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.

Congenital Anomalies of the Kidney and Urinary Tract (CAKUT): An Emerging Relationship With Pregestational Diabetes Mellitus Among First Nations and Non-First Nations People in Saskatchewan-Results From the DIP: ORRIIGENSS Project.

OBJECTIVES: Because congenital anomalies of the kidneys and urinary tract (CAKUT) represent a frequent cause of end stage renal disease (ESRD) in the young, we explored the epidemiology of CAKUT and the role of diabetes in pregnancy. METHODS: This was a retrospective cohort study of CAKUT, by maternal diabetes status, from among all 1980‒2009 births in Saskatchewan First Nations (FN) and non-First Nations (non-FN) people. We determined frequencies, predictors and complications of CAKUT, as well as cumulative survival (to 2014) of affected persons until ESRD and death. RESULTS: Of the 411,055 babies (204,167 mothers) in the Saskatchewan maternal-infant database, 2,540 had CAKUT (391 FN and 2,149 non-FN). Overall annual CAKUT incidence was 0.63% for non-FN and 0.57% for FN (p=0.082), but 5-year CAKUT incidence only increased among FN (0.40% in 1980‒1984 and 0.76% in 2005‒2009, p<0.0001) and was highest among offspring of FN mothers with pregestational diabetes (pre-G/DM) (0% before 1995, 2.51% in 2000‒2004 and 1.66% in 2005-2009). Pre-G/DM, but not gestational diabetes mellitus (GDM), was an independent predictor of CAKUT in non-FN (odds ratio, 1.79; 95% confidence interval, 1.20 to 2.69), and in FN interacting with maternal history of stillbirth (odds ratio, 7.90; 95% confidence interval, 1.14 to 54.6). ESRD was >100-fold more likely among offspring with CAKUT compared with all other offspring and was responsible for 40% of ESRD cases in young FN and non-FN people. CONCLUSIONS: In Saskatchewan, pre-G/DM is an emerging cause of CAKUT, accounting for 40% of ESRD cases in FN/non-FN children and young adults. Because pre-G/DM‒related CAKUT is potentially preventable with optimal glycemic management, increased recognition of this serious complication is required.

Epidemiology of Diabetes in Pregnancy Among First Nations and Non-First Nations Women in Saskatchewan, 1980‒2013. Part 2: Predictors and Early Complications; Results From the DIP: ORRIIGENSS Project.

OBJECTIVES: Because of disparities in incidence of diabetes in pregnancy (DIP) among First Nations (FN) and non-First Nations (non-FN) women in Saskatchewan, we compared predictors and early maternal/child complication rates of gestational diabetes (GDM) and pre-GDM between the 2 populations from 1980 to 2013. METHODS: Using Ministry of Health administrative databases, we examined overall GDM and pre-GDM predictors among a cohort of FN and non-FN women using logistic regression models. We compared early birth complications by ethnicity and DIP status using chi-square analysis. RESULTS: Deidentified data were obtained for 69,176 FN and 344,410 non-FN pregnancies. Important GDM and pre-GDM predictors for FN and non-FN pregnancies were increasing maternal age, a previous high birthweight (HBW) or stillborn infant, and, most importantly, previous maternal GDM. Both GDM and pre-GDM were over 2.3-fold as likely to occur among FN in multivariable analysis. FN and non-FN pregnancies with GDM and pre-GDM had higher rates of prematurity, shoulder dystocia, caesarean section, HBW and stillborn and infant death than those with no DIP. The largest rate disparities between FN and non-FN with DIP occurred with stillborn, HBW and shoulder dystocia. CONCLUSIONS: Along with previously recognized predictors of GDM and pre-GDM, FN ethnicity was an independent determinant of DIP in Saskatchewan from 1980 to 2013. Early mother/child birth complications were increased in both FN and non-FN with DIP, but more so in FN. Effective DIP prevention strategies, and improvements in preconception, prenatal and perinatal care, are required to remove ethnicity-based disparities in DIP rates and outcomes.

