Self-reported factors associated with community ambulation after stroke: The Canadian Longitudinal Study on Aging.

Community ambulation is frequently limited for people with stroke. It is, however, considered important to people with stroke. The objectives were to identify factors associated with self-reported community ambulation in Canadians aged 45+ with stroke and to identify factors associated with community ambulation specific to Canadian males and to Canadian females with stroke. Data were utilized from the Canadian Longitudinal Study on Aging Tracking Cohort. Multivariate logistic regression models were developed for community ambulation. Mean age was 68 (SE 0.5) years (45% female). In the final community ambulation model (n = 855), factors associated with being less likely to 'walk outdoors sometimes or often' included difficulty or being unable to walk 2-3 blocks (decreased endurance) vs. no difficulty. Being more likely to walk outdoors was associated with 'better weather' months and being 55-64 years of age vs 75-85. Differences were noted between the models of only males and only females. Decreased walking endurance is associated with a decreased likelihood of walking in the community-a factor that can be addressed by rehabilitation professionals and in community based programs.

How well do obesity indices predict undiagnosed hypertension in the Persian cohort (Shahedieh) adults community population of all ages?

Background and Aims: Hypertension is the leading preventable risk factor for cardiovascular disease, chronic kidney disease and cognitive impairment, and mortality and disability worldwide. Since prevention, early detection, and treatment of blood pressure improve public health, the aim of present study was to determine the best obesity indices and estimate the optimal cut-off point for each one to predict the risk of elevated/stage 1 and undiagnosed hypertension in the population of center of Iran based on American ACC/AHA 2020 guidelines. Methods: This cross-sectional study was performed on 9715 people who enrolled in 2018 in Persian Adult Cohort in Shahedieh area of Yazd, Iran in 2018. The anthropometric indices including body mass index (BMI) and waist circumference (WC), wrist circumference, hip circumference, waist-to-hip ratio, and waist-to height ratio of individuals, were extracted. The receiver operating characteristic curve was utilized to determine the optimum cut-off point of each anthropometric index to predict hypertension stages and compare their predictive power by age-sex categories. Statistical analysis was done using SPSS version 23.0. Results: The results showed that BMI has the best predictive power to recognize the risk of elevated/stage 1 hypertension for female (area under the curve [AUC] = 0.72 and optimal cut-off = 30.10 kg/m2) and WC for male (AUC = 0.66 and optimal cut-off = 93.5 cm) in 35-45 age group. BMI had the best predictive power for the risk of undiagnosed hypertension for 35-45 years old male (AUC = 0.73 and optimal cut-off = 28.90 kg/m2) and female (AUC = 0.75 and optimal cut-off = 5.10 kg/m2), and hip circumference revealed similar predictive power for female as well (AUC = 0.75 and optimal cut-off = 112 cm). Conclusion: Based on our findings, BMI and WC, which are simple, inexpensive, and noninvasive means, are the best markers to predict the risk of elevated/stage 1 and undiagnosed hypertension in young Iranians. It shows that the approach of reducing hypertension prevalence through primary prevention, early detection, and enhancing its treatment is achievable.

Community ambulation in older adults and people with OA - a model verification using Canadian Longitudinal Study on Aging (CLSA) data.

BACKGROUND: There are health and well-being benefits of community ambulation; however, many older adults do not regularly walk outside of their home. Objectives were to estimate the associations between latent constructs related to community ambulation in older adults aged 65-85 (65+), and in adults with osteoarthritis (OA) aged 45-85. METHODS: Secondary data analysis of the comprehensive baseline and maintaining contact questionnaire data from the Canadian Longitudinal Study of Aging (CLSA) was completed. Based on a previous model of community ambulation post-stroke, structural equation modeling (SEM) was used to develop measurement and structural models for two groups: older adults 65+ and people with OA. Multi-group SEM was conducted to test measurement invariance across sex and age groups. Measurement models were developed for the following latent factors: ambulation (frequency of walking outside/week, hours walked/day, ability to walk without help, frequency and aids used in different settings); health perceptions (general health, pain frequency/intensity); timed functional mobility (gait speed, timed up-and-go, sit-to-stand, balance). Variables of depression, falls, age, sex, and fear of walking alone at night were covariates in the structural models. RESULTS: Data were used from 11,619 individuals in the 65+ group (mean age 73 years ±6, 49% female) and 5546 individuals in the OA group (mean age 67 ± 10, 60% female). The final 65+ model had a close fit with RMSEA (90% CI) = 0.018 (0.017, 0.019), CFI = 0.91, SRMR = 0.09. For the OA group, RMSEA (90% CI) = 0.021 (0.020, 0.023), CFI = 0.92, SRMR = 0.07. Health perceptions and timed functional mobility had a positive association with ambulation. Depression was associated with ambulation through negative associations with health perceptions and timed functional mobility. Multi-group SEM results reveal the measurement model was retained for males and females in the 65+ group, for males and females and for age groups (65+, < 65) in the OA group. CONCLUSIONS: The community ambulation model post-stroke was verified with adults aged 65+ and for those with OA. The models of community ambulation can be used to frame and conceptualize community ambulation research and clinical interventions.

