Hypertension associated with hearing health problems among Canadian adults aged 19 to 79 years.

BACKGROUND: Hypertension is a common condition experienced by close to one-quarter of the adult population in Canada. There is evidence that this condition or the medications used to treat it may lead to hearing health problems (defined in this study as having hearing loss, tinnitus or both conditions). DATA AND METHODS: Data from the Canadian Health Measures Survey from 2012 to 2015 were used to estimate the prevalence of hypertension and hearing health problems for individuals aged 19 to 79 years (n=6,198). Data from cycles 3 (n=3,072) and 4 (n=3,126) were combined. The relationship of hypertension to hearing health problems was assessed with multivariate logistic regression. RESULTS: An estimated 40% of the adult population were free of hearing health problems, while the remaining 60% had either hearing loss (23%), tinnitus (22%) or both conditions (14%); 22% of the adult population had hypertension. Hearing health problems were significantly more prevalent among adults with hypertension (79%) than among those without hypertension (54%). Hypertension was associated with greater odds of hearing health problems in both males (adjusted odds ratio [AOR]=1.7) and females (AOR=1.6), even after accounting for age, sociodemographic, health-related and noise exposure variables. INTERPRETATION: This study adds to the body of evidence that identifies hypertension as a potentially modifiable risk factor for hearing loss and tinnitus. Males and females with hypertension had a higher risk of experiencing hearing health problems, demonstrating the importance of screening those with hypertension for hearing health.

Association of frailty and pre-frailty with increased risk of mortality among older Canadians.

BACKGROUND: Frailty is a complex syndrome that is associated with aging but not synonymous with the normal aging process. It has been associated with all-cause mortality, but less is known about frailty and mortality from specific causes. DATA AND METHODS: Data from the 2013 and 2014 Canadian Community Health Survey (CCHS) linked to the Canadian Vital Statistics - Death Database were used to estimate the prevalence of frailty among Canadians aged 65 or older. Levels of frailty were based on validated cut-points for the 30-item frailty index. The relationship of frailty to mortality risk during the period of three to five years following the CCHS interview was assessed with Cox proportional hazards models adjusted for sociodemographic factors and health behaviours. Associations between frailty and mortality from neoplasms, circulatory diseases and disease of the respiratory system were examined in separate models. RESULTS: An estimated 1.1 million (22%) community-dwelling older adults were frail in 2013 and 2014, and another 1.6 million (32%) were considered pre-frail. Frailty was more common among females than males and among those in older age groups. The risk of mortality increased significantly with increasing levels of frailty, even after accounting for sociodemographic factors and health behaviours. This was the case for all-cause mortality, as well as for death from three major underlying causes-neoplasms, and diseases of the circulatory and respiratory systems. DISCUSSION: Even individuals who were classified as pre-frail had an increased risk of mortality overall and from three leading causes compared with those who were robust, demonstrating the importance of screening community-dwelling older adults for frailty.

Prescription medication use among Canadian children and youth, 2012 to 2017.

BACKGROUND: Prescription medications are used throughout the life course, including among children and youth. Prescribing practices may be influenced by emerging medical conditions, the availability of new medications, changing clinical practices, and evolving knowledge of the safety and effectiveness of medications. The Canadian Health Measures Survey (CHMS) provides national-level information to help monitor the use of prescribed medications in the population. DATA AND METHODS: Based on data from the CHMS (2012 to 2017), this article describes prescription medication use in the past month among those aged 3 to 19 years. Information on up to 45 prescription medications was recorded and classified according to Health Canada's Anatomical Therapeutic Chemical classification. Frequencies and bivariate analyses examined medication use by sociodemographic and health-related factors. The most common medication classes were identified for each age group. RESULTS: An estimated 23% of Canadian children and youth (1.5 million) had used at least one prescription medication in the past month and 9% had used two or more prescription medications.Prescription medication use was more common among those who reported lower levels of general and mental health, as well as among those with asthma (51%), a mood disorder (71%), attention deficit disorder (60%) or a learning disability (43%). Medications for the respiratory and nervous systems were among those most commonly prescribed. Of youth aged 14 years or older, 4% had misused prescription medications for non-medicinal purposes, for the experience, for the feeling they cause or to get high. DISCUSSION: Prescription medication use among children and youth is common in Canada. It is associated with lower levels of self-reported health and the presence of chronic conditions. The estimates provide a benchmark to help monitor prescription drug use in Canada.

