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Evans C, Li W, Matskiv G, Brogly S. Epidemiology and association of neighbourhood marginalisation on violent knife assaults in Ontario: a population-based case-control study. Inj Prev 2024:ip-2023-045156. [PMID: 39033021 DOI: 10.1136/ip-2023-045156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 05/26/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Violent knife assaults ('stabbings') are underappreciated as a source of morbidity and mortality. The two objectives of this study were to describe the epidemiology of stabbing injuries in the population of Ontario, Canada and to assess the associations between two measures of neighbourhood marginalisation-material deprivation and housing instability, and the risk of stabbing injury. METHODS We conducted a population-based case-control study over 2004-18 using linked administrative data. Cases suffered a stabbing injury resulting in an emergency department visit, hospitalisation or death. Four age and sex-matched controls were matched to each case. Multivariate logistic regression was used to assess the associations between neighbourhood material deprivation as well as housing instability and the risk of injury. Mean annualised injury incidences were estimated using the number of cases identified divided by the total population of Ontario for that year. RESULTS We identified 26 657 individuals with a stabbing injury, of which 724 (2.7%) were fatal. The mean annualised incidence was 13.4 per 100 000 (95% CI: 12.7 to 15.9). Victims were disproportionately young (median age 25 years; IQR: 20-37 years) males (84.1%), from large urban centres (77.5%), and in the lowest income quintile (39.3%). In multivariate models, neighbourhood material deprivation (OR 1.45, 95% CI: 1.43 to 1.47) and housing instability (OR 1.4, 95% CI: 1.22 to 1.26) were associated with risk of injury. CONCLUSIONS Stabbing injuries are a substantial public health problem that affects individuals of all ages and demographics but disproportionately affects younger men in urban settings. There is a weak association between residence in marginalised neighbourhoods and the risk of stabbing injury. Future studies should aim to better understand the nature of this association and consider opportunities for public health interventions to reduce the burden of violent knife injuries.
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Affiliation(s)
- Christopher Evans
- Emergency Medicine, Queen's University, Kingston, Ontario, Canada
- ICES Queen's, Kingston, Ontario, Canada
| | - Wenbin Li
- ICES Queen's, Kingston, Ontario, Canada
| | - George Matskiv
- Emergency Medicine, Queen's University, Kingston, Ontario, Canada
| | - Susan Brogly
- ICES Queen's, Kingston, Ontario, Canada
- Surgery, Queen's University, Kingston, Ontario, Canada
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Xu J, Saeedi M, Zalzal J, Zhang M, Ganji A, Mallinen K, Wang A, Lloyd M, Venuta A, Simon L, Weichenthal S, Hatzopoulou M. Exploring the triple burden of social disadvantage, mobility poverty, and exposure to traffic-related air pollution. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 920:170947. [PMID: 38367734 DOI: 10.1016/j.scitotenv.2024.170947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/26/2024] [Accepted: 02/11/2024] [Indexed: 02/19/2024]
Abstract
Understanding the relationships between ultrafine particle (UFP) exposure, socioeconomic status (SES), and sustainable transportation accessibility in Toronto, Canada is crucial for promoting public health, addressing environmental justice, and ensuring transportation equity. We conducted a large-scale mobile measurement campaign and employed a gradient boost model to generate exposure surfaces using land use, built environment, and meteorological conditions. The Ontario Marginalization Index was used to quantify various indicators of social disadvantage for Toronto's neighborhoods. Our findings reveal that people in socioeconomically disadvantaged areas experience elevated UFP exposures. We highlight significant disparities in accessing sustainable transportation, particularly in areas with higher ethnic concentrations. When factoring in daily mobility, UFP exposure disparities in disadvantaged populations are further exacerbated. Furthermore, individuals who do not generate emissions themselves are consistently exposed to higher UFPs, with active transportation users experiencing the highest UFP exposures both at home and at activity locations. Finally, we proposed a novel index, the Community Prioritization Index (CPI), incorporating three indicators, including air quality, social disadvantage, and sustainable transportation. This index identifies neighborhoods experiencing a triple burden, often situated near major infrastructure hubs with high diesel truck activity and lacking greenspace, marking them as high-priority areas for policy action and targeted interventions.
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Affiliation(s)
- Junshi Xu
- Civil and Mineral Engineering, University of Toronto, Canada.
| | - Milad Saeedi
- Civil and Mineral Engineering, University of Toronto, Canada.
| | - Jad Zalzal
- Civil and Mineral Engineering, University of Toronto, Canada.
| | - Mingqian Zhang
- Civil and Mineral Engineering, University of Toronto, Canada
| | - Arman Ganji
- Civil and Mineral Engineering, University of Toronto, Canada.
| | - Keni Mallinen
- Civil and Mineral Engineering, University of Toronto, Canada.
| | - An Wang
- Urban Lab, Massachusetts Institute of Technology, United States.
| | - Marshall Lloyd
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Canada.
| | - Alessya Venuta
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Canada.
| | - Leora Simon
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Canada.
| | - Scott Weichenthal
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Canada.
