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.

Data profile: Expanding the research potential of the Canadian Health Measures Survey using paired respondent data.

The family environment is an important influence on the health and behaviours of children. Few large-scale datasets include detailed and objectively measured health data about multiple individuals from the same family who are living in the same household. The Canadian Health Measures Survey (CHMS) is a repeating, cross-sectional survey that selects two members of a household-a child and a randomly selected older member of the household aged 12 to 79 years-with at least one child aged 3 to 11 years in residence. These paired respondent records, available in the CHMS relationship files, provide unique opportunities to researchers interested in examining associations between two members of the same household for health behaviours and outcomes. A range of pairings are captured in the relationship files (e.g., parent and child, siblings, grandchild and grandparent) with birth parent-child pairs being the most common. These paired respondent data are an important analytical asset of the CHMS and enhance the research potential of the survey significantly.

Associations between parent and child sedentary behaviour and physical activity in early childhood.

BACKGROUND: Parents are central to healthy development in early childhood. Study objectives were to examine the associations between parent and child sedentary behaviour and physical activity in a large representative sample of Canadian 3-5-year-olds, and to determine if associations differed between sons and daughters and mothers and fathers. DATA AND METHODS: Participants were 1,116 children aged 3-5 years and one of their biological parents from cycles 2-5 (2009-2017) of the repeated cross-sectional Canadian Health Measures Survey. Sedentary time, light-intensity physical activity (LPA), and moderate- to vigorous-intensity physical activity (MVPA) were objectively-measured in both parents and children with Actical accelerometers. Average minutes/day for all valid days, valid weekdays, and valid weekend days (n=935) were calculated. Screen time of both parents and children was parent-reported, and average hours/day were calculated. Pearson correlations and linear regression models with interaction terms were conducted. RESULTS: In the overall sample, all of the parental physical activity and sedentary behaviours were significantly correlated with children's behaviours (r=0.08-0.20). No significant parental or child sex interactions were observed in linear regression models so models were not stratified by parent or child sex. Significant associations with small effect sizes were observed between all of the parental behaviours and children's behaviours. For accelerometer data this was consistent for total days, weekdays, and weekend days. DISCUSSION: Parental sedentary behaviour and physical activity may be intervention targets in early childhood. This appears consistent regardless of the sex of the parent or child. Given the small effect sizes observed, additional intervention targets should also be considered.

Exercise and screen time during the COVID-19 pandemic.

BACKGROUND: The objective of this paper is to describe the exercise and changes in screen time habits, and their relationship with health, among participants of the Canadian Perspectives Survey Series (CPSS). DATA AND METHODS: Between March 29th and April 3rd 2020, CPSS participants (n = 4,524) reported whether they were exercising outdoors or indoors and whether they increased, decreased or maintained their TV, Internet and video game use. Participants also reported their self-perceived general and mental health. RESULTS: More women reported very good or excellent mental health if they were exercising outdoors (54%) compared with those who were not (41%). More women reported very good or excellent general health if they were exercising outdoors (75%) compared with those who were not (49%), with the same trend evident for those exercising indoors (69%) compared to those who were not (62%). More men (65%) and women (62%) rated their mental and general health as very good or excellent if they maintained or decreased TV time compared with those who increased TV time (57% and 43%, respectively), with the same evident for Internet use in women only (maintained/decreased: 61% versus increased: 44%). More men (63%) and women (52%) rated their mental health as very good or excellent if they maintained or decreased video game time compared with those who increased video game time (48% and 29%, respectively). More men and women reported very good or excellent mental and general health if they increased none or one type of screen and/or were exercising outdoors compared with those who increased 2 or 3 types of screens and who were not exercising outdoors, with the exception of general health among men. DISCUSSION: Maintaining opportunities for outdoor exercise and limiting screen time may promote better mental and general health during periods of confinement.

Change in total sugars consumption among Canadian children and adults.

