Associations between chronic conditions and death in hospital among adults (aged 20+ years) during first acute care hospitalizations with a confirmed or suspected COVID-19 diagnosis in Canada.

PURPOSE: We aimed to quantify life course-specific associations between death in hospital and 30 chronic conditions, and comorbidity among them, in adults (aged 20+ years) during their first acute care hospitalization with a confirmed or suspected COVID-19 diagnosis in Canada. METHODS: We identified 35,519 first acute care hospitalizations with a confirmed or suspected COVID-19 diagnosis in the Discharge Abstract Database as of March 31, 2021. For each of five life-course age groups (20-34, 35-49, 50-64, 65-79, and 80+ years), we used multivariable logistic regression to examine associations between death in hospital and 30 chronic conditions, comorbidity, period of admission, and pregnant status, after adjusting for sex and age. RESULTS: About 20.9% of hospitalized patients with COVID-19 died in hospital. Conditions most strongly associated with in-hospital death varied across the life course. Chronic liver disease, other nervous system disorders, and obesity were statistically significantly associated (α = 0.05) with in-hospital death in the 20-34 to 65-79 year age groups, but the magnitude of the associations decreased as age increased. Stroke (aOR = 5.24, 95% CI: 2.63, 9.83) and other inflammatory rheumatic diseases (aOR = 4.37, 95% CI: 1.64, 10.26) were significantly associated with in-hospital death among 35 to 49 year olds only. Among 50+ year olds, more chronic conditions were significantly associated with in-hospital death, but the magnitude of the associations were generally weaker except for Down syndrome in the 50 to 64 (aOR = 8.49, 95% CI: 4.28, 16.28) and 65 to 79 year age groups (aOR = 5.19, 95% CI: 1.44, 20.91). Associations between comorbidity and death also attenuated with age. Among 20 to 34 year olds, the likelihood of death was 19 times greater (aOR = 18.69, 95% CI: 7.69, 48.24) in patients with three or more conditions compared to patients with none of the conditions, while for 80+ year olds the likelihood of death was two times greater (aOR = 2.04, 95% CI: 1.70, 2.45) for patients with six or more conditions compared to patients with none of the conditions. CONCLUSION: Conditions most strongly associated with in-hospital death among hospitalized adults with COVID-19 vary across the life course, and the impact of chronic conditions and comorbidity attenuate with age.

Lifetime risk, life expectancy, and years of life lost to type 2 diabetes in 23 high-income jurisdictions: a multinational, population-based study.

