Medicine and Health Sciences Commons^™

Health Care Utilization By Immigrants With Multimorbidity: A Population Based Cross-Sectional Study Of The 2015-2016 Canadian Community Health Survey (Cchs), Chinmoy Talukder

Electronic Thesis and Dissertation Repository

Immigrants face unique healthcare barriers, which can negatively impact their health and health service use. Those with multimorbidity face a particular challenge as multimorbidity is associated with increased need for healthcare. The purpose of this study was to compare healthcare utilization, as measured by number of visits to family physicians and specialists, between immigrants and Canadian-born populations with multimorbidity, stratified by sex and for specific chronic diseases. A cross-sectional analysis using 2015-2016 Canadian Community Health Survey (CCHS) was conducted. After adjusting for relevant covariates, no statistically significant differences in visits to family physicians or specialists were observed between immigrants and …

The Conundrum Of Low Covid-19 Mortality Burden In Sub-Saharan Africa: Myth Or Reality?, Janica Adams, Mary J. Mackenzie, Adeladza Kofi Amegah, Alex Ezeh, Muktar A. Gadanya, Akinyinka Omigbodun, Ahmed M. Sarki, Paul Thistle, Abdhalah K. Ziraba, Saverio Stranges, Michael Silverman

Global Health Equity Publications

Key Messages

• Evidence suggests the demographic age structure of sub-Saharan Africa is the leading factor of the low morbidity and mortality of COVID-19 compared to other regions of the world.

• Widespread social mitigation strategies, such as lockdowns, have resulted in severe economic and societal consequences in terms of food security, adolescent pregnancy, gender-based violence, and disruptions in treating other diseases.

• It is imperative to weigh the risks and benefits of social mitigation strategies for future waves.

Quantifying Timely Access To Surgery: A Global Modelling Study, Joo-Hyun Jeong

Electronic Thesis and Dissertation Repository

The Lancet Commission on Global Surgery proposed six core indicators to track access to safe, timely, and affordable surgery. We identified published data for countries reporting Indicator 1 (Access to timely essential surgery), defined as a country’s proportion of population living within two hours from the nearest surgery-capable facility, and conducted geospatial analyses to estimate this metric in other countries. In the primary analysis using this data, linear regression models were run to project this indicator for all countries globally according to their Human Development Index; followed by secondary analyses using broader definitions for surgical access, then by sensitivity analyses …

Residential Greenness And Substance Use, Evan R. Wiley

Electronic Thesis and Dissertation Repository

INTRODUCTION: Research has identified positive associations between green space and health and green space and mental health. Substance use outcomes, however, have received considerably less attention.

OBJECTIVE: The purpose of this study was to investigate associations between residential greenness and patterns of substance use among transitional aged youth (age 15-25) in Canada.

METHODS: This study utilized three waves (2016-2018) of the Canadian Community Health Survey (CCHS) as well as residential greenness data from the Canadian Urban Environmental Health Consortium (CANUE). Multivariable regression was used to explore variation in the pattern of substance use between greenness quartiles. The sample included 14,070 …

Incidence Of Cancer And Stage At Diagnosis Among People With Recent-Onset Psychotic Disorders, Jared C. Wootten

Electronic Thesis and Dissertation Repository

Evidence on cancer incidence in people with psychotic disorders, compared to the general population, is equivocal, although those with psychotic disorders so have more advanced stage of cancer at the time of diagnosis. The objective of this thesis was to compare cancer incidence and stage at diagnosis for people with psychotic disorders, relative to the general population. Our systematic review did not observe a significant difference in overall cancer incidence among people diagnosed with psychotic disorders (RR = 1.08, 95% CI: 1.00 to 1.16), however people with psychotic disorders were more likely to be present with advanced stage cancer at …

Mental Health Services Provision In Primary Care And Emergency Department Settings: Analysis Of Blended Fee-For-Service And Blended Capitation Models In Ontario, Canada., Thyna Vu, Kelly K Anderson, Nibene H Somé, Amardeep Thind, Sisira Sarma

Epidemiology and Biostatistics Publications

Treating mental illnesses in primary care is increasingly emphasized to improve access to mental health services. Although family physicians (FPs) or general practitioners are in an ideal position to provide the bulk of mental health care, it is unclear how best to remunerate FPs for the adequate provision of mental health services. We examined the quantity of mental health services provided in Ontario's blended fee-for-service and blended capitation models. We evaluated the impact of FPs switching from blended fee-for-service to blended capitation on the provision of mental health services in primary care and emergency department using longitudinal health administrative data …

The Association Between Ethnicity And Caregiver Health, Adetola Aboyeji

Electronic Thesis and Dissertation Repository

Background: Existing research shows that caregiving is associated with several adverse health outcomes. Despite the growing number of caregivers in Canada, little research has been conducted on caregivers' potential unique experiences and outcomes based on their ethnicity. The main objective of this study was to investigate whether ethnicity was associated with a caregiver’s health.