BACKGROUND: Free sugars are nutrients of public health concern that have been associated with negative health outcomes, including dental caries in children and excess weight gain. Since national-level free sugars data are not currently available for Canadians, total sugars intake was examined to understand sugars intake in the population. The objective of this analysis was to describe and compare total sugars consumption among Canadians in 2004 and 2015. DATA AND METHODS: Data are from the 2004 and 2015 Canadian Community Health Survey-Nutrition. Separate descriptive analyses of total sugars for children aged 2 to 18 (n=13,919) and adults aged 19 and older (n=31,156) were conducted by year and by misreporting status (under-, plausible and over-reporters), and the top sources of total sugars were identified. Misreporting status was studied to better understand differences in sugars intakes between survey years. T-tests were used to determine significant differences between survey years. RESULTS: In 2015, the average daily total sugars consumption was 101 grams (24 teaspoons) for children aged 1 to 8, 115 grams (27 teaspoons) for children aged 9 to 18, and 85 grams (20 teaspoons) for adults. Sugary beverages, taken together, were the top source of sugars for all age groups. Total sugars consumption decreased from 2004 to 2015 overall, although not by misreporting status. Total sugars from food alone increased from 2004 to 2015, and total sugars from beverages alone decreased, regardless of age or misreporting status. DISCUSSION: The overall decrease in total sugars consumption from 2004 to 2015 may be explained by changes in misreporting. Total sugars from food alone increased, while total sugars from beverages alone decreased. This was true for all age groups and for plausible reporters.

Overweight and obesity are associated with lower vitamin D status in Canadian children and adolescents.

INTRODUCTION: There is evidence that 25-hydroxyvitamin D levels are lower in overweight and obese youth. This study examined the relationship between weight status and 25-hydroxyvitamin D, while controlling for confounders, in Canadian youth. METHODS: Plasma 25-hydroxyvitamin D from subjects aged 6 to 17 years from the Canadian Health Measures Survey cycles 1 (2007 to 2009) and 2 (2009 to 2011) was used. Sex-specific multiple linear regression and logistic regressions examined the relationship of overweight and obesity (body mass index ≥ 85th percentile) with 25-hydroxyvitamin D levels and the odds of 25-hydroxyvitamin D <40 nmol/L and <50 nmol/L. RESULTS: The prevalence of risk of vitamin D deficiency (25-hydroxyvitamin D < 30 nmol/L) was 6% (95% confidence interval [CI] 3.26% to 10.12%). Vitamin D inadequacy, estimated by levels <40 nmol/L, was 15% (95% CI 10.34% to 20.39%; 19% [95% CI 13.1 to 25.6] for teenagers). Seventy per cent (95% CI 63.59 to 75.17) had levels >50 nmol/L, consistent with achieving the Recommended Dietary Allowance. In adjusted analyses, overweight/obesity (1/3 of subjects) was independently associated with lower 25-hydroxyvitamin D for both sexes after adjustment for age, race, income, season, vitamin D supplementation and daily milk consumption. For 25-hydroxyvitamin D <40 nmol/L, the overweight/obese odds ratio for males was 2.63 (95% CI 1.34 to 5.18). For 25-hydroxyvitamin D <50 nmol/L, overweight/obese odds ratios were 2.19 (95% CI 1.46 to 3.28) for males and 1.39 (95% CI 1.05 to 1.84) for females. CONCLUSIONS: This study confirms the inverse association between adiposity and serum concentrations of 25-hydroxyvitamin D in Canadian youth and the independent association of overweight/obesity to 25-hydroxyvitamin D level and vitamin D status after adjustment for other factors.

Vitamin C status of Canadian adults: Findings from the 2012/2013 Canadian Health Measures Survey.

