Reported need for and access to oral health care services during the COVID-19 pandemic in Canada.

Background: The COVID-19 pandemic interrupted routine and preventive dental services until precautions could be implemented to limit virus transmission. Access to services for dental emergencies was maintained. The objective of this study was to describe the reported need for, access to, and receipt of oral health care in Canada during the first year of the pandemic. Data and methods: The 2021 Survey on Access to Health Care and Pharmaceuticals During the Pandemic collected information from Canadians aged 18 years and older. Respondents were asked whether they needed (routine) dental care in the previous 12 months, whether they received that care, whether they experienced any mouth or tooth pain (indicative of a dental emergency), and whether and how COVID-19 affected service access. Results: Of the 44.5% of Canadians who reported needing dental care in the 12 months before the survey, 5.8% did not receive the care they reportedly needed. Almost 20% of those with a reported need had their appointment cancelled, rescheduled, or delayed because of COVID-19, and this was more common for individuals with unmet dental care needs (46.9%) than it was for those who had received dental care (17.1%). For those requiring more urgent care, 23.3% of Canadians experienced pain in their mouth or teeth in the previous 12 months. Among those with dental pain, 64.2% sought treatment, and the majority (86.4%) received the treatment they needed. One-third (33.2%) avoided care for their dental-related pain because of fear of contracting COVID-19. Interpretation: During the first year of the pandemic, many Canadians experienced cancelled or delayed dental services or did not receive the oral health care services they reportedly needed. Ongoing monitoring could help determine whether these COVID-19 service interruptions will have lasting effects on Canadians' oral health.

Where do 15- to -17-year-olds in Canada get their sexual health information?

Background: Sexual health education delivered in school, provided by parents, or provided by other formal sources has been associated most closely with increased rates of condom use and improvements in many other sexual risk behaviours. Friends and the internet are other information sources, although quality and accuracy are not always as high. Nationally representative Canadian data about where adolescents obtain their sexual health information are lacking. Data and methods: Weighted data from the 2019 Canadian Health Survey on Children and Youth were used to examine the sources typically used to obtain sexual health information by 15- to 17-year-olds, as well as the prevalence and characteristics of adolescents reporting not having an adult to talk with about sexual health and puberty. Results: Most 15- to 17-year-olds in Canada reported having at least one source of sexual health information (96.6%). More than half identified school (55.6%) and parents or guardians (51.2%) as sources of sexual health information. The internet (45.9%), friends (36.2%), and health care professionals (20.9%) were other common sources. Whereas 61.2% of adolescents identified more than one source of sexual health information, 3.4% reported not having any source. Nearly 15% of adolescents reported not having an adult to talk with about sexual health or puberty. Differences in sources consulted and having an adult to talk with depended on many factors, including sexual attraction and/or gender diversity, sex, immigrant status, racialized status, lower-income status, strength of parent-adolescent relationship, region of residence, and mental health. Interpretation: An improved understanding of the sources of sexual health information used by adolescents and identification of characteristics associated with adolescents reporting not having an adult to talk with could help develop strategies to improve sexual health outcomes via better access to sexual health promotion and educational resources.

Using the Severity of Dependence Scale to examine cannabis consumers with impaired control in Canada.