BACKGROUND: Diabetes is a major public health issue. Because lifetime risk, life expectancy, and years of life lost are meaningful metrics for clinical decision making, we aimed to estimate these measures for type 2 diabetes in the high-income setting. METHODS: For this multinational, population-based study, we sourced data from 24 databases for 23 jurisdictions (either whole countries or regions of a country): Australia; Austria; Canada; Denmark; Finland; France; Germany; Hong Kong; Hungary; Israel; Italy; Japan; Latvia; Lithuania; the Netherlands; Norway; Scotland; Singapore; South Korea; Spain; Taiwan; the UK; and the USA. Our main outcomes were lifetime risk of type 2 diabetes, life expectancy in people with and without type 2 diabetes, and years of life lost to type 2 diabetes. We modelled the incidence and mortality of type 2 diabetes in people with and without type 2 diabetes in sex-stratified, age-adjusted, and calendar year-adjusted Poisson models for each jurisdiction. Using incidence and mortality, we constructed life tables for people of both sexes aged 20-100 years for each jurisdiction and at two timepoints 5 years apart in the period 2005-19 where possible. Life expectancy from a given age was computed as the area under the survival curves and lifetime lost was calculated as the difference between the expected lifetime of people with versus without type 2 diabetes at a given age. Lifetime risk was calculated as the proportion of each cohort who developed type 2 diabetes between the ages of 20 years and 100 years. We estimated 95% CIs using parametric bootstrapping. FINDINGS: Across all study cohorts from the 23 jurisdictions (total person-years 1 577 234 194), there were 5 119 585 incident cases of type 2 diabetes, 4 007 064 deaths in those with type 2 diabetes, and 11 854 043 deaths in those without type 2 diabetes. The lifetime risk of type 2 diabetes ranged from 16·3% (95% CI 15·6-17·0) for Scottish women to 59·6% (58·5-60·8) for Singaporean men. Lifetime risk declined with time in 11 of the 15 jurisdictions for which two timepoints were studied. Among people with type 2 diabetes, the highest life expectancies were found for both sexes in Japan in 2017-18, where life expectancy at age 20 years was 59·2 years (95% CI 59·2-59·3) for men and 64·1 years (64·0-64·2) for women. The lowest life expectancy at age 20 years with type 2 diabetes was observed in 2013-14 in Lithuania (43·7 years [42·7-44·6]) for men and in 2010-11 in Latvia (54·2 years [53·4-54·9]) for women. Life expectancy in people with type 2 diabetes increased with time for both sexes in all jurisdictions, except for Spain and Scotland. The life expectancy gap between those with and without type 2 diabetes declined substantially in Latvia from 2010-11 to 2015-16 and in the USA from 2009-10 to 2014-15. Years of life lost to type 2 diabetes ranged from 2·5 years (Latvia; 2015-16) to 12·9 years (Israel Clalit Health Services; 2015-16) for 20-year-old men and from 3·1 years (Finland; 2011-12) to 11·2 years (Israel Clalit Health Services; 2010-11 and 2015-16) for 20-year-old women. With time, the expected number of years of life lost to type 2 diabetes decreased in some jurisdictions and increased in others. The greatest decrease in years of life lost to type 2 diabetes occurred in the USA between 2009-10 and 2014-15 for 20-year-old men (a decrease of 2·7 years). INTERPRETATION: Despite declining lifetime risk and improvements in life expectancy for those with type 2 diabetes in many high-income jurisdictions, the burden of type 2 diabetes remains substantial. Public health strategies might benefit from tailored approaches to continue to improve health outcomes for people with diabetes. FUNDING: US Centers for Disease Control and Prevention and Diabetes Australia.

Trends in all-cause mortality among people with diagnosed diabetes in high-income settings: a multicountry analysis of aggregate data.

BACKGROUND: Population-level trends in mortality among people with diabetes are inadequately described. We aimed to examine the magnitude and trends in excess all-cause mortality in people with diabetes. METHODS: In this retrospective, multicountry analysis, we collected aggregate data from 19 data sources in 16 high-income countries or jurisdictions (in six data sources in Asia, eight in Europe, one from Australia, and four from North America) for the period from Jan 1, 1995, to Dec 31, 2016, (or a subset of this period) on all-cause mortality in people with diagnosed total or type 2 diabetes. We collected data from administrative sources, health insurance records, registries, and a health survey. We estimated excess mortality using the standardised mortality ratio (SMR). FINDINGS: In our dataset, there were approximately 21 million deaths during 0·5 billion person-years of follow-up among people with diagnosed diabetes. 17 of 19 data sources showed decreases in the age-standardised and sex-standardised mortality in people with diabetes, among which the annual percentage change in mortality ranged from -0·5% (95% CI -0·7 to -0·3) in Hungary to -4·2% (-4·3 to -4·1) in Hong Kong. The largest decreases in mortality were observed in east and southeast Asia, with a change of -4·2% (95% CI -4·3 to -4·1) in Hong Kong, -4·0% (-4·8 to -3·2) in South Korea, -3·5% (-4·0 to -3·0) in Taiwan, and -3·6% (-4·2 to -2·9) in Singapore. The annual estimated change in SMR between people with and without diabetes ranged from -3·0% (95% CI -3·0 to -2·9; US Medicare) to 1·6% (1·4 to 1·7; Lombardy, Italy). Among the 17 data sources with decreasing mortality among people with diabetes, we found a significant SMR increase in five data sources, no significant SMR change in four data sources, and a significant SMR decrease in eight data sources. INTERPRETATION: All-cause mortality in diabetes has decreased in most of the high-income countries we assessed. In eight of 19 data sources analysed, mortality decreased more rapidly in people with diabetes than in those without diabetes. Further longevity gains will require continued improvement in prevention and management of diabetes. FUNDING: US Centers for Disease Control and Prevention, Diabetes Australia Research Program, and Victoria State Government Operational Infrastructure Support Program.