Methods: To address these research gaps, we used data from the 2012 Canadian General Social Survey (GSS) Caregiving and Care Receiving. Focusing on caregivers (n=9,552), we examined the association using three measures of health – self-reported overall health, self-reported mental health, and the Health Utility Index3 …

Descriptive Analysis Of Fall-Related Injuries Among Older Adults In Ontario, Nicolette Lappan

Electronic Thesis and Dissertation Repository

Falls are the leading cause of injury-related hospitalizations among older adults in Canada. The purpose of this study was to describe the characteristics of older adults who experienced fall-related injuries (FRIs) and the types of falls that caused them. We analyzed Ontario-wide secondary data from three databases (NACRS, DAD, RPDB) covering 2010-2014. Older adults (≥ 65 years) who visited emergency departments (ED) with FRIs were selected using ICD-10-CA codes for a fall and injury. Counts, measures of central tendency, and prevalence rates (crude, age- and sex-specific, age-standardized) were calculated. There were 304,610 (63.0% females) ED admissions (3,089 per 100,000 population) …

Fall Risk-Increasing Drugs And Gait Performance In Community-Dwelling Older Adults: Results From The Gait And Brain Study, Abdelhady Osman

Electronic Thesis and Dissertation Repository

Medication use and gait impairment are two of the most important risk factors for falls. Several drug classes have been classified as fall risk-increasing drugs (FRIDs). Gait is an important marker of overall health and independence in older adults. The overall aim of this thesis was to examine the relationship between FRIDs and gait performance in older adults through two studies. Firstly, our systematic review of twenty studies on the association between FRIDs and gait performance found that the use of drugs with sedative properties is associated with reduced gait speed. Secondly, we conducted a cross-sectional analysis of data from …

Interplay Between Shift Work, Psychological Distress, Sleep Quality, And Cognitive Performance, Rea Therese Alonzo

Electronic Thesis and Dissertation Repository

Shift work schedules are designed to maintain a continuous operation of goods and services. However, engaging in shift work may impact cognitive functioning. This thesis assessed the relationship between shift work and cognitive performance. Using cross-sectional data from the Canadian Longitudinal Study on Aging, multiple linear regression models were used to investigate the association between shift work and cognitive performance, as well as the moderating effects of psychological distress and sleep quality. Differences by sex and retirement status were also investigated. Shift work was significantly associated with poor performance for executive functioning but not for declarative memory. Poorer cognitive performance …

Analysis Of Health Care Costs Over A One-Year Period Following Anticoagulant Therapy Among Ontario Patients Diagnosed With Atrial Fibrillation, Michael Situ

Electronic Thesis and Dissertation Repository

Atrial fibrillation patients are at high risk of ischemic strokes, which can be drastically reduced using oral anticoagulants (OACs). Warfarin has been the standard OAC for this population but its effectiveness rests on consistent monitoring with the potential for severe bleeding events. Newer OACs, like rivaroxaban and apixaban, address these drawbacks but have a comparatively higher upfront cost. Uncertainty remains over which OAC is cost-saving from a health care system perspective. Using a retrospective cohort study design and inverse probability weighting regression adjustment estimators, one-year health care costs among patients treated with warfarin, rivaroxaban, and apixaban were compared. Compared to …

Characterizing Risk Factors Associated With The Recurrence Of Infective Endocarditis And Mortality Among People Who Inject Drugs, Janica A. Adams

Electronic Thesis and Dissertation Repository

Background. The incidence of infective endocarditis is progressively rising among people who inject drugs.

Methods. A retrospective cohort study was conducted using data from electronic medical records to characterize important predictors that contribute to the recurrence of infective endocarditis and evaluate the associations of survival time and predictors of interest in the presence of competing risks among people who inject drugs. Multivariate logistic and survival regression analyses were carried out to identify factors associated with infective endocarditis recurrence and death.

Results. We identified a significant association between PICC line misuse and infective endocarditis recurrence (OR=2.62, P=0.005). In addition, survival …

Quality Of Diabetes Care In Blended Fee-For-Service And Blended Capitation Payment Systems., Mary Aderayo Bamimore, Rose Anne Devlin, Gregory S Zaric, Amit X Garg, Sisira Sarma

Epidemiology and Biostatistics Publications

OBJECTIVES: In the middle to late 2000s, many family physicians switched from a Family Health Group (FHG; a blended fee-for-service model) to a Family Health Organization (FHO; a blended capitation model) in Ontario, Canada. The evidence on the link between physician remuneration schemes and quality of diabetes care is mixed in the literature. We examined whether physicians who switched from the FHG to FHO model provided better care for individuals living with diabetes relative to those who remained in the FHG model.

