Long-term projections of cancer incidence and mortality in Canada: The OncoSim All Cancers Model.

Using the OncoSim All Cancers Model, we estimated the annual cancer incidence, mortality and cancer management costs in Canada from 2020 to 2040. Incidence for each cancer type was estimated from logistic regression analyses of the Canadian Cancer Registry (1992-2017), with province/territory, sex, five-year age groups and year as covariates. Deaths were estimated by sex and tumour site for cancers diagnosed between 2000 and 2017 (deaths to the end of 2017). The total cost of a cancer type was the sum of costs for individuals across four phases of cancer care. The projections presented in this study were generated based on a simulation of 32 million cases. The OncoSim All Cancers Model projects a 40% increase in the overall number of incident cancer cases from 2020 to 2040. The number of the four most commonly diagnosed cancers in Canada (breast, colorectal, lung, and prostate) are projected to increase annually. The overall number of cancer deaths is projected to increase by 44% from 2020 to 2040. More cancer deaths are projected in males than in females. The age-standardized mortality rate is expected to remain relatively stable over time. Overall cancer management costs are projected to increase from $20.6B in 2020 to $31.4B in 2040. Due mainly to an aging population and population growth in Canada, we estimate that cancer incidence, mortality and cancer management costs will increase considerably between 2020 and 2040. These results highlight the importance of planning for increasing investment and capacity in cancer control.

Exploring the intersectionality of characteristics among those who experienced opioid overdoses: A cluster analysis.

Background: As Canada continues to experience an opioid crisis, it is important to understand the intersection between the demographic, socioeconomic and service use characteristics of those experiencing opioid overdoses to better inform prevention and treatment programs. Data and methods: The Statistics Canada British Columbia Opioid Overdose Analytical File (BCOOAF) represents people's opioid overdoses between January 2014 and December 2016 (n = 13,318). The BCOOAF contains administrative health data from British Columbia linked to Statistics Canada data, including on health, employment, social assistance and police contacts. Cluster analysis was conducted using the k-prototypes algorithm. Results: The results revealed a six-cluster solution, composed of three groups (A, B and C), each with two distinct clusters (1 and 2). Individuals in Group A were predominantly male, used non-opioid prescription medications and had varying levels of employment. Individuals in Cluster A1 were employed, worked mostly in construction, had high incomes and had a high rate of fatal overdoses, while individuals in Cluster A2 were precariously employed and had varying levels of income. Individuals in Group B were predominantly female; were mostly taking prescription opioids, with about one quarter or less receiving opioid agonist treatment (OAT); mostly had precarious to no employment; and had low to no income. People in Cluster B1 were primarily middle-aged (45 to 65 years) and on social assistance, while people in Cluster B2 were older, more frequently used health services and had no social assistance income. Individuals in Group C were primarily younger males aged 24 to 44 years, with higher prevalence of having experienced multiple overdoses, were medium to high users of health care services, were mostly unemployed and were recipients of social assistance. Most had multiple contacts with police. Those in Cluster C1 predominantly had no documented use of prescription opioid medications, and all had no documented OAT, while all individuals in Cluster C2 were on OAT. Interpretation: The application of machine learning techniques to a multidimensional database enables an intersectional approach to study those experiencing opioid overdoses. The results revealed distinct patient profiles that can be used to better target interventions and treatment.

Prevalence of prescription and non-prescription polypharmacy by frailty and sex among middle-aged and older Canadians.

