How Were Wait Times for Priority Procedures in Canada Impacted during the First Six Months of the COVID-19 Pandemic?

In 2020, health systems across Canada responded to the COVID-19 pandemic by making rapid changes to reduce the risk of exposure for patients and staff and to allocate resources toward the treatment of COVID-19 patients. This included postponing surgical and diagnostic procedures. Data collected by the Canadian Institute for Health Information show that these interventions resulted in longer wait times across all provinces in April-September 2020 for scheduled surgical procedures, such as hip and knee replacements and cataract surgeries. The impact on wait times for cancer surgeries and diagnostic imaging varied by type of procedure and jurisdiction, while the wait times for hip fracture repair and radiation therapy were not impacted. Subsequent waves of the COVID-19 pandemic added to the initial backlog of procedures, and it will take time to assess the long-term impact of surgical and diagnostic imaging delays on patient outcomes and wait times.

Hospital Stays for Harm Caused by Substance Use among Youth in Canada.

The rise in harms associated with misuse of substances such as cannabis, alcohol and opioids is a public health issue gaining increasing importance in Canada. Taking a closer look at who is being hospitalized, and for which substances, helps inform efforts to improve access to services for youth. Between 2017 and 2018, hospitalizations for harm caused by substance use accounted for about one in 20 of all hospital stays among youths aged 10-24 years in Canada. Cannabis use was documented in nearly 40% of these hospitalizations, while alcohol was associated with 26%. Approximately one in every six youths (17%), who were hospitalized for harm caused by substance use, was hospitalized more than once for substance use within the same year.

Comparing individual and area-based income measures: impact on analysis of inequality in smoking, obesity, and diabetes rates in Canadians 2003-2013.

OBJECTIVES: The aims of this study were to examine (1) the concordance between income measured at the individual and area-based level and (2) the impact of using each measure of income on inequality estimates for three health indicators-the prevalence, respectively, of diabetes, smoking, and obesity. METHODS: Data for the health indicators and individual income among adults came from six cycles of the Canadian Community Health Survey (cycles 2003 through 2013). Area-based income was obtained by linking respondents' residential postal codes to neighbourhood income quintiles derived from the 2006 Canadian census. Relative and absolute inequality between the lowest and highest income quintiles for each measure was assessed using rate ratios and rate differences, respectively. RESULTS: Concordance between the two income measures was poor in the overall sample (weighted Kappa estimates ranged from 0.19 to 0.21 for all years), and for the subset of participants reporting diabetes, smoking, or obesity. Despite the poor concordance, both individual and area-based income measures identified generally comparable levels of relative and absolute inequality in the rates of diabetes, smoking, and obesity over the 10-year study period. CONCLUSION: The results of this study show that individual and area-based income measures categorize Canadians differently according to income quintile, yet both measures reveal striking income-related inequalities in rates of diabetes and smoking, and obesity among women. This suggests that either individual or area-level measures can be used to monitor income-related health inequalities in Canada; however, whenever possible, it is informative to consider both measures since they likely represent distinct social constructs.

The Second National Sun Survey: overview and methods.

The Second National Sun Survey (NSS2) was carried out in 2006 to estimate ultraviolet radiation (UVR) exposure, sun protection and related knowledge, attitudes and beliefs among Canadians. This paper provides a detailed overview of NSS2 methods and discusses the strengths and limitations of the survey. The NSS2 consists of two questionnaires administered to two samples of adults (age 16+ years). The base sample provides in-depth information on UVR exposure, protective behaviours, tanning, and knowledge, attitudes and beliefs about sun safety for adults, as well as some sun behaviour information for a sample of their children aged 1-12 years. The shorter comparison sample facilitates direct comparison with the 1996 first national sun survey. Data were collected using computer-assisted telephone interviewing, and sample weights were computed for all respondents for estimation and analysis of both adult and child data. Base sample interviews were completed for 7,121 adults, of whom 1,437 reported on the sun behaviour of one of their children, and the comparison sample yielded 2,115 interviews. Response rates were 63% for both surveys. The NSS2 provides in-depth and up-to-date UVR exposure information among Canadians. The results of this survey will aid health promotion experts and policy-makers in developing effective programs to minimize UVR exposure. A public use data file and training in statistical analysis of the NSS2 has been made available to data analysts from across Canada. Key strengths and limitations identified in this survey will inform the development and implementation of future sun surveys.

Work-time sun behaviours among Canadian outdoor workers: results from the 2006 National Sun Survey.