Background: The 2018 Cannabis Act legalizing the production, sale, and use of cannabis for non-medical purposes renewed interest in the importance of ongoing and more detailed monitoring of cannabis consumption and consequences. Some cannabis users will experience impaired control over their use of cannabis, putting them at risk for cannabis use disorder (CUD, sometimes called addiction) and other harms. Including the Severity of Dependence Scale (SDS) in the annual Canadian Community Health Survey (CCHS) would allow for monitoring of one of the more harmful consequences of cannabis use in the post-legalization period. Data and methods: Data from the nationally representative 2019-2020 CCHS were used to examine cannabis consumers with and without impaired control. Respondents who used cannabis in the past year were categorized according to their SDS scores: those with impaired control (SDS ≥ 4) versus those without impaired control (SDS < 4). Cross-tabulations were used to examine the sociodemographic, mental health, health behaviour and cannabis exposure characteristics of those with impaired control. Multivariable logistic regression models assessed associations between these characteristics and the risk of impaired control. The prevalence of self-reported cannabis-related problems experienced by consumers-with and without impaired control-is also presented. Results: In 2019-2020, 4.7% of past-year cannabis consumers scored ≥ 4 on the SDS and were considered to have impaired control. Multivariable logistic regression suggested that the odds of having impaired control remained higher for people who were male, were aged 18 to 24 years, were single or never married, were from lower-income households, were diagnosed with an anxiety or a mood disorder, started consuming cannabis at age ≤ 15, and consumed at least monthly. Interpretation: A better understanding of the characteristics of cannabis consumers experiencing impaired control (a correlate of future CUD or addiction) could help with the development of more effective education, prevention and treatment strategies.

Correlates of vaping among adolescents in Canada.

Background: Vaping is more prevalent among younger than older Canadians. While vaping is less harmful than combustible tobacco, it is not without health risk. Data and methods: Data from the 2019 Canadian Health Survey on Children and Youth were used to estimate vaping prevalence. Logistic regression models assessed the association of sociodemographic, youth, parenting and peer factors with vaping. The 2020 Canadian Community Health Survey identified adolescents who reported vaping before tobacco smoking. Data from the 2019 Canadian Tobacco and Nicotine Survey were used to examine vaping of e-liquids containing nicotine and flavours. Results: Vaping rates for 15- to 17-year-olds were nearly four times (21.3%) higher than those of 12- to 14-year-olds (5.4%). Two-thirds (66.1%) of 12- to 17-year-olds who had used both tobacco and e-cigarettes reported trying e-cigarettes first. E-liquids containing nicotine were used by 89.3% of 15- to 19-year-olds who reported vaping in the past 30 days; comparable with older adults. For both younger and older adolescents, having friends who engaged in negative behaviours, having been employed, and having consumed alcohol increased the odds. For 12- to 14-year-olds, attention deficit hyperactivity disorder was a risk factor, whereas having parents who usually knew who they were with and higher relatedness scores were protective. Among older adolescents, being male, being Canadian-born, having lower grades, and using tobacco or cannabis increased the odds of vaping. Interpretation: An adolescent's risk of vaping was most strongly correlated with other substance use, although other youth, parenting and peer characteristics also mattered. Because most of the data presented were collected before the COVID-19 pandemic and new vaping regulations, ongoing monitoring remains important.

Looking back from 2020, how cannabis use and related behaviours changed in Canada.

BACKGROUND: The Canadian government legalized non-medical cannabis use by adults in October 2018 to minimize associated harms and redirect profits from criminals. In October 2019, a wider array of products, including edibles, was legalized, with entry into the legal market beginning in December. DATA AND METHODS: Three quarters (the first quarters of 2018 and 2019 and the fourth quarter of 2020) of the National Cannabis Survey were used to examine changes in cannabis use (overall use and daily or almost daily (DAD) use), consumption methods, products and sources. RESULTS: Cannabis use in the past three months was higher in late 2020 (20.0%) than in 2019 (17.5%) and 2018 (14.0%), and this was particularly the case among: females (for whom rates rose to equal male rates for the first time), adults aged 25 and older, and some provinces. Similarly, DAD use, at 7.9% also increased. Higher percentages of Canadians reported getting at least some of their cannabis from legal sources or growing it, and fewer were relying on friends and family or illegal sources in 2020. DISCUSSION: This study spans three years-from before legalization to about two years after. It provides a more complete picture of the law's impact on cannabis use and related behaviours, given the more established legal cannabis industry better equipped to compete with the black market on price, convenience and selection. Findings demonstrate that change is continuing, and, as before, some cautions and assurances remain. The impact of the COVID-19 pandemic on cannabis use continues to be difficult to measure. Monitoring remains important, given the ever-changing provincial retail landscapes; the introduction of new products; and the pressure by the industry to remove or adjust potency limits, and allow widespread delivery, farm-gate sales and cannabis lounges.