Epidemiology of Diabetes in Pregnancy Among First Nations and Non-First Nations Women in Saskatchewan, 1980‒2013. Part 1: Populations, Methodology and Frequencies (1980‒2009); Results From the DIP: ORRIIGENSS Project.

OBJECTIVES: Because of the immediate and long-term consequences of diabetes in pregnancy (DIP) for mother and child, we compared frequencies of gestational diabetes (GDM) and pre-GDM between First Nations (FN) and non-FN people in Saskatchewan from 1980 to 2009. METHODS: Using Ministry of Health administrative databases, we conducted a retrospective cohort study of GDM and pre-GDM rates within all FN and non-FN pregnancies in Saskatchewan. Annual crude and 10-year age-adjusted incidence of GDM and pre-GDM were determined as were maternal age-specific rates of DIP. RESULTS: De-identified data were obtained for 69,176 FN and 344,410 non-FN pregnancies. The crude annual incidence of GDM rose from 1.0% to 6.6% among FN and from 0.4% to 3.6% among non-FN between 1980 and 2009. The crude annual incidence of pre-GDM rose from 0.7% to 2.0% among FN and from 0.4% to 0.9% among non-FN over the same period. The 10-year age-standardized incidence of GDM increased from 3.53% in 1980-1989 to 8.37% in 2000-2009 for FN, and from 1.55% to 3.13% for non-FN. For pre-GDM, the corresponding increases were from 1.65% to 3.26% for FN and from 0.5% to 0.91% for non-FN. Both GDM and pre-GDM rates increased with increasing maternal age, reaching 10.9% and 8.0% of FN pregnancies, and 7.7% and 1.1% of non-FN pregnancies, respectively, for mothers >40 years old. CONCLUSIONS: The proportion of pregnancies complicated by DIP increased steadily among FN and non-FN women in Saskatchewan in 1980‒2009, but the incidence of GDM and pre-GDM is 2- to 3-fold higher among FN.

Risk of upper gastrointestinal complications associated with cyclooxygenase-2 selective and nonselective nonsteroidal antiinflammatory drugs.

STUDY OBJECTIVE: To estimate the risk of upper gastrointestinal complications associated with use of cyclooxygenase-2 (COX-2) selective (celecoxib and rofecoxib) and individual nonselective nonsteroidal antiinflammatory drugs (NSAIDs) compared with nonuse of these drugs. DESIGN: Nested case-control study. DATA SOURCE: Administrative health care databases of Saskatchewan, Canada. PATIENTS: Among a population of men and women aged 20-89 years who were covered by public health insurance with prescription drug benefits between November 15, 1999, and December 31, 2001, 726 case patients with first hospitalization for upper gastrointestinal complications (with validation of cases through review of hospital medical records) were confirmed from 1,054,532 person-years of follow-up, and 20,002 control patients were randomly selected from all eligible controls, frequency matched to cases on their index date (+/- 3 mo). MEASUREMENTS AND MAIN RESULTS: Logistic regression was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the association between upper gastrointestinal complications and use of NSAIDs. Current rofecoxib and naproxen users had the highest risk for upper gastrointestinal complications with adjusted ORs of 3.6 (95% CI 2.2-5.7) and 3.4 (95% CI 1.8-6.7), respectively. No association was found between the risk of upper gastrointestinal complications and use of celecoxib (OR 1.1, 95% CI 0.7-1.8) or the use of diclofenac plus misoprostol (OR 0.7, 95% CI 0.3-1.8). A dose-response relationship was observed for rofecoxib and naproxen with ORs for high dose of 5.2 (95% CI 2.5-10.6) and 5.1 (95% CI 2.1-12.3), respectively. Short-term users of celecoxib and naproxen had a higher risk than long-term users, whereas among users of rofecoxib the risk was higher among long-term than short-term users. CONCLUSION: These findings support the variability of individual NSAIDs in the elevated risk of upper gastrointestinal complications. Our results suggest that the risk for rofecoxib is similar to that for naproxen. Celecoxib users appear to have a similar risk for upper gastrointestinal complications as nonusers; however, the risk may be increased at the start of treatment with celecoxib.

