient across HRs was 0.4. The average individual fell within the 6thdecile for relative household income. Living in a HR with greater income inequality was not associated with lower individual CVH (β= -0.04 p-value=0.91), though living in an HR with higher median household income was associated with better individual CVH (β= 0.32 p=0.004). Finally, having higher relative household income was associated with better individual CVH (β= 0.05 p<0.0001), regardless of the median income of the region of residence.Conclusion:While the inequality of income within a HR did not significantly affect CVH, higher regional income and relative individual income was associated with better CVH. Results of this study contribute to the growing body of evidence attempting to disentangle the true associations between income, income inequality, and CVH.

Objective: The objective of this study was to examine the association of patient- and county-level factors with the emergency department (ED) visits among adult fee-for-service (FFS) Medicaid beneficiaries residing in Maryland, Ohio, and West Virginia.Methods: A cross-sectional design using retrospective observational data was implemented. Patient-level data were obtained from 2010 Medicaid Analytic eXtract files. Information on county-level health-care resources was obtained from the Area Health Resource file and County Health Rankings file.Results: In adjusted analyses, the following patient-level factors were associated with higher number of ED visits: African Americans (incidence rate ratios [IRR] = 1.47), Hispanics (IRR = 1.63), polypharmacy (IRR = 1.89), and tobacco use (IRR = 2.23). Patients with complex chronic illness had a higher number of ED visits (IRR = 3.33). The county-level factors associated with ED visits were unemployment rate (IRR = 0.94) and number of urgent care clinics (IRR = 0.96).Conclusion: Patients with complex healthcare needs had a higher number of ED visits as compared to those without complex healthcare needs. The study results provide important baseline context for future policy analysis studies around Medicaid expansion options.