Association of Severe Trauma With Work and Earnings in a National Cohort in Canada.

Importance: Traumatic injury disproportionately affects adults of working age. The ability to work and earn income is a key patient-centered outcome. The association of severe injury with work and earnings appears to be unknown. Objective: To evaluate the association of severe traumatic injury with subsequent employment and earnings in long-term survivors. Design, Setting, and Participants: This is a retrospective, matched, national, population-based cohort study of adults who had employment and were hospitalized with severe traumatic injury in Canada between January 2008 and December 2010. All acute care hospitalizations for severe injury were included if they involved adults aged 30 to 61 years who were hospitalized with severe traumatic injury, working in the 2 years prior to injury, and alive through the third calendar year after their injury. Patients were matched with unexposed control participants based on age, sex, marital status, province of residence, rurality, baseline health characteristics, baseline earnings, self-employment status, union membership, and year of the index event. Data analysis occurred from March 2019 to December 2019. Main Outcomes and Measures: Changes in employment status and annual earnings, compared with unexposed control participants, were evaluated in the third calendar year after injury. Weighted multivariable probit regression was used to compare proportions of individuals working between those who survived trauma and control participants. The association of injury with mean yearly earnings was quantified using matched difference-in-difference, ordinary least-squares regression. Results: A total of 5167 adults (25.6% female; mean [SD] age, 47.3 [8.8] years) with severe injuries were matched with control participants who were unexposed (25.6% female; mean [SD] age, 47.3 [8.8] years). Three years after trauma, 79.3% of those who survived trauma were working, compared with 91.7% of control participants, a difference of -12.4 (95% CI, -13.5 to -11.4) percentage points. Three years after injury, patients with injuries experienced a mean loss of $9745 (95% CI, -$10 739 to -$8752) in earnings compared with control participants, representing a 19.0% difference in annual earnings. Those who remained employed 3 years after injury experienced a 10.8% loss of earnings compared with control participants (-$6043 [95% CI, -$7101 to -$4986]). Loss of work was proportionately higher in those with lower preinjury income (lowest tercile, -18.5% [95% CI, -20.8% to -16.2%]; middle tercile, -11.5% [95% CI, -13.2% to -9.9%]; highest tercile, -6.0% (95% CI, -7.8% to -4.3%]). Conclusions and Relevance: In this study, severe traumatic injury had a significant association with employment and earnings of adults of working age. Those with lower preinjury earnings experienced the greatest relative loss of employment and earnings.

Sexual behaviours, condom use and other contraceptive methods among 15- to 24-year-olds in Canada.

BACKGROUND: Sexual and reproductive health are key issues for adolescents and young adults. Detailed national Canadian data about sexual behaviours, condom use and other contraceptive use by youth are lacking. DATA AND METHODS: Data from the 2015/2016 Canadian Community Health Survey were used to examine sexual behaviours, condom and other contraceptive use, and reasons for non-use by selected characteristics. RESULTS: In 2015/2016, 54.1% of 15- to 24-year-olds reported having had sexual intercourse in the past year. Among those who had intercourse in the previous year, the percentage of males (42.6%) who had multiple sexual partners was higher than the percentage of females (31.4%). Gay and bisexual males (67.4% and 72.5%, respectively) and bisexual females (47.5%) were more likely to report having had multiple partners than their heterosexual counterparts. Overall, 60.1% of youth reported using a condom the last time they had sex. This was more common at younger ages, among males and among those who reported having had sex with more than one partner in the previous year. When asked the reason for not using a condom, monogamy and use of another method, such as oral contraceptive pills, were each cited by nearly half of non-users. Some reasons for not using a condom also differed by age, sex and number of partners. For example, youth aged 20 to 24 were more likely to report not using a condom because they disliked them, whereas those aged 15 to 17 were more likely to report none were available. About one-fifth of 15- to 24-year-olds reported using neither a condom nor another method of contraception the last time they had sex. One in 10 currently sexually active females reported using emergency contraception in the past year. DISCUSSION: A substantial proportion of youth in Canada are at high risk for sexually transmitted infections and unplanned pregnancy, and the findings have implications for comprehensive sexual health education and related policies and programs.