Social isolation and mortality among Canadian seniors.

BACKGROUND: Subjective and objective measures of isolation have been associated with increased risk of mortality in many studies, and some have found differential effects. DATA AND METHODS: Canadian Community Health Survey-Healthy Aging data (2008/2009) linked to the Canadian Vital Statistics-Death Database were used to estimate the prevalence of social isolation measured objectively (low social participation) and subjectively (feelings of loneliness and weak sense of community belonging). Associations with death during the 8 to 9 year follow-up period were examined with multivariate Cox proportional hazards models controlling for sociodemographic and health-related characteristics. Structural equation models (SEM) examined direct paths with survival time and indirect effects through health status controlling for covariates that were significant in the Cox models. Analyses were stratified by sex. RESULTS: An estimated 525,000 people (12%) aged 65 or older felt socially isolated and over 1 million (1,018,000) (24%) reported low participation. In multivariate Cox models, low participation was significantly associated with death for men and women even when the potential confounding effects of subjective isolation, socio-demographic characteristics, health status, and health behaviours were considered. Subjective isolation was not associated with death in final multivariate models for men or women. SEM revealed significant associations between low participation and survival time for men and women. In addition to the direct effects, there were significant indirect effects mediated by health status. There were no direct effects of subjective isolation on survival for men or women, only indirect effects mediated through health status. DISCUSSION: Subjective and objective isolation differed in their association with mortality.

Health-related concerns and precautions during the COVID-19 pandemic: A comparison of Canadians with and without underlying health conditions.

BACKGROUND: The risk of experiencing adverse outcomes from the coronavirus disease 2019 (COVID-19), such as hospitalization, admission to intensive care units and death, is elevated for older individuals and those with certain underlying health conditions including diabetes, chronic conditions affecting lungs, heart or kidneys, and a compromised immune system. DATA AND METHODS: Data collected between March 29 and April 3, 2020 from the Canadian Perspectives Survey Series 1: Impacts of COVID-19 (n=4,627) were used to estimate the prevalence of underlying health conditions, health concerns and precautionary behaviours among Canadians aged 15 or older living in the provinces. Multivariate analyses examined associations between these variables after accounting for age, sex and education. RESULTS: Close to 1 in 4 Canadians (24%) had an underlying health condition that increased their risk of adverse outcomes from COVID-19. Overall, 36% of the population were very or extremely concerned about the impact of COVID-19 on their own health. Individuals with underlying health conditions had higher odds (odds ratio: 2.0, 95% confidence interval: 1.6 to 2.5) of being highly concerned than those without these conditions, after adjustment for demographic characteristics. High percentages of Canadians took precautions to reduce the risk of infection regardless of whether or not they had underlying health conditions. DISCUSSION: Health status was associated with higher levels of concern for one's own health in the early period of the COVID-19 pandemic. Most Canadians were taking precautions recommended by public health authorities to protect themselves and others.

Unperceived hearing loss among Canadians aged 40 to 79.

BACKGROUND: People with audiometrically measured hearing loss do not always self-report a hearing impairment. DATA AND METHODS: Data were collected from 2012 through 2015 as part of the Canadian Health Measures Survey. The study sample was composed of respondents aged 40 to 79 with valid audiometric results for both ears (n = 3,964). Unperceived hearing loss was defined by four criteria: audiometrically measured hearing loss, no self-reported hearing impairment, no hearing aid(s) and no history of a hearing problem diagnosis. RESULTS: Of the 8.2 million older adults with measured high-frequency hearing loss, an estimated 77% (6.3 million) had hearing loss that was unperceived. Individuals who had never worked in a noisy environment were more likely to have unperceived hearing loss. People who had experienced tinnitus were less likely than others to have unperceived hearing loss. DISCUSSION: Unperceived hearing loss occurs more often among those with mild or unilateral hearing loss and those who may not expect to experience hearing loss. Regular screening has been proposed to help raise awareness about hearing loss and to promote earlier detection and intervention that may ultimately improve the quality of life of those experiencing diminished hearing acuity.