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Ekhtiari S, Pincus D, Croxford R, Gatley JM, Khoshbin A, Atrey A, Paterson JM, Ravi B. Impact of the coronavirus disease 2019 pandemic on equity of access to hip and knee replacements: a population-level study. INTERNATIONAL ORTHOPAEDICS 2024; 48:635-642. [PMID: 38012311 DOI: 10.1007/s00264-023-06042-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE The COVID-19 pandemic had innumerable impacts on healthcare delivery. In Canada, this included limitations on inpatient capacity, which resulted in an increased focus on outpatient surgery for non-emergent cases such as joint replacements. The objective of this study was to assess whether the pandemic and the shift towards outpatient surgery had an impact on access to joint replacement for marginalized patients. METHODS Data from Ontario's administrative healthcare databases were obtained for all patients undergoing an elective hip or knee replacement between January 1, 2018 and August 31, 2021. All surgeries performed before March 15, 2020 were classified as "pre-COVID," while all procedures performed after that date were classified as "post-COVID." The Ontario Marginalization Index domains were used to analyze proportion of marginalized patients undergoing surgery pre- and post-COVID. RESULTS A total of 102,743 patients were included-42,812 hip replacements and 59,931 knee replacements. There was a significant shift towards outpatient surgery during the post-COVID period (1.1% of all cases pre-COVID to 13.2% post-COVID, p < 0.001). In the post-COVID cohort, there were significantly fewer patients from some marginalized groups, as well as fewer patients with certain co-morbidities, such as congestive heart failure and chronic obstructive pulmonary disease. CONCLUSION The most important finding of this population-level database study is that, compared to before the COVID-19 pandemic, there has been a change in the profile of patients undergoing hip and knee replacements in Ontario, specifically across a range of indicators. Fewer marginalized patients are undergoing joint replacement surgery since the COVID-19 pandemic. Further monitoring of access to joint replacement surgery is required in order to ensure that surgery is provided to those who are most in need.
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Affiliation(s)
- Seper Ekhtiari
- Addenbrooke's - Cambridge University Hospitals, University of Cambridge, Cambridge, UK.
- Division of Orthopaedic Surgery, Sinai Health, University of Toronto, 476B-600 University Ave, Toronto, ON, M5G 1X5, Canada.
| | - Daniel Pincus
- Department of Surgery, Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | | | - Amir Khoshbin
- ICES, Toronto, Ontario, Canada
- Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Amit Atrey
- ICES, Toronto, Ontario, Canada
- Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | | | - Bheeshma Ravi
- Department of Surgery, Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
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4
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AlSaeed H, Sucha E, Bhatt M, Mitsakakis N, Bresee N, Bechard M. Rates of pediatric emergency department visits vary according to neighborhood marginalization in Ottawa, Canada. CAN J EMERG MED 2024; 26:119-127. [PMID: 38117415 DOI: 10.1007/s43678-023-00625-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/13/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVES To determine the association between neighborhood marginalization and rates of pediatric ED visits in Ottawa, Ontario. Secondary objectives investigated if the association between neighborhood marginalization and rates varied by year, acuity, and distance to hospital. METHODS We calculated rates of pediatric ED visits per 1000 person-years for census dissemination areas within 100 km of the Children's Hospital of Eastern Ontario for patients < 18 years old from January 2018 through December 2020. The 2016 Ontario Marginalization Index categorized neighborhoods along quintiles of residential instability, material deprivation, ethnic concentration, and dependency. Generalized mixed-effects models determined the incidence rate ratios of pediatric ED visits for each quintile of marginalization; multivariate models were used to control for year of presentation and distance to hospital. Analysis was repeated for low versus high acuity ED visits. RESULTS There were 154,146 ED visits from patients in 2055 census dissemination areas within 100 km of CHEO from 2018 to 2020. After controlling for year and distance from hospital in multivariate analyses, there were higher rates of pediatric ED visits for dissemination areas with high residential instability, high material deprivation, and low ethnic concentration. These findings did not change according to visit acuity. CONCLUSIONS Neighborhood residential instability and material deprivation should be considered when locating alternatives to emergency care.
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Affiliation(s)
- Habeeb AlSaeed
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada
- University of Ottawa, Ottawa, ON, Canada
| | - Ewa Sucha
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada
| | - Maala Bhatt
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada
- University of Ottawa, Ottawa, ON, Canada
| | - Nicholas Mitsakakis
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada
| | - Natalie Bresee
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada
- University of Ottawa, Ottawa, ON, Canada
| | - Melanie Bechard
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada.
- University of Ottawa, Ottawa, ON, Canada.