What has changed since cannabis was legalized?

BACKGROUND: The Canadian government legalized non-medical cannabis use by adults in October 2018 in order to minimize associated harms and re-direct profits from criminals. DATA AND METHODS: Seven quarters of (NCS) data were combined into two groups: pre- and post-legalization periods - to examine changes in: cannabis use (overall, daily or almost daily (DAD)), source of product, driving after consumption and riding in a vehicle with a driver who had consumed. RESULTS: By 2019, overall cannabis use had increased (16.8% vs. 14.9%), particularly among: males, adults aged 25 and older, and in Newfoundland and Labrador, Nova Scotia, New Brunswick, and Alberta. DAD use, at 6.0%, remained stable, as did the prevalence of driving within 2 hours of consumption (13.2%). Riding in a vehicle with a driver who had used declined, overall (from 5.3% to 4.2%) and among: females, persons aged 25 and older, and in Newfoundland and Labrador, Ontario and Alberta. Where Canadians reported obtaining their cannabis also changed, with increasing percentages reporting getting some or all of their cannabis from legal sources, and fewer using illegal sources or relying on friends/family. Some provinces experienced more change than others. DISCUSSION: While too soon to observe the longer-term impacts associated with the Cannabis Act, early indications based on data collected in the months surrounding enactment suggests some cautions and also some assurances. Ongoing monitoring will be essential particularly given the 2.0 Act modifications and the ever-changing provincial retail and regulatory landscapes.

Effects of Cardiovascular Health Shocks on Spouses' Work and Earnings: A National Study.

BACKGROUND: Acute health shocks can reduce the ability to work and earn among working-age survivors. The full economic impact includes labor market effects on spouses/partners, but there is a knowledge gap in this area. OBJECTIVES: The objective of this study was to assess how 3 common health shocks, acute myocardial infarction, stroke, and cardiac arrest, influence work and earnings of spouses aged 35-61 years. RESEARCH DESIGN: This retrospective cohort study of case and control couples used population-based, linked Canadian income tax and hospitalization data from 2005 to 2013. SUBJECTS: Case couples comprised 1 partner aged 41-61 years who experienced a health shock in the index year and survived 3 years hence, and a working-age partner. Control couples were matched up to 5:1 on 12 characteristics, with neither experiencing the health shock of interest in the index year. MEASURES: Primary outcome was the change in spousal annual earnings between the year prior and 3 years after the event. Pre-to-post spousal income changes were categorized into 9 levels and compared between case spouses and control spouses by the Pearson χ test. RESULTS: There were 11,208 matched case couples for acute myocardial infarction, 622 for cardiac arrest, and 2288 for stroke. Overall, case and control spouses experienced similar distributional changes in preevent to postevent earning (all P≥0.27). Heterogeneity analysis indicated that spouses of more severe stroke sufferers ceased working at a higher rate than for control spouses. CONCLUSION: Beyond assessing average values, detailed analysis of changes in spousal earnings after common cardiovascular health shocks did not demonstrate effects attributable to those health shocks.

Analysis of trends in the prevalence of cannabis use and related metrics in Canada.