Verification of a comprehensive framework for mobility using data from the Canadian Longitudinal Study on Aging: a structural equation modeling analysis.

BACKGROUND: Mobility within and between life spaces is fundamental for health and well-being. Our objective was to verify a comprehensive framework for mobility. METHODS: This was a cross-sectional study. We used structural equation modeling to estimate associations between latent factors with data from the Canadian Longitudinal Study on Aging for participants 65-85 years of age (65+, n = 11,667) and for adults with osteoarthritis (OA) aged 45-85 (n = 5,560). Latent factors included life space mobility, and physical, psychosocial, environmental, financial, and cognitive elements. Personal variables (age, sex, education) were covariates. RESULTS: The models demonstrated good fit (65+: CFI = 0.90, RMSEA (90% CI) = 0.025 (0.024, 0.026); OA: CFI = 0.90, RMSEA (90% CI) = 0.032 (0.031, 0.033)). In both models, better psychosocial and physical health, and being less afraid to walk after dark (observed environmental variable) were associated with greater life space mobility. Greater financial status was associated with better psychosocial and physical health. Higher education was related to better cognition and finances. Older age was associated with lower financial status, cognition, and physical health. Cognitive health was positively associated with greater mobility only in the 65 + model. Models generated were equivalent for males and females. CONCLUSIONS: Associations between determinants described in the mobility framework were verified with adults 65-85 years of age and in an OA group when all factors were considered together using SEM. These results have implications for clinicians and researchers in terms of important outcomes when assessing life space mobility; findings support interdisciplinary analyses that include evaluation of cognition, depression, anxiety, environmental factors, and community engagement, as well as physical and financial health. Public policies that influence older adults and their abilities to access communities beyond their homes need to reflect the complexity of factors that influence life space mobility at both individual and societal levels.

Life Course Predictors of Young Men Surviving to Age 90 in a Cohort Study: The Manitoba Follow-up Study.

The purpose of this study was to identify factors at various time points in life that are associated with surviving to age 90. Data from men enrolled in a cohort study since 1948 were considered in 12-year intervals. Logistic regression models were constructed with the outcome of surviving to age 90. Factors were: childhood illness, blood pressure (BP), body mass index (BMI), chronic diseases, and electrocardiogram (ECG) findings. After 1996, the Short Form-36 was added. A total of 3,976 men were born in 1928 or earlier, and hence by the end of our study window in 2018, each had the opportunity of surviving to age 90. Of these, 721 did live to beyond his 90th birthday.The factors in 1948 which predicted surviving were: lower diastolic BP, lower BMI, and not smoking. In 1960, these factors were: lower BP, lower BMI, not smoking, and no major ECG changes. In 1972, these factors were lower BP, not smoking, and fewer disease states. In 1984, these factors were lower systolic BP, not smoking, ECG changes, and fewer disease states. In 1996, the factors were fewer disease states and higher physical and mental health functioning. In 2008, only higher physical functioning predicted survival to the age of 90. In young adulthood, risk factors are important predictors of surviving to age 90; in mid-life, chronic illnesses emerge, and in later life, functional status becomes predominant.

Factors associated with social participation and community ambulation in people with osteoarthritis: Findings from the Canadian Longitudinal Study on Aging.