Infant bed sharing in Canada.

BACKGROUND: There is debate about the practice of bed sharing, which is defined as sharing a sleep surface with an infant. Most public health guidance in Canada, including the 2011 Joint Statement on Safe Sleep, advises parents against it because of an association with infant injury and death. However, proponents cite potential physical and psychological benefits, and evidence suggests that the risks associated with bed sharing are low in the absence of other risk factors. Until now, little has been known about the prevalence of and reasons for bed sharing in Canada. DATA AND METHODS: Canadian Community Health Survey data from 2015 and 2016 were used to estimate the prevalence of and reasons for bed sharing by selected characteristics among women aged 15 to 55 who had given birth in the past five years. Multivariate analysis examined factors independently associated with frequent bed sharing. RESULTS: An estimated 33% of women reported that their infant had frequently (every day or almost every day) shared a sleep surface with someone else; 27% had bed shared occasionally (once or twice a week, a few times a month or less than once a month) and 40% had never bed shared. Breastfeeding was the most common reason for bed sharing (39%), followed by facilitating the mother's or infant's sleep (29%). In multivariate analysis, age group, marital status, province or territory of residence, region of mother's birth and breastfeeding were significantly associated with frequent bed sharing. DISCUSSION: The data indicate that bed sharing is relatively common and suggest that parents are doing it for practical reasons. The results of this study will provide baseline data and inform policies and programs related to safe sleep practices.

Tinnitus in Canada.

BACKGROUND: Tinnitus, which has no cure, can be a temporary irritant or a life-altering condition. Many factors can precipitate tinnitus, including hearing loss, exposure to loud noise and other otologic causes, neurological injuries or disease, dental disorders, some medications, and certain infectious diseases. This study summarizes new tinnitus data from the Canadian Health Measures Survey (CHMS). DATA AND METHODS: Data were collected for individuals aged 19 to 79 years (n=6,571) from 2012 through 2015 as part of the CHMS. Tinnitus is described as "the presence of hissing, buzzing, ringing, rushing or roaring sounds in your ears when there is no other sound around you." Bothersome tinnitus refers to tinnitus affecting sleep, concentration or mood. Factors associated with tinnitus were examined using bivariate and logistic regression analyses. RESULTS: An estimated 37% of adult Canadians (9.2 million) had experienced tinnitus in the past year; it was bothersome for 7% of the population. Individuals aged 19 to 29 were significantly more likely to have past-year tinnitus (46%) than those aged 30 to 49 (33%) and 50 to 70 (35%). Tinnitus was associated with poor self-reported mental health, mood disorder, a weak sense of community belonging, high daily stress and poor quality sleep. People with hearing loss and tinnitus were twice as likely as those with hearing loss alone to use hearing aids, at 11% compared with 5% respectively. DISCUSSION: Tinnitus is a common condition among Canadian adults. Recent exposure to loud noise may contribute to the higher prevalence of past-year tinnitus at younger ages. Canadians could benefit from greater awareness of tinnitus, prevention strategies and management options.

Canadians vulnerable to workplace noise.

BACKGROUND: Health and safety legislation is designed to protect workers from hazards, including excessive noise. However, some workers are not required to use hearing protection when exposed to loud noise and may be vulnerable to adverse outcomes, including hearing difficulties and tinnitus. DATA AND METHODS: Data for 19- to 79-year-olds (n=6,571) were collected from 2012 through 2015 as part of the Canadian Health Measures Survey. People exposed to loud workplace noise were defined as those who had to raise their voices to communicate at arm's length. Vulnerable workers were defined as those who were not required to use hearing protection when working in noisy environments and who only used hearing protection sometimes, rarely or never. RESULTS: An estimated 11 million Canadians (43%) have worked in noisy environments, and over 6 million of them (56%) were classified as vulnerable to workplace noise. Although the percentage of vulnerable women (72%) was greater than that of men (48%), men outnumbered women in these circumstances at 3.7 million, compared with 2.4 million. The self-employed were more likely than employees to be vulnerable, as were those in white-collar versus blue-collar occupations. Vulnerable workers were more likely to report hearing difficulties and tinnitus than those who had never worked in a noisy environment. DISCUSSION: A large percentage of workers exposed to noisy workplaces were vulnerable because hearing protection was neither required nor routinely used. Further work is required to assess whether this reflects gaps in health and safety legislation or its implementation.

Multiple sclerosis: Prevalence and impact.

This article provides new information about multiple sclerosis (MS) using the 2010/2011 Neurological Conditions Prevalence File, the 2011/2012 Survey of Neurological Conditions in Institutions in Canada, and the 2011 Survey on Living with Neurological Conditions in Canada. An estimated 93,500 Canadians living in private households and 3,800 residents of long-term care institutions had been diagnosed with MS. Prevalence estimates were 159 and 418 cases per 100,000 population for men and women, respectively; 2.6 women reported MS for every man with the condition. Among the household population, MS was generally diagnosed between the ages of 20 and 49 (82%). For the majority (68%), MS was their only neurological condition. The impact of MS included pain that prevented activities, impairments in mobility, cognition or sleep, and limitations in social functioning. Almost two-thirds (64%) stated that MS affected their lives at least moderately.

Family networks and health among Métis aged 45 or older.

BACKGROUND: Social networks are important for promoting and maintaining health and well-being. Social networks, including family and friendship ties, are sources of emotional, practical and other support that enhance social participation and help combat isolation and loneliness. Aboriginal seniors have been identified as a population at risk of social isolation. DATA AND METHODS: The data are from the 2012 Aboriginal Peoples Survey, a national survey of First Nations people living off reserve, Métis, and Inuit. Frequencies, cross-tabulations, and logistic regression models were used to look at family networks and self-perceived general and mental health among Métis aged 45 or older. RESULTS: An estimated 48% of Métis men and 60% of Métis women aged 45 or older had strong family networks. Older age, lower education, and non-participation in the labour force were associated with strong networks. Métis men and women with strong family networks had higher odds than did those with weak networks of reporting positive mental health, even when potential confounders were taken into account. Among Métis men, a relationship between strong family networks and positive general health was also observed. DISCUSSION: Strong family networks are associated with positive self-perceived general and mental health among Métis adults. In addition to individual behaviours, family well-being is important for general health promotion.

Nutritional risk, hospitalization and mortality among community-dwelling Canadians aged 65 or older.

BACKGROUND: Nutritional risk has been associated with various negative health outcomes among older people. Limited longitudinal research has examined the relationship between nutritional risk and hospitalization and death in community-dwelling older people. DATA AND METHODS: Data from the 2008/2009 Canadian Community Health Survey-Healthy Aging (CCHS-HA) linked to the Discharge Abstract Database and the Canadian Mortality Database were used to estimate the prevalence of nutritional risk among seniors and examine its relationship with acute care hospitalization and death during the 25- to 36-month period following the CCHS-HA interview. Multivariate Cox proportional hazards models were used to identify important covariates, while adjusting for demographic and socioeconomic characteristics, health status, and lifestyle factors. RESULTS: A third (34%; 979,000) of Canadians aged 65 or older living in 9 provinces (excluding Quebec) were at nutritional risk in 2008/2009. These seniors had a higher risk of an acute care hospitalization (hazard ratio (HR) 1.2; 95% CI: 1.1 to 1.4) or death (HR 1.6; 95% CI: 1.3 to 2.0) during the follow-up period, even when potential confounders were taken into account. Seniors at nutritional risk in 2008/2009 were more likely than those not at nutritional risk to die during follow-up (9% versus 5%) and averaged shorter survival times: 498 days (95% CI: 462 to 534) compared with 538 days (95% CI: 501 to 574). INTERPRETATION: Based on an analysis of data from a large population-based survey linked to routinely collected hospital and death data, nutritional risk is independently associated with acute care hospitalization and mortality. Results highlight the importance of monitoring seniors for nutritional risk.

Cycling in Canada.

This article provides an overview of cycling, including fatalities and bicycle helmet use, based on data from the 1994/1995 National Population Health Survey, the 2013/2014 Canadian Community Health Survey and the Vital Statistics-Death Database. In 2013/2014, an estimated 7.0 million Canadians aged 12 or older (24%) reported cycling in the previous three months, compared with 6.5 million (29%) in 1994/95. The prevalence of cycling declined with age, and was more common among males and people living in higher-income and -education households. From 1994 through 2012, 1,408 cyclists were killed, an average of 74 annually, most of whom were male (84%). In 2013/2014, 45% of those who had cycled in the past three months reported that they always wore a helmet.

Hearing difficulties and feelings of social isolation among Canadians aged 45 or older.

BACKGROUND: Social isolation is associated with reduced health-related quality of life, increased morbidity, and mortality. Social isolation can be a concern for older Canadians, especially those with conditions that interfere with making and maintaining social connections. DATA AND METHODS: The 2008/2009 Canadian Community Health Survey-Healthy Aging (CCHS-HA) collected data from a population-based sample of Canadians aged 45 or older living in private households. Frequencies, cross-tabulations and logistic regression were used to examine the prevalence of hearing difficulties and social isolation, and associations between them when controlling for sociodemographic characteristics, other functional limitations (for example, vision, mobility, and cognition), incontinence, and fear of falling. RESULTS: Social isolation was more common among 45- to 59-year-olds than among people aged 60 or older. Women were more likely than men to be socially isolated (16% versus 12%), but they were less likely to report hearing difficulties (5% versus 7%). Hearing difficulties were more prevalent at older ages: 25% of men and 18% of women at age 75 or older. When sociodemographic factors (age, education, living arrangements, regular driver, workforce participation), incontinence, fear of falling, and functional limitations were taken into account, the odds of being socially isolated increased with the severity of the hearing impairment among women but not among men (OR: 1.04, 95% CI: 1.00, 1.09). INTERPRETATION: Hearing difficulties are associated with age, and therefore, a growing public health concern as Canada's population ages. For women, hearing difficulties were found to be associated with social isolation.

Alzheimer's disease and other dementias in Canada.

This article provides information on Alzheimer's disease and other dementias, using the 2010/2011 Canadian Community Health Survey, the 2011/2012 Survey of Neurological Conditions in Institutions in Canada, and the 2011 Survey on Living with Neurological Conditions in Canada. Among Canadians aged 45 or older, an estimated 0.8% in private households and 45% in long-term residential care facilities had a diagnosis of dementia. Prevalence rose with age. The vast majority of people with dementia in private households received assistance with medical care (81%), housework and home maintenance (83%), meal preparation (88%), emotional support (90%), transportation (92%), and managing care (92%). Among those receiving assistance, 85% relied, at least in part, on family, friends or neighbours. The primary caregiver tended to be a spouse (46%) or an adult child (44%), most of whom were daughters (71%). The majority of primary caregivers lived in the same household (83%) and provided daily care (86%).

Parkinson's disease: Prevalence, diagnosis and impact.

This article provides information on Parkinson's disease, using the 2010/2011 Canadian Community Health Survey, the 2011/2012 Survey of Neurological Conditions in Institutions in Canada, and the 2011 Survey of Living with Neurological Conditions in Canada. An estimated 0.2% of Canadian adults in private households (55,000), and 4.9% of those in residential institutions (12,500), had Parkinson's disease. Younger age at symptom onset was associated with a longer period to disease diagnosis. As a result of the condition, 58% reported that social interactions were negatively affected, 61% reported out-of-pocket expenses, and 56% reported receiving assistance with activities such as housework, transportation or personal care. Among those receiving assistance, 84% relied at least in part on family, friends or neighbours. The primary informal caregiver tended to be a spouse (64%), female (62%), live in the same household (72%), and provide assistance on a daily basis (76%).

Prevalence of migraine in the Canadian household population.

Based on data from the 2010 and 2011 Canadian Community Health Surveys and the 2011 Survey of Living with Neurological Conditions in Canada, this article provides information about migraine among people living in private households. In 2010/2011, an estimated 8.3% of Canadians (2.7 million) reported that they had been diagnosed with migraine by a health professional. Females were more likely than males to report migraine: 11.8% versus 4.7%. Migraine prevalence was highest among people in their 30s and 40s: 17.0% for women and 6.5% for men. Compared with the national figure, the prevalence of migraine was lower in Quebec (6.8%) and higher in Manitoba (9.5%), Nova Scotia (9.1%) and Ontario (8.8%). Among people who reported a migraine diagnosis, 42% took prescription medication for their condition, and 56% incurred medication-related out-of-pocket expenses. Migraine was highly comorbid with depression and affected many aspects of daily life including education, work, sleep, and driving.

Nutritional risk among older Canadians.

BACKGROUND: Nutritional risk screening is typically done in clinical settings to identify individuals at risk of malnourishment. This article presents the first population-level assessment of nutritional risk based on a large national sample representative of Canadian householders aged 65 or older. DATA SOURCES AND METHODS: Data from the 2008/2009 Canadian Community Health Survey-Healthy Aging were used to estimate the prevalence of nutritional risk by selected characteristics. Factors associated with nutritional risk were examined with restricted and full logistic models. The distribution of responses on the SCREEN II-AB nutritional risk instrument is reported. RESULTS: Based on the results of the 2008/2009 survey, 34% of Canadians aged 65 or older were at nutritional risk. Women were more likely than men to be at risk. Among people with depression, 62% were at nutritional risk, compared with 33% of people without depression. Level of disability, poor oral health, and medication use were associated with nutritional risk, as were living alone, low social support, infrequent social participation, and not driving on a regular basis. Lower income and education were also associated with nutritional risk. INTERPRETATION: Nutritional risk is common among seniors living in private households in Canada. The characteristics of people most likely to be at nutritional risk provide evidence for targeted screening and assessment.

Urinary incontinence and loneliness in Canadian seniors.

BACKGROUND: Urinary incontinence (UI), a prevalent condition among seniors, can have substantial impacts on quality of life. DATA AND METHODS: Data from the 2008/2009 Canadian Community Health Survey-Healthy Aging were used to examine the prevalence of UI, as well as the relationship between UI and loneliness in a sample of 16,369 people aged 65 or older. Multivariate logistic regression was used to identify significant relationships, while adjusting for potential confounders. RESULTS: In 2008/2009, an estimated 512,000 seniors reported that they experienced UI. Women were more likely than men to have this complaint (14% versus 9%), as were older seniors. Those with UI were significantly more likely to be lonely than were those without the condition (OR=1.8, 95% CI: 1.5 to 2.0). This association persisted when socio-demographic, social and functional health factors were taken into account (OR=1.5, 95% CI: 1.3 to 1.7). INTERPRETATION: This study highlights the prevalence of UI among Canadian seniors and its correlation with loneliness, which, itself, is associated with negative health outcomes. Further research is needed to establish exactly how UI has an impact on seniors' feelings of loneliness.

Adopting leisure-time physical activity after diagnosis of a vascular condition.

BACKGROUND: A better understanding of factors associated with adopting leisure-time physical activity among people with chronic vascular conditions can help policy-makers and health care professionals develop strategies to promote secondary prevention among older Canadians. DATA AND METHODS: Cross-sectional data from the 1994/1995 National Population Health Survey (NPHS), household component, and the 2007/2008 Canadian Community Health Survey were used to estimate the prevalence of inactivity. Longitudinal data from eight cycles (1994/1995 through 2008/2009) of the NPHS, household component, were used to examine the adoption of leisure-time physical activity, intentions to change health risk behaviours, and barriers to change. RESULTS: Over half (54%) of the population aged 40 or older were inactive during their leisure time in 2007/2008. A new vascular diagnosis was not associated with initiating leisure-time physical activity. Among the newly diagnosed, those with no disability or a mild disability had higher odds of undertaking leisure-time physical activity. INTERPRETATION: The majority of Canadians in mid- to late life are inactive. They tend to remain so when diagnosed with a vascular condition.