BACKGROUND: The Canadian federal government legalized non-medical cannabis use by adults in October 2018. Ongoing monitoring of the effects of the change is needed because uncertainty remains about the impact of the legislation on cannabis use behaviours and whether the impact will affect some more than others. DATA AND METHODS: Data from the Canadian Tobacco, Alcohol and Drugs Survey and the Canadian Tobacco Use Monitoring Survey were used to examine longer-term (historical) rates of use during 2004 to 2017. Five iterations of the National Cannabis Surveys (NCS) (2018-2019) were used to examine current use (overall, daily or almost daily (DAD), quantities, and types of products) in the months before and after legalization. RESULTS: From 2004 through 2017 cannabis use decreased among 15 to 17 year olds, remained stable for 18 to 24 year olds, and increased among adults aged 25 to 64. During 2018 and into 2019, rates of cannabis use increased overall from 14% to 18%; with statistically significant increases also for males generally (16% to 22%) and males aged 18 to 64. Rates of cannabis use remained largely stable for females (13%) and seniors (4%). In 2019, about 60% of consumers reported using one cannabis product; use of dried cannabis (flower/leaf) was the most common (84.2%). The average user consumed 27.5 grams of dried cannabis (flower/leaf) over three months; amounts consumed varied depending on use frequency (e.g. occasional users: 2.6 grams/3 months versus DAD users: 62.6 grams/3 months). DISCUSSION: Results highlight the importance of understanding pre-legalization behaviours as changes in use after legalization may have begun prior to the legislation. NCS allows for the early impacts of legalisation to be examined and provides a picture of not only changes in who is using but also what and how much.

Effects of cardiovascular and cerebrovascular health events on work and earnings: a population-based retrospective cohort study.

BACKGROUND: Survivors of acute health events can experience lasting reductions in functional status and quality of life, as well as reduced ability to work and earn income. We aimed to assess the effect of acute myocardial infarction (MI), cardiac arrest and stroke on work and earning among working-age people. METHODS: For this retrospective cohort study, we used the Canadian Hospitalization and Taxation Database, which contains linked hospital and income tax data, from 2005 to 2013 to perform difference-in-difference analyses. We matched patients admitted to hospital for acute MI, cardiac arrest or stroke with controls who were not admitted to hospital for these indications. Participants were aged 40-61 years, worked in the 2 years before the event and were alive 3 years after the event. Patients were matched to controls for 11 variables. The primary outcome was working status 3 years postevent. We also assessed earnings change attributable to the event. We matched 19 129 particpants who were admitted to hospital with acute MI, 1043 with cardiac arrest and 4395 with stroke to 1 820 644, 307 375 and 888 481 controls, respectively. RESULTS: Fewer of the patients who were admitted to hospital were working 3 years postevent than controls for acute MI (by 5.0 percentage points [pp], 95% confidence interval [CI] 4.5-5.5), cardiac arrest (by 12.9 pp, 95% CI 10.4-15.3) and stroke (by 19.8 pp, 95% CI 18.5-23.5). Mean (95% CI) earnings declines attributable to the events were $3834 (95% CI 3346-4323) for acute MI, $11 143 (95% CI 8962-13 324) for cardiac arrest, and $13 278 (95% CI 12 301-14 255) for stroke. The effects on income were greater for patients who had lower baseline earnings, comorbid disease, longer hospital length of stay or needed mechanical ventilation. Sex, marital status or self-employment status did not affect income declines. INTERPRETATION: Acute MI, cardiac arrest and stroke all resulted in substantial loss in employment and earnings that persisted for at least 3 years after the events. These outcomes have consequences for patients, families, employers and governments. Identification of subgroups at high risk for these losses may assist in targeting interventions, policies and legislation to promote return to work.

Prevalence and correlates of non-medical only compared to self-defined medical and non-medical cannabis use, Canada, 2015.