Population coverage of the Canadian Chronic Disease Surveillance System: a survey of the contents of health insurance registries across Canada. / Couverture de la population dans le Système canadien de surveillance des maladies chroniques : enquête sur le contenu des registres d'assurance-maladie au Canada.

INTRODUCTION: Health insurance registries, which capture insurance coverage and demographic information for entire populations, are a critical component of population health surveillance and research when using administrative data. Lack of standardization of registry information across Canada's provinces and territories could affect the comparability of surveillance measures. We assessed the contents of health insurance registries across Canada to describe the populations covered and document registry similarities and differences. METHODS: A survey about the data and population identifiers in health insurance registries was developed by the study team and representatives from the Public Health Agency of Canada. The survey was completed by key informants from most provinces and territories and then descriptively analyzed. RESULTS: Responses were received from all provinces; partial responses were received from the Northwest Territories. Demographic information in health insurance registries, such as primary address, date of birth and sex, were captured in all jurisdictions. Data captured on familial relationships, ethnicity and socioeconomic status varied among jurisdictions, as did start and end dates of coverage and frequency of registry updates. Identifiers for specific populations, such as First Nations individuals, were captured in some, but not all jurisdictions. CONCLUSION: Health insurance registries are a rich source of information about the insured populations of the provinces and territories. However, data heterogeneity may affect who is included and excluded in population surveillance estimates produced using administrative health data. Development of a harmonized data framework could support timely and comparable population health research and surveillance results from multi-jurisdiction studies.

The Canadian Chronic Disease Surveillance System: A model for collaborative surveillance.

Chronic diseases have a major impact on populations and healthcare systems worldwide. Administrative health data are an ideal resource for chronic disease surveillance because they are population-based and routinely collected. For multi-jurisdictional surveillance, a distributed model is advantageous because it does not require individual-level data to be shared across jurisdictional boundaries. Our objective is to describe the process, structure, benefits, and challenges of a distributed model for chronic disease surveillance across all Canadian provinces and territories (P/Ts) using linked administrative data. The Public Health Agency of Canada (PHAC) established the Canadian Chronic Disease Surveillance System (CCDSS) in 2009 to facilitate standardized, national estimates of chronic disease prevalence, incidence, and outcomes. The CCDSS primarily relies on linked health insurance registration files, physician billing claims, and hospital discharge abstracts. Standardized case definitions and common analytic protocols are applied to the data for each P/T; aggregate data are shared with PHAC and summarized for reports and open access data initiatives. Advantages of this distributed model include: it uses the rich data resources available in all P/Ts; it supports chronic disease surveillance capacity building in all P/Ts; and changes in surveillance methodology can be easily developed by PHAC and implemented by the P/Ts. However, there are challenges: heterogeneity in administrative databases across jurisdictions and changes in data quality over time threaten the production of standardized disease estimates; a limited set of databases are common to all P/Ts, which hinders potential CCDSS expansion; and there is a need to balance comprehensive reporting with P/T disclosure requirements to protect privacy. The CCDSS distributed model for chronic disease surveillance has been successfully implemented and sustained by PHAC and its P/T partners. Many lessons have been learned about national surveillance involving jurisdictions that are heterogeneous with respect to healthcare databases, expertise and analytical capacity, population characteristics, and priorities.

Assessing the burden of hospitalized and community-care heart failure in Canada.

BACKGROUND: The surveillance of heart failure (HF) is currently conducted using either survey or hospital data, which have many limitations. Because Canada is collecting medical information in administrative health data, the present study seeks to propose methods for the national surveillance of HF using linked population-based data. METHODS: Linked administrative data from 5 Canadian provinces were analyzed to estimate prevalence, incidence, and mortality rates for persons with HF between 1996/1997 and 2008/2009 using 2 case definitions: (1) 1 hospitalization with an HF diagnosis in any field (H_Any) and (2) 1 hospitalization in any field or at least 2 physician claims within a 1-year period (H_Any_2P). One hospitalization with an HF diagnosis code in the most responsible diagnosis field (H_MR) was also compared. Rates were calculated for individuals aged ≥ 40 years. RESULTS: In 2008/2009, combining the 5 provinces (approximately 82% of Canada's total population), both age-standardized HF prevalence and incidence were underestimated by 39% and 33%, respectively, with H_Any when compared with H_Any_2P. Mortality was higher in patients with H_MR compared with H_Any. The degree of underestimation varied by province and by age, with older age groups presenting the largest differences. Prevalence estimates were stable over the years, especially for the H_Any_2P case definition. CONCLUSIONS: The prevalence and incidence of HF using inpatient data alone likely underestimates the population rates by at least 33%. The addition of physician claims data is likely to provide a more inclusive estimate of the burden of HF in Canada.