Background: Estimates of polypharmacy have primarily been derived from prescription claims, and less is known about the use of non-prescription medications (alone or in combination with prescription medications) across the frailty spectrum or by sex. Our objectives were to estimate the prevalence of polypharmacy (total, prescription, non-prescription, and concurrent prescription and non-prescription) overall, and by frailty, sex and broad age group. Data: Canadian Health Measures Survey, Cycle 5, 2016 to 2017. Methods: Among Canadians aged 40 to 79 years, all prescription and non-prescription medications used in the month prior to the survey were documented. Polypharmacy was defined as using five or more medications total (prescription and non-prescription), prescription only and non-prescription only. Concurrent prescription and non-prescription use was defined as two or more and three or more of each. Frailty was defined using a 31-item frailty index (FI) and categorized as non-frail (FI ≤ 0.1) and pre-frail or frail (FI > 0.1). Survey-weighted descriptive statistics were calculated overall and age standardized. Results: We analyzed 2,039 respondents, representing 16,638,026 Canadians (mean age of 56.9 years; 51% women). Overall, 52.4% (95% confidence interval [CI] = 47.3 to 57.4) were defined as pre-frail or frail. Age-standardized estimates of total polypharmacy, prescription polypharmacy and concurrent prescription and non-prescription medication use were significantly higher among pre-frail or frail versus non-frail adults (e.g., total polypharmacy: 64.1% versus 31.8%, respectively). Polypharmacy with non-prescription medications was common overall (20.5% [95% CI = 16.1 to 25.8]) and greater among women, but did not differ significantly by frailty. Interpretation: Polypharmacy and concurrent prescription and non-prescription medication use were common among Canadian adults, especially those who were pre-frail or frail. Our findings highlight the importance of considering non-prescribed medications when measuring the exposure to medications and the potential risk for adverse outcomes.

Significant factors associated with problematic use of opioid pain relief medications among the household population, Canada, 2018.

BACKGROUND: Reliance on the use of opioids to manage pain has increased over time, as have opioid-related morbidity and deaths. In 2018, 12.7% of Canadians reported having used opioid pain relief medications (OPRMs) in the previous year. Among these people, 9.6% had engaged in problematic use that could cause harm to their health. Though socioeconomic characteristics associated with opioid-related harms have previously been reported, population-level evidence based on administrative health data lacks important behavioural and psychosocial information. This analysis extends previous research by using modelling to report factors related to the problematic use of OPRMs for the household population aged 15 and older in Canada. DATA AND METHODS: This analysis uses responses to the 2018 Canadian Community Health Survey to identify factors that are significantly associated, after adjustment using multivariate logistic regression models, with elevated odds of problematic use of OPRMs. RESULTS: The fully adjusted model confirmed that being male, being younger (ages 20 to 24), having fair or poor mental health, having unmet needs for help with mental or emotional health or substance problems, being a smoker, or being unattached and living with others were significantly related to problematic OPRM use. INTERPRETATION: Subjective perceptions significantly related to problematic OPRM use, independent of socioeconomic circumstances, were examined in this study. While previous research based on administrative health data has contributed much to knowledge about factors associated with opioid harms, modelled results revealed that self-reported experiential factors also warrant consideration as they are significantly associated with problematic use. Having fair or poor mental health, having unmet perceived needs for help, and being unattached in terms of household arrangement relationship were related to problematic use of OPRMs, even after adjustment for socioeconomic and other health covariates. This study suggests risk profiles that could be used to inform health care providers, and strategies to support safe pain management.

Understanding the socioeconomic profile of people who experienced opioid overdoses in British Columbia, 2014 to 2016.

BACKGROUND: Following the 2016 opioid overdose emergency declaration in British Columbia (B.C.), provincial stakeholders collaborated to link data that resulted in the B.C. Provincial Overdose Cohort. This database provides information about people who have experienced opioid overdoses to inform policy and intervention developments. Subsequently, Statistics Canada likewise constructed a cohort and integrated federal data to broaden the scope of the B.C. initiative. This provided federally sourced information about people's circumstances that was not otherwise available. DATA AND METHODS: The Statistics Canada British Columbia Opioid Overdose Analytical File further characterizes the socioeconomic circumstances of 13,318 people who experienced illicit drug toxicity deaths and non-fatal opioid overdoses in B.C. between January 1, 2014, and December 31, 2016. Statistics Canada linked federal data on immigration, employment, the justice system and social assistance receipt in the year of, and prior to, people's first overdose. RESULTS: During the observation period, most people (78%) had one overdose episode, rather than several. Seven percent were immigrants or temporary residents, 41% of whom arrived in Canada more than 20 years before their index overdose. Half (49.6%) had not received social assistance, and one-third (33.8%) were employed-primarily within construction (21% of those employed)-in the year prior to their index overdose. Most employed people (65.5%) experienced periods of unemployment within five years prior to their index overdose. Employment was more prevalent among people who experienced illicit-drug toxicity death (36.1%). About 60% of people had not had any formal police contact within the two years prior to the index overdose. DISCUSSION: This project demonstrated further added value to existing data by using this linkage approach and aligned with strategies underway by BC public health partners to provide cross-sectoral evidence to inform efforts to prevent and manage opioid overdoses.