BACKGROUND: The Canadian federal government has committed to legalizing non-medical cannabis use by adults in 2018. Medical use was legalized in 2001; however, not all people reporting medical use have medical authorization. To prepare for monitoring the effects of the policy change, a greater understanding of the prevalence of cannabis use and the characteristics of all cannabis users is needed. DATA AND METHODS: Data from the 2015 Canadian Tobacco, Alcohol and Drugs Survey (CTADS) were used to estimate prevalence and examine reasons for medical use and factors associated with people who reported using cannabis Non-Medically Only (NMO), compared with people who reported Self-Defined Medical and Non-Medical use (SDMNM), including use of other drugs and the non-therapeutic use of psychoactive pharmaceuticals. RESULTS: In 2015, 9.5% of Canadians aged 15 and older reported NMO cannabis use, while another 2.8% reported SDMNM use. Half of Canadians reporting some self-defined medical use cited pain as the primary reason. Daily and near-daily use was significantly more common among SDMNM users (47.2%) than among individuals considered NMO users (26.4%). Past-year cannabis users of any type were more likely to be male and younger, to have used other illicit drugs and at least one of three classes of psychoactive pharmaceutical drugs non-therapeutically, and to be daily smokers or heavy drinkers. SDMNM cannabis use was more common among people reporting worse health (general and mental), use of psychoactive pharmaceuticals, and living in lower-income households. DISCUSSION: Because non-medical cannabis use is common to both user groups analyzed, many similarities were anticipated. Nevertheless, SDMNM users also had several unique characteristics consistent with use to address medical problems. However, because the CTADS does not collect information about whether the individual has received a health care practitioner's authorization to use cannabis for a medical purpose this analysis should not be interpreted as an evaluation of people who access cannabis through Health Canada's medical access program, the Access Cannabis for Medical Purposes Regulations (ACMPR).

Analysis of trends in the prevalence of cannabis use in Canada, 1985 to 2015.

BACKGROUND: The Canadian federal government has committed to legalize, regulate, and restrict non-medical cannabis use by adults in 2018. To prepare for monitoring the health, social and economic impacts of this policy change, a greater understanding of the long-term trends in the prevalence of cannabis use in Canada is needed. DATA AND METHODS: Nine national surveys of the household population collected information about cannabis use during the period from 1985 through 2015. These surveys are examined for comparability. The data are used to estimate past-year (current) cannabis use (total, and by sex and age). Based on the most comparable data, trends in use from 2004 through 2015 are estimated. RESULTS: From 1985 through 2015, past-year cannabis use increased overall. Analysis of comparable data from the Canadian Tobacco Use Monitoring Survey and the Canadian Tobacco, Alcohol and Drugs Survey for the 2004-to-2015 period suggests that use was stable among 15- to 17-year-old males, decreased among 15- to 17-year-old females and among 18- to 24-year-olds (both sexes), and increased among people aged 25 or older. DISCUSSION: According to data from national population surveys, since 2004, cannabis use was stable or decreased among youth, and rose among adults. Results highlight the importance of consistent monitoring of use in the pre-and post-legalization periods.

High use of acute care hospital services at age 50 or older.

BACKGROUND: A small fraction of the population accounts for a disproportionate share of health care spending and resources. Linking data from health surveys with hospital and death records offers an opportunity to examine high use of acute care in more depth than is possible with administrative data alone. DATA AND METHODS: Data for 62,675 respondents to three cycles of the Canadian Community Health Survey were linked to the Discharge Abstract Database and the Canadian Mortality Database. Respondents were categorized according to cumulative annual days in hospital: high users (30 days or more), non-high users (1 to 29), or not hospitalized. Cross-tabulations stratified by age (50 to 74 and 75 or older) were used to describe the socio-demographic, health, health behaviour, and hospital experience characteristics of the three groups. Multinomial logit and logistic regression were used to examine associations between these characteristics and high use or no hospitalization versus non-high use. RESULTS: High users made up 0.5% of the population aged 50 to 74 and 2.6% of those aged 75 or older, but they accounted for 45.6% and 56.1%, respectively, of the days that people of these ages spent in hospital. Not having a partner, being at the end of life, having a neurological condition, as well as inactivity and comorbidity (ages 50 to 74) increased the odds of high use. Being female, not having major chronic conditions, not being at the end of life, normal/overweight, and being active were associated with no hospitalization. INTERPRETATION: Linking survey, hospital, and death data improves understanding of factors associated with high hospital use.