The objective of the study was to describe summer work-related sun behaviours among Canadian outdoor workers. Information on time in the sun and sun protection practices at work during the summer of 2006 were collected from 1,337 outdoor workers aged 16-64 years as part of the Second National Sun Survey. Proportions (and 95% confidence intervals) were estimated using procedures appropriate for complex survey designs. Twenty-six percent of all Canadians, 39% of males and 33% of those aged 16-24 years work outdoors during the summer. Although 41% spend four or more hours daily in the sun at work, just over half always or often protect themselves by covering their heads (58%), wearing protective clothing (56%) or wearing sunglasses (54%), and only 29% use sunscreen. Males and those aged 16-24 spend the most work time in the sun but are the least likely to use protection. The prevalence of outdoor work and sun behaviours varies among regions. Study findings confirm the need for strategies to reduce time in the sun and increase the use of sun protection among outdoor workers. In order to be effective, these strategies must include both enhanced workplace policies and practice, and increased individual use of sun protection.

Sun behaviour in Canadian children: results of the 2006 National Sun Survey.

Childhood sun exposure is a particularly important determinant of skin cancer, yet little data are available for children. This paper describes sun behaviour among Canadian children for the summer of 2006. As part of the Second National Sun Survey (NSS2), 1,437 parents reported on the time spent in the sun, and the frequency of sun protection behaviours and sunburning for one of their children aged 1 to 12 years. Analysis was carried out using complex survey procedures in SAS and STATA. The majority of children (94%) spend at least 30 minutes in the sun on a typical summer day; however, regular sun protection is only commonly reported for young children (1 to 5 years) and involves covering their heads and wearing sunscreen (85%). The frequency of other protective behaviours is much lower, and sun protection decreases with age. Older children are also twice as likely to spend extended time in the sun and to get a sunburn. Among older children, boys are more likely to cover their heads and girls are more likely to wear sunscreen. Regular sun protection among Canadian children is low, given their sun exposure. Heavy reliance on sunscreen is consistent with previous reports and indicates that other measures, such as seeking shade and wearing protective clothing, need to be promoted. Riskier sun behaviour among older children may reflect decreased parental control, as well as changing attitudes and peer pressure, and highlights the importance of adult role models and targeted interventions for this age group.

Filing for workers' compensation among Ontario cases of mesothelioma.

BACKGROUND/OBJECTIVE: For many types of cancer, disease attribution to occupational exposures is difficult. Mesothelioma, however, is a 'sentinel' occupational cancer associated with asbestos exposure. The present study linked workers' compensation claims data with cancer registry data to explore the completeness of reporting of mesothelioma to the Ontario Workplace Safety and Insurance Board (WSIB) according to characteristics of cases diagnosed among Ontario residents. METHODS: Two data sources were linked at the person level: the WSIB Occupational Disease Information and Surveillance System and the Ontario Cancer Registry. Filing rates were calculated as the proportion of Ontario Cancer Registry mesothelioma cases (International Classification of Diseases - Oncology code 905) that linked to a WSIB-filed cancer claim. Filing rates were calculated for the period 1980 to 2002, and trends were calculated by year, age and county of residence at diagnosis. RESULTS: The filing rate for compensation has increased little over the past 20 years, reaching a high of 43% in 2000. Overall, filing rates were highest among pleural mesothelioma cases among men (range 27% to 57%). Filing rates were highest among individuals 50 to 59 years of age and declined substantially throughout the retirement years. There was substantial variation in filing rates by area of residence, with the highest rate being in Lambton County, Ontario. CONCLUSION: The filing rate for compensation in Ontario was much lower than the estimated proportion of cases eligible for compensation. The increased filing rate in Lambton County was likely related to this community's awareness of the association between asbestos and mesothelioma. Physicians can play an important role in educating patients of their potential entitlement to compensation benefits.

Trends and characteristics of compensated occupational cancer in Ontario, Canada, 1937-2003.

BACKGROUND: In Canada, administrative databases maintained by provincial workers' compensation boards are often the best or the only available data source for describing trends and characteristics of occupational cancer. In Ontario, approximately 75% of the labor force is covered by the Ontario Workplace Safety and Insurance Board (WSIB) and allowed cancer claims date back to 1937. METHODS: The purpose of this study was to describe WSIB-allowed cancer claims by worker demographics, claim characteristics, year of filing, cancer type, and work exposure measures including workplace agent, occupation and industry. RESULTS: In total, claims were filed and compensated for one or more malignant neoplasms by, or on behalf of, 3,126 workers between 1937 and 2003. CONCLUSIONS: Results show trends in cancer compensation reflecting changes in the characteristics and prevalence of workers exposed to workplace carcinogens, as well as changes to WSIB adjudication policies over time.