Health behaviours and socio-economic status in Ontario, Canada

Data from the 1990 Ontario Health Survey were used to investigate the association of socio-economic status with the likelihood of meeting current recommendations for four health behaviours (smoking, fat intake, alcohol consumption, and physical activity level) in adults living in Ontario (Canada). Health behaviours were categorised as unhealthy if they did not meet current recommendations in Ontario (smoking, fat intake < 30% of dietary energy, alcohol intake < 14 units per week, low level of leisure-time physical activity). Two summary variables based on the number ofÔ unhealthyÕ behaviours were also examined: the crude number of unhealthy behaviours reported and the likelihood of reporting 3 or 4 unhealthy behaviours. Four measures of socio-economic status were used: educational achievement, household income status, source of household income, and occupational prestige. Multiple logistic and linear regression analyses were performed to explore the association of each unhealthy behaviour and of the summary variables with socio-economic status indicators (taken independently or simultaneously), controlling for demographic characteristics. Except for the positive relationship between income status and high alcohol intake, measures of unhealthy behaviours were inversely associated with the socio-economic indices, suggesting that individuals in lower socio-economic groups are at an increased risk for health problems.     

Investigations of pesticide contaminations in rural wells, 1979–1984, Ontario,Canada

Between the years 1979 and 1984, investigations were conducted into 311 events of suspected contaminations of wells with pesticides. This involved the analyses of water from 359 wells where the suspected contamination originated from (i) spills (ii) spray drift or (iii) surface runoff waters carrying pesticides into wells. Investigations covered 83 spill events involving 104 rural wells; tests revealed 79 of these became contaminated. The contaminations were caused by (i) spills of pesticide concentrates (ii) back-siphoning of spray solutions and/or (iii) spills from overfilling, emptying or rinsing spray equipment. The pesticides either entered directly into the wells or contaminated the area in the vicinity of the wells. In spite of cleanup attempts, difficulty was experienced in decontaminating most well waters and some had to be abandoned. The longest period of monitoring a contaminated well was 1, 117 days; during that time the decline in residue was slow.Investigations were made into 228 events involving 255 wells where spray drift and/or surface runoff waters with pesticides were observed as entering the well; however, only 55 were found to contain detectable residues. The highest proportion of these events was associated with surface runoff or spray drift from cornfields; of 86 wells involved only 26 contained measurable residues and all involved atrazine. Fifty-seven well investigations were associated with spraying right-of-ways and 16 waters were contaminated with 2,4-D and dichlorprop. The remaining 13 well contaminations were associated with various other land-use activities. It required 45 to 347 days to decontaminate these 55 wells.     

The economic costs of illicit drug use in Ontario, 1992

The use of illicit drugs causes health and social problems which imply economic costs to society. This paper uses the cost-of-illness method, in particular, the human–capital approach to estimate the prevalence-based economic costs of illicit drug use in Ontario in 1992. This methodology is consistent with international guidelines formulated at the 1994 International Symposium on Economic and Social Costs of Substance Abuse. The economic cost of illicit drug use is estimated at $489.29 million (Canadian dollars) in 1992. Associated with these costs are health-related harms: 211 deaths, half of which occur before the age of 35; and 20 690 days stay in public hospitals. © 1998 John Wiley & Sons, Ltd.     

The use of chewing tobacco and snuff in Canada, 1986

This paper reviews current data relating to the use of smokeless tobacco products in Canada. Sources of data include production, disposition, and sales statistics; special population surveys, and estimates obtained from the 1986 Labour Force Survey smoking supplement. In Canada, the use of smokeless tobacco products is confined to the male population. About 0.7% of males over age 15 use chewing tobacco and 0.4% use snuff. The pattern of use is similar to that of the United States in the early 70s. Prevalence rates for both substances tend to be higher in older age groups. Men employed in outdoor occupations are more likely to use chewing tobacco or snuff. Chewing tobacco use tends to be more prevalent in eastern Canada and snuff use in western Canada. The low national prevalence estimates conceal the relatively high usage rates among sub-populations. Among Inuit youth in the Northwest Territories in 1982, 25% of the 10-14 age group used smokeless tobacco.     

Homicide surveillance--United States, 1979-1988.

From 1979 through 1988, 217,578 homicides occurred in the United States, an average of greater than 21,000 per year. Homicide rates during this 10-year period were about 1.5 times higher than the rates during the 1950s. The national homicide rate of 10.7/100,000 in 1980 was the highest ever recorded. Homicide occurs disproportionately among young adults. Among the 15- to 34-year age group, homicide is the fourth most common cause of death among white females, the third most common cause among white males, and the most common cause among both black females and black males. In 1988, nearly two-thirds (61%) of homicide victims were killed with a firearm, 75% of these with a handgun. More than half (52%) of homicide victims were killed by a family member or acquaintance, and about one-third (35%) of homicides stemmed from a conflict not associated with another felony. The homicide mortality rate among young black males 15-24 years of age has risen 54% since 1985. Ninety-nine percent of the increase was accounted for by homicides in which the victim was killed with a firearm. The surveillance data summarized in this report should assist public health practitioners, researchers, and policymakers in addressing this important public health problem.     

Health care administration in the United States and Canada: micromanagement, macro costs.

A decade ago, U.S. health administration costs greatly exceeded Canada's. Have the computerization of billing and the adoption of a more business-like approach to care cut administrative costs? For the United States and Canada, the authors calculated the 1999 administrative costs of health insurers, employers' health benefit programs, hospitals, practitioners' offices, nursing homes, and home care agencies; they analyzed published data, surveys of physicians, employment data, and detailed cost reports filed by hospitals, nursing homes, and home care agencies; they used census surveys to explore time trends in administrative employment in health care settings. Health administration costs totaled at least dollar 294.3 billion, dollar 1,059 per capita, in the United States vs. dollar 9.4 billion, dollar 307 per capita, in Canada. After exclusions, health administration accounted for 31.0 percent of U.S. health expenditures vs. 16.7 percent of Canadian. Canada's national health insurance program had an overhead of 1.3 percent, but overhead among Canada's private insurers was higher than in the U.S.: 13.2 vs. 11.7 percent. Providers' administrative costs were far lower in Canada. Between 1969 and 1999 administrative workers' share of the U.S. health labor force grew from 18.2 to 27.3 percent; in Canada it grew from 16.0 percent in 1971 to 19.1 percent in 1996. Reducing U.S. administrative costs to Canadian levels would save at least dollar 209 billion annually, enough to fund universal coverage.     

Trends in smokeless tobacco use among men in four states, 1988 through 1993.

OBJECTIVES: Trends in smokeless tobacco use were examined for men in Indiana, Iowa, Montana, and West Virginia from 1988 through 1993. METHODS: State survey data from the Behavioral Risk Factor Surveillance System (BRFSS) were analyzed. RESULTS: Demographic characteristics associated with smokeless tobacco use included age less than 35 years, a high school education or less, and rural residence. Overall, there was little change in smokeless tobacco use among men in these states (range = -0.4-0.4 percentage points annually); only West Virginia had a significant decline. CONCLUSIONS: Reasons for the overall lack of decline may include increased advertising and promotional expenditures or substitution of smokeless tobacco for cigarettes. Increased prevention and cessation efforts are needed.     

Early menopause and infertility in females after treatment for childhood cancer diagnosed in 1964-1988 in Ontario, Canada.

This study was conducted to determine the risk of menopause and infertility in female childhood cancer survivors who received abdominal-pelvic radiation and/or chemotherapy with alkylating agents in comparison with those who were treated by nonsterilizing surgery only. Females who were diagnosed in 1964-1988 before age 20 years with a histologically confirmed malignancy and who had survived for at least 5 years, had attained age 18, and were alive at time of study were identified through the Ontario Cancer Registry. Reproductive outcomes were ascertained by a telephone-administered questionnaire, and treatment data were abstracted from medical records for 830 subjects aged 18-49 years; 719 survivors who were nonmenopausal at the end of treatment were included in the analyses. Survivors who received both alkylating agents and abdominal-pelvic radiation were more likely to be postmenopausal than were those who underwent surgery (risk ratio = 2.58; 95% confidence interval: 1.14, 5.80). Women treated with abdominal-pelvic radiation alone had a fertility deficit of 23% compared with those in the surgery group; the deficit was restricted to women diagnosed postpuberty. Risks of menopause and infertility increased with increasing dose of abdominal-pelvic radiation and amount of alkylating agent.     

A population based time series analysis of asthma hospitalisations in Ontario, Canada: 1988 to 2000

Background  

Stroke patients' care in hospital tends to be poorly organised, with poor communication and a lack of information being frequent sources of complaint. The purpose of this study was to evaluate whether a patient-held record (PHR) would result in greater patient satisfaction and better care planning for stroke patients.     

A population based time series analysis of asthma hospitalisations in Ontario, Canada: 1988 to 2000

Background  

Asthma is a common yet incompletely understood health problem associated with a high morbidity burden. A wide variety of seasonally variable environmental stimuli such as viruses and air pollution are believed to influence asthma morbidity. This study set out to examine the seasonal patterns of asthma hospitalisations in relation to age and gender for the province of Ontario over a period of 12 years.     

Mortality attributable to tobacco use in Canada and its regions, 1998

OBJECTIVES: The purpose of this report is to calculate 1998 smoking attributable mortality (SAM) and to explore whether SAM estimates have changed from the late 1980s to the late 1990s. METHODS: Using the data from the National Population Health Survey and the Canadian Mortality Database, a modified Smoking-Attributable Mortality, Morbidity and Economic Cost (SAMMEC) method was applied to estimate national and regional smoking-attributable mortality for 1998. FINDINGS: The results indicate that in 1998, 30,230 men and 17,351 women died as a result of both active and passive smoking, including 96 children under the age of 1. This includes 1,107 Canadians who died from both lung cancer and ischemic heart disease attributable to environmental tobacco smoke. The total of 47,581 deaths represents an increase of 9,224 deaths since 1989, with females accounting for 6,531 of these increased deaths. The increase in female mortality is divided between cancers (2,452), cardiovascular diseases (1,646), and respiratory diseases (2,283). In 1998, the top causes of adult smoking-related deaths were lung cancer (13,951 deaths), ischemic heart disease (9,289 deaths) and chronic airways obstruction (6,457 deaths). CONCLUSION: Cigarette smoking remains the number one preventable cause of death in Canada and its impact on the health of Canadians continues to be an unacceptable burden.     

Health expectancy in Canada, late 1970s: demographic, regional, and social dimensions.

Based on estimates of activity restriction from the Canada Health Survey, institutional data on long-term care, and survival data from vital statistics, we have calculated an index of health expectancy (life expectancy in each state of health), and a summary of these indices which we have called quality-adjusted life expectancy. At birth, expected years of long-term institutionalization were 0.8 for men and 1.5 for women. Expected years of activity restriction not involving long-term institutionalization were 10.8 for men and 14.0 for women; 3.0 of the expected years of activity restriction for men and 1.3 of these years for women were in the most severe category of restriction (unable to do major activity). For both sexes together, quality-adjusted life expectancy was 1.4 years greater in Ontario and the Prairies than in the Atlantic region, 3.2 years greater in Canada's three largest cities than in rural areas and small towns, and 7.7 years greater among persons from high-income families than among persons from low-income families.     

Spontaneous abortions in Ontario, 1979 to 1984

Hospital data may be used to estimate the frequency of hospital admission for spontaneous abortion (miscarriage) in Ontario. Although many episodes of spontaneous abortion will be missed, especially those occurring early in gestation, these estimates can be used to identify fluctuations in the provincial average. Hospital Medical Records Institute (HMRI) provided data on hospital admissions for all hospitals in Ontario. Using these records, provincial admissions for spontaneous abortion (ICD 9 codes 632, 634 and 637) were analyzed for the period 1979 to 1984. Miscarriages occurring under 20 weeks were calculated as a percentage of total reported pregnancies, which included livebirths, stillbirths, and induced abortions. The miscarriage rate was steady throughout the period of observation, ranging from 6.8% to 7.2% and was observed to vary with maternal age and county of residence. Several Ontario counties consistently experienced high rates of spontaneous abortion for the years 1980 to 1984 inclusive. Possible reasons for these observations are discussed and suggestions for further investigations are proposed.     

Socio-spatial patterns of home care use in Ontario, Canada: A case study

Home care is the fastest growing segment of Canada's health care system. Since the mid-1990s, the management and delivery of home care has changed dramatically in the province of Ontario. The objective of this paper is to examine the socio-spatial characteristics of home care use (both formal and informal) in Ontario among residents aged 20 and over. Data are drawn from two cycles of the Canadian Community Health Survey (CCHS Cycle 3.1 2005 and Cycle 4.1 2007) and are analyzed at a number of geographical scales and across the urban to rural continuum. The study found that rural residents were more likely than their urban counterparts to receive government-funded home care, particularly nursing care services. However, rural residents were less likely to receive nursing care that was self-financed through for-profit agencies and were more reliant on informal care provided by a family member. The study also revealed that women and seniors were far more dependent on services that they paid for as compared to informal services. People with lower incomes and poorer health status, as well as rural residents, were also more likely to use informal services. The paper postulates that the introduction of managed competition in Ontario's home care sector may be effective in more populated parts of the province, including large cities, but at the same time may have left a void in access to for-profit formal services in rural and remote regions.     

Enthusiasm or uncertainty: small area variations in the use of mammography services in Ontario, Canada.

STUDY OBJECTIVE: To examine the variation in mammography utilisation in relation to age group and indication across health planning regions in Ontario, Canada. DESIGN: This study includes all women aged 30 and over in Ontario who received a mammogram between July 1, 1990 and December 31, 1991. Data from a sample of 10,000 women aged 50-69 were used to assign mammogram indication as "screening", "possible diagnostic", or "probable diagnostic" based on previous health care utilisation patterns. Age specific rates and age adjusted rates in relation to age group (30-39, 40-49, 50-69, and 70 + years) and region were derived. MAIN RESULTS: Overall, 572,762 women received one or more mammograms. Rates increased from 30-54 years and decreased thereafter. Similar variations were seen in the 40-49 and 50-69 age groups. The ranking in the area specific rates remained consistent for all ages except the 30-39 year range. In relation to indication, the largest variation across regions occurred in the screening group. CONCLUSIONS: Mammography utilisation varies across age groups. The greatest variability is for screening, probably because of physician referral patterns, patient uptake, and perhaps access to mammography. The extent of variation was similar when compared between groups where recommendations were consistent (ages 50-59) and where they were inconsistent (ages 40-49) suggesting that perhaps enthusiasm rather than uncertainty is related to regional variation for this procedure.     

Morbidity and mortality attributable to alcohol, tobacco, and illicit drug use in Canada

OBJECTIVES: This study estimated morbidity and mortality attributable to substance abuse in Canada. METHODS: Pooled estimates of relative risk were used to calculate etiologic fractions by age, gender, and province for 91 causes of disease or death attributable to alcohol, tobacco, or illicit drugs. RESULTS: There were 33,498 deaths and 208,095 hospitalizations attributed to tobacco, 6701 deaths and 86,076 hospitalizations due to alcohol, and 732 deaths and 7095 hospitalizations due to illicit drugs in 1992. CONCLUSIONS: Substance abuse exacts a considerable toll on Canadian society in terms of morbidity and mortality, accounting for 21% of deaths, 23% of years of potential life lost, and 8% of hospitalizations.     

Ongoing use of conventional devices and safety device activation rates in hospitals in Ontario, Canada

This study assessed voluntary compliance with the use of sharp safety devices in lieu of conventional ones and the activation status of these safety devices: VanishPoint syringes, Terumo Surshield butterflies, and Insyte Autoguard IV catheters. Sharps disposal containers from various wards in three private, not-for profit, university-affiliated Ontario hospitals were audited during 9 days in August 2007. In the 149 audited sharps containers, 55% of all syringes found were conventional compared with 45% that were safety syringes. In the three hospitals, the percentages of conventional (non-safety) vs. safety syringes found in used sharps containers were as follows, respectively: (i) 72% conventional and 28% safety, (ii) 55% conventional and 45% safety, and (iii) 65% conventional and 35% safety. In addition, it was found that 77% of 2131 Terumo butterflies, 97% of 1117 Insyte Autoguard IV catheters, and 87% of 4897 VanishPoint syringes in the containers had been activated. This study, carried out approximately 1 year before it was legally required to use safety instead of sharp conventional devices, found that most devices in use were conventional ones. It was also found that only the activation rate for the safety IV device was acceptable.