A spatiotemporal analysis of inequalities in life expectancy and 20 causes of mortality in sub-neighbourhoods of Metro Vancouver,British Columbia,Canada, 1990–2016

Spatially varying baseline data can help identify and prioritise actions directed to determinants of intra-urban health inequalities. Twenty-seven years (1990–2016) of cause-specific mortality data in British Columbia, Canada were linked to three demographic data sources. Bayesian small area estimation models were used to estimate life expectancy (LE) at birth and 20 cause-specific mortality rates by sex and year. The gaps in LE for males and females ranged from 6.9 years to 9.5 years with widening inequality in more recent years. Inequality ratios increased for almost all causes, especially for HIV/AIDS and sexually transmitted infections, maternal and neonatal disorders, and neoplasms.     

Detection of ‘Candidatus Ehrlichia khabarensis’ in rodents and ticks removed from rodents in British Columbia,Canada

‘Candidatus Ehrlichia khabarensis’ was first described from rodents and insectivores in the Far East territory of Khabarovsk on the Russian Pacific Coast. Here we report the detection of DNA from this microorganism in rodents and fed ticks collected from rodents in British Columbia, Canada in 2013–2014. ‘Candidatus Ehrlichia khabarensis’ was detected in (i) a female Ixodes angustus tick collected from a Peromyscus maniculatus; (ii) a female Dermacentor andersoni tick collected from a Perognathus parvus; (iii) a pool of 2 larval Ixodes pacificus ticks collected from a single P. maniculatus; and (iv) a pool of 3 nymphal I. pacificus ticks collected from a single P. maniculatus. Three of these four rodents (2 P. maniculatus and 1 P. parvus) with infected ticks also had evidence of ‘Candidatus Ehrlichia khabarensis’ in at least one tissue type. The infected P. maniculatus and Ixodes ticks came from the Vancouver area in western British Columbia and the P. parvus and Dermacentor tick from an inland site in central British Columbia. Although it remains to be determined whether ‘Candidatus Ehrlichia khabarensis’ has any negative impacts on wildlife, domestic animals or humans, we note that all three tick species found to contain the DNA of this microorganism are known to bite humans. Future detection of this microorganism either in ticks collected from rodents and allowed to molt to the next life stage prior to being tested, or from host-seeking ticks, is required to determine if it can survive the tick’s molt after being ingested via an infectious blood meal.     

Under-reporting of infectious gastrointestinal illness in British Columbia, Canada: who is counted in provincial communicable disease statistics?

Under-reporting of infectious gastrointestinal illness (IGI) in British Columbia, Canada was calculated using simulation modelling, accounting for the uncertainty and variability of input parameters. Factors affecting under-reporting were assessed during a cross-sectional randomized telephone survey. For every case of IGI reported to the province, a mean of 347 community cases occurred (5th and 95th percentile estimates ranged from 181 to 611 community cases, respectively). Vomiting [odds ratio (OR) 2.15, 95% confidence interval (CI) 1.03-4.49] and antibiotic use in the previous 28 days (OR 3.59, 95% CI 1.17-10.97) significantly predicted health-care visits in a logistic regression model. In bivariate analyses, physicians were significantly less likely to request stool samples from patients with vomiting (RR 0.09, 95% CI 0.01-0.65) and patients of North American as opposed to non-North American cultural groups (RR 0.38, 95% CI 0.15-0.96). Physicians were more likely to request stool samples from older patients (P=0.003), patients with fewer household members (P=0.002) and those who reported anti-diarrhoeal use following illness (RR 3.33, 95% CI 1.32-8.45). People with symptoms of vomiting were under-represented in provincial communicable disease statistics. Differential degrees of under-reporting must be understood before biased surveillance data can be adjusted.     

Time on wait lists for coronary bypass surgery in British Columbia,Canada, 1991 – 2000

Background  

In British Columbia, Canada, all necessary medical services are funded publicly. Concerned with growing wait lists in the mid-1990s, the provincial government started providing extra funding for coronary artery bypass grafting (CABG) operations annually. Although aimed at improving access, it is not known whether supplementary funding changed the time that patients spent on wait lists for CABG. We sought to determine whether the period of registration on wait lists had an effect on time to isolated CABG and whether the period effect was similar across priority groups.     

Epidemiology of work-related injuries requiring hospitalization among sawmill workers in British Columbia, 1989–1997

This study describes hospitalized injuries among workers in British Columbia lumber industry. Between April 1989 and December 1997, from the hospital records of 5,745 male sawmill workers were analyzed for the present study. Work relatedness was determined using either ICD-9 external cause of injury codes, which have a digit-indicating place of occurrence, or a payment field, which can identify workers compensation agency. Poisson regression models were used to analyze differences in hospitalization rates across race, job category, age group, and calendar year. The crude and adjusted rate ratios were calculated along with the 95% confidence intervals (CIs). During the follow-up period, there were 164 work related hospitalization resulting in a rate for work-related hospitalization of 5.38 per 1,000 person years. The higher rates by nature of injury were for dislocation, sprains & strains, open wounds, and fracture of upper limbs. During the study period, the higher rates of injury by causes were machinery related, falls, and struck against. In the multivariate models, there were no statistically significant relationship of injury risk with age and race. In respect to occupation, compared to foremen/supervisor, other sawmills’ workers did not have significantly elevated risk of injury. The trend analyses found a significant negative trend (P = 0.004) of injury risk over the whole study period. Knowing the causes and nature of injury and their related risk factors are helpful to employers, compensation officials, and other stakeholders to target preventive measures.     

The impact of changes in social policies on household food insecurity in British Columbia, 2005–2012

As concerns about food insecurity in high income countries grow, there is a need to better understand the impact of social policy decisions on this problem. In Canada, provincial government actions are particularly important because food insecurity places substantial burden on provincial health care budgets. This study was undertaken to describe the socio-demographic and temporal patterning of food insecurity in British Columbia (BC) from 2005 to 2012 and determine the impact of BC's one-time increase in social assistance and introduction of the Rental Assistance Program (RAP) on food insecurity rates among target groups. Using data from the Canadian Community Health Surveys, logistic regression analyses were conducted to identify trends and assess changes in food insecurity among subgroups differentiated by main source of income and housing tenure. Models were run against overall food insecurity, moderate and severe food insecurity, and severe food insecurity to explore whether the impact of policy changes differed by severity of food insecurity. Overall food insecurity rose significantly among households in BC between 2005 and 2012. Following the increase in social assistance benefits, overall food insecurity and moderate and severe food insecurity declined among households on social assistance, but severe food insecurity remained unchanged. We could discern no effect of the RAP on any measure of food insecurity among renter households. Our findings indicate the sensitivity of food insecurity among social assistance recipients to improvements in income and highlight the importance of examining severity of food insecurity when assessing the effects of policy interventions.     

Decreasing Hepatitis C Incidence Among a Population With Repeated Tests: British Columbia,Canada, 1993–2011

Objectives. We estimated HCV incidence among individuals who repeatedly underwent anti-HCV testing.Methods. We studied HCV-negative individuals who had at least 2 tests between April 1992 and September 2012 in British Columbia, Canada. We calculated incidence as the number of new infections per 100 person-years at risk.Results. From 1992 to 2012, 323 598 individuals who persistently tested negative and 7490 HCV seroconverters contributed 1 774 262 person-years of observation time. Incidence rates ranged from 2.66 infections per 100 person-years (95% confidence interval [CI] = 2.07, 3.35) in 1993 to 0.25 infections per 100 person-years (95% CI = 0.21, 0.29) in 2011. Rates declined sharply in the 1990s and declined more gradually in the 2000s. Incidence declined with age; highest incidence rates were among those aged 15 to 24 years. Incidence among male repeat testers exceeded that of female repeat testers across all years, although the gap narrowed over time.Conclusions. Addictions treatment, harm reduction, prevention education, and novel initiatives to remove barriers in health infrastructure need to be intensified for those who inject drugs, particularly men and younger persons.HCV infection is a major global cause of liver-related morbidity and mortality.1 Transmission is through blood contact, and in developed nations HCV is endemic among persons who inject drugs (PWID), the core group involved in forward transmission of the epidemic.1–4 The number of new HCV infections is projected to decrease, whereas the number of individuals with advanced liver disease as a result of HCV is projected to increase.5,6 Decisions regarding the prevention of HCV-related morbidity and mortality are at a critical juncture, as end-stage liver disease is imminent in many of those infected and more effective, better tolerated curative therapies have recently been approved.7 Despite these advances, treatment rates among PWID are low, and linking this group to care is considered key in having a population-level impact on the epidemic.4Monitoring HCV incidence in core groups is important for planning and evaluating prevention efforts, treatment, and resource allocation. However, distinguishing recent from established HCV infection is challenging because of the high proportion of asymptomatic cases and the absence of a reliable serologic test to differentiate between acute and chronic infection.8,9 A further challenge in incidence estimation is defining and quantifying the population at risk for HCV, the denominator in calculations of incidence.In British Columbia, a western Canadian province with a population of 4.5 million, HCV cases are identified by HCV antibody screening. HCV testing is targeted at individuals with specific risk factors—a history of injection drug use, hemodialysis, receipt of blood products before 1992 or clotting factors before 1988, exposure to the blood of a high-risk individual, incarceration, and unregulated tattoos—as well as individuals with HIV or persistently elevated liver enzymes.10As a pragmatic indicator of incidence, Canadian provinces use the rate of acute HCV, defined as a first-time anti-HCV positive laboratory result in an individual with a negative test on record in the past 12 months.11 Thus, identification of incident cases relies on repeat testing behavior and excludes more than three quarters of all newly diagnosed cases each year that are positive at first test. Although imperfect, these rates provide some indication of transmission trends. In British Columbia, acute HCV rates have been decreasing since 2008, from 3.4 to 1.5 cases per 100 000 population in 2011 (unpublished British Columbia Centre for Disease Control data).Methods of incidence estimation as determined by repeat laboratory testing have been developed for HIV and other sexually transmitted infections and are applicable to HCV.12,13 Among individuals who test repeatedly, annual incidence is calculated as the number of seroconversions over the total person-time at risk for HCV infection. Person-time at risk starts from the first negative test to either the last negative or first positive test on record. This approach is most useful in jurisdictions like British Columbia, where laboratory testing for HCV is centralized or the linkage of all HCV testing is possible.In a novel application of this method to HCV surveillance data, using a province-wide laboratory-testing database, we examined incident cases among individuals who repeatedly tested for HCV in British Columbia. Our purpose was to (1) estimate trends in provincial HCV incidence among all repeat testers, and (2) evaluate the method for ongoing monitoring purposes.     

Analysing ‘cultural safety’ in mental health policy reform: lessons from British Columbia,Canada

In response to the mental health disparities experienced by Aboriginal peoples, and related inequities regarding the accessibility to appropriate mental health care, there has been a shift in health policy to endorse ‘By Indigenous for Indigenous’ health care delivery models. In Canada, this has resulted in the creation of new mechanisms for Aboriginal participation in health care planning by health authorities with the goal of fostering culturally safe mental health and addictions care. Yet, there is a growing concern about the effects of neo-liberal cost concerns in health policy on the effective implementation of such progressive reform ideas. Drawing on a critical policy review and ethnographic interviews with four community-based Aboriginal organisations and one health authority, this article uses ‘cultural safety’ as a critical lens to discuss emerging tensions within the context of regional Aboriginal mental health care reform in British Columbia. The findings of this study draw attention to the intersecting ways that dominant socio-historical and political ideologies undermine cultural safety in decision-making and funding practices, thereby creating situations of cultural risk for both Aboriginal people working within the area of Aboriginal mental health and by extension for Aboriginal people who are seeking mental health and addictions care. The insights gained from this research contribute to the ongoing dialogue regarding how to foster culturally safe mental health policy and practice, and for action in the political realm.     

Dissipation of cyanazine and metolachlor on a clay loam soil,Ontario, Canada, 1987–1990

Dissipation of cyanazine and metolachlor was determined following two and three applications, respectively, to a clay loam soil at the Animal Research Centre Farm, Ottawa between 1987 and 1990. Residue decline, leachability into the soil profile, movement into tile drainage water, and contamination of the groundwater of the two herbicides were measured. The amount of each herbicide applied to the soil surface was accounted for in the upper layer during the first week following treatment.Cyanazine disappeared from the upper 15 cm of the soil in 181 days in 1987 and 90 days in 1988, with a calculated half-life disappearance of 27 and 12 days respectively. Residues of cyanazine were not detected in the soil profile below 15 cm or in tile drainage water. A single residue was detected in a sample of groundwater in 1988 at the detection level of 0.01 g/L.The decline of metolachlor was followed in the upper 15 cm of the soil for 332, 364 and 370 days respectively in 1987, 1988 and 1989 and the half-life disappearance of 80, 99 and 142 days were calculated. Residues of metolachlor were detected between 15 and 30 cm but not below 30 cm in the soil profile. Metolachlor was detected in some tile drainage waters throughout the study period 1987–90. Between 0.003 and 0.01% of the metolachlor applied to the surface appeared in tile drainage water following each of three applications. Metolachlor was present in groundwaters 1.2 to 4.6 m deep between the fall of 1988 to the summer of 1989. It was estimated that by the end of the season between 0.06 and 0.19% of the metolachlor moved into the shallow groundwater between the depths of 1.2 and 4.6 m.Contribution Number 1730 from Animal Research Centre.     

Effects of dietary ABATE® on reproductive success,duckling survival,behavior, and clinical pathology in game-farm mallards

Forty-four pairs of game-farm mallards (Anas platyrhynchos) were fed ABATE^® 4E (temephos) to yield 0, 1, or 10 ppm ABATE^® beginning before the initiation of lay, and terminating when ducklings were 21 days of age. The mean interval between eggs laid was greater for hens fed 10 ppm ABATE^® than for controls. Clutch size, fertility, hatchability, nest attentiveness of incubating hens, and avoidance behavior of ducklings were not significantly affected by ABATE^® ingestion. The percentage survival of ducklings to 21 days of age was significantly lower in both treated groups than in controls, but brain acetylcholinesterase (AChE) activity was not inhibited in young which died before termination of the study. In 21-day-old ducklings, aspartate aminotransferase (AST) activity increased and plasma nonspecific cholinesterase (ChE) activity was inhibited by about 20% in both treatment groups, but there were no significant differences in brain AChE or plasma alanine aminotransferase (ALT) activities, or plasma uric acid concentration. Clinical chemistry values of adults were not affected. No ABATE^®, ABATE^® sulfoxide, or ABATE^® sulfone residues were found in eggs or tissue samples.     

Should North America’s first and only supervised injection facility (InSite) be expanded in British Columbia, Canada?

Background

This article reports qualitative findings from a sample of 31 purposively chosen injection drug users (IDUs) from Vancouver, Surrey and Victoria, British Columbia interviewed to examine the context of safe injection site in transforming their lives. Further, the purpose is to determine whether the first and only Supervised injection facility (SIF) in North America, InSite, needs to be expanded to other cities.

Methods

Semi-structured qualitative interviews were conducted in a classical anthropological strategy of conversational format as drug users were actively involved in their routine activities. Purposive sampling combined with snowball sampling techniques was employed to recruit the participants. Audio recorded interviews were transcribed verbatim and analyzed thematically using NVivo 9 software.

Results

Attending InSite has numerous positive effects on the lives of IDUs including: saving lives, reducing HIV and HCV risk behavior, decreasing injection in public, reducing public syringe disposal, reducing use of various medical resources and increasing access to nursing and other primary health services.

Conclusions

There is an urgent need to expand the current facility to cities where injection drug use is prevalent to reduce overdose deaths, reduce needle sharing, reduce hospital emergency care, and increase safety. In addition, InSite’s positive changes have contributed to a cultural transformation in drug use within the