Abstract Background Canadian provinces and territories routinely collect health information for administrative purposes. This study used Canadian medical and hospital administrative data for population-based surveillance of diagnosed ischemic heart disease (IHD). Methods Hospital discharge abstracts and physician billing claims data from seven provinces were analyzed to estimate prevalence and incidence of IHD using three validated algorithms: a) one hospital discharge abstract with an IHD diagnosis or procedure code (1H); b) 1H or at least three physician claims within a one-year period (1H3P) and c) 1H or at least two physician claims within a one-year period (1H2P). Crude and age-standardized prevalence and incidence rates were calculated for Canadian adults aged 20 +. Results IHD prevalence and incidence varied by province, were consistently higher among males than females, and increased with age. Prevalence and incidence were lower using the 1H method compared to using the 1H2P or 1H3P methods in all provinces studied for all age groups. For instance, in 2006/07, crude prevalence by province ranged from 3.4%-5.5% (1H), from 4.9%-7.7% (1H3P) and from 6.0%-9.2% (1H2P). Similarly, crude incidence by province ranged from 3.7-5.9 per 1,000 (1H), from 5.0-6.9 per 1,000 (1H3P) and from 6.1-7.9 per 1,000 (1H2P). Conclusions Study findings show that incidence and prevalence of diagnosed IHD will be underestimated by as much as 50% using inpatient data alone. The addition of physician claims data are needed to better assess the burden of IHD in Canada.
Parkinson''s disease (PD) rates were examined by province and by sex for Canada for the years 1979–1984. As seen with other studies, PD displayed an uneven geographic distribution in the average annual prevalence rates for both males and females. The distribution of prevalence rates indicated a higher prevalence of PD in the western-most provinces. Nationally, males had a statistically significantly higher prevalence than females. Three provinces displayed a statistically significant sex difference with 2 provinces having a higher prevalence rate among males and 1 with a higher prevalence among females. The uneven distribution of prevalence rates offers some support for the involvement of environmental influences in the etiology of PD.
Food insecurity is frequent in both developed and developing countries ranging from 5 to 25 percent of the general population in different research reports.The aim of this study was to evaluate the validity of a short questionnaire for the surveillance of food insecurity in Iran.This cross sectional study was conducted on 300 subjects selected randomly in Asadabadi area of the north-west of Iran.Hunger and hidden hunger were defined as inadequate intake of energy, and as inadequate intake of key nutrients (energy, protein, calcium, vitamine A and B2), respectively.The validity of the short questionnaire (six-items) was assessed using the data obtained on food consumption from 24-hours food recall questionnaire for three days of a week.The prevalence of hunger and hidden hunger using 24-hours food recall questionnaire was 26 (Confidence Intervals 95%:21-31) and 42 percent (Confidence Intervals 95%:37-48), respectively.Sensitivity, specificity and accuracy of the short questionnaire for the screening of the hunger in the population were 98.7 (Confidence Intervals 95%:93-99), 85.5 (Confidence Intervals 95%:80-90) and 89 percent (Confidence Intervals 95%:85-92), respectively, while the same figures for hidden hunger were 23.5 (Confidence Intervals 95%:17-32), 96.9 (Confidence Intervals 95%:92-99)and 56.3 percent (Confidence Intervals 95%:50-63).Our findings indicated that this short questionnaire may be used as a simple, lowcost, and rapid tool for the surveillance of food insecurity in the area and similar regions.
If we are to improve the patient experience, knowing where and with whom people receive professional health advice and treatment (the ecology of medical care) is the first step. We designed this study to define the ecology of medical care in Alberta and to examine whether province-wide implementation of 5 policy changes between 2003 and 2012 changed patterns of care among adults in the province.This was a retrospective cohort study of adults (age ≥ 18 yr) in Alberta using routinely collected data from 6 linked administrative health databases, the 2016 Canadian Community Health Survey and the Alberta Health Link teletriage system. We collected data on all encounters with pharmacists, primary care physicians, specialists, emergency departments and hospitals in 2002/03, 2009/10 and 2016/17.Between 2002/03 and 2016/17, the community-dwelling adult population of Alberta increased from 2.66 million to 3.84 million; the median age increased from 41 to 43 years, and the proportion with at least 1 ambulatory-care-sensitive condition increased from 20.6% to 27.8%. The proportion who saw a primary care physician decreased significantly (from 70.8% to 68.2%, p < 0.001), as did the proportion who visited an emergency department (from 20.6% to 19.2%, p < 0.001); the declines were seen in all subgroups examined. The proportion who saw a specialist as an outpatient increased from 31.9% to 33.2% (p < 0.001), and the proportion who received at least 1 medication dispensation increased from 54.9% to 60.2% (p < 0.001). The proportion admitted to an acute care hospital (5.6%-6.5%) or academic hospital (1.2%) was relatively stable over time.Despite implementation of 5 system-wide changes designed to affect the delivery of primary and specialty medical care as well as the use of pharmacist and nursing services in Alberta, patterns of health care delivery changed little between 2002/03 and 2016/17. Rather than searching for a policy "magic bullet," health care planners may be better served by focusing on upscaling and implementing interventions proven to be efficacious.