Nutritional risk, hospitalization and mortality among community-dwelling Canadians aged 65 or older.

BACKGROUND: Nutritional risk has been associated with various negative health outcomes among older people. Limited longitudinal research has examined the relationship between nutritional risk and hospitalization and death in community-dwelling older people. DATA AND METHODS: Data from the 2008/2009 Canadian Community Health Survey-Healthy Aging (CCHS-HA) linked to the Discharge Abstract Database and the Canadian Mortality Database were used to estimate the prevalence of nutritional risk among seniors and examine its relationship with acute care hospitalization and death during the 25- to 36-month period following the CCHS-HA interview. Multivariate Cox proportional hazards models were used to identify important covariates, while adjusting for demographic and socioeconomic characteristics, health status, and lifestyle factors. RESULTS: A third (34%; 979,000) of Canadians aged 65 or older living in 9 provinces (excluding Quebec) were at nutritional risk in 2008/2009. These seniors had a higher risk of an acute care hospitalization (hazard ratio (HR) 1.2; 95% CI: 1.1 to 1.4) or death (HR 1.6; 95% CI: 1.3 to 2.0) during the follow-up period, even when potential confounders were taken into account. Seniors at nutritional risk in 2008/2009 were more likely than those not at nutritional risk to die during follow-up (9% versus 5%) and averaged shorter survival times: 498 days (95% CI: 462 to 534) compared with 538 days (95% CI: 501 to 574). INTERPRETATION: Based on an analysis of data from a large population-based survey linked to routinely collected hospital and death data, nutritional risk is independently associated with acute care hospitalization and mortality. Results highlight the importance of monitoring seniors for nutritional risk.

Acute care hospitalization by Aboriginal identity, Canada, 2006 through 2008.

BACKGROUND: National data about acute care hospitalization of Aboriginal people are scarce. This study addresses that information gap by describing patterns of hospitalization by Aboriginal identity for leading diagnoses for all provinces and territories except Quebec. DATA AND METHODS: The 2006 Census was linked to the 2006/2007-to-2008/2009 Discharge Abstract Database, which contains hospital records from all acute care facilities in Canada (excluding Quebec). With these linked data, hospital records could be examined by Aboriginal identity, as reported to the census. Hospitalizations were grouped by International Classification of Diseases (ICD-10) chapters based on "the most responsible diagnosis." Age-standardized hospitalization rates were calculated per 100,000 population, and rate ratios (RR) were calculated for Aboriginal groups relative to non-Aboriginal people. RESULTS: Hospitalization rates were almost invariably higher for First Nations living on and off reserve, Métis, and Inuit living in Inuit Nunangat than for the non-Aboriginal population, regardless of ICD diagnostic chapter. The ranking of age-standardized hospitalization rates by frequency of diagnoses varied slightly by Aboriginal identity. RRs were highest among First Nations living on reserve, especially for endocrine, nutritional and metabolic diseases (RR = 4.9), mental and behavioural disorders (RR = 3.6), diseases of the respiratory system (RR = 3.3), and injuries (RR = 3.2). As well, the rate for endocrine, nutritional and metabolic diseases was high among First Nations living off reserve (RR = 2.7). RRs were also high among Inuit for mental and behavioural disorders (RR = 3.3) and for diseases of the respiratory system (RR = 2.7). INTERPRETATION: Hospitalization rates varied by Aboriginal identity, and were consistent with recognized health disparities between Aboriginal and non-Aboriginal people. Because many factors besides health affect hospital use, further research is required to understand differences in hospital use by Aboriginal identity. These national data are relevant to health policy formulation and service delivery planning.

Linking 2006 Census and hospital data in Canada.

BACKGROUND: Record linkage is commonly used in health research to fill data gaps. This study summarizes the linkage of the 2006 Census of Population (excluding Quebec) to hospital data from the Discharge Abstract Database (DAD). DATA AND METHODS: Hierarchical deterministic exact matching was employed to link 2006 Census and DAD (2006/2007, 2007/2008 and 2008/2009) data, based on linkage keys derived from three variables common to both files-date of birth, postal code and sex. The full census file (short-form; 23.4 million) was used for record linkage; the 20% file (long-form; 4.65 million) representing the study cohort was used for validation. Linked files were compared across jurisdictions, years and other selected covariates in terms of eligibility for linkage, keys linked, and linkage and coverage rates. RESULTS: Overall, 80% of linkage keys identified in the DAD were linked to the 2006 Census. The percentage of long-form census respondents linked to at least one hospital record ranged between 5% and 8% across jurisdictions; linkage rates were higher among known high users of hospital services: older age groups, lower-income individuals, and Aboriginal people. In general, the linked census file represents the majority of hospital events that occurred during the study period. Coverage rates (weighted/unweighted) varied by geography and age group, with lower weighted rates for the territories and some younger age groups. INTERPRETATION: With hierarchical deterministic exact matching, census data can be linked to multiple years of DAD data. Incorporation of updated postal codes from tax files reduced linkage rate attrition over time. Lower coverage rates for the territories and younger age groups suggest that these populations may be underrepresented in the linked files.

Oral contraceptive use among women aged 15 to 49: Results from the Canadian Health Measures Survey.

BACKGROUND: Oral contraceptives (OCs) have been available in Canada for over 50 years and are the most commonly used method of reversible contraception. OCs have evolved over time, with decreasing estrogen doses, new progestins, and different dosing regimens. Detailed data about OCs use among Canadian women are lacking. DATA AND METHODS: Data from Statistics Canada's 2007/2009 and 2009/2011 Canadian Health Measures Survey (CHMS) were used to estimate OC use, by selected sociodemographic characteristics, cardiovascular risk factors, and estrogen dose and progestin type. Logistic regression was used to model relationships between OC use and sociodemographic factors. RESULTS: An estimated 1.3 million (16%) women aged 15 to 49 reported taking OCs in the previous month. OC use decreased with age (30% among 15- to 19-year-olds; 3% among 40- to 49-year-olds). OC users were significantly more likely than non-users to be nulliparous, sexually active and Canadian-born. At ages 35 to 49, users were less likely than non-users to have one or more cardiovascular risk factors. Almost all (99%) OC users took combined formulations containing ethinyl estradiol (EE) and progestin. Two-thirds of OCs users took formulations containing 30 or more mcg of EE. Women aged 15 to 24 were more likely than those aged 35 to 49 to use lower-dose formulations (less than 30 mcg of EE). INTERPRETATION: A substantial percentage of reproductive-aged Canadian women, particularly younger women, used OCs. OC use varied by sociodemographic and some cardiovascular risk factors. The majority took formulations containing 30 or more mcg of EE.

Prevalence and correlates of marijuana use in Canada, 2012.

Based on data from the 2012 Canadian Community Health Survey--Mental Health, past-year and lifetime marijuana use among the household population aged 15 or older in the 10 provinces was examined. In 2012, 42.5% of the population reported having ever used marijuana, and 12.2% reported use in the past year. At 33.3%, the prevalence of past-year marijuana use was higher among 18- to 24-year-olds than among other age groups (20.0% at ages 15 to 17, 15.6% at ages 25 to 44, 6.7% at ages 45 to 64, and 0.8% at age 65 or older). Past-year use was higher in British Columbia and Nova Scotia and lower in Saskatchewan, compared with the rest of Canada. While the overall percentage of people reporting past-year use in 2012 was unchanged from 2002, the percentage of males who had ever used marijuana rose from 47.0% to 49.4%; among females, the prevalence of lifetime use remained stable at 36%.