BACKGROUND: Although vitamin C is not produced in the body, it is important for many biochemical and physiological functions. Little is known about the current vitamin C status of Canadians. This study describes the correlates of vitamin C status in a nationally representative sample of adults. DATA AND METHODS: Data are from the 2012/2013 Canadian Health Measures Survey. Plasma vitamin C (L-ascorbic acid) concentrations were measured among a fasting subsample of respondents aged 20 to 79 (n = 1,615). Vitamin C status, prevalence of deficiency (plasma vitamin C < 11 µmol/L), and use of vitamin C-containing supplements were estimated. Multivariate regression models were used to examine associations between vitamin C status and sociodemographic characteristics, smoking, body mass index, supplement use, and consumption of fruit juice and citrus fruit. RESULTS: The mean plasma vitamin C concentration of adults aged 20 to 79 was 53 µmol/L; fewer than 3% were vitamin C-deficient. Almost 22% took a vitamin C-containing supplement. Concentrations were lower among smokers and people who were obese, and higher among vitamin C supplement users and fruit juice and citrus fruit consumers. Multivariate models showed that supplement use was the strongest and most consistent predictor of vitamin C status; fruit juice and citrus fruit consumption were predictors only among populations with lower vitamin C concentrations (for example, smokers, obese). INTERPRETATION: Few Canadians were vitamin C-deficient. Smokers and people with a higher BMI were most at risk of lower vitamin C concentrations; concentrations were higher among supplement users and consumers of fruit juice and citrus fruit.

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%.

Omega-3 Index of Canadian adults.

BACKGROUND: Cardioprotective properties have been associated with two fatty acids-eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). The Omega-3 Index indicates the percentage of EPA+DHA in red blood cell fatty acids. Omega-3 Index levels of the Canadian population have not been directly measured. DATA AND METHODS: Data for respondents aged 20 to 79 from cycle 3 (2012/2013) of the Canadian Health Measures Survey were used to calculate means and the prevalence of Omega-3 Index coronary heart disease (CHD) risk cut-offs-high (4% or less), moderate (more than 4% to less than 8%), and low (8% or more)-by sociodemographic and lifestyle characteristics, including fish consumption and use of omega-3 supplements. Associations between the Omega-3 Index and CHD-related factors including biomarkers, risk factors, and previous CHD events, were examined in multivariate regression models. RESULTS: The mean Omega-3 Index level of Canadians aged 20 to 79 was 4.5%. Levels were higher for women, older adults, Asians and other non-white Canadians, omega-3 supplement users, and fish consumers; levels were lower for smokers and people who were obese. Fewer than 3% of adults had levels associated with low CHD risk; 43% had levels associated with high risk. No CHD-related factor was associated with the Omega-3 Index when control variables were taken into account. INTERPRETATION: Omega-3 Index levels among Canadian adults were strongly related to age, race, supplement use, fish consumption, smoking status and obesity. Fewer than 3% of adults had Omega-3 Index levels associated with low risk for CHD.

Symptom onset, diagnosis and management of osteoarthritis.

BACKGROUND: The time between symptom onset and physician diagnosis is a period when people with osteoarthritis can make lifestyle changes to reduce pain, improve function and delay disability. DATA AND METHODS: This study analyses data for a nationally representative sample of 4,565 Canadians aged 20 or older who responded to the Arthritis component of the 2009 Survey on Living with Chronic Diseases in Canada. Descriptive statistics are used to report the prevalence of hip and knee osteoarthritis; the mean age of symptom onset and diagnosis; medication use; and contacts with health professionals during the previous year. RESULTS: Among people with a physician diagnosis of arthritis, 37% reported osteoarthritis. Of these, 70% experienced pain in the hip(s), knee(s), or hip(s) and knee(s). Close to half (48%) of these people experienced symptoms the same year that they were diagnosed; 42% experienced symptoms at least a year before the diagnosis; and 10% experienced symptoms after the diagnosis. Among those who had symptoms before diagnosis, the average time between symptom onset and diagnosis was 7.7 years. INTERPRETATION: Individuals with osteoarthritis may experience symptoms for several years before they obtain a physician diagnosis.