Self-monitoring of blood glucose in type 2 diabetes: Results of the 2011 Survey on Living with Chronic Diseases in Canada.

BACKGROUND: For insulin-treated patients with type 2 diabetes mellitus (T2DM), self-monitoring of blood glucose (SMBG) may be vital in adjusting insulin dosages. For patients who do not use insulin, evidence supporting the use of SMBG is inconclusive. METHODS: The prevalence, frequency and correlates of SMBG are examined. Data pertain to 2,682 individuals aged 20 or older with T2DM who responded to the 2011 Survey on Living with Chronic Diseases in Canada. Multivariate prevalence rate ratios for associations between respondents' characteristics and their use of SMBG were derived using binomial regression models. RESULTS: A large majority of the study population (87.8%) reported SMBG. No difference in the prevalence of SMBG was observed between oral medication users compared with insulin users; however, the frequency of SMBG was lower for those taking oral medication only. Significant determinants of SMBG were a health professional's recommendation, having insurance coverage, and receiving an A1C test from a health professional. INTERPRETATION: The use of SMBG by adults with T2DM is common, and does not differ between those taking oral medication only and those treated with insulin.

Surveillance of ischemic heart disease should include physician billing claims: population-based evidence from administrative health data across seven Canadian provinces.

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.

Hypertension prevalence, awareness, treatment and control in national surveys from England, the USA and Canada, and correlation with stroke and ischaemic heart disease mortality: a cross-sectional study.

OBJECTIVE: Comparison of recent national survey data on prevalence, awareness, treatment and control of hypertension in England, the USA and Canada, and correlation of these parameters with each country stroke and ischaemic heart disease (IHD) mortality. DESIGN: Non-institutionalised population surveys. SETTING AND PARTICIPANTS: England (2006 n=6873), the USA (2007-2010 n=10 003) and Canada (2007-2009 n=3485) aged 20-79 years. OUTCOMES: Stroke and IHD mortality rates were plotted against countries' specific prevalence data. RESULTS: Mean systolic blood pressure (SBP) was higher in England than in the USA and Canada in all age-gender groups. Mean diastolic blood pressure (DBP) was similar in the three countries before age 50 and then fell more rapidly in the USA, being the lowest in the USA. Only 34% had a BP under 140/90 mm Hg in England, compared with 50% in the USA and 66% in Canada. Prehypertension and stages 1 and 2 hypertension prevalence figures were the highest in England. Hypertension prevalence (≥140 mm Hg SBP and/or ≥90 mm Hg DBP) was lower in Canada (19·5%) than in the USA (29%) and England (30%). Hypertension awareness was higher in the USA (81%) and Canada (83%) than in England (65%). England also had lower levels of hypertension treatment (51%; USA 74%; Canada 80%) and control (<140/90 mm Hg; 27%; the USA 53%; Canada 66%). Canada had the lowest stroke and IHD mortality rates, England the highest and the rates were inversely related to the mean SBP in each country and strongly related to the blood pressure indicators, the strongest relationship being between low hypertension awareness and stroke mortality. CONCLUSIONS: While the current prevention efforts in England should result in future-improved figures, especially at younger ages, these data still show important gaps in the management of hypertension in these countries, with consequences on stroke and IHD mortality.

The impact of cardiovascular risk-factor profiles on blood pressure control rates in adults from Canada and the United States.