AIM: Walking in the community allows participation in meaningful activities which positively influences self-rated health and quality of life. Our objective was to identify factors associated with social participation and community ambulation in a representative sample of Canadian adults with osteoarthritis (OA). METHODS: Data were from >3800 participants in the Baseline Tracking Dataset of the Canadian Longitudinal Study on Aging with OA of the hip and/or knee. Outcomes included frequency of participation in 8 community-based activities (past year, social participation), and frequency walking outside the home (past 7 days, community ambulation). Explanatory variables (15 for social participation, 11 for community ambulation) established in previous literature were evaluated. Variables significant in univariate binary logistic regression models were entered into multivariable models. RESULTS: Frequency of social participation was greater for females, and individuals with higher levels of education. Those who were younger, dissatisfied with life, and had difficulty walking 2-3 blocks were less likely to participate. Having fewer chronic conditions, being younger, being single/widowed and being interviewed in spring/summer were associated with more frequent ambulation. Lower self-rated health, difficulty walking 2-3 blocks, pain and being female were associated with less frequent walking outside the home. CONCLUSION: Many factors influence frequency of social participation and community ambulation. The ability to walk short distances is positively associated with both outcomes. This important factor can and should be addressed clinically to improve health and quality of life in people with OA.

Prevalence of obesity and elevated body mass index along a progression of rurality: A cross-sectional study - The Canadian Longitudinal Study on Aging.

Introduction: Obesity is an important public health concern, and large studies of rural-urban differences in prevalence of obesity are lacking. Our purpose is to compare body mass index (BMI) and obesity in Canada using an expanded definition of rurality. Methods: A cross-sectional analysis of self-reported BMI across diverse communities of Canadians aged 45-85 years was conducted using data from the Canadian Longitudinal Study on Aging (CLSA), a national sample representative of community-dwelling residents. Rurality was identified in the CLSA based on residential postal codes, which were divided into 4 categories: urban, peri-urban, mixed and rural. Logistic regression models were constructed to calculate adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs) between obesity (BMI ≥30 kg/m2 from self-reported weight and height) and rurality, adjusting for age, sex, province, marital status, number of residents in household and household income. Results: Twenty-one thousand one hundred and twenty-six Canadian residents aged 45-85 years, surveyed during 2010-2015, were included. 26.8% were obese. Obesity was less prevalent amongst urban (25.2%) than rural (30.3%, P < 0.0001), mixed (28.7%, P < 0.0001) or peri-urban communities (28.1%, P < 0.0001). When compared to urban areas, the aOR (95% CI) for obesity was 1.09 (1.00-1.20) in rural regions and 1.20 (1.08-1.35) in peri-urban settings. In areas of mixed urban and rural residence, the aOR was 1.12 (0.99-1.27). Conclusion: One in four Canadian adults were obese. Living in a non-urban setting is an independent risk factor for obesity. Rural-urban health disparities could underlie rural-urban differences, but further research is needed.

Résumé Introduction: L'obésité est un important problème de santé publique et des études de grande envergure sur les différences de prévalence de l'obésité entre les régions rurales et urbaines font défaut. Notre objectif est de comparer l'indice de masse corporelle (IMC) et l'obésité au Canada en utilisant une définition élargie de la ruralité. Méthodes: Une analyse transversale de l'IMC autodéclaré dans diverses communautés de Canadiens âgés de 45 à 85 ans a été réalisée à l'aide des données de l'Étude longitudinale canadienne sur le vieillissement (ELCV); un échantillon national représentatif des résidents vivant en communauté. Dans l'ELCV, la ruralité a été identifiée à partir des codes postaux résidentiels, qui ont été divisés en 4 catégories: urbain, périurbain, mixte et rural. Des modèles de régression logistique ont été construits pour calculer les rapports de cotes ajustés (RCa) avec des intervalles de confiance à 95% (95% IC) entre l'obésité (IMC ≥30 kg/m2 à partir du poids et de la taille autodéclarés) et la ruralité, en tenant compte de l'âge, du sexe, de la province, de l'état civil, du nombre de résidents dans le ménage et du revenu du ménage. Résultats: 21 126 résidents canadiens âgés de 45 à 85 ans, interrogés au cours de la période 2010-2015, ont été inclus. 26,8% étaient obèses. L'obésité était moins répandue dans les communautés urbaines (25,2%) que rurales (30,3%, P < 0,0001), mixtes (28,7%, P < 0,0001) ou périurbaines (28,1%, P < 0,0001). Par rapport aux zones urbaines, le RCa (95% IC) pour l'obésité était de 1,09 (1,00, 1,20) dans les régions rurales, et de 1,20 (1,08, 1,35) dans les milieux périurbains. Dans les zones de résidence mixte urbaine et rurale, le RCa était de 1,12 (0,99, 1,27). Conclusion: Un adulte canadien sur quatre était obèse. Le fait de vivre dans un milieu non urbain est un facteur de risque indépendant d'obésité. Les disparités en matière de santé entre les régions rurales et urbaines pourraient être à l'origine de ces différences, mais des recherches supplémentaires sont nécessaires. Mots-clés: Rural, Obésité, Indice de masse corporelle, ELCV.

