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Abstract Urban areas have complex thermal distribution. We examined the association between extreme temperature and mortality in urban Ontario, using two temperature data sources: high-resolution and weather station data. We used distributed lag non-linear Poisson models to examine census division-specific temperature–mortality associations between May and September 2005–2012. We used random-effect multivariate meta-analysis to pool results, adjusted for air pollution and temporal trends, and presented risks at the 99th percentile compared to minimum mortality temperature. As additional analyses, we varied knots, examined associations using different temperature metrics (humidex and minimum temperature), and explored relationships using different referent values (most frequent temperature, 75th percentile of temperature distribution). Weather stations yielded lower temperatures across study months. U-shaped associations between temperature and mortality were observed using both high-resolution and weather station data. Temperature–mortality relationships were not statistically significant; however, weather stations yielded estimates with wider confidence intervals. Similar findings were noted in additional analyses. In urban environmental health studies, high-resolution temperature data is ideal where station observations do not fully capture population exposure or where the magnitude of exposure at a local level is important. If focused upon temperature–mortality associations using time series, either source produces similar temperature–mortality relationships.

In Ontario, despite the increasing prevalence of Parkinson's disease (PD), barriers to access-to-care for people with Parkinson's disease (PwP) and their caregivers are not well understood. The objective of this study is to examine spatial patterns of health care utilization among PwP and identify factors associated with PD-related health care utilization of individuals in Ontario. We employed a retrospective, population-based study design involving administrative health data to identify PwP as of March 31, 2018 (N = 35,482) using a previously validated case definition. An enhanced 2-step floating catchment area method was used to measure spatial accessibility to PD care and a descriptive spatial analysis was conducted to describe health service utilization by geographic area and specialty type. Negative binomial regression models were then conducted to identify associated geographic, socioeconomic, comorbidity and demographic factors. There was marked spatial variability in PD-related service utilization, with neurology and all provider visits being significantly higher in urban areas (CMF>1.20; p1.20; p

BackgroundChildhood food insecurity has been associated with prevalent asthma in cross-sectional studies. Little is known about the relationship between food insecurity and incident asthma.MethodsWe used administrative databases linked with the Canadian Community Health Survey, to conduct a retrospective cohort study of children ResultsAmong the 27,746 included children, 5.1% lived in food insecure households. Over a median of 8.34 years, the incidence of asthma was 7.33/1000 person-years (PY) among food insecure children and 5.91/1000 PY among food secure children (unadjusted hazard ratio [HR] 1.24, 95% CI 1.00 to 1.54, p = 0.051). In adjusted analyses associations were similar (HR 1.16, 95% CI 0.91 to 1.47, p = 0.24 adjusted for clinical risk factors, HR 1.24, 95% CI 0.97 to 1.60, p = 0.09 adjusted for clinical/socioeconomic factors). Associations did not qualitatively change by HFSSM respondent type, severity of food insecurity, and age of asthma diagnosis. There was no evidence of interaction in our models.ConclusionsFood insecure children have numerous medical and social challenges. However, in this large population-based study, we did not observe that childhood food insecurity was associated with an increased risk of incident asthma when adjusted for important clinical and socioeconomic confounders.

The purpose of this study was to examine the spatial variability of asthma outcomes in Ontario, Canada and broad environmental factors that contribute to this variability. Age-/sex-standardized asthma prevalence and health services use rates (2003-2013) were obtained from a provincial cohort of asthma patients. Employing an ecological-level study design, descriptive and Bayesian spatial regression analyses were used to examine patterns of asthma outcomes and their relationship to physical environment, socioeconomic environment and healthcare factors. Significant spatial variation in asthma outcomes was found between southern urban/suburban areas and northern/rural areas. Rurality was found to have a substantial effect on all asthma outcomes, except hospitalizations. For example, the most rural areas were associated with lower asthma prevalence and physician visits [RR = 0.708, 95% credible interval (CI): 0.636-0.795 and RR = 0.630, 95% CI: 0.504-0.758, respectively], and with higher ED visits (RR = 1.818, 95% CI: 1.194-2.858), when compared to urban areas. Strong associations were also found between material deprivation and ED visits (RR = 1.559, 95% CI: 1.358-1.737) and hospitalizations (RR = 1.259, 95% CI: 1.143-1.374). Associations between asthma outcomes and environmental variables such as air pollution and temperature were also found. Findings can be expected to inform the development of improved public health strategies, which take into account local environmental, socioeconomic and healthcare characteristics.