Health care utilization of patients with chronic obstructive pulmonary disease and lung cancer in the last 12 months of life.

BACKGROUND: Previous studies have documented similar levels of end-of-life symptom burden for lung cancer and chronic obstructive pulmonary disease (COPD) patients, yet there has been little comparison of health care utilization during this period. This study contrasts health care utilization by people with COPD and those with lung cancer in the 12 months prior to death. METHODS: We performed a retrospective cohort study of 1098 patients who died in 2004 with a cause of death recorded as COPD or lung cancer using administrative health data. Our outcomes of interest included acute, long-term and home care service utilization. RESULTS: The study population was 42% female with a mean age of 77 years (S.D.=11). In the last 12 months of life, decedents with COPD were more likely to be institutionalized in a LTC setting (41% vs. 12.5%, p<0.05) and to receive long-term home care (26% vs. 9.7%, p<0.05), but were much less likely to receive palliative care in hospital (47.6% vs. 5.1%, p<0.001) or at home (37.4% vs. 2.8%, p<0.05) than people with lung cancer. In contrast, decedents with lung cancer made greater use of acute care services than those with COPD in that they were more likely to be hospitalized (94.2% vs. 80.4%, p<0.05) and had longer median LOS (7.0 vs. 5.7 days, p<0.05) than those with COPD. No differences in the number of out-patient physician visits were noted. CONCLUSIONS: Patterns of end-of-life health care utilization differ significantly between people with lung cancer and those with COPD. Further research is needed to establish need and determine gaps in services to better address the needs of people dying with COPD.

Risk of breast cancer in association with exposure to two different groups of tricyclic antidepressants.

PURPOSE: In 2002, we reported an epidemiological study in which we found that some tricyclic antidepressants (identified as genotoxic in Drosophila Melanogaster) were associated with an increased risk of breast cancer, when exposure took place 11-15 years before the date of diagnosis. The implications of the results found lead us to carry out a separate case-control study, using the same source population, to validate the conclusions drawn from our previous study. METHODS: We accrued 7330 breast cancer cases, diagnosed between 1981 and 2000, and 29 320 controls matched on age and time. RESULTS: The association between exposure to genotoxic TCAs 11-15 years before diagnosis and the risk of breast cancer development was much weaker, as compared to what was reported in our previous study. The relative risk of breast cancer in women exposed to high doses of genotoxic TCAs 11-15 years before diagnosis was 1.17 (95%CI: 0.79-1.74), while in women exposed to high levels of non-genotoxic TCAs during the same period it was 0.95 (95%CI: 0.61-1.48). CONCLUSION: In conclusion, we did not find supporting evidence for an increased risk of breast cancer among women exposed to TCAs up to 20 years in the past.

Risk of hospitalization with peptic ulcer disease or gastrointestinal hemorrhage associated with nabumetone, Arthrotec, diclofenac, and naproxen in a population based cohort study.