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Zeitouny S, Cheung DC, Bremner KE, Pataky RE, Pequeno P, Matelski J, Peacock S, Del Giudice ME, Lapointe-Shaw L, Tomlinson G, Mendlowitz AB, Mulder C, Tsui TCO, Perlis N, Walker JD, Sander B, Wong WWL, Krahn MD, Kulkarni GS. The impact of the early COVID-19 pandemic on healthcare system resource use and costs in two provinces in Canada: An interrupted time series analysis. PLoS One 2023; 18:e0290646. [PMID: 37682823 PMCID: PMC10490868 DOI: 10.1371/journal.pone.0290646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 08/11/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION The aim of our study was to assess the initial impact of COVID-19 on total publicly-funded direct healthcare costs and health services use in two Canadian provinces, Ontario and British Columbia (BC). METHODS This retrospective repeated cross-sectional study used population-based administrative datasets, linked within each province, from January 1, 2018 to December 27, 2020. Interrupted time series analysis was used to estimate changes in the level and trends of weekly resource use and costs, with March 16-22, 2020 as the first pandemic week. Also, in each week of 2020, we identified cases with their first positive SARS-CoV-2 test and estimated their healthcare costs until death or December 27, 2020. RESULTS The resources with the largest level declines (95% confidence interval) in use in the first pandemic week compared to the previous week were physician services [Ontario: -43% (-49%,-37%); BC: -24% (-30%,-19%) (both p<0.001)] and emergency department visits [Ontario: -41% (-47%,-35%); BC: -29% (-35%,-23%) (both p<0.001)]. Hospital admissions declined by 27% (-32%,-23%) in Ontario and 21% (-26%,-16%) in BC (both p<0.001). Resource use subsequently rose but did not return to pre-pandemic levels. Only home care and dialysis clinic visits did not significantly decrease compared to pre-pandemic. Costs for COVID-19 cases represented 1.3% and 0.7% of total direct healthcare costs in 2020 in Ontario and BC, respectively. CONCLUSIONS Reduced utilization of healthcare services in the overall population outweighed utilization by COVID-19 patients in 2020. Meeting the needs of all patients across all services is essential to maintain resilient healthcare systems.
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Affiliation(s)
- Seraphine Zeitouny
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, British Columbia, Canada
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Douglas C. Cheung
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
- Divisions of Urology and Surgical Oncology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Karen E. Bremner
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Reka E. Pataky
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - John Matelski
- Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
| | - Stuart Peacock
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - M. Elisabeth Del Giudice
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lauren Lapointe-Shaw
- ICES, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Department of General Internal Medicine, Toronto General Hospital, Toronto, Ontario, Canada
| | - George Tomlinson
- Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
| | - Andrew B. Mendlowitz
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Carol Mulder
- Chiefs of Ontario, Toronto, Ontario, Canada
- Queen’s University, Kingston, Ontario, Canada
| | - Teresa C. O. Tsui
- ICES, Toronto, Ontario, Canada
- Child Health and Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Canadian Centre for Applied Research in Cancer Control, Ontario Health-Cancer Care Ontario, Toronto, Ontario, Canada
| | - Nathan Perlis
- Divisions of Urology and Surgical Oncology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Urology, Sprott Department of Surgery, University Health Network, Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Jennifer D. Walker
- ICES, Toronto, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Beate Sander
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - William W. L. Wong
- ICES, Toronto, Ontario, Canada
- School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
| | - Murray D. Krahn
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Girish S. Kulkarni
- Divisions of Urology and Surgical Oncology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Division of Urology, Sprott Department of Surgery, University Health Network, Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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Rotenberg M, Tuck A, Anderson KK, McKenzie K. Neighbourhood-level social capital, marginalisation, and the incidence of schizophrenia and schizoaffective disorder in Toronto, Canada: a retrospective population-based cohort study. Psychol Med 2023; 53:2643-2651. [PMID: 34809726 PMCID: PMC10123822 DOI: 10.1017/s003329172100458x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 10/18/2021] [Accepted: 10/22/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Studies have shown mixed results regarding social capital and the risk of developing a psychotic disorder, and this has yet to be studied in North America. We sought to examine the relationship between neighbourhood-level marginalisation, social capital, and the incidence of schizophrenia and schizoaffective disorder in Toronto, Canada. METHODS We used a retrospective population-based cohort to identify incident cases of schizophrenia and schizoaffective disorder over a 10 year period and accounted for neighbourhood-level marginalisation and a proxy indicator of neighbourhood social capital. Mixed Poisson regression models were used to estimate adjusted incidence rate ratios (aIRRs). RESULTS In the cohort (n = 649 020) we identified 4841 incident cases of schizophrenia and schizoaffective disorder. A 27% variation in incidence was observed between neighbourhoods. All marginalisation dimensions, other than ethnic concentration, were associated with incidence. Compared to areas with low social capital, areas with intermediate social capital in the second [aIRR = 1.17, 95% confidence interval (CI) 1.03-1.33] and third (aIRR = 1.23, 95% CI 1.08-1.40) quintiles had elevated incidence rates after accounting for marginalisation. There was a higher risk associated with the intermediate levels of social capital (aIRR = 1.18, 95% CI 1.00-1.39) when analysed in only the females in the cohort, but the CI includes the possibility of a null effect. CONCLUSIONS The risk of developing schizophrenia and schizoaffective disorder in Toronto varies by neighbourhood and is associated with socioenvironmental exposures. Social capital was not linearly associated with risk, and risk differs by sex and social capital quintile. Future research should examine these relationships with different forms of social capital and examine how known individual-level risk factors impact these findings.
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Affiliation(s)
- Martin Rotenberg
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Andrew Tuck
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Kelly K. Anderson
- Department of Epidemiology & Biostatistics, Department of Psychiatry, The University of Western Ontario, London, ON, Canada
| | - Kwame McKenzie
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
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Yan M, Tjong M, Chan WC, Darling G, Delibasic V, Davis LE, Doherty M, Hallet J, Kidane B, Mahar A, Mittmann N, Parmar A, Tan V, Tan H, Wright FC, Coburn NG, Louie AV. Dyspnea in patients with stage IV non-small cell lung cancer: a population-based analysis of disease burden and patterns of care. J Thorac Dis 2023; 15:494-506. [PMID: 36910044 PMCID: PMC9992624 DOI: 10.21037/jtd-22-919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 12/09/2022] [Indexed: 02/23/2023]
Abstract
Background Patients with metastatic non-small cell lung cancer (NSCLC) experience significant morbidity with dyspnea being a common symptom with a prevalence of 70%. The objective of this study was to determine factors associated with a moderate-to-severe dyspnea score based on the Edmonton Symptom Assessment System (ESAS), as well as resultant patterns of intervention and factors correlated to intervention receipt. Methods Using health services administrative data, we conducted a population-based study of all patients diagnosed with metastatic NSCLC treated from January 2007 to September 2018 in the province of Ontario. The primary outcomes of interest are the prevalence of moderate-to-severe dyspnea scores, and the receipt of dyspnea-directed intervention. Differences in baseline characteristic between moderate-to-severe dyspnea and low dyspnea score cohorts were assessed by comparative statistics. Predictors of intervention receipt for patients with moderate-to-severe dyspnea scores were estimated using multivariable modified Poisson regression. Results The initial study cohort included 13,159 patients diagnosed with metastatic NSCLC and of these, 9,434 (71.7%) reported a moderate-to-severe dyspnea score. Compared to patients who did not report moderate-to-severe dyspnea scores, those who reported a moderate-to-severe dyspnea score were more likely to complete a greater number of ESAS surveys, be male, have a higher Elixhauser comorbidity index (ECI) score, and receive subsequent systemic therapy after diagnosis. Most patients with a moderate-to-severe dyspnea score received intervention (96%), of which the most common were palliative care management (87%), thoracic radiotherapy (56%) and thoracentesis (37%). Multivariable regression identified older patients to be less likely to undergo pleurodesis. Thoracentesis was less common for patients living in rural and non-major urban areas, lower income areas, and earlier year of diagnosis. Receipt of thoracic radiotherapy was less common for older patients, females, those with ECI ≥4, patients living in major urban areas, and those with later year of diagnosis. Finally, palliative care referrals were less frequent for patients with ECI ≥4, age 60-69, residence outside of major urban areas, earlier year of diagnosis, and lower income areas. Conclusions Dyspnea is a prevalent symptom amongst patients with metastatic NSCLC. Subpopulations of patients with moderate-to-severe dyspnea scores were in which inequities may exist in access to care that require further attention and evaluation.
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Affiliation(s)
- Michael Yan
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Michael Tjong
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Wing C Chan
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada
| | - Gail Darling
- Division of Thoracic Surgery, University of Toronto, Toronto, ON, Canada
| | - Victoria Delibasic
- Department of Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Laura E Davis
- Department of Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Mark Doherty
- Department of Oncology, St. Vincent's Hospital Group, Dublin, Ireland.,Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Julie Hallet
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Biniam Kidane
- Division of Thoracic Surgery, University of Manitoba, Winnipeg, Canada
| | - Alyson Mahar
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Nicole Mittmann
- Canadian Agency for Drugs and Technology in Health, Ottawa, Canada
| | - Ambica Parmar
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Vivian Tan
- Department of Radiation Oncology, University of Western Ontario, London, Canada
| | - Hendrick Tan
- Department of Radiation Oncology, Fiona Stanley Hospital, Perth, Australia
| | - Frances C Wright
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Natalie G Coburn
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Alexander V Louie
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
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Azra KK, Nielsen A, Kim C, Dusing GJ, Chum A. Investigating suicide related behaviours across sexual orientation and neighbourhood deprivation levels: A cohort study using linked health administrative data. PLoS One 2023; 18:e0282910. [PMID: 36989270 PMCID: PMC10058080 DOI: 10.1371/journal.pone.0282910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 02/24/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND There have been no studies examining how neighbourhood deprivation modifies the effects of sexual minority status on suicide-related behaviours (SRB). Sexual minority individuals in deprived areas may face unique challenges and stressors that exacerbate their risk of SRB. This study aims to investigate the association between sexual minority status and clinical SRB, and examine whether the effect of neighbourhood deprivation differs across sexual orientation. METHODS A population-representative survey sample (169,090 respondents weighted to represent 8,778,120 individuals; overall participation rate 75%) was linked to administrative health data in Ontario, Canada to measure SRB-related events (emergency department visits, hospitalizations, and deaths) from 2007 to 2017. Neighbourhood-level deprivation was measured using the Ontario Marginalisation index measure of material deprivation at the dissemination area level. Discrete-time survival analysis models, stratified by sex, tested the effects of neighbourhood deprivation and sexual minority status, while controlling for individual-level covariates. RESULTS Sexual minority men had 2.79 times higher odds of SRB compared to their heterosexual counterparts (95% CI 1.66 to 4.71), while sexual minority women had 2.14 times higher odds (95% CI 1.54 to 2.98). Additionally, neighbourhood deprivation was associated with higher odds of SRB: men in the most deprived neighbourhoods (Q5) had 2.01 times higher odds (95% CI 1.38 to 2.92) of SRB compared to those in the least deprived (Q1), while women had 1.75 times higher odds (95% CI 1.28 to 2.40). No significant interactions were observed between sexual minority status and neighbourhood deprivation levels. CONCLUSION In both men and women, sexual minority status and neighbourhood deprivation are independent risk factors for SRB. Despite the lack of effect modification, sexual minorities living in the most deprived neighbourhoods have the highest chances of SRB. Future investigations should evaluate interventions and policies to improve sexual minority mental health and address neighbourhood deprivation.
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Affiliation(s)
- Karanpreet Kaur Azra
- Department of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Andrew Nielsen
- Department of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
- Canadian Institute for Health Information, Toronto, Ontario, Canada
| | - Chungah Kim
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Gabriel John Dusing
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Antony Chum
- Department of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Patel RV, Ravindran M, Qiu F, Manoragavan R, Sud M, Tam DY, Madan M, Marcus G, Elbaz‐Greener G, Mamas MA, Wijeysundera HC. Social Deprivation and Post-TAVR Outcomes in Ontario, Canada: A Population-Based Study. J Am Heart Assoc 2022; 12:e028144. [PMID: 36565194 PMCID: PMC9973610 DOI: 10.1161/jaha.122.028144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Transcatheter aortic valve replacement (TAVR)/intervention has become the standard of care for treatment of severe aortic stenosis across the spectrum of risk. There are socioeconomic disparities in access to TAVR. The impact of these disparities on postprocedural outcomes remains unknown. Our objective was to examine the association between neighborhood-level social deprivation and post-TAVR mortality and hospital readmission. Methods and Results We conducted a population-based retrospective cohort study of all 4145 patients in Ontario, Canada, who received TAVR from April 1, 2017, to March 31, 2020. Our co-primary outcomes were 1-year postprocedure mortality and 1-year postprocedure readmission. Using Cox proportional hazards models for mortality and cause-specific competing risk hazard models for readmission, we evaluated the relationship between neighborhood-level measures of residential instability, material deprivation, and concentration of racial and ethnic groups with post-TAVR outcomes. After multivariable adjustment, we found a statistically significant relationship between residential instability and postprocedural 1-year mortality, ranging from a hazard ratio of 1.64 to a hazard ratio of 2.05. There was a significant association between the highest degree of residential instability and 1-year readmission (hazard ratio, 1.23 [95% CI, 1.01-1.49]). There was no association between material deprivation and concentration of racial and ethnic groups with post-TAVR outcomes. Conclusions Residential instability was associated with increased risk for post-TAVR mortality, and the highest quintile of residential instability was associated with increased post-TAVR readmission. To reduce health disparities and promote an equitable health care system, further research and policy interventions will be required to identify and support economically and socially minoritized patients undergoing TAVR.
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Affiliation(s)
- Raumil V. Patel
- Temerty Faculty of MedicineUniversity of TorontoOntarioTorontoCanada,Institute for Health Policy, Management, and EvaluationOntarioTorontoCanada
| | | | - Feng Qiu
- Institute for Clinical Evaluative SciencesOntarioTorontoCanada
| | - Ragavie Manoragavan
- Division of Cardiology, Department of MedicineSchulich Heart Program, Sunnybrook Health Sciences CentreOntarioTorontoCanada
| | - Maneesh Sud
- Temerty Faculty of MedicineUniversity of TorontoOntarioTorontoCanada,Institute for Health Policy, Management, and EvaluationOntarioTorontoCanada,Division of Cardiology, Department of MedicineSchulich Heart Program, Sunnybrook Health Sciences CentreOntarioTorontoCanada
| | - Derrick Y. Tam
- Temerty Faculty of MedicineUniversity of TorontoOntarioTorontoCanada,Institute for Health Policy, Management, and EvaluationOntarioTorontoCanada,Division of Cardiac Surgery, Department of SurgerySchulich Heart Program, Sunnybrook Health Sciences CentreOntarioTorontoCanada
| | - Mina Madan
- Temerty Faculty of MedicineUniversity of TorontoOntarioTorontoCanada,Division of Cardiology, Department of MedicineSchulich Heart Program, Sunnybrook Health Sciences CentreOntarioTorontoCanada
| | - Gil Marcus
- Division of Cardiology, Department of MedicineSchulich Heart Program, Sunnybrook Health Sciences CentreOntarioTorontoCanada
| | | | - Mamas A. Mamas
- Keele Cardiovascular Research GroupKeele UniversityKeeleUnited Kingdom
| | - Harindra C. Wijeysundera
- Temerty Faculty of MedicineUniversity of TorontoOntarioTorontoCanada,Institute for Health Policy, Management, and EvaluationOntarioTorontoCanada,Institute for Clinical Evaluative SciencesOntarioTorontoCanada,Division of Cardiology, Department of MedicineSchulich Heart Program, Sunnybrook Health Sciences CentreOntarioTorontoCanada,Sunnybrook Research InstituteOntarioTorontoCanada
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10
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Cheung DC, Bremner KE, Tsui TCO, Croxford R, Lapointe-Shaw L, Giudice LD, Mendlowitz A, Perlis N, Pataky RE, Teckle P, Zeitouny S, Wong WWL, Sander B, Peacock S, Krahn MD, Kulkarni GS, Mulder C. "Bring the Hoses to Where the Fire Is!": Differential Impacts of Marginalization and Socioeconomic Status on COVID-19 Case Counts and Healthcare Costs. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1307-1316. [PMID: 35527165 PMCID: PMC9072854 DOI: 10.1016/j.jval.2022.03.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 02/01/2022] [Accepted: 03/24/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Local health leaders and the Director General of the World Health Organization alike have observed that COVID-19 "does not discriminate." Nevertheless, the disproportionate representation of people of low socioeconomic status among those infected resembles discrimination. This population-based retrospective cohort study examined COVID-19 case counts and publicly funded healthcare costs in Ontario, Canada, with a focus on marginalization. METHODS Individuals with their first positive severe acute respiratory syndrome coronavirus 2 test from January 1, 2020 to June 30, 2020, were linked to administrative databases and matched to negative/untested controls. Mean net (COVID-19-attributable) costs were estimated for 30 days before and after diagnosis, and differences among strata of age, sex, comorbidity, and measures of marginalization were assessed using analysis of variance tests. RESULTS We included 28 893 COVID-19 cases (mean age 54 years, 56% female). Most cases remained in the community (20 545, 71.1%) or in long-term care facilities (4478, 15.5%), whereas 944 (3.3%) and 2926 (10.1%) were hospitalized, with and without intensive care unit, respectively. Case counts were skewed across marginalization strata with 2 to 7 times more cases in neighborhoods with low income, high material deprivation, and highest ethnic concentration. Mean net costs after diagnosis were higher for males ($4752 vs $2520 for females) and for cases with higher comorbidity ($1394-$7751) (both P < .001) but were similar across levels of most marginalization dimensions (range $3232-$3737, all P ≥ .19). CONCLUSIONS This study suggests that allocating resources unequally to marginalized individuals may improve equality in outcomes. It highlights the importance of reducing risk of COVID-19 infection among marginalized individuals to reduce overall costs and increase system capacity.
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Affiliation(s)
- Douglas C Cheung
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada; Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Surgical Oncology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Karen E Bremner
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Teresa C O Tsui
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | | | - Lauren Lapointe-Shaw
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; General Internal Medicine, Toronto General Hospital, Toronto, Ontario, Canada
| | - Lisa Del Giudice
- Department of Family and Community Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Mendlowitz
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Nathan Perlis
- Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Reka E Pataky
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Paulos Teckle
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Seraphine Zeitouny
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - William W L Wong
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada; School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
| | - Beate Sander
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Public Health Ontario, Toronto, Ontario, Canada
| | - Stuart Peacock
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Murray D Krahn
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; General Internal Medicine, Toronto General Hospital, Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Girish S Kulkarni
- Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Surgical Oncology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Carol Mulder
- Chiefs of Ontario, Toronto, Ontario, Canada; Queen's University, Kingston, Ontario, Canada.
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11
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van Ingen T, Matheson FI. The 2011 and 2016 iterations of the Ontario Marginalization Index: updates, consistency and a cross-sectional study of health outcome associations. Canadian Journal of Public Health 2021; 113:260-271. [PMID: 34432255 DOI: 10.17269/s41997-021-00552-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 06/09/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The Ontario Marginalization Index (ON-Marg) is an area-based measure used widely to measure health inequalities in Ontario. Recently, the index was updated for 2011 and 2016. The loss of the 2011 long-form census required the use of alternative data sources for the 2011 version. This paper describes the update of ON-Marg, assesses consistency in the indices across census years using Dissemination Areas, and examines associations between ON-Marg 2016 and four health and social outcomes to demonstrate its potential to measure health inequalities. METHODS ON-Marg was created using factor analysis. Differences in quintile assignment was compared over time to assess whether the use of taxfiler, immigration, property assessment, and health card address data in 2011 affected consistency in measurement of marginalization. Inequalities in rates of overall mortality, gonorrhea incidence, mental health emergency department visits, and alcohol retail locations across quintiles of ON-Marg 2016 were quantified using the Relative Index of Inequality. RESULTS Depending on the dimension, between 81% and 96% of DAs showed limited or no changes in quintiles of marginalization between 2006, 2011 and 2016. Of the 45-64% of DAs that did not change quintile between 2006 and 2016, 1.8% to 8.8% of DAs in 2011 differed by two or more quintiles. Findings showed significant differences in rates of health and social outcomes across quintiles of ON-Marg 2016, with strength and directionality varying by dimension of ON-Marg. CONCLUSION Alternative data sources did not substantially affect the consistency of the 2011 version of ON-Marg. The updated ON-Marg is a comprehensive tool that can be used to study health inequalities in Ontario.
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Affiliation(s)
- Trevor van Ingen
- Public Health Ontario, 661 University Avenue, Suite 1701, Toronto, ON, M5G 1M1, Canada.
| | - Flora I Matheson
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College Street, Room 500, Toronto, ON, M5T 3M7, Canada
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12
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Caminada S, Turatto F, Iorio S, Paglione L, Errigo M, Mazzalai E, Jaljaa A, Giannini D, Tofani M, Michelazzo MB, Landi A, Napoli M, Brandimarte MA, Salvatori LM, Angelozzi A, Baglio G, Di Rosa E, Battisti A, Marceca M. Urban Health and Social Marginality: Perceived Health Status and Interaction with Healthcare Professionals of a Hard-to-Reach Community Living in a Suburban Area of Rome (Italy). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168804. [PMID: 34444550 PMCID: PMC8394967 DOI: 10.3390/ijerph18168804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 11/16/2022]
Abstract
The study reports an urban health investigation conducted in Bastogi, an outskirt of Rome (Italy) characterised by social marginalization and deprivation. Our aim was to analyse the health perception, health-related behaviours, and interaction with healthcare professionals of the inhabitants of Bastogi compared to the population living in the area of the same local health unit (ASL). The Progresses of Health Authorities for Health in Italy questionnaire (PASSI) was administered to a sample of 210 inhabitants of Bastogi. Data were analysed and compared to those of the ASL collected in 2017–2018. The socio-economic indicators showed an overall worse condition for the inhabitants of Bastogi, with a significantly higher proportion of foreign and unemployed residents and a lower educational level compared to the ASL. Significant differences in the prevalence of non-communicable diseases, mental health complaints, and participation in prevention strategies, including cancer screening, were found. The questionnaire showed a lower help-seeking behaviour and a lack of reliance on health professionals in Bastogi inhabitants. Our findings highlight how social determinants produce health inequities and barriers to accessing healthcare. The difficulties of conducting quantitative research in complex and hard-to-reach contexts, characterized by high social vulnerability, are outlined.
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Affiliation(s)
- Susanna Caminada
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (F.T.); (E.M.); (A.J.); (D.G.); (M.T.); (A.A.); (M.M.)
- Correspondence:
| | - Federica Turatto
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (F.T.); (E.M.); (A.J.); (D.G.); (M.T.); (A.A.); (M.M.)
| | - Silvia Iorio
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 00185 Rome, Italy;
| | - Lorenzo Paglione
- Department of Civil, Constructional and Environmental Engineering, Sapienza University of Rome, 00184 Rome, Italy;
- Department of Prevention, Local Health Unit Roma 1, 00135 Rome, Italy; (A.L.); (M.N.); (M.A.B.); (E.D.R.)
| | - Miriam Errigo
- Department of Social Sciences and Economics, Sapienza University of Rome, 00185 Rome, Italy;
| | - Elena Mazzalai
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (F.T.); (E.M.); (A.J.); (D.G.); (M.T.); (A.A.); (M.M.)
| | - Anissa Jaljaa
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (F.T.); (E.M.); (A.J.); (D.G.); (M.T.); (A.A.); (M.M.)
| | - Dara Giannini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (F.T.); (E.M.); (A.J.); (D.G.); (M.T.); (A.A.); (M.M.)
| | - Marco Tofani
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (F.T.); (E.M.); (A.J.); (D.G.); (M.T.); (A.A.); (M.M.)
| | - Maria Benedetta Michelazzo
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Adelaide Landi
- Department of Prevention, Local Health Unit Roma 1, 00135 Rome, Italy; (A.L.); (M.N.); (M.A.B.); (E.D.R.)
| | - Massimo Napoli
- Department of Prevention, Local Health Unit Roma 1, 00135 Rome, Italy; (A.L.); (M.N.); (M.A.B.); (E.D.R.)
| | | | | | - Aurora Angelozzi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (F.T.); (E.M.); (A.J.); (D.G.); (M.T.); (A.A.); (M.M.)
| | - Giovanni Baglio
- Research and International Relations Office, Agenzia Nazionale per i Servizi Sanitari Regionali (AGENAS), 00187 Rome, Italy;
| | - Enrico Di Rosa
- Department of Prevention, Local Health Unit Roma 1, 00135 Rome, Italy; (A.L.); (M.N.); (M.A.B.); (E.D.R.)
| | - Alessandra Battisti
- Department of Planning, Design, and Technology of Architecture, Sapienza University of Rome, 00196 Rome, Italy;
| | - Maurizio Marceca
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (F.T.); (E.M.); (A.J.); (D.G.); (M.T.); (A.A.); (M.M.)
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Kim W, Jang S, Lee G, Chang YJ. Disparities in Cancer-Related Avoidable Mortality by the Level of Area Deprivation in South Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157856. [PMID: 34360148 PMCID: PMC8345709 DOI: 10.3390/ijerph18157856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/20/2021] [Accepted: 07/20/2021] [Indexed: 12/03/2022]
Abstract
Background: This study investigated trends in cancer-related avoidable (preventable and treatable) mortality and its association with area deprivation in Korea. Methods: Cancer-related avoidable mortality rates per 100,000 population between 2015 and 2019 were measured using the Causes of Death Statistics. Area Deprivation Index (ADI) was measured from the Population and Housing Census and information on other independent variables from the Korea Community Health Survey. The gap in avoidable mortality between the more and less deprived groups was expressed as rate ratios (RR) and absolute differences (ADs) with a 95 percent confidence interval (95% CI). The association between avoidable mortality and ADI was investigated through Poisson regression modelling. Results: The more deprived areas had higher avoidable (RR 1.15, 95% CI 1.13–1.17; AD 6.58, 95% CI 5.59–7.57) and preventable (RR 1.19, 95% CI 1.17–1.21; AD 6.22, 95% CI 5.38–7.06) mortality. The overall cancer-related avoidable mortality decreased but the gap between the more and less deprived groups did not decline significantly during the study period. The association between avoidable and preventable mortality and area deprivation remained significant after adjusting for variables, including area levels of smokers and alcohol drinkers. Conclusions: The gap in avoidable mortality signifies the importance of addressing related disparities in cancer.
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14
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Shahidi FV, Parnia A, Siddiqi A. Trends in socioeconomic inequalities in premature and avoidable mortality in Canada, 1991-2016. CMAJ 2021; 192:E1114-E1128. [PMID: 32989024 DOI: 10.1503/cmaj.191723] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Recent epidemiologic findings suggest that socioeconomic inequalities in health may be widening over time. We examined trends in socioeconomic inequalities in premature and avoidable mortality in Canada. METHODS We conducted a population-based repeated cohort study using the 1991, 1996, 2001, 2006 and 2011 Canadian Census Health and Environment Cohorts. We linked individual-level Census records for adults aged 25-74 years to register-based mortality data. We defined premature mortality as death before age 75 years. For each census cohort, we estimated age-standardized rates, risk differences and risk ratios for premature and avoidable mortality by level of household income and education. RESULTS We identified 16 284 045 Census records. Between 1991 and 2016, premature mortality rates declined in all socioeconomic groups except for women without a high school diploma. Absolute income-related inequalities narrowed among men (from 2478 to 1915 deaths per 100 000) and widened among women (from 1008 to 1085 deaths per 100 000). Absolute education-related inequalities widened among men and women. Relative socioeconomic inequalities in premature mortality widened progressively over the study period. For example, the relative risk of premature mortality associated with the lowest income quintile increased from 2.10 (95% confidence interval [CI] 2.02-2.17) to 2.79 (95% CI 2.66-2.91) among men and from 1.72 (95% CI 1.63- 1.81) to 2.50 (95% CI 2.36-2.64) among women. Similar overall trends were observed for avoidable mortality. INTERPRETATION Socioeconomically disadvantaged groups have not benefited equally from recent declines in premature and avoidable mortality in Canada. Efforts to reduce socioeconomic inequalities and associated patterns of disadvantage are necessary to prevent this pattern of widening health inequalities from persisting or worsening over time.
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Affiliation(s)
- Faraz Vahid Shahidi
- Institute for Work & Health (Shahidi); Dalla Lana School of Public Health (Parnia, Siddiqi), University of Toronto, Toronto, Ont.; Gillings School of Public Health (Siddiqi), University of North Carolina, Chapel Hill, NC
| | - Abtin Parnia
- Institute for Work & Health (Shahidi); Dalla Lana School of Public Health (Parnia, Siddiqi), University of Toronto, Toronto, Ont.; Gillings School of Public Health (Siddiqi), University of North Carolina, Chapel Hill, NC
| | - Arjumand Siddiqi
- Institute for Work & Health (Shahidi); Dalla Lana School of Public Health (Parnia, Siddiqi), University of Toronto, Toronto, Ont.; Gillings School of Public Health (Siddiqi), University of North Carolina, Chapel Hill, NC
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