METHODS: Using longitudinal health administrative data from 2006 to 2016, we investigated the impact of physicians switching from …

Interplay Between Social Media Use, Sleep Quality, And Mental Health In Youth: A Systematic Review, Rea Alonzo, Junayd Hussain, Saverio Stranges, Kelly K. Anderson

Epidemiology and Biostatistics Publications

Social media applications are increasingly prominent among youth. This systematic review provides a comprehensive assessment of the literature on the relationship between active social media use, sleep quality, and common mental health outcomes (anxiety, depression, and psychological distress) among youth. MEDLINE, PsychINFO, EMBASE and Scopus were searched for observational studies investigating this relationship among youth (aged 16–25). Thirty-six cross-sectional studies and six prospective cohort studies met the inclusion criteria. Among cross-sectional studies, significant associations between excessive social media use with poor mental health outcomes (n = 33), poor sleep quality (n = 24), and significant associations between poor sleep quality …

Correlates Of Positive Mental Health Among Migrants In Canada, Branka Vujcic

Electronic Thesis and Dissertation Repository

Introduction: Positive mental health is of increasing interest as a public health measure, and is understudied among migrants.

Objective: The purpose of this project was to examine positive mental health and associated factors among migrants in Canada.

Methods: We used the Canadian Community Health Survey (CCHS) 2011-2012 cycles. A total of 28,051 respondents identified as migrants, which accounted for 23.2% of the entire sample. Using multivariable regression models, positive mental health among migrants was compared to non-migrants, and the effects of sociodemographic, lifestyle, and health-related factors were examined.

Results: The present study found that time spent in Canada since migration …

Association Between Air Pollution And Incidence Of Dementia: A Systematic Review And Meta-Analysis Of Cohort Studies, Ehsan Abolhasani

Electronic Thesis and Dissertation Repository

Objective. To estimate the risk of dementia in association with exposure to air pollutants.

Methods. Six databases were searched. Cohort studies that reported the hazard ratio (HR) of dementia in association with exposure to air pollutants in adults > 40y were included. For all meta-analyses, the random-effects model was used.

Results. A total of 16 and 13 studies were included in the systematic review and the meta-analysis, respectively. Risk of dementia increased by 4% per 1μg/m³ increase in fine particulate matter level (HR, 1.04; 95%CI, [1.02, 1.06]), which was statistically significant. The risk of dementia increased by 3% per 10μg/m …

Emergency Department Use Following Incentives To Provide After-Hours Primary Care: A Retrospective Cohort Study., Michael Hong, Amardeep Thind, Gregory S Zaric, Sisira Sarma

Epidemiology and Biostatistics Publications

BACKGROUND: Access to primary care outside of regular working hours is limited in many countries. This study investigates the relation between the after-hours premium, an incentive for primary care physicians to provide services after hours, and less-urgent visits to the emergency department in Ontario, Canada.

METHODS: We analyzed a retrospective cohort of a random sample of Ontario residents from April 2002 to March 2006, and a subcohort of patients followed from April 2005 to March 2016. We linked patient and primary care physician data with emergency department visit data. We used fixed-effects regression models to analyze the association between the …

The Risk Of Physical Multimorbidity In People With Psychotic Disorders: A Systematic Review And Meta-Analysis, Myanca Rodrigues, Joshua C. Wiener, Saverio Stranges, Bridget L. Ryan, Kelly K. Anderson

Epidemiology and Biostatistics Publications

Background: The occurrence of multiple co-occurring chronic health conditions, known as multimorbidity, is associated with decreases in quality of life for patients and poses unique challenges for healthcare systems. Since people with psychotic disorders have an excess of physical health conditions compared to the general population, they may also be at a higher risk for multimorbidity. We conducted a systematic review and meta-analysis to quantify the prevalence and excess risk of multimorbidity among people with psychotic disorders, relative to those without psychosis.

Methods: We searched the MEDLINE, EMBASE, and PsycINFO databases, and conducted forward and backward citation tracing of included …

Physician Remuneration Schemes, Psychiatric Hospitalizations And Follow-Up Care: Evidence From Blended Fee-For-Service And Capitation Models., Thyna Vu, Kelly K Anderson, Rose Anne Devlin, Nibene H Somé, Sisira Sarma

Epidemiology and Biostatistics Publications

Psychiatric hospitalizations could be reduced if mental illnesses were detected and treated earlier in the primary care setting, leading to the World Health Organization recommendation that mental health services be integrated into primary care. The mental health services provided in primary care settings may vary based on how physicians are incentivized. Little is known about the link between physician remuneration and psychiatric hospitalizations. We contribute to this literature by studying the relationship between physician remuneration and psychiatric hospitalizations in Canada's most populous province, Ontario. Specifically, we study family physicians (FPs) who switched from blended fee-for-service (FFS) to blended capitation remuneration …