Frequency of data collection and estimation of trajectories of physical functioning and their associations with survival in older men: analyses of longitudinal data from the Manitoba Follow-Up Study.

OBJECTIVE: In studies of trajectories of physical functioning among older people, the data cannot be measured continuously, but only at certain time points in prespecified cycles. We examine how data collection cycles can affect the estimation of trajectories and their associations with survival. STUDY DESIGN AND SETTING: Longitudinal data from the Manitoba Follow-Up Study (MFUS), with 12 measurements collected annually from 2004 to 2015, are analysed using a summary measures of physical functioning from the Short Form-36 questionnaire. Based on the joint models of the functioning trajectories and risk of death, we compare the estimations among models using different frequency of data collection (annually, biennially and triennially). RESULTS: Our 2004 baseline includes 964 men who were survivors from the original MFUS cohort with mean age of 84 years and range between 75 and 94 years. Results from analysis of annual data indicate that the mean physical functioning is significantly decreasing over time. Further, the rate of decline is increasing over time. The current value of physical functioning is significantly associated with the hazard of death (p<0.001), whereas the association between the change rate and mortality is marginally significant (p<0.10). Results from analysis of biennial and triennial data reveal similar trajectory patterns of physical functioning, but could not reveal the association between the change rate of physical functioning and mortality. The frequency of data collection also impacts substantially on the estimation of heterogeneity of functioning trajectory. The prediction of mortality risk obtained using annual measurements of physical functioning are better than using biennial or triennial measurements, while the predictions obtained using biennial or triennial measurements are almost equivalent. CONCLUSION: The impact of frequency of data collection depends on the shape of functional trajectories and its linking structure to survival outcome.

Functional status in rural and urban adults: The Canadian Longitudinal Study on Aging.

PURPOSE: To document the prevalence of functional impairment in middle-aged and older adults from rural regions and to determine urban-rural differences. METHODS: We have conducted a secondary analysis using data from an ongoing population-based cohort study, the Canadian Longitudinal Study on Aging (CLSA). We used a cross-sectional sample from the baseline wave of the "tracking cohort." The definition of rurality was the same as the one used in the CLSA sampling frame and based on the 2006 census. This definition includes rural areas, defined as all territory lying outside of population centers, and population centers, which collectively cover all of Canada. We grouped these into "Urban," "Peri-urban," "Mixed" (areas with both rural and urban areas), and "Rural," and compared functional status across these groups. Functional status was measured using the Older Americans Resource Survey (OARS) and categorized as not impaired versus having any functional impairment. Logistic regression models were constructed for the outcome of functional status and adjusted for covariates. FINDINGS: No differences were found in functional status between those living in rural, mixed, peri-urban, and urban areas in unadjusted analyses and in analyses adjusting for sociodemographic and health-related factors. There were no rural-urban differences in any of the individual items on the OARS scales. CONCLUSIONS: We found no rural-urban differences in functional status.

Depressive symptoms in adults in rural and urban regions of Canada: a cross-sectional analysis of the Canadian Longitudinal Study on Aging.

OBJECTIVES: Previous studies on depression in rural areas have yielded conflicting results. Features of rural areas may be conducive or detrimental to mental health. Our objective for this study was to determine if there are rural-urban disparities in depressive symptoms between those living in rural and urban areas of Canada. DESIGN: We conducted a cross-sectional analysis of a prospective cohort study, which is as representative as possible of the Canadian population-the Tracking Cohort of the Canadian Longitudinal Study on Aging. For this cohort, data were collected from 2010 to 2014. Data were analysed and results were obtained in 2020. PARTICIPANTS: 21 241 adults aged 45-85. MEASURES: Rurality was grouped as urban (n=11 772); peri-urban (n=2637); mixed (n=2125; postal codes with both rural and urban areas); and rural (n=4707). Depressive symptoms were measured using the 10-item Center for Epidemiological Studies-Depression. We considered age, sex, education, marital status and disease states as potential confounding factors. RESULTS: The adjusted beta coefficient was -0.24 (95% CI -0.42 to -0.07; p=0.01) for rural participants, -0.17 (95% CI -0.40 to 0.05; p=0.14) for peri-urban participants and -0.30 (95% CI -0.54 to -0.05; p=0.02) for participants in mixed regions, relative to urban regions. Risk factors associated with depressive symptoms were similar in rural and urban regions. CONCLUSIONS: The small differences in depressive symptoms among those living in rural and urban regions are unlikely to be relevant at a clinical or population level. The findings do suggest some possible approaches to reducing depressive symptoms in both rural and urban populations. Future research is needed in other settings and on change in depressive symptoms over time.