BACKGROUND: It is unclear whether blood pressure control varies across the spectrum of atherosclerotic risk. METHODS: We used data from nonpregnant adults who had fasted laboratory samples drawn for the 2007-2009 cycle of the Canadian Health Measures Survey (CHMS) or the 2005-2008 US National Health and Nutrition Examination Survey (NHANES). RESULTS: The 1692 CHMS subjects and 3541 NHANES participants were demographically similar (aged a mean of 45 years), although NHANES participants exhibited higher obesity rates (33.8% vs. 22.2%, P < 0.001). Over 80% of CHMS and NHANES subjects with hypertension had at least 1 other cardiovascular risk factor. As the number of atherosclerotic risk factors increased, hypertension prevalence increased, but blood pressure control rates improved (from 48% among hypertensives with no other risk factors in CHMS to 77% among those with 3 or more risk factors, and from 35% to 53% in NHANES). However, the converse was not true: The distribution of Framingham risk scores for those subjects with "controlled hypertension" was nearly identical to the distribution among those adults with uncontrolled hypertension in both CHMS and NHANES and substantially higher than scores in normotensive subjects. CONCLUSIONS: Although control of blood pressure was better in patients with multiple atherosclerotic risk factors, hypertensives with controlled blood pressures exhibited risk-factor profiles similar to those of participants with uncontrolled blood pressures. This suggests the need, in educational messaging and therapy decision making, for an increased focus on total atherosclerotic risk rather than just blood pressure control.

Comparison of diagnosed, self-reported, and physically-measured hypertension in Canada.

BACKGROUND: Hypertension is a substantial health concern because it poses significant risks for cardiovascular morbidity and mortality and is highly prevalent in the population. Tracking hypertension is important because it is a risk factor for other conditions, but prevalence estimates might vary depending on the data source used. METHODS: This report describes 3 national population-based data sources for estimating hypertension prevalence in Canada and discusses their strengths and weaknesses to aid in their use for policy and program planning. They are compared based on: sample coverage, case identification, and prevalence estimates. RESULTS: Each source produces a different measure of hypertension prevalence, as follows: (1) diagnosed hypertension from the Canadian Chronic Disease Surveillance System (CCDSS) (2007/2008); (2) self-reported diagnosed hypertension from the Canadian Community Health Survey (CCHS) (2007-2008); and, (3) physically-measured hypertension from the Canadian Health Measures Survey (CHMS) (2007-2009). Crude rates and counts of hypertension prevalence among individuals aged 20 to 79 years of age, excluding pregnant women, are compared, resulting in prevalence ranging from 18.2% in self-report data to 20.3% in diagnosed data. The data sources differ in terms of target population, case identification, and limitations, which affects the estimates. CONCLUSIONS: Each source has unique strengths and is best suited for addressing particular research questions. For example, diagnosed hypertension can be used to determine health care utilization patterns, self-reported to examine health determinants, and measured high blood pressure to improve awareness, treatment, and control. Combined, they can address multiple issues and increase our knowledge of hypertension in Canada.

Antihypertensive medication use, adherence, stops, and starts in Canadians with hypertension.

BACKGROUND: Some of the greatest barriers to achieving blood pressure control are perceived to be failure to prescribe antihypertensive medication and lack of adherence to medication prescriptions. METHODS: Self-reported data from 6017 Canadians with diagnosed hypertension who responded to the 2008 Canadian Community Health Survey and the 2009 Survey on Living with Chronic Diseases in Canada were examined. RESULTS: The majority (82%) of individuals with diagnosed hypertension reported using antihypertensive medications. The main reasons for not taking medications were either that they were not prescribed (42%) or that blood pressure had been controlled without medications (45%). Of those not taking antihypertensive medications in 2008 (n = 963), 18% had started antihypertensive medications by 2009, and of those initially taking medications (n = 5058), 5% had stopped. Of those taking medications in 2009, 89% indicated they took the medication as prescribed, and 10% indicated they occasionally missed a dose. Participants who were recently diagnosed, not measuring blood pressure at home, not having a plan to control blood pressure, or not receiving instructions on how to take medications were less likely to be taking antihypertensive medications; similar factors tended to be associated with stopping antihypertensive medication use. CONCLUSIONS: Compatible with high rates of hypertension control, most Canadians diagnosed with hypertension take antihypertensive medications and report adherence. Widespread implementation of self-management strategies for blood pressure control and standardized instructions on antihypertensive medication may further optimize drug treatment.

Factors associated with lack of awareness and uncontrolled high blood pressure among Canadian adults with hypertension.