ABSTRACT Objectives To estimate the effectiveness of mRNA COVID-19 vaccines against symptomatic infection and severe outcomes. Design We applied a test-negative design study to linked laboratory, vaccination, and health administrative databases, and used multivariable logistic regression adjusting for demographic and clinical characteristics associated with SARS-CoV-2 and vaccine receipt to estimate vaccine effectiveness (VE) against symptomatic infection and severe outcomes. Setting Ontario, Canada between 14 December 2020 and 19 April 2021. Participants Community-dwelling adults aged ≥16 years who had COVID-19 symptoms and were tested for SARS-CoV-2. Interventions Pfizer-BioNTech’s BNT162b2 or Moderna’s mRNA-1273 vaccine. Main outcome measures Laboratory-confirmed SARS-CoV-2 by RT-PCR; hospitalization/death associated with SARS-CoV-2 infection. Results Among 324,033 symptomatic individuals, 53,270 (16.4%) were positive for SARS-CoV-2 and 21,272 (6.6%) received ≥1 vaccine dose. Among test-positive cases, 2,479 (4.7%) had a severe outcome. VE against symptomatic infection ≥14 days after receiving only 1 dose was 60% (95%CI, 57 to 64%), increasing from 48% (95%CI, 41 to 54%) at 14–20 days after the first dose to 71% (95%CI, 63 to 78%) at 35–41 days. VE ≥7 days after 2 doses was 91% (95%CI, 89 to 93%). Against severe outcomes, VE ≥14 days after 1 dose was 70% (95%CI, 60 to 77%), increasing from 62% (95%CI, 44 to 75%) at 14–20 days to 91% (95%CI, 73 to 97%) at ≥35 days, whereas VE ≥7 days after 2 doses was 98% (95%CI, 88 to 100%). For adults aged ≥70 years, VE estimates were lower for intervals shortly after receiving 1 dose, but were comparable to younger adults for all intervals after 28 days. After 2 doses, we observed high VE against E484K-positive variants. Conclusions Two doses of mRNA COVID-19 vaccines are highly effective against symptomatic infection and severe outcomes. Single-dose effectiveness is lower, particularly for older adults shortly after the first dose.
IntroductionThe Province of Alberta maintains a mature data ecosystem with linkable data dating back over 30 years. The population-based nature of the data makes this a valuable asset for driving analytics to support health system innovation, with a focus on improving health outcomes and quality of life.
Objectives and ApproachAlberta Health has created the Secondary Use Data Access (SUDA) initiative to leverage its administrative health data. SUDA envisions strengthening partnerships between the public and private sectors with two main access approaches. The first is direct access to de-identified data held within the Alberta Health data warehouse by key health system stakeholders (e.g. academic instituions, Health Quality Council of Alberta, regulatory colleges). The second is indirect access to private and not-for-profit stakeholders, using a safe haven approach. Indirect access is achieved through private sector investments to a trusted third party that hires analysts to be placed within Alberta Health.
ResultsStaffing agreements and privacy impact assessments have been drafted to support the work. The indirect access route includes a multiple stakeholder steering committee to vette and prioritize projects. Private and not-for-profit stakeholders do not have access to the data, but rather receive access to aggregate data and statitstical models. All disclosures are done by Alberta Health staff to ensure compliance with Alberta's Health Information Act. Direct access has been established for the Alberta Medical Association as part of a long standing data sharing agreement, with access restricted to de-identified data only. To date, seven industry proposals for analytics have been received and are currently being actioned.
Conclusion/ImplicationsThe Secondary Use Data Access initiative uses a safe haven approach to leveraging data. It reduces the need to provision data outside of the data warehouse and allows for better monitoring of access and use of data. The approach provides assurances that people's health information is secure.
A sample of 457 undergraduate university students were surveyed to assess their current use of illicit drugs. Such information is to be used as a baseline to examine the effectiveness of drug prevention programs designed for this population. Marijuana was the most common illicit drug used among these students, and men were significantly more likely to report use. Age differences were noted; older students (age greater than or equal to 22 yr.) were more likely to report drug use than those students under 22 years of age. The age differences suggest that there may be a shift away from drug use among the younger students. The low over-all rate of drug use may make difficult the evaluation of prevention programs.