OBJECTIVE: To identify the unbiased differences in the risk of hospitalization with peptic ulcer disease (PUD) or gastrointestinal (GI) hemorrhage among populations using 4 nonsteroidal antiinflammatory drugs (NSAID): nabumetone, Arthrotec, diclofenac plus a cytoprotective agent dispensed separately (diclo+coRx), and naproxen. METHODS: A population based historical cohort study using linked data from provincial healthcare databases. The population of the province of Saskatchewan, Canada, entitled to drug plan benefits in 1995 was eligible (roughly 91% of 1 million people). Participants were identified if they filled a prescription for one of the 4 study NSAID (18,424 individuals). They were then followed for 6 months to determine outcomes. Logistic regression was used to produce estimates of the risk of admission to hospital with a primary diagnosis of PUD or GI hemorrhage associated with the study drugs unbiased by known confounders. RESULTS: Compared to Arthrotec the adjusted odds of hospitalization for PUD for participants taking nabumetone was 2.6 (95% CI 1.0-6.6), diclo+coRx 6.8 (95% CI 3.5-13.4), and naproxen 7.9 (95% CI 3.9-15.9). Compared to nabumetone the adjusted odds of hospitalization for PUD for participants taking diclo+coRx was 2.7 (95% CI 1.2-6.0) and naproxen 3.1 (95% CI 1.3-7.1). No significant differences were noted in terms of admissions for GI hemorrhage. CONCLUSION: Participants taking nabumetone and Arthrotec had significantly lower risk of hospitalization for PUD than those taking the other study drugs. Arthrotec was superior to nabumetone in a head to head comparison and especially when compared with the diclo+coRx and naproxen groups. No short term differences were seen in the rates of admission for GI hemorrhage. It appears that inherent gastroprotective strategies with Arthrotec and to a lesser extent with nabumetone do translate into decreased serious GI side effects at the population level in the short term.

A population based historical cohort study of the mortality associated with nabumetone, Arthrotec, diclofenac, and naproxen.

OBJECTIVE: To identify the unbiased differences in all cause mortality among populations using 4 non-steroidal antiinflammatory drugs (NSAID): nabumetone, Arthrotec, diclofenac plus a cytoprotective agent dispensed separately (diclofenac+), and naproxen. METHODS: We performed a population based historical cohort study using linked data from several provincial health care databases. Logistic regression was used to produce estimates of the mortality associated with the study drugs unbiased by known confounders. The entire population of the province of Saskatchewan, Canada entitled to drug plan benefits in 1995 was eligible (approximately 91% of 1 million people). Participants were identified if they filled a prescription for one of the 4 study NSAID (18,424 individuals). They were then followed forward in time for 6 months to determine all cause mortality. RESULTS: Compared to nabumetone, the adjusted odds of death for participants taking Arthrotec was 1.4 (95% confidence interval, CI: 0.9-2.1), for diclofenac+ 2.0 (1.3-3.1), and naproxen 3.0 (1.9-4.6). CONCLUSION: The multivariate analysis showed patients taking nabumetone and Arthrotec had significantly lower mortality than those taking other study drugs. Nabumetone had 1/3 to 1/5 the mortality associated with the diclofenac+ and naproxen groups. It appears that inherent gastroprotective strategies in the study NSAID may translate into decreased mortality at the population level.

New use of antiarrhythmia drugs in Saskatchewan.

BACKGROUND: Cardiac dysrhythmias are a diverse group of disorders and many are associated with significant morbidity and mortality. Because their recent therapeutic management has not been adequately described, this study details the antiarrhythmia drugs that were dispensed to patients who had not received therapy in the preceding two years, and it evaluates the potential indications for the drugs as well as whether the therapy is consistent with the recommended procedures. METHODS: Patients who were dispensed a [Vaughn Williams?] class I or class III antiarrhythmia drug in 1993 or 1994, but not during the two previous years, were identified from the Saskatchewan prescription drug datafile. The drug data were linked with other information that was obtained from the provincial administrative health care utilization datafiles. Further clinical data were obtained from hospital charts and, to a limited extent, from physicians' records. RESULTS: Most patients were elderly (median age of 70 years) and were men (58.0%), although sotalol was prescribed more frequently to women (53.0%). A potential indication was identified for 63.8% of the patients and, of these, the most common was atrial fibrillation (65.3%). Almost half of the patients had a history of myocardial infarction, congestive heart failure or cardiomyopathy, and one-quarter of those were treated with amiodarone. CONCLUSIONS: While it is not possible to prove a direct link, the results of the present study are broadly consistent with the 'evidence-based' lessons of the Cardiac Arrhythmia Suppression Trial and other studies. The increasing use of propafenone, however, may indicate a lack of appreciation for the fact that, as a class IC drug, there is at least the potential for an adverse outcome when propafenone is used in patients with structural heart disease.