Social determinants and spatio-temporal variation of Ischemic Heart Disease in Manitoba.

INTRODUCTION: The aim was to study any spatial and/or temporal patterns of ischemic heart disease (IHD) prevalence and measure the effects of selected social determinants on these spatial and space-time patterns. METHODS: Data were obtained from the Population Research Data Repository housed at the Manitoba Centre for Health Policy to identify persons who were diagnosed with IHD between 1995 and 2018. These persons were geocoded to 96 geographic regions of Manitoba. An area-level socioeconomic factor index (SEFI-2) and the proportion of the population who was Indigenous were calculated for each geographic region using the 2016 Canadian Census data. Associations between these factors and IHD prevalence were measured using Bayesian spatial Poisson regression models. Temporal trends and spatio-temporal trends were measured using Bayesian spatio-temporal Poisson regression models. RESULTS: Univariable models showed a significant association with increased regional Indigenous population proportion associated with a higher prevalence of IHD (RR: 0.07, 95% CredInt: (0.05, 0.10)) and for SEFI-2 (RR: 0.17, 95% CredInt: (0.11, 0.23)). Using a multivariable model, after accounting for the proportion of the population that was Indigenous, there was no evidence of an association between IHD prevalence and area-level socioeconomic factor. Spatio-temporal models showed no significant overall temporal trend in IHD prevalence, but there were significant spatially varying temporal trends within the 96 regions. CONCLUSIONS: Association between Indigenous population proportion and IHD is consistent with previous research. No significant overall temporal trend was measured. However, regions with significantly increasing trends and significantly decreasing trends in IHD prevalence were identified.

Life satisfaction in adults in rural and urban regions of Canada - the Canadian Longitudinal Study on Aging.

INTRODUCTION: Understanding rural-urban differences, and understanding levels of life satisfaction in rural populations, is important in planning social and healthcare services for rural populations. The objectives of this study were to determine patterns of life satisfaction in Canadian rural populations aged 45-85 years, to determine rural-urban differences in life satisfaction across a rural-urban continuum after accounting for potential confounding factors and to determine if related social and health factors of life satisfaction differ in rural and urban populations. METHODS: A secondary analysis was conducted using data from an ongoing population-based cohort study, the Canadian Longitudinal Study on Aging. A cross-sectional sample from the baseline wave of the tracking cohort was used, which was intended to be as generalizable as possible to the Canadian population. Four geographic areas were compared on a rural-urban continuum: rural, mixed (indicating some rural, but could also include some peri-urban areas), peri-urban, and urban. Life satisfaction was measured using the Satisfaction with Life Scale and dichotomized as satisfied versus dissatisfied. Other factors considered were province of residence, age, sex, education, marital status, living arrangement, household income, and chronic conditions. These factors were self-reported. Bivariate analyses using χ2 tests were conducted for categorical variables. Logistic regression models were constructed with the outcome of life satisfaction, after which a series of models were constructed, adjusting for province of residence, age, and sex, for sociodemographic factors, and for health-related factors. To report on differences in the factors associated with life satisfaction in the different areas, logistic regression models were constructed, including main effects for the variable of interest, for the variable rurality, and for the interaction term between these two variables. RESULTS: Individuals living in rural areas were more satisfied with life than their urban counterparts (odds ratio (OR)=1.23; 95% confidence interval (CI): 1.13-1.35), even after accounting for the effect of confounding sociodemographic and health-related factors (OR=1.32, 95%CI: 1.19-1.45). Those living in mixed (OR=1.30, 95%CI: 1.14-1.49) and peri-urban (OR=1.21, 95%CI: 1.07-1.36) areas also reported being more satisfied than those living in urban areas. In addition, a positive association was found between life satisfaction and age, as well as between life satisfaction and being female. A strong graded association was noted between income and life satisfaction. Most chronic conditions were associated with lower life satisfaction. Finally, no major interaction was noted between rurality and each of the previously mentioned different factors associated with life satisfaction. CONCLUSION: Rural-urban differences in life satisfaction were found, with higher levels of life satisfaction in rural populations compared to urban populations. Preventing and treating common chronic illness, and also reducing inequalities in income, may prove useful to improving life satisfaction in both rural and urban areas. Studies of life satisfaction should consider rurality as a potential confounding factor in analyses of life satisfaction within and across societies.

