Hospitalization related to chronic hepatitis B and C in recent immigrants in Canada: An immigration administrative data-linked, population-based cohort study.

Background: Canadian immigrants from countries where the hepatitis B virus (HBV) and hepatitis C virus (HCV) are endemic may be at higher risk of liver-related disease than Canadian-born residents. This study compared HBV- and HCV-related hospitalizations in Canadian immigrants (arriving from 1980 to 2013) and long-term residents (Canadian-born population and pre-1980 immigrants) and aimed to describe the burden of disease in both groups. Methods: Based on the 2004/2005-to-2013/2014 hospital Discharge Abstract Database linked to the 1980-to-2013 Longitudinal Immigration Database, this descriptive cross-sectional study examined the distribution of HBV- and HCV-related hospitalizations, lengths of stay, comorbidities, and sequelae incurred by immigrants and long-term residents in Canada. With a linkage rate of 85%, 5,854,949 immigrants were included in the study. Proportions of HBV- and HCV-related hospitalizations attributable to immigrants were calculated. Results: By birth country risk level, 22% of HBV-related hospital events among recent immigrants, and 20% of those related to HCV, were among people from high-risk countries. Proportionally, fewer immigrants had comorbidities than long-term residents. The top two hospital-related sequelae in both groups were cirrhosis and ascites, and liver cancer. While immigrants made up 16% of the Canadian population, they incurred 37% of HBV-related hospitalizations and 9% of HCV-related hospitalizations, giving ratios of hepatitis-related hospitalizations relative to the population share of 2.3 (95% confidence interval [CI]: 2.2 to 2.5) and 0.5 (95% CI: 0.5 to 0.6) respectively. These ratios were higher among seniors, at 4.4 (95% CI: 3.9 to 4.9) and 2.3 (95% CI: 1.9 to 2.6), respectively. Interpretation: Immigrants can require hospitalization for hepatitis in Canada, especially for HBV. These results may inform health screening for HBV or HCV in the Canadian immigration context.

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.

Use of medication and psychological counselling among Canadians with mood and/or anxiety disorders. / Recours aux médicaments et aux consultations psychologiques chez les Canadiens atteints d'un trouble de l'humeur et/ou d'anxiété.

INTRODUCTION: This study describes the use of prescription medications and psychological counselling in the past 12 months among Canadian adults with a self-reported mood and/or anxiety disorder diagnosis; the sociodemographic and clinical characteristics associated with their use; and reasons for not using them. METHODS: We used data from the 2014 Survey on Living with Chronic Diseases in Canada-Mood and Anxiety Disorders Component. The study sample (n = 2916) was divided into four treatment subgroups: (1) taking medication only; (2) having received counselling only; (3) both; or (4) neither. We combined the first three subgroups and carried out descriptive and multivariate logistic regression analyses comparing those who are taking medication and/or have received counselling in the past 12 months, versus those doing neither. Estimates were weighted to represent the Canadian adult household population living in the 10 provinces with diagnosed mood and/or anxiety disorders. RESULTS: The majority (81.8%) of Canadians with a mood and/or an anxiety disorder diagnosis reported they are taking medications and/or have received counselling (47.6% taking medications only; 6.9% received counselling only; and 27.3% taking/having received both). Upon controlling for individual characteristics, taking medications and/or having received counselling was significantly associated with older age; higher household income; living in the Atlantic region or Quebec versus Ontario; and having concurrent disorders or mood disorders only. Symptoms controlled without medication was the most common reason for not taking medications, while preferring to manage on their own and taking medications were among the common reasons for not having received counselling. CONCLUSION: The majority of Canadian adults with a mood and/or an anxiety disorder diagnosis are taking medications, while few have received counselling. Insights gained regarding the factors associated with these treatments, and reasons for not using them, emphasize the importance of discussing treatment options and perceived barriers with patients to ensure they receive the best treatment according to their needs and preference.

INTRODUCTION: L'étude décrit le recours aux médicaments sur ordonnance et aux consultations psychologiques au cours des 12 derniers mois chez les Canadiens adultes ayant déclaré avoir reçu un diagnostic de trouble de l'humeur et/ou d'anxiété, les caractéristiques sociodémographiques et cliniques associées à ce recours et les raisons invoquées pour ne pas y recourir. MÉTHODOLOGIE: L'Enquête sur les personnes ayant une maladie chronique au Canada ­ Composante sur les troubles de l'humeur et d'anxiété de 2014 a été utilisée. L'échantillon de l'étude (n = 2 916) a été divisé en quatre sous-groupes de traitement : (1) prend des médicaments seulement; (2) a reçu des consultations psychologiques seulement; (3) prend des médicaments et a reçu des consultations psychologiques; ou (4) n'a eu recours à aucun de ces deux traitements. Nous avons combiné les trois premiers sous-groupes et effectué des analyses descriptives et de régression logistique multivariée pour comparer ceux qui prenaient des médicaments et/ou avaient reçu des consultations psychologiques par rapport à ceux n'ayant pas eu recours à ces deux traitements. Nous avons pondéré toutes les estimations afin que les données soient représentatives de la population canadienne adulte vivant en logement privé dans l'une des 10 provinces et ayant déclaré avoir reçu un diagnostic de troubles de l'humeur et/ou d'anxiété. RÉSULTATS: La majorité (81,8 %) des Canadiens adultes ayant déclaré avoir reçu un diagnostic de trouble de l'humeur et/ou d'anxiété ont indiqué prendre des médicaments et/ou avoir reçu des consultations psychologiques (47,6 % prenaient des médicaments seulement, 6,9 % avaient reçu des consultations psychologiques seulement et 27,3 % avaient eu recours aux deux modalités de traitement). Après ajustement des caractéristiques individuelles, le recours aux médicaments et/ou aux consultations psychologiques était significativement associé à un âge plus avancé, à un revenu du ménage plus élevé, à une résidence dans la région de l'Atlantique ou au Québec et à un trouble de l'humeur et d'anxiété concomitants ou à un trouble de l'humeur seulement. Le contrôle des symptômes sans l'utilisation de médicaments était la raison le plus souvent invoquée pour ne pas prendre de médicaments, et le désir de se débrouiller seul et la prise de médicaments figuraient parmi les raisons le plus souvent citées pour ne pas avoir bénéficié de consultations psychologiques. CONCLUSION: La majorité des Canadiens adultes atteints d'un trouble de l'humeur et/ou d'anxiété diagnostiqué prenaient des médicaments, mais une moins grande proportion d'entre eux avaient reçu des consultations psychologiques. En dégageant les facteurs associés au recours à ces traitements et les raisons invoquées pour ne pas y recourir, cette étude met en lumière l'importance de discuter avec les patients des options de traitement et des obstacles perçus afin d'offrir un traitement adapté à leurs besoins et leurs préférences.