Mental health and neurocognitive disorder-related hospitalization rates in immigrants and Canadian-born population: a linkage study.

OBJECTIVES: Mental health and neurocognitive conditions are important causes of hospitalization among immigrants, though patterns may vary by immigrant category, world region of origin, and time since arrival in Canada. This study uses linked administrative data to explore differences in mental health hospitalization rates between immigrants and individuals born in Canada. METHODS: Hospital records from the Discharge Abstract Database and the Ontario Mental Health Reporting System for 2011 to 2017 were linked to the 2016 Longitudinal Immigrant Database and to Statistics Canada's 2011 Canadian Census Health and Environment Cohort. Age-standardized hospitalization rates for mental health-related conditions (ASHR-MHs) were derived for immigrants and the Canadian-born population. ASHR-MHs overall and for leading mental health conditions were compared between immigrants and the Canadian-born population, stratified by sex and selected immigration characteristics. Quebec hospitalization data were not available. RESULTS: Overall, immigrants had lower ASHR-MHs compared to the Canadian-born population. Mood disorders were leading causes of mental health hospitalization for both cohorts. Psychotic, substance-related, and neurocognitive disorders were also leading causes of mental health hospitalization, although there was variation in their relative importance between subgroups. Among immigrants, ASHR-MHs were higher among refugees and lower among economic immigrants, those from East Asia, and those who arrived in Canada most recently. CONCLUSION: Differences in hospitalization rates among immigrants from various immigration streams and world regions, particularly for specific types of mental health conditions, highlight the importance of future research that incorporates both inpatient and outpatient mental health services to further understand these relationships.

RéSUMé: OBJECTIFS: Les problèmes de santé mentale et les troubles neurocognitifs sont des causes importantes d'hospitalisation chez les immigrants, bien que les tendances puissent varier selon la catégorie d'immigrants, la région d'origine mondiale et le temps écoulé depuis l'arrivée au Canada. Cette étude utilise des données administratives couplées afin d'explorer les différences dans les taux d'hospitalisation en santé mentale entre les immigrants et les personnes nées au Canada. MéTHODES: Les dossiers hospitaliers de la Base de données sur les congés des patients et du Système d'information ontarien sur la santé mentale de 2011 à 2017 ont été couplés à la Base de données longitudinales sur l'immigration de 2016 et aux cohortes santé et environnement du Recensement canadien de 2011 de Statistique Canada. Les taux d'hospitalisation normalisés selon l'âge pour les problèmes de santé mentale (THNA-SM) ont été comparés entre les immigrants et la population née au Canada, stratifiés selon le sexe et certaines caractéristiques d'immigration. Les données sur les hospitalisations au Québec n'étaient pas disponibles. RéSULTATS: Dans l'ensemble, les immigrants avaient des THNA-SM plus faibles que la population née au Canada. Les troubles de l'humeur étaient les principales causes d'hospitalisation en santé mentale pour les deux cohortes. Les troubles psychotiques, liés aux substances et neurocognitifs étaient également les principales causes d'hospitalisation en santé mentale, bien que leur importance relative varie entre les sous-groupes. Chez les immigrants, les THNA-SM étaient plus élevés chez les réfugiés et plus faibles chez les immigrants économiques, ceux de l'Asie de l'Est et ceux qui sont arrivés au Canada plus récemment. CONCLUSION: Les différences dans les taux d'hospitalisation chez les immigrants des divers groupes d'immigration et régions du monde, plus particulièrement pour certains types de problèmes de santé mentale, soulignent l'importance de recherches futures qui intègrent les services de santé mentale aux patients hospitalisés ainsi qu'aux patients externes afin de mieux comprendre ces relations.

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.

Trends in HIV care cascade engagement among diagnosed people living with HIV in Ontario, Canada: A retrospective, population-based cohort study.

BACKGROUND: The HIV cascade is an important framework for assessing systems of care, but population-based assessment is lacking for most jurisdictions worldwide. We measured cascade indicators over time in a population-based cohort of diagnosed people living with HIV (PLWH) in Ontario, Canada. METHODS: We created a retrospective cohort of diagnosed PLWH using a centralized laboratory database with HIV diagnostic and viral load (VL) test records linked at the individual-level. Individuals enter the cohort with record of a nominal HIV-positive diagnostic test or VL test, and remain unless administratively lost to follow-up (LTFU, >2 consecutive years with no VL test and no VL test in later years). We calculated the annual percent of diagnosed PLWH (cohort individuals not LTFU) between 2000 and 2015 who were in care (≥1 VL test), on ART (as documented on VL test requisition) or virally suppressed (<200 copies/ml). We also calculated time from diagnosis to linkage to care and viral suppression among individuals newly diagnosed with HIV. Analyses were stratified by sex and age. Upper/lower bounds were calculated using alternative indicator definitions. RESULTS: The number of diagnosed PLWH increased from 8,859 (8,859-11,389) in 2000 to 16,110 (16,110-17,423) in 2015. Over this 16-year period, the percent of diagnosed PLWH who were: in care increased from 81% (63-81%) to 87% (81-87%), on ART increased from 55% (34-60%) to 81% (70-82%) and virally suppressed increased from 41% (23-46%) to 80% (67-81%). Between 2000 and 2014, the percent of newly diagnosed individuals who linked to care within three months of diagnosis or achieved viral suppression within six months of diagnosis increased from 67% to 82% and from 22% to 42%, respectively. Estimates were generally lower for females and younger individuals. DISCUSSION: HIV cascade indicators among diagnosed PLWH in Ontario improved between 2000 and 2015, but gaps still remain-particularly for younger individuals.

Trends in human immunodeficiency virus diagnoses among men who have sex with men in North America, Western Europe, and Australia, 2000-2014.

PURPOSE: The aim of the article was to investigate recent trends in human immunodeficiency virus (HIV) diagnosis rates among men who have sex with men (MSM) in high-income countries in North America, Western Europe, and Australia. METHODS: Data on annual rates of HIV diagnoses among MSM aged 15 to 65 years from 2000 to 2014 were collected from 13 high-income countries. Joinpoint regression software was used to empirically determine country-specific trend periods. Trends in HIV diagnosis rates and in the proportion of diagnoses occurring in young MSM aged 15 to 24 years were analyzed using Poisson regression and log-binomial regression, respectively. RESULTS: Six countries experienced an increasing trend from 2000 to 2007-08 followed by either a stable or declining trend through 2014. Five countries had recently increasing trends, and two countries had one stable trend from 2000 to 2014. All 13 countries experienced increases in the proportion of diagnoses occurring in young MSM. CONCLUSIONS: Since 2008, half of the 13 high-income countries examined experienced stable or decreasing trends. Still, some countries continue to experience increasing HIV trends, and young MSM are increasingly represented among new diagnoses. Efforts to support early sexual health promotion, reduce barriers to pre-exposure prophylaxis, and improve care engagement for young MSM are critical to addressing current HIV trends.

Acceptability of human papillomavirus vaccination and sexual experience prior to disclosure to health care providers among men who have sex with men in Vancouver, Canada: implications for targeted vaccination programs.

BACKGROUND: Men who have sex with men (MSM) may benefit from human papillomavirus (HPV) vaccine due to increased risk for HPV infection and related disease. We assessed HPV vaccine acceptability and sexual experience prior to disclosure to Health Care Providers (HCP) to understand implications of targeted vaccination strategies for MSM. METHODS: From July 2008 to February 2009, 1169 MSM aged ≥19 years were recruited at community venues in Vancouver. We assessed key variables from a self-administered questionnaire and independent predictors of HPV vaccine acceptability using multivariate logistic regression. RESULTS: Of 1041 respondents, 697 (67.0%) were willing to receive HPV vaccine and 71.3% had heard of HPV. Significant multivariate predictors of higher vaccine acceptability were (adjusted odds ratio [95% CI]): previous diagnosis of genital warts (1.7 [1.1, 2.6]), disclosure of sexual behavior to HCP (1.6 [1.1, 2.3]), annual income at least $20,000 (1.5 [1.1, 2.1]), previous hepatitis A or B vaccination (1.4 [1.0, 2.0]), and no recent recreational drug use (1.4 [1.0, 2.0]). Most MSM (78.7%) had disclosed sexual behavior to HCP and median time from first sexual contact with males to disclosure was 6.0 years (IQR 2-14 years); for men ≤26 years these were 72.0% and 3.0 years (IQR 1-8 years) respectively. CONCLUSIONS: Willingness to receive HPV vaccine was substantial among MSM in Vancouver; however, acceptability varied by demographics, risk, and health history. HPV vaccine programs delivered by HCP would offer limited benefit given the duration of time from sexual debut to disclosure to HCP.

Feasibility of incorporating self-collected rectal swabs into a community venue-based survey to measure the prevalence of HPV infection in men who have sex with men.

BACKGROUND: Inclusion of self-collected rectal swabs (SCRS) into existing community venue-based HIV surveillance systems for men who have sex with men (MSM) may provide a feasible method for monitoring human papillomavirus (HPV) vaccine-related outcomes in this population. We measured the prevalence of HPV and anal dysplasia through incorporating SCRS into ManCount, the Vancouver site of the M-Track HIV surveillance system. METHODS: Participating MSM were provided with a self-collection kit for collection on-site or at a follow-up venue. Swabs were subject to polymerase chain reaction amplification for HPV detection, and cytology slides were reviewed for anal dysplasia. Factors associated with participation were identified through multivariate logistic regression. RESULTS: Of 766 men completing ManCount, 268 (35%) agreed to participate, self-collecting 252 specimens (247 on-site). Of 239 complete specimens, 33.5% did not have detectable ß-globin; in the remainder (159 specimens) the prevalence of HPV infection was 62.3% (23.3% HPV type 16 or 18; 38.4% HPV type 6, 11, 16, or 18). In the 62.3% (149) of specimens adequate for cytology, the prevalence of anal dysplasia was 42.3% (HSIL 11.4%, LSIL 18.8%, ASC-US 6.7%, ASC-H 5.4%). Participation was associated with venue type, availability of on-site collection, and other characteristics. CONCLUSIONS: SCRS can be feasibly integrated within existing community venue-based HIV surveillance systems for MSM, and may be a suitable method for monitoring the impact of HPV vaccination in this population. However, participation may be influenced by venue type and availability of on-site collection, and adequacy of SCRS specimens may be lower in community venues as compared with clinical settings.

Patterns of HIV testing among Ontario physicians.

OBJECTIVE: HIV testing is important for HIV prevention and control. Nevertheless, approximately 35% of HIV infections in Ontario remain undiagnosed. We examined patterns of HIV testing among physicians to determine provider-related factors associated with HIV testing in Ontario. METHODS: Providers identified from HIV test requisitions submitted to the Ontario Public Health Laboratory in 2006 were linked to a database of Ontario physicians using probabilistic matching. We examined HIV testing frequency by demographic characteristics and physician specialty. In multivariate logistic regression, we assessed factors associated with high testing frequency (20+ tests). RESULTS: 12,477 physicians (59.3% of Ontario physicians) prescribed at least one HIV test in 2006; the proportion was highest in Central East/other (72.4%) and Northern (69.4%) regions compared to others (53.7-58.7%), and highest among the most recent graduates (68.4% versus 59.0% among earlier graduates). A substantial proportion of physicians in family medicine/general practice (83.6%), obstetrics/gynecology (82.1%) and internal medicine (47.7%) prescribed HIV testing. Overall, most physicians (67.5%) prescribed fewer than 20 tests. High testing frequency was significantly associated with practice in Toronto (AOR 2.95), Central East/other (AOR 2.02), or Ottawa region (AOR 2.28), and specialty in family medicine/general practice (AOR 11.47), obstetrics/gynecology (AOR 6.31) or internal medicine (AOR 1.37). Physician sex and graduation country were not associated with high testing in multivariate regression. Of 361,609 tests, 1,048 (0.29%) were HIV-positive; 436 physicians (3.5%) had at least one HIV-positive result. CONCLUSION: HIV testing among Ontario physicians varied substantially by health region, graduation year and specialty. These factors should be considered when delivering continuing medical education on HIV testing.

Pertussis vaccine effectiveness after mass immunization of high school students in Australia.

Vaccine effectiveness in the first large-scale use of adolescent pertussis vaccine in Australia was evaluated by the screening method. Vaccine effectiveness was 78.0% (95% CI: 60.7-87.6%) for all study cases (n = 167), increasing to 85.4% (95% CI: 83.0-87.5%) for laboratory-confirmed cases (n = 155). Effectiveness should be comparable in settings with similar programs, such as the United States and Canada.

How reliable are Australian Childhood Immunisation Register coverage estimates for indigenous children? An assessment of data quality and coverage.

Low levels of reporting indigenous status to the Australian Childhood Immunisation Register (ACIR) in the past have resulted in reduced confidence in vaccination coverage data for Aboriginal and Torres Straight Islander children. This study shows that the reporting of indigenous status has improved from 42% of the estimated national cohort of Indigenous children aged 12 to 14 months in 2002 to 95% in 2005. Over that period diphtheria-tetanus-pertussis (DTP) vaccination coverage estimates for Indigenous children increased slightly from 86.0% to 86.9%. Data by state and territory or remoteness are also presented. ACIR vaccination coverage estimates for Indigenous children can now be used with confidence for program planning at the national and jurisdictional level.