BACKGROUND: Approximately 17% of Canadians with high blood pressure were unaware of their condition, and of Canadians aware of having the condition, approximately 1 in 5 have uncontrolled high blood pressure despite high rates of pharmacotherapy. The objectives of the current study are to estimate the prevalence of resistant hypertension and examine factors associated with (1) lack of awareness and (2) uncontrolled hypertension despite pharmacotherapy. METHODS: Using the 2007-2009 Canadian Health Measures Survey (N = 3473, aged 20-79 years) and logistic regression, we quantified relationships between characteristics and (1) presence of hypertension, (2) lack of awareness (among those with hypertension), and (3) uncontrolled high blood pressure (among those treated for hypertension). RESULTS: Older age, lowest income, and less than high school education were associated with presence of hypertension. Men (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1-2.2) and adults < 60 years (OR, 1.7; 95% CI, 1.1-2.6) were more likely than others to be unaware. Among those aged 60+ years, women were more likely than men to have uncontrolled high blood pressure (OR, 2.4; 95% CI, 1.1-5.2) despite treatment. Elevated systolic blood pressure was the issue in over 90% of women and 80% of men with uncontrolled hypertension. Depending on the definition employed, 4.4% (95% CI, 2.4-6.4) to 7.8% (95% CI, 6.0-9.6) of the population with hypertension had resistant hypertension. CONCLUSIONS: Messaging or interventions encouraging screening may be helpful for all younger Canadian adults and men; programs encouraging blood pressure control may help older women.

Diagnosed hypertension in Canada: incidence, prevalence and associated mortality.

BACKGROUND: Hypertension is a leading risk factor for cardiovascular diseases. Our objectives were to examine the prevalence and incidence of diagnosed hypertension in Canada and compare mortality among people with and without diagnosed hypertension. METHODS: We obtained data from linked health administrative databases from each province and territory for adults aged 20 years and older. We used a validated case definition to identify people with hypertension diagnosed between 1998/99 and 2007/08. We excluded pregnant women from the analysis. RESULTS: This retrospective population-based study included more than 26 million people. In 2007/08, about 6 million adults (23.0%) were living with diagnosed hypertension and about 418,000 had a new diagnosis. The age-standardized prevalence increased significantly from 12.5% in 1998/99 to 19.6% in 2007/08, and the incidence decreased from 2.7 to 2.4 per 100. Among people aged 60 years and older, the prevalence was higher among women than among men, as was the incidence among people aged 75 years and older. The prevalence and incidence were highest in the Atlantic region. For all age groups, all-cause mortality was higher among adults with diagnosed hypertension than among those without diagnosed hypertension. INTERPRETATION: The overall prevalence of diagnosed hypertension in Canada from 1998 to 2008 was high and increasing, whereas the incidence declined during the same period. These findings highlight the need to continue monitoring the effectiveness of efforts for managing hypertension and to enhance public health programs aimed at preventing hypertension.

Prevalence of, and barriers to, preventive lifestyle behaviors in hypertension (from a national survey of Canadians with hypertension).

Patients with hypertension are advised to lower their blood pressure to <140/90 mm Hg through sustained lifestyle modification and/or pharmacotherapy. To describe the use of lifestyle changes for blood pressure control and to identify the barriers to these behaviors, the data from 6,142 Canadians with hypertension who responded to the 2009 Survey on Living With Chronic Diseases in Canada were analyzed. Most Canadians with diagnosed hypertension reported limiting salt consumption (89%), having changed the types of food they eat (89%), engaging in physical activity (80%), trying to control or lose weight if overweight (77%), quitting smoking if currently smoking (78%), and reducing alcohol intake if currently drinking more than the recommended levels (57%) at least some of the time to control their blood pressure. Men, those aged 20 to 44 years, and those with lower educational attainment and lower income were, in general, less likely to report engaging in lifestyle behaviors for blood pressure control. A low desire, interest, or awareness were commonly reported barriers to salt restriction, changes in diet, weight loss, smoking cessation, and alcohol reduction. In contrast, the most common barrier to engaging in physical activity to regulate blood pressure was the self-reported challenge of managing a coexisting physical condition or time constraints. In conclusion, programs and interventions to improve the adherence to lifestyle changes to treat hypertension may need to consider the identified barriers to lifestyle behaviors in their design.