Quality of life in an adolescent orthodontic population.

OBJECTIVES: To investigate adolescent orthodontic patient experiences and quality of life with fixed appliances compared to Invisalign. MATERIALS AND METHODS: Adolescent patients in active treatment with Invisalign or fixed appliances for a minimum of 6 months were provided with the Child Oral Health Impact Profile-Short Form 19 questionnaire, along with additional items of interest that were assessed separately. Pearson's χ2 test was used to compare responses (P < .05), and unpaired t-tests (P < .05) were used to test for differences in mean satisfaction, quality of life, and domain scores. RESULTS: In total, 74 patients (37 in each treatment group) participated. Overall, no significant differences were noted in the mean quality of life, satisfaction, or domain scores between the two groups. A significant difference was noted in the time taken to adjust to appliances, with the Invisalign group demonstrating faster adaptation. Additionally, the fixed appliance group was 3.8 times more likely to report missing school because of their appliance (95% confidence interval [CI]: 1.2, 12.5) and 2.7 times more likely to report having difficulty eating certain foods (95% CI: 1.1, 7.1). When the sample of females between the ages of 14 and 18 was analyzed, the Invisalign group reported feeling attractive more often than the fixed appliance group. CONCLUSIONS: Both treatment groups were generally very satisfied with their treatment modality. The overall quality of life of adolescent orthodontic patients undergoing treatment with fixed appliances and Invisalign for a minimum of 6 months was similar.

Patterns of Functional Impairment over Time Amongst Older Men-the Manitoba Follow-up Study.

BACKGROUND: To determine the incidence and prevalence patterns of activity of daily living (ADL) impairments in ageing men. METHODS: 3,983 men were enrolled in the Manitoba Follow-up Study (MFUS) cohort study in 1948. From 1996 onwards, functional status was measured. We classified basic (BADL) and instrumental (IADL) into mutually exclusive categories as a time dependant factor after the second survey wave as: First survey response; no limitation; incident (first episode of disability); persistent (limitation which was seen on all questionnaires after the incident episode); resilient (noted in previous surveys but not present); and recurrent (noted in present survey, and limitations noted as present and absent in previous surveys). RESULTS: There were 1,745 participants in 1996 at a mean age of 76 years. Incident BADL limitations increased substantially with age: from 1% at age 75 to 15% at age 95. Similarly, persistent limitations increased with age: from 0.4% at age 75 to 18% at age 95. However, BADL function was fluid, with many individuals grouped within the resilient and recurrent patterns. Similar age effects and variability were noted in IADLs. CONCLUSION: New and persistent disabilities are highly associated with age. However, there is considerable change in functional status over time.

Healthcare utilisation among Canadian adults in rural and urban areas - The Canadian Longitudinal Study on Aging.

OBJECTIVE: The objective is to determine the use of health-care services (physician visits, emergency department use and hospitalisations) in rural areas and examine differences in four geographic areas on a rural to urban spectrum. METHODS: We conducted a secondary analysis of cross-sectional data from a population-based prospective cohort study, the Canadian Longitudinal Study on Aging (CLSA). Participants included community-dwelling adults aged 45-85 years old from the tracking cohort of the CLSA (n = 21,241). Rurality was classified based on definitions from the CLSA sampling frame and similar to the 2006 census. Main outcome measures included self-reported family physician and specialist visits, emergency department visits and hospitalisations within the previous 12 months. Results were compared for four geographic areas on a rural-urban continuum. Univariate and bivariate analyses were performed on data from the 'tracking cohort' of the CLSA, Chi-square tests were used for categorical variables. Logistic regression models were created for the main outcome measures. RESULTS: Participants in rural and mixed rural and urban areas were less likely to have seen a family physician or a specialist physician compared to urban areas. Those living in rural and peri-urban areas were more likely to visit an emergency department compared to urban areas. These differences persisted after adjusting for sociodemographic and health-related variables. There were no significant rural-urban differences in hospitalisations. CONCLUSION: Rural-urban differences were found in visits to family physicians, specialists and emergency departments.

Objectif: Déterminer l'utilisation des services de santé (consultations chez un médecin, visites à l'urgence et hospitalisations) dans les régions rurales et examiner les différences dans 4 régions géographiques sur un spectre rural-urbain. Méthodologie: Nous avons réalisé une analyse secondaire des données transversales tirées d'une étude de cohorte prospective de population, l'étude CLSA (Canadian Longitudinal Study on Aging). La population était composée d'adultes vivant en communauté de 45 à 85 ans ayant participé à la cohorte de suivi de l'étude CLSA (N = 21 241). La ruralité était classée en fonction des définitions du cadre d'échantillonnage de l'étude CLSA et était semblable au recensement de 2006. Les principaux paramètres d'évaluation étaient les consultations rapportées par les patients chez un médecin de famille et un spécialiste, les visites à l'urgence et les hospitalisations durant les 12 mois précédents. Les résultats ont été comparés sur un continuum rural-urbain dans 4 régions géographiques. Des analyses univariées et bivariées ont été réalisées sur les données de la " cohorte de suivi " de l'étude CLSA, les tests de chi carré ont été utilisés pour les variables catégoriques. Des modèles de régression logistique ont été créés pour les principaux paramètres d'évaluation. Résultats: Les participants des régions rurales et mixtes rurales-urbaines avaient moins tendance à avoir vu un médecin de famille ou un spécialiste comparativement aux participants des régions urbaines. Les sujets des régions rurales et périurbaines avaient plus tendance à s'être rendus à l'urgence comparativement aux sujets des régions urbaines. Ces différences ont persisté après ajustement en fonction des variables sociodémographiques et liées à la santé. On n'a observé aucune différence significative des hospitalisations entre les régions rurales et urbaines. Conclusion: Des différences entre les régions rurales et urbaines ont été observées pour les consultations aux médecins de famille et aux spécialistes, et les visites à l'urgence. Mots-clés: Canadian Longitudinal Study on Aging, disparités rurales-urbaines, visites chez le médecin, hospitalisations, utilisation des soins de santé.

Multimorbidity in Canadians living in the community: Results from the Canadian Longitudinal Study of Aging.

OBJECTIVE: To determine the mean number of chronic diseases in Canadians aged 45 to 85 years who are living in the community, and to characterize the association of multimorbidity with age, sex, and social position. DESIGN: An analysis of data from the Canadian Longitudinal Study on Aging. The number of self-reported chronic diseases was summed, and then the mean number of chronic health problems was standardized to the 2011 Canadian population. Analyses were conducted stratified on sex, age, individual income, household income, and education level. SETTING: Canada. PARTICIPANTS: A total of 21 241 community-living Canadians aged 45 to 85 years. MAIN OUTCOME MEASURES: Overall, 31 chronic diseases (self-reported from a list) were considered, as were risk factors that were not mental health conditions or acute in nature. Age, sex, education, and household and individual incomes were also self-reported. RESULTS: Multimorbidity was common, and the mean number of chronic illnesses was 3.1. Women had a higher number of chronic illnesses than men. Those with lower income and less education had more chronic conditions. The number of chronic conditions was strongly associated with age. The mean number of conditions was 2.1 in those aged 45 to 54; 2.9 in those 55 to 64; 3.8 in those aged 65 to 74, and 4.8 in those aged 75 and older (P < .05, ANOVA [analysis of variance]). CONCLUSION: Multimorbidity is common in the Canadian population and is strongly related to age.

Chronic Liver Disease and Metabolic Comorbidities in Healthy Young Males Followed for 65 Years: The Manitoba Follow-up Study.

BACKGROUND & AIMS: The prevalence of chronic liver disease (CLD) is largely derived from cross-sectional epidemiologic surveys. The goal of this long-term, prospective study was to document the lifetime risk of developing chronic liver disease and determine the impact of common metabolic conditions associated with metabolic syndrome (MetS) on the development and outcomes of CLD. METHODS: 3,983 air force men were enrolled in the Manitoba Follow-up Study in 1948. The comprehensive database on results of routine physicals and health encounters was examined for evidence of CLD and MetS. The joint relationship between CLD and components of MetS on mortality was examined using Cox proportional hazard model. RESULTS: In 65 follow-up years, 5.2% of men developed CLD and 6.4% MetS. Hypertension was the strongest predictor of CLD (HR 2.958, 95% CI - 2.065 to 4.236, p < .0001), followed by insulin resistance /diabetes mellitus (IR/DM) (2.008, 95% CI - 1.332 to 3.027, p = .0009) and obesity (1.958, 95% CI - 1.419 to 2.703, p < .0001). Relative to men without MetS comorbidities, an increasing gradient of risk for CLD was apparent with increasing numbers of MetS components; the HR of 3.67, 5.97 and 14.3 for IR/DM, IR/DM + one component, and IR/DM + two or more components respectively. The relative risk of mortality in men with vs. without CLD was 3.33 (95% CI - 2.83 to 3.91, p < .0001) and 1.505 (95% CI - 1.31 to 1.73, p < .0001) in men with vs. without MetS. CONCLUSIONS: CLD and MetS independently increase the relative risk of mortality; the magnitude of the effect is greater in CLD.

Associations between concussion and risk of diagnosis of psychological and neurological disorders: a retrospective population-based cohort study.

OBJECTIVE: To investigate associations between concussion and the risk of follow-up diagnoses of attention-deficit hyperactivity disorder (ADHD), mood and anxiety disorders (MADs), dementia and Parkinson's disease. DESIGN: A retrospective population-based cohort study. SETTING: Administrative health data for the Province of Manitoba between 1990-1991 and 2014-2015. PARTICIPANTS: A total of 47 483 individuals were diagnosed with a concussion using International Classification of Diseases (ICD) codes (ICD-9-CM: 850; ICD-10-CA: S06.0). All concussed subjects were matched with healthy controls at a 3:1 ratio based on age, sex and geographical location. Associations between concussion and conditions of interest diagnosed later in life were assessed using a stratified Cox proportional hazards regression model, with adjustments for socioeconomic status and pre-existing medical conditions. RESULTS: 28 021 men (mean age ±SD, 25±18 years) and 19 462 women (30±21 years) were included in the concussion group, while 81 871 men (25±18 years) and 57 159 women (30±21 years) were included in the matched control group. Concussion was associated with adjusted hazard ratios of 1.39 (95% CI 1.32 to 1.46, p<0.001) for ADHD, 1.72 (95% CI 1.69 to 1.76; p<0.001) for MADs, 1.72 (95% CI 1.61 to 1.84; p<0.001) for dementia and 1.57 (95% CI 1.41 to 1.75; p<0.001) for Parkinson's disease. CONCLUSION: Concussion was associated with an increased risk of diagnosis for all four conditions of interest later in life.

Exploring ethno-cultural variations in how older Canadians define healthy aging: The Canadian Longitudinal Study on Aging (CLSA).

An understanding of how older adults conceptualize healthy aging is important for the development of policies, programs, and services designed to promote health; this understanding must reflect the ethno-cultural diversity of the population. This pilot study aimed to examine Canadians' definitions of healthy aging and ethno-cultural variations in these definitions. The baseline data for a sub-sample (n = 535) of the Canadian Longitudinal Study on Aging (CLSA) Tracking Cohort (n = 21,241) were examined. Narrative responses to an open-ended question on healthy aging were analyzed using a previously developed coding system. The most common themes for all the ethno-cultural groups were "lifestyle", "physical activity", and "attitude"; other themes varied by ethno-cultural background. These findings demonstrate that older Canadians from various ethno-cultural backgrounds define healthy aging differently. These variations must be taken into consideration for developing culturally sensitive programs to promote healthy aging among all Canadians. Theorizing on healthy (or 'successful') aging must envision it as a subjective and multidimensional concept.

Self-Rated Health Predicts Mortality in Very Old Men-the Manitoba Follow-Up Study.

BACKGROUND: Self-rated health (SRH) predicts death, but there are few studies over long-time horizons that are able to explore the effect age may have on the relationship between SRH and mortality. OBJECTIVES: 1. To determine how SRH evolves over 20 years; and 2. To determine if SRH predicts death in very old men. METHODS: We analyzed a prospective cohort study of men who were fit for air crew training in the Second World War. In 1996, a regular questionnaire was administered to the 1,779 surviving participants. SRH was elicited with a 5-point Likert Scale with the categories: excellent, very good, good, fair and poor/bad. We examined the age-specific distribution of SRH in these categories from the age of 75 to 95 years, to the end of the follow-up period in 2018. We constructed age-specific Cox proportional hazard models with an outcome of time to death. RESULTS: SRH declined with age. The gradient in risk of death persisted across all ages; those with poor/fair/bad SRH had consistently higher mortality rates. However, the discrimination between good and excellent was less in those aged 85+. CONCLUSIONS: SRH declines with advancing age, but continues to predict death in older men.