A national cohort study of community belonging and its influence on premature mortality.

BACKGROUND: Community belonging, an important constituent of subjective well-being, is an important target for improving population health. Ageing involves transitioning across different social conditions thus, community belonging on health may vary across the life course. Using a nationally representative cohort, this study estimates the life stage-specific impact of community belonging on premature mortality. METHODS: Six cycles of the Canadian Community Health Survey (2000-2012) were combined and linked to the Canadian Vital Statistics Database (2000-2017). Respondents were followed for up to 5 years. Multivariable-adjusted modified Poisson regression models were used to estimate the relative risk of premature mortality for three life stages: early adulthood (18-35 years), middle adulthood (36-55 years) and late adulthood (56-70 years). RESULTS: The final analytical sample included 477 100 respondents. Most reported a 'somewhat strong' sense of belonging (45.9%). Compared with their 'somewhat strong' counterparts, young adults reporting a 'somewhat weak' sense of belonging exhibited an increased relative risk (RR) of 1.76 (95% CI 1.27 to 2.43) for premature mortality, whereas middle-aged adults reporting the same exhibited a decreased RR of 0.82 (95% CI 0.69, 0.98). Among older adults, groups reporting a 'very strong' (RR 1.10, 95% CI 1.01, 1.21) or a 'very weak' sense (RR 1.14, 95% CI 1.01, 1.28) of belonging exhibited higher RRs for premature mortality. CONCLUSION: The results demonstrate how community belonging relates to premature mortality differs across age groups underscoring the importance of considering life stage-specific perspectives when researching and developing approaches to strengthen belonging.

A retrospective population-based analysis of wait times for cataract surgery in Ontario, Canada.

BACKGROUND: Current methods used to estimate surgical wait times in Ontario may be subject to inconsistencies and inaccuracies. In this population-level study, we aimed to estimate cataract surgery wait times in Ontario using a novel, objective and data-driven method. METHODS: We identified adults who underwent cataract surgery between 2005 and 2019 in Ontario, using administrative records. Wait time 1 represented the number of days from referral to initial visit with the surgeon, and wait time 2 represented the number of days from the decision for surgery until the first eye surgery date. In the primary analysis, a ranking method prioritized referrals from optometrists, followed by ophthalmologists and family physicians. RESULTS: The cohort consisted of 1 138 532 people with mostly female patients (57.4%) and those aged 65 years and older (79.0%). In the primary analysis, the median was 67 days for wait time 1 (interquartile range [IQR] 29-147). There was a median of 77 days for wait time 2 (IQR 37-155). Overall, the following proportions of patients waited less than 3, 6 and 12 months: 54.1%, 78.5% and 91.7%, respectively. For wait time 2, the proportions of patients who waited less than 3, 6 and 12 months were 49.5%, 77.1% and 93.3%, respectively. In total, 19.3% of patients did not meet the provincial target for wait time 1, 20.5% did not meet the target for wait time 2 and 35.0% did not meet the target for wait times 1 or 2. INTERPRETATION: Administrative health services data can be used to estimate cataract surgery wait times. With this method, 35.0% of patients in 2005-2019 did not receive initial consultation or surgery within the provincial wait time target.

Is life satisfaction associated with future mental health service use? An observational population-based cohort study.

OBJECTIVE: To investigate the prospective association between life satisfaction and future mental health service use in: (1) hospital/emergency department, and (2) outpatient settings. DESIGN AND SETTING: Population-based cohort study of adults from Ontario, Canada. Baseline data were captured through pooled cycles of the Canadian Community Health Survey (CCHS 2005-2014) and linked to health administrative data for up to 5 years of follow-up. PARTICIPANTS: 131 809 Ontarians aged 18 years and older. MAIN OUTCOME MEASURE: The number of mental health-related visits in (1) hospitals/emergency department and (2) outpatient settings within 5 years of follow-up. RESULTS: Poisson regression models were used to estimate rate ratios in each setting, adjusting for sociodemographic measures, history of mental health-related visits, and health behaviours. In the hospital/emergency setting, compared to those most satisfied with life, those with the poorest satisfaction exhibited a rate ratio of 3.71 (95% CI 2.14 to 6.45) for future visits. In the outpatient setting, this same comparison group exhibited a rate ratio of 1.83 (95% CI 1.42 to 2.37). When the joint effects of household income were considered, compared with the highest income and most satisfied individuals, the least satisfied and lowest income individuals exhibited the highest rate ratio in the hospital/emergency setting at 11.25 (95% CI 5.32 to 23.80) whereas in the outpatient setting, the least satisfied and highest income individuals exhibited the highest rate ratio at 3.33 (95% CI 1.65 to 6.70). CONCLUSION: The findings suggest that life satisfaction is a risk factor for future mental health visits. This study contributes to an evidence base connecting positive well-being with health system outcomes.