All-cause acute care hospitalization rates of immigrants and the Canadian-born population: A linkage study.

BACKGROUND: As Canadian immigration levels increase, knowledge concerning immigrant health becomes increasingly important for health system policy and planning. This study compares the rate of all-cause hospitalization among immigrants with that of their Canadian-born counterparts. DATA AND METHODS: Using records from the Discharge Abstract Database (2004/2005 to 2016/2017) and the Ontario Mental Health Reporting System (2006/2007 to 2017/2018) linked to the 2016 Longitudinal Immigration Database, this study compared the age-standardized hospitalization rates (ASHRs) among immigrants with those of the Canadian-born population; the latter were obtained from a linkage based on the 2011 National Household Survey. Comparisons were made at the International Classification of Diseases chapter level by immigrant landing year, admission category and world region of birth. Quebec data were not available. RESULTS: Overall, ASHRs among immigrants were lower than for the Canadian-born population. Immigrants in the economic class had the lowest ASHR, followed by those in the family class and among refugees. After pregnancy was excluded, leading hospitalization causes were similar for immigrants and the Canadian-born population, where top causes included digestive system and circulatory diseases, injuries, and cancer. In male and female immigrants, the ASHRs were lowest among those from East Asia. By landing year, males arriving earlier had the highest ASHR compared with the most recent arrivals. When pregnancy was excluded and while the differential in ASHRs among females by landing year remained, the magnitude was smaller. INTERPRETATION: These results corroborate those from previous studies suggesting a healthy immigrant effect, but also reveal heterogeneity in ASHRs within the immigrant population. They provide a baseline for comparison of health status between populations, which enables further monitoring and informs health-system policy and planning.

Associations between the receipt of inpatient palliative care and acute care outcomes: A retrospective study.

BACKGROUND: Palliative care (PC) has been shown to improve outcomes for individuals at the end of life. Despite this, many Canadians do not receive PC prior to death. The present study examines the receipt of inpatient PC and its association with location of death, as well as with admission to intensive care units (ICUs) and use of alternate level of care (ALC) beds in hospital in the last 30 days of life. DATA AND METHODS: The study sample is a retrospective cohort of adult Canadians (aged 19 and older) who died between April 1, 2010, and December 31, 2014. Deaths were ascertained from the Canadian Vital Statistics Database and linked to hospitalizations records in the Discharge Abstract Database to identify the receipt of inpatient PC. RESULTS: More than half (57.7%) of Canadian adults died in hospital, with only 12.6% receiving any inpatient PC in the year prior to death, and 1.7% receiving a preterminal PC designation (i.e., PC initiated prior to the last 30 days of life). In the adjusted analyses, receipt of any inpatient PC was associated with a higher likelihood of death in hospital but lower odds of ICU admission. Pre-terminal PC was associated with lower odds of death in hospital, ICU admission and ALC bed use. DISCUSSION: This study offers new insights into the association between inpatient PC and outcomes at the end of life among Canadians. Future studies could expand on these observations to further understanding of the role of inpatient PC in the end-of-life experience for different populations in Canada.

Changes in Caregiver Health in the Years Surrounding the Birth of a Child With Health Problems: Administrative Data From British Columbia.

BACKGROUND: Caregivers of children with health problems (CHPs; usually mothers) experience more physical and psychological health problems than those of children without health problems (non-CHPs). Primarily cross-sectional and survey-driven, this literature has not yet explored whether these health differences existed before the birth of the CHPs, or are exacerbated postbirth. METHODS: Using linked administrative health data on all mother-child dyads for children born in the year 2000 in British Columbia, Canada, we examined maternal health before, during, and after the birth of CHPs, and compared it between mothers of CHPs and non-CHPs with piecewise growth curve modeling. RESULTS: Compared with mothers of non-CHPs, mothers of CHPs had more physician visits (8.09 vs. 11.07), more medication types (1.81 vs. 2.60), and were more likely to be diagnosed with selected health conditions (30.9% vs. 42.5%) 4 years before the birth of the child. Over the 7-year postbirth period, the health of the 2 groups of mothers further diverged: while mothers of CHPs showed increases on physician visits and types of medication, mothers of non-CHPs did not experience any changes in physician visits and had less steep increases for types of medication. CONCLUSIONS: Health issues associated with having a child with a health problem may begin well before the birth of the child, but also appear to be exacerbated postbirth. The health challenges of caregivers of CHPs may be multifactorial, involving both preexisting conditions and the stresses associated with caring for a child with health problems.

Measuring health related quality of life (HRQoL) in community and facility-based care settings with the interRAI assessment instruments: development of a crosswalk to HUI3.

BACKGROUND: Health-related quality of life (HRQoL) measures are of interest because they can be used to describe health of populations and represent a broader health outcome for population health analyses than mortality rates or life expectancy. The most widely used measure of HRQoL for deriving estimates of health-adjusted life expectancy is the Health Utilities Index Mark 3 (HUI3). The HUI3 is available in most national surveys administered by Statistics Canada, and has been used as part of a microsimulation model to examine the impact of neurological conditions over the life course. Persons receiving home care and nursing home services are often not well-represented in these surveys; however, interRAI assessment instruments are now used as part of normal clinical practice in these settings for nine Canadian provinces/territories. Building on previous research that developed a HUI2 crosswalk for the interRAI assessments, the present study examined a new interRAI HRQoL index crosswalked to the HUI3. METHODS: interRAI and survey data were used to examine the distributional properties of global and domain-specific interRAI HRQoL and HUI3 index scores, respectively. Three populations were considered: well-elderly persons not receiving home care, home care clients and nursing home residents. RESULTS: The mean HUI3 and interRAI HRQoL index global scores declined from independent healthy older persons to home care clients, followed by nursing home residents. For the home care and nursing home populations, the interRAI HRQoL global estimates tended to be lower than HUI3 global scores obtained from survey respondents. While there were some statistically significant age, sex and diagnostic group differences in global scores and within attributes, the most notable differences were between populations from different care settings. DISCUSSION: The present study provides strong evidence for the validity of the interRAI HRQoL based on comparisons of distributional properties with those obtained with survey data based on the HUI3. The results demonstrate the importance of admission criteria for home care and nursing home settings, where function plays a more important role than demographic or diagnostic criteria. The interRAI HRQoL has a distinct advantage because it is gathered as part of normal clinical practice in care settings where interRAI instruments are mandatory and are used to assess all eligible persons in those sectors. In particular, those with severe cognitive and functional impairments (who tend to be under-represented in survey data) will be evaluated using the interRAI tools. Future research should build on this work by providing direct, person-level comparisons of interRAI HRQoL index and HUI3 scores, as well as longitudinal analyses to examine responsiveness to change.

Social and economic characteristics of those experiencing hospitalizations due to opioid poisonings.

Hospitalizations due to opioid poisonings are increasing. While considerable information is available on the demographic and geographic distribution of opioid-related events, national data on the social and economic circumstances of those experiencing these events are limited. This study uses data from the National Household Survey (2011) linked to the Discharge Abstract Database (2011 to 2016) to provide the first national-level estimates of the socio-economic characteristics of individuals experiencing opioid-related hospitalizations. Results reveal elevated hospitalization rates among people who have lower levels of income and education, are unemployed or out of the labour force, identify as Indigenous, live in lone-parent households, and spend more than 50% of their household income on housing. Understanding the circumstances of individuals who experienced adverse opioid events will help inform policies addressing potential determinants.

Transitions to long-term and residential care among older Canadians.

BACKGROUND: The aging of the Canadian population has increased attention on the future need for nursing home beds. Although current projections rely primarily on age and sex, other factors also contribute to the need for long-term care. This study seeks to identify additional factors to age and sex that contribute to Canadians transitioning from living at home to living in a seniors' residence or nursing home. DATA AND METHODS: As part of a larger record linkage project, three cycles of the Canadian Community Health Survey (CCHS) were linked to the 2011 Census of Population: Cycle 3.1 (2005/2006), Cycle 4.1 (2007/2008), and CCHS-Healthy Aging (2008/2009). The sample was limited to successfully linked CCHS respondents who were aged 60 years or older as of Census Day 2011 (May 10, 2011; n=81,411). Sex-specific generalized multinomial logistic regression models were conducted to examine the association between each respondent's characteristics and dwelling location (private dwelling, private dwelling with additional family, nursing home, or seniors' residence) on Census Day. RESULTS: On Census Day, 1.4% of the study sample were living in a nursing home, 1.2% in a seniors' residence, 7.1% in a private dwelling with additional family, and 90.3% in a private dwelling. Women were more likely than men to be living in a nursing home (1.8% of women vs. 0.9% of men) or seniors' residence (1.7% of women vs. 0.7% of men). Regression models showed that, aside from age, there were increased odds of living in a nursing home or seniors' residence among individuals who lost their spouse or who were not married, who did not own their dwelling, who had poor self-rated health, or who had been diagnosed with dementia. The association of other factors with dwelling place differed according to sex and type of dwelling. DISCUSSION: Although age is strongly associated with living in a nursing home or seniors' residence, other demographic and health factors affect the likelihood of an individual transitioning to an institutional dwelling. Such factors could be considered when planning for the future housing and care needs of the Canadian population.

Associations between cadmium levels in blood and urine, blood pressure and hypertension among Canadian adults.

BACKGROUND: Cadmium has been inconsistently related to blood pressure and hypertension. The present study seeks to clarify the relationship between cadmium levels found in blood and urine, blood pressure and hypertension in a large sample of adults. METHODS: The study sample included participants ages 20 through 79 from multiple cycles of the Canadian Health Measures Survey (2007 through 2013) with measured blood cadmium (n=10,099) and urinary cadmium (n=6988). Linear regression models examined the association between natural logarithm transformed cadmium levels and blood pressure (separate models for systolic and diastolic blood pressure) after controlling for known covariates. Logistic regression models were used to examine the association between cadmium and hypertension. Models were run separately by sex, smoking status, and body mass index category. RESULTS: Men had higher mean systolic (114.8 vs. 110.8mmHg, p<0.01) and diastolic (74.0 vs. 69.6mmHg, p<0.01) blood pressure compared to women. Although, geometric mean blood (0.46 vs. 0.38µg/L, p<0.01) and creatinine-adjusted standardized urinary cadmium levels (0.48 vs. 0.38µg/L, p<0.01) were higher among those with hypertension, these differences were no longer significant after adjustment for age, sex and smoking status. In overall regression models, increases in blood cadmium were associated with increased systolic (0.70mmHg, 95% confidence interval [CI]=0.25-1.16, p<0.01) and diastolic blood pressure (0.74mmHg, 95% CI=0.30-1.19, p<0.01). The associations between urinary cadmium, blood pressure and hypertension were not significant in overall models. Model stratification revealed significant and negative associations between urinary cadmium and hypertension among current smokers (OR=0.61, 95% CI=0.44-0.85, p<0.01), particularly female current smokers (OR=0.52, 95% CI=0.32-0.85, p=0.01). CONCLUSION: This study provides evidence of a significant association between cadmium levels, blood pressure and hypertension. However, the significance and direction of this association differs by sex, smoking status, and body mass index category.

Housing conditions and respiratory hospitalizations among First Nations people in Canada.

BACKGROUND: Respiratory diseases are among the leading causes of acute care hospitalization for First Nations people. Poor housing conditions are associated with respiratory disorders and may be related to the likelihood of hospitalization. This analysis examines whether First Nations identity is associated with higher odds of hospitalization for respiratory conditions relative to non-Aboriginal persons, and whether such differences in hospitalization rates remain after consideration of housing conditions. DATA AND METHODS: Data from the 2006 Census linked to the Discharge Abstract Database were used to analyze differences in hospitalization for respiratory tract infections and asthma between First Nations and non-Aboriginal people when housing conditions were taken into account. RESULTS: Rural on-reserve First Nations people were more likely than non-Aboriginal people to be hospitalized for a respiratory tract infection (1.5% versus 0.5%) or for asthma (0.2% versus 0.1%). For respiratory tract infection hospitalizations, adjustment for housing conditions, household income and residential location reduced differences, but the odds remained nearly three times higher for on-reserve First Nations people (OR = 2.83; CI: 2.69 to 2.99) and two times higher for off-reserve First Nations people (OR = 2.03; CI: 1.87 to 2.21), compared with the non-Aboriginal cohort. For asthma hospitalizations, adjustment for household income reduced the odds more than did adjustment for housing conditions. Even with full adjustment, the odds of asthma hospitalization relative to non-Aboriginal people remained significantly higher for First Nations people. INTERPRETATION: First Nations people are significantly more likely than non-Aboriginal people to be hospitalized for respiratory tract infections and asthma, even when housing conditions, household income and residential location are taken into account. While housing conditions are associated with such hospitalizations, household income may be more important.

Development of a population-based microsimulation model of body mass index.

BACKGROUND: The increasing prevalence of overweight and obesity has necessitated the development of body mass index (BMI) projection models such as the POpulation HEalth Model (POHEM). This study describes the POHEM-BMI model, a microsimulation tool that can be used to support evidence-based health policy making for obesity reduction. DATA AND METHODS: The National Population Health Survey, the Canadian Community Health Survey (CCHS), and the Canadian Health Measures Survey (CHMS) were used to develop and validate a predictive model of BMI for adults and childhood BMI history. Models were incorporated into POHEM and used to transition BMI over time in a fully dynamic simulated Canadian population. RESULTS: POHEM-BMI projections of self-reported and measured adult BMI and childhood BMI history agree well with CCHS and CHMS validation estimates. Among men and women, average BMI is projected to increase by more than one BMI unit between 2001 and 2030. Projections of self-reported BMI show that 59% of the adult population will be overweight or obese by 2030; projections of measured BMI show that the percentage will be 66%. INTERPRETATION: Using empirically developed BMI prediction models for adults and childhood BMI history integrated into the POHEM framework, validated projections of BMI for the Canadian population can be produced. Projections of BMI trends could have important applications in tracking the prevalence of related diseases, and in planning and comparing intervention strategies.

Risk of work loss due to illness or disability in patients with osteoarthritis: a population-based cohort study.

OBJECTIVES: To estimate the risk of work loss due to illness or disability in a cohort of employed persons with OA compared with matched non-OA individuals. METHODS: We performed a population-based cohort analysis using the last six cycles of the Canadian longitudinal National Population Health Survey from 2000 to 2010. OA cases and up to four age- and sex-matched non-OA individuals were selected. Discrete time hazard regression models were used to estimate the hazard of work loss due to illness or disability. To analyse the effect of a self-reported OA measure on the outcome, we performed a sensitivity analyses for case selection. RESULTS: From 7273 employed individuals between the ages of 20 and 70 years in the National Population Health Survey, 659 OA cases were selected and matched to 2144 non-OA individuals. The proportion of OA cases who experienced work loss due to illness or disability during the follow-up period was 12.6%, compared with 9.3% for non-OA individuals (P < 0.001). OA cases had a 90% [hazard ratio (HR) 1.90 (95% CI 1.36, 3.23)] higher hazard of work loss due to illness or disability compared with their matched non-OA individuals after adjusting for sociodemographic, health and work-related status. The adjusted HRs were 1.61 (95% CI 1.13, 2.30) and 2.04 (95% CI 1.74, 4.75) for females and males, respectively. CONCLUSION: OA is independently associated with an increased risk of work loss due to illness or disability. Given the high prevalence of OA in the population of working age, future research may wish to investigate ways to improve occupational participation among OA patients.

Alzheimer's and other dementias in Canada, 2011 to 2031: a microsimulation Population Health Modeling (POHEM) study of projected prevalence, health burden, health services, and caregiving use.

BACKGROUND: Worldwide, there is concern that increases in the prevalence of dementia will result in large demands for caregivers and supportive services that will be challenging to address. Previous dementia projections have either been simple extrapolations of prevalence or macrosimulations based on dementia incidence. METHODS: A population-based microsimulation model of Alzheimer's and related dementias (POHEM:Neurological) was created using Canadian demographic data, estimates of dementia incidence, health status (health-related quality of life and mortality risk), health care costs and informal caregiving use. Dementia prevalence and 12 other measures were projected to 2031. RESULTS: Between 2011 and 2031, there was a projected two-fold increase in the number of people living with dementia in Canada (1.6-fold increase in prevalence rate). By 2031, the projected informal (unpaid) caregiving for dementia in Canada was two billion hours per year, or 100 h per year per Canadian of working age. CONCLUSIONS: The projected increase in dementia prevalence was largely related to the expected increase in older Canadians, with projections sensitive to changes in the age of dementia onset.

Cadmium levels and sources of exposure among Canadian adults.

BACKGROUND: Cadmium is a heavy metal found naturally in the environment that has been associated with negative health outcomes. The present study examines levels of blood cadmium (BCd), urinary cadmium (UCd), and the main sources of cadmium exposure among Canadians aged 20 to 79. DATA AND METHODS: The data are from cycles 1 (2007 to 2009) and 2 (2009 to 2011) of the Canadian Health Measures Survey (CHMS), including measures of BCd and UCd, markers of smoking status (self-reported and second-hand smoke exposure), and self-reported consumption of foods known to be high in cadmium. The relationship between sources of exposure and cadmium levels was examined descriptively. The magnitude of the contribution of different exposure sources was examined in regression models. RESULTS: Age and smoking status were the greatest contributors to BCd and UCd: older people and current smokers had the highest cadmium levels. Dietary exposure, while significant, was a modest contributor overall, but a more important source of cadmium among never-smokers. INTERPRETATION: Smoking was the greatest contributor to cadmium levels among Canadians aged 20 to 79. Dietary differences explained a small percentage of variation in cadmium levels.

Development and implementation of microsimulation models of neurological conditions.

BACKGROUND: As part of a program of the first National Population Health Study of Neurological Conditions launched in 2009, a series of microsimulation models of neurological conditions (called POHEM-Neurological meta-model) was developed to project health and economic impacts of seven neurological conditions (NCs)-Alzheimer's disease and other dementias, cerebral palsy, epilepsy, multiple sclerosis, Parkinson's disease, traumatic brain injury, and traumatic spinal cord injury-over a 20-year horizon. DATA AND METHODS: The common framework of the seven models allows for dynamic, continuous-time, discrete-event simulation of synthetic large populations in which persons are subject to the risk of developing the NC under study and are assigned a value of functional health and a probability of receiving a caregiver and of entering long-term care. Calculations for transitions are done every year over the life course, and costs are accumulated throughout the life of the synthetic person. The need to reconcile empirical estimates of incidence and mortality with prevalence required implementation of "cure" parameters for two of the NCs. RESULTS: The POHEM-Neurological meta-model integrates the latest Canadian microdata on neurological conditions and satisfies most criteria for validation of microsimulation models, including conceptualization, computer implementation, assessment of output plausibility, and comparison with external data. Limitations include an absence of risk factors and the lack of uncertainty measures. INTERPRETATION: The POHEM-Neurological meta-model has been useful for projections of health and economic impacts of NCs on persons affected and their caregivers, and allows for comparison of specific scenarios to the base case.

Developing a non-categorical measure of child health using administrative data.

BACKGROUND: Few studies have examined the potential of linked administrative data for research on child health. This analysis describes the application of a non-categorical survey-based tool, the Children with Special Health Care Needs (CSHCN) Screener, to administrative data. DATA AND METHODS: Five Screener items were applied to linked administrative health data from Population Data British Columbia. Hospital admissions and demographic and community characteristics for a cohort of children aged 6 to 10 in 2006 were examined to validate the use of these items. RESULTS: Overall, 17.5% of children were identified as CSHCN. An estimated 14% of children used more medical care and 5.2% had more functional limitations than is usual for children of the same age; 3.3% were prescribed long-term medication; 1.9% needed/received treatment or counselling; and 0.1% needed/received special therapy. Boys were more likely than girls to be identified as CSHCN. INTERPRETATION: With some limitations, the CSHCN Screener can be applied to Canadian administrative health data.

Trajectories of psychological distress among Canadian adults who experienced parental addiction in childhood.

BACKGROUND: Childhood experiences can influence mental health in adulthood. Parental addiction is a relatively common adverse experience in childhood. However, understanding of the relationship between parental addiction and levels of distress over the adult life course is incomplete. DATA AND METHODS: Data are from the National Population Health Survey longitudinal file (1994/1995 to 2010/2011). Sex-specific trajectories of psychological distress in relation to exposure to parental addiction in childhood were examined among Canadian adults from ages 18 to 74. RESULTS: Psychological distress levels decreased with age, but were consistently higher throughout the life course among individuals who experienced parental addiction in childhood, compared with those who did not. The gap in psychological distress scores by parental addiction status was wide in young adulthood, but narrowed as individuals aged. INTERPRETATION: Exposure to parental addiction in childhood can be associated with psychological distress well into adulthood, but levels decrease over time.