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Introduction: The Canadian Community Health Survey (CCHS) - Nutrition 2004 (n=35,107; interview dates from January 2004 to January 2005) linked to the Canadian Vital Statistics - Death Database (CVSD) (2011) represents a novel linkage of a population-based, nationally representative nutrition survey with routinely collected mortality records (including date and cause of death). The linkage was done through individual tax data in Canada, and contains longitudinal records for 29,897 Canadians aged 0 years and older--1,753 of whom died--in the 10 provinces of Canada. The median follow-up time was 7.49 years, with 102,953 personyears among males and 114,876 person-years among females (unweighted), and included a special sampling survey weight (for linked data) to account for those who did not agree to share and link their information. The CCHS - Nutrition 2004 linked to CVSD has been used to evaluate associations between lifestyle and sociodemographic characteristics and mortality. Using these data, statistical methods have been developed and tested to control random and systematic measurement errors when evaluating the relationship between different dietary exposures (evaluated using repeated 24-hour dietary recalls) and health outcomes. The linked data are available through Statistics Canada's Research Data Centres. [ABSTRACT FROM AUTHOR]

Background Characterizing smoking patterns over time is essential for evaluating the impact of tobacco control interventions and predicting smoking-related mortality. Beginning with a 1920s birth cohort, smoking histories (i.e., estimates of smoking initiation and cessation, and prevalence of current and former smokers) were generated. Data The Ontario sample (n = 238,411) of the 2003 to 2013 cycles of the Canadian Community Health Survey, which is conducted biennially, was used to obtain cross-sectional information on current smoking behaviour. Methods Age at smoking initiation and age at smoking cessation were used to construct smoking histories for each respondent, up to the survey date. An age-periodcohort model was generated and used to examine survival differences by smoking status. Using the model, and adjusting for survival differences in smoking status, the prevalence of current, former and never smokers was estimated in cohorts from 1920 to 1985. Smoking initiation, cessation and intensity were then estimated for age-specific distributions of each birth cohort. These rates were projected forward through to 2041. Smoking patterns by highest level of education were generated using education-stratified models. Results Smoking histories show clear trends over time by sex, cohort and age. If current patterns persist, smoking prevalence is projected to decline to single digits (below 10%) by 2023 for women and 2040 for men. Interpretation Birth-cohort-specific smoking histories can be generated using cross-sectional health surveys. These cohort histories can describe smoking patterns over time and into the future. In turn, these histories can be used in micro-simulation models to evaluate historic or planned tobacco control interventions, and to project smoking prevalence. [ABSTRACT FROM AUTHOR]

Background: Hypertension (or high blood pressure) affects almost one in four adults in Canada. Quantifying risk factors associated with hypertension may help to inform prevention efforts. Data and methods: Data from the first four cycles of the Canadian Health Measures Survey (including 13,407 respondents) were used to identify hypertension status by systolic and diastolic blood pressure levels and the use of antihypertensive medications. Logistic regression analysis was employed to estimate the association between six cardiovascular risk factors (individually and as a composite score) and hypertension. Results: Engaging in less than 150 minutes per week of moderate-to-vigorous physical activity, eating fruits and vegetables fewer than five times per day, being overweight or obese, having diabetes, and having chronic kidney disease were all independently associated with an increased risk of hypertension. When these factors were combined into a risk score, there was a linear increase in the predicted risk of hypertension with each additional risk factor. The predicted prevalence of hypertension for those with all six risk factors was 55% in women and 44% in men aged 20 to 39 years, and 80% in women and 76% in men aged 70 to 79 years. Being overweight or obese, consuming fruits and vegetables less often, being inactive, and having diabetes contributed to the largest attributable fractions for hypertension in the Canadian population. Interpretation: Physical activity, diet, body mass index, the presence of diabetes, and the presence of chronic kidney disease were strong risk factors for hypertension. Many of these risk factors are modifiable and highlight targets for future prevention strategies. [ABSTRACT FROM AUTHOR]

Background: In Canada, hypertension control is significantly less likely in older women taking antihypertensive medication than in older men. This study examines factors that may explain some of the differences in hypertension control between women and men. Methods: The analysis is based on data collected for 2,111 adults aged 60 to 79 who were taking antihypertensive medication in the first four cycles of the Canadian Health Measures Survey. Hypertension, treatment and control were estimated based on measured systolic and diastolic blood pressure and on the Drug Identification Numbers of antihypertensive medications. Risk factors included health behaviours, comorbidities and a family history of hypertension. Sex-specific logistic regression models examined associations between risk factors and hypertension control. Results: The systolic blood pressure of women taking antihypertensive medication was higher than that of men, regardless of hypertension control. For women, older age and diabetes were significantly associated with poorer hypertension control, while older age, ethnicity, diabetes, no cardiovascular disease, and nonsteroidal anti-inflammatory drug use were significant for men. Interpretation: Based on current blood pressure targets, women and men aged 60 to 79 taking antihypertensive medication in Canada continue to differ in control and factors associated with control. Further research to better understand the underlying cause of these associations may help reduce disparities in hypertension control rates between women and men in Canada. [ABSTRACT FROM AUTHOR]

Background: The aging of the Canadian population has increased attention on the future need for nursing home beds. Although current projections rely primarily on age and sex, other factors also contribute to the need for long-term care. This study seeks to identify additional factors to age and sex that contribute to Canadians transitioning from living at home to living in a seniors' residence or nursing home. Data and methods: As part of a larger record linkage project, three cycles of the Canadian Community Health Survey (CCHS) were linked to the 2011 Census of Population: Cycle 3.1 (2005/2006), Cycle 4.1 (2007/2008), and CCHS-Healthy Aging (2008/2009). The sample was limited to successfully linked CCHS respondents who were aged 60 years or older as of Census Day 2011 (May 10, 2011; n=81,411). Sex-specific generalized multinomial logistic regression models were conducted to examine the association between each respondent's characteristics and dwelling location (private dwelling, private dwelling with additional family, nursing home, or seniors' residence) on Census Day. Results: On Census Day, 1.4% of the study sample were living in a nursing home, 1.2% in a seniors' residence, 7.1% in a private dwelling with additional family, and 90.3% in a private dwelling. Women were more likely than men to be living in a nursing home (1.8% of women vs. 0.9% of men) or seniors' residence (1.7% of women vs. 0.7% of men). Regression models showed that, aside from age, there were increased odds of living in a nursing home or seniors' residence among individuals who lost their spouse or who were not married, who did not own their dwelling, who had poor self-rated health, or who had been diagnosed with dementia. The association of other factors with dwelling place differed according to sex and type of dwelling. Interpretation: Although age is strongly associated with living in a nursing home or seniors' residence, other demographic and health factors affect the likelihood of an individual transitioning to an institutional dwelling. Such factors could be considered when planning for the future housing and care needs of the Canadian population. [ABSTRACT FROM AUTHOR]

Background: Economic immigrants generally, and economic class principal applicants (ECPAs) specifically, tend to have better health than other immigrants, as well as the Canadian-born population. However, health outcomes vary among subcategories within this group, especially by sex. Methods: This study examines hospitalization rates among ECPAs aged 25 to 74 who arrived in Canada between 1980 and 2006 as skilled workers, business immigrants, or live-in caregivers. The analysis used two linked databases to estimate age-standardized hospitalization rates (ASHRs) overall and for leading causes by sex. ASHRs of ECPA subcategories were compared with each other and with those of the Canadian-born population. Logistic regression was used to derive odds ratios for hospitalization among ECPAs, by sex. Results: Male and female ECPAs aged 25 to 74 had significantly lower all-cause ASHRs than did the Canadian-born population in the same age range. This pattern prevailed for each ECPA subcategory and for each disease examined. Compared with skilled workers, business immigrants had lower odds of hospitalization; live-in caregivers who arrived after 1992 had higher odds. Adjustment for education, official language proficiency, and world region reduced the strength of or eliminated these associations. Interpretation: Compared with the Canadian-born population, ECPAs generally had lower hospitalization rates. Differences were apparent among ECPA subcategories. [ABSTRACT FROM AUTHOR]

Background: Refugees arrive in Canada with settlement challenges different from those faced by other immigrants, including a higher risk of poor health. This study reports hospitalization rates for the three fiscal years from 2006/2007 through 2008/2009 for immigrants who arrived during the 1980-to-2006 period, with a focus on three refugee groups. Methods: Information from two linked databases was used to estimate age-standardized hospitalization rates (ASHRs) per 10,000 population aged 30 or older for all causes (excluding pregnancy) and for leading causes, by immigrant category and by refugee subcategory. The analysis focused on refugees from Poland, Vietnam and the Middle East, whose hospitalization rates were compared with those of the Canadian-born population and/or economic class immigrants from the same source areas. Results: Immigrants aged 30 or older, including refugees, had significantly lower all-cause ASHRs than did the Canadian-born population. All-cause ASHRs were 470 per 10,000 for immigrants overall and 494 for refugees, compared with 891 for the Canadian-born. Of the three source areas, immigrants and refugees from Vietnam had lower ASHRs. The circulatory disease-specific ASHR for government-assisted refugees from the Middle East was similar to that of the Canadian-born population (142 and 158, respectively). Except for those from Poland, refugees typically had higher ASHRs than did their economic class counterparts. Interpretation: Refugees, like other immigrants, generally had lower hospitalization rates than did the Canadian-born population, but some subgroups were particularly susceptible to hospitalization for specific chronic diseases. [ABSTRACT FROM AUTHOR]

Background: This study summarizes the linkage of the Canadian Community Health Survey (CCHS) and the Canadian Mortality Database (CMDB), which was performed to examine relationships between social determinants, health behaviours and mortality in the household population. Data and methods: The 2000/2001-to-2011 Canadian Community Health Surveys were linked to the 2000-to-2011 CMDB using probabilistic methods based on common identifiers (names, date of birth, postal code and sex) for eligible respondents (85%; n = 614,774). Mortality records from January 1, 2000 through December 31, 2011 for people aged 12 or older were eligible for linkage (n = 2.774 million). The linkage was enhanced with information from the Historical Tax Summary File. Quality assessment consisted of internal and external validation. Cox survival analysis (age-adjusted) was conducted to estimate hazard ratios (HRs) associated with selected health behaviours. Results: Overall, 5.3% of eligible CCHS respondents linked to a mortality record; false positive and false negative rates were 0.04% and 2.43%, respectively. Linkage rates were higher among males (5.8%) and people aged 75 or older (20.2%), reflecting known mortality risks. Survival analyses confirmed elevated mortality risk associated with heavy (HR 2.36, CI 1.84, 2.89) and light smoking (HR 1.91, CI 1.52, 2.33), compared with not smoking; underweight and obesity, compared with normal and overweight; low fruit and vegetable consumption; and lack of physical activity. Interpretation: Linking health behaviour information from the CCHS to mortality data from the CMDB allows for a greater understanding of modifiable determinants of mortality. [ABSTRACT FROM AUTHOR]

Background: Although immigrants tend to be healthier than the Canadian-born population when they arrive, subgroups, notably different immigration categories, may differ in health and health care use. Data limitations have meant the research has seldom focused on category of immigrant-economic, family or refugee. A newly linked database has made it possible to study acute care hospitalization by immigration category and source region. Data and methods: The Immigrant Landing File-Hospital Discharge Abstract Linked Database (n = 2.6 million) was used to derive sex-specific crude and age-standardized hospitalization rates (ASHRs) per 10,000 population for all-cause and leading causes of hospitalization during the 2006/2007-to-2008/2009 period. Results: Economic class immigrants had lower all-cause ASHRs than did their family class or refugee counterparts. Male refugees had high ASHRs overall and for circulatory diseases, digestive diseases, injury, and cancer. Female differences by immigrant class were less pronounced. All-cause ASHRs (excluding pregnancy) rose with years since arrival in Canada for male and female immigrants. Immigrants from East Asia had the lowest ASHRs; those from the United States, the highest. Interpretation: Although hospital use is an imperfect indicator of health status, this study supports an initial healthy immigrant effect and its subsequent decline. Marked differences emerged among immigrant subgroups with some, notably refugees and immigrants from the United States, having significantly higher hospitalization rates overall and for leading causes, compared with other groups. [ABSTRACT FROM AUTHOR]

Background: As part of a program of the first National Population Health Study of Neurological Conditions launched in 2009, a series of microsimulation models of neurological conditions (called POHEM-Neurological meta-model) was developed to project health and economic impacts of seven neurological conditions (NCs)--Alzheimer's disease and other dementias, cerebral palsy, epilepsy, multiple sclerosis, Parkinson's disease, traumatic brain injury, and traumatic spinal cord injury--over a 20-year horizon. Data and methods: The common framework of the seven models al lows for dynamic, cont inuous- time, discrete-event simulation of synthetic large populations in which persons are subject to the risk of developing the NC under study and are assigned a value of functional health and a probability of receiving a caregiver and of entering long-term care. Calculations for transitions are done every year over the life course, and costs are accumulated throughout the life of the synthetic person. The need to reconcile empirical estimates of incidence and mortality with prevalence required implementation of "cure" parameters for two of the NCs. Results: The POHEM-Neurological meta-model integrates the latest Canadian microdata on neurological conditions and satisfies most criteria for validation of microsimulation models, including conceptualization, computer implementation, assessment of output plausibility, and comparison with external data. Limitations include an absence of risk factors and the lack of uncertainty measures. Interpretation: The POHEM-Neurological meta-model has been useful for projections of health and economic impacts of NCs on persons affected and their caregivers, and allows for comparison of specific scenarios to the base case. [ABSTRACT FROM AUTHOR]

Background: Statins are prescribed to treat dyslipidemia (abnormal amount of lipids such as cholesterol and/or fat in the blood) and reduce cardiovascular disease (CVD) risk. This study describes the CVD risk profile of Canadians aged 20 to 79, compares current treatment patterns with guideline recommendations, and investigates the population health impact of statin treatment. Data and methods: The baseline CVD risk of the Canadian population aged 20 to 79 was estimated by applying population-weighted risk factor data from the 2007 to 2011 Canadian Health Measures Survey (CHMS) to the Framingham Risk Score. Estimates of statin effectiveness from the literature were applied to baseline risk to assess the number of CVD events avoided owing to actual (CHMS-reported) and recommended (2012 Canadian Cardiovascular Society guidelines) statin treatment. Results: An estimated 2.8 million Canadian adults (about 1 in 10) were treated with statin drugs. The mean 10-year CVD risk of those treated was 27%. Assuming optimal adherence, it was estimated that statin treatment avoided around 18,900 CVD events annually and yielded a number-needed-to-treat (average number of patients treated to prevent one additional CVD event) of 15 over 10 years. In comparison, 6.5 million Canadian adults (about 1 in 4) were recommended for treatment under the 2012 guidelines. The mean 10-year CVD risk of those recommended for treatment was 24%, which translates into a number-needed-to-treat of 17 over 10 years, or approximately 38,600 CVD events avoided annually. The largest gaps in treatment and potential CVD events avoided were among people at high and intermediate risk for CVD. Interpretation: Canadians' CVD risk could be lessened with enhanced targeting of statin treatment to individuals at high and intermediate risk. Such a strategy would likely require additional investments. [ABSTRACT FROM AUTHOR]

Background: Immigrants tend to have better health than the Canadian-born. However, the "healthy immigrant" effect diminishes over time and varies by source country. This study examines whether lower hospitalization rates persist from the first (G1) to the second generation (G2) of immigrants, compared with other Canadians (G3+). All-cause and circulatory disease-related hospitalization rates were examined by generation, with special attention to people of Chinese and South Asian descent. Data and methods: Data from the 2006 Census-hospitalization linkage database (which excludes Quebec) were analysed using logistic regression. Age-standardized all-cause (excluding pregnancy) and circulatory disease-related hospitalization rates were derived for the urban population aged 30 or older for the 2006/2007 to 2008/2009 fiscal years. Results: Over the generations, immigrants' all-cause and circulatory disease-related hospitalization rates converged with those of the Canadian population overall. Compared with G3+, the age-adjusted odds of all-cause hospitalization among men were 0.49 (CI = 0.48-0.51) for recent G1 immigrants, 0.78 (CI = 0.77-0.79) for long-term G1 immigrants, and 0.95 (CI = 0.94-0.97) for G2. Adjustments for socioeconomic status reduced the difference, especially between G2 and G3+. For South Asians, rates converged for circulatory disease, notably among men. Hospitalization rates for people of Chinese descent rose across generations, but remained significantly below rates for G3+. Interpretation: The lower circulatory disease-related hospitalization risk experienced by G1 is maintained in G2 among people of Chinese descent, but not among South Asians. [ABSTRACT FROM AUTHOR]

Objectives This article examines the association between introduction of Ontario's Universal Influenza Immunization Program and changes in vaccination rates over time in Ontario, compared with the other provinces combined. Data sources The data are from the 1996/97 National Population Health Survey and the 2000/01 and 2003 Canadian Community Health Survey, both conducted by Statistics Canada. Analytical techniques Cross-tabulations were used to estimate vaccination rates for the total population aged 12 or older, for groups especially vulnerable to the effects of influenza, and by selected socio-demographic variables. Z tests and multiple logistic regression were used to examine differences between estimates. Main results Between 1996/97 and 2000/01, the increase in the overall vaccination rate in Ontario was 10 percentage points greater than the increase in the other provinces combined. Increases in Ontario were particularly pronounced among people who were: younger than 65, more educated, and had a higher household income. Between 2000/01 and 2003, vaccination rates were stable in Ontario, while rates continued to rise in the other provinces. Even so, Ontario's 2003 rates exceeded those in the other provinces. [ABSTRACT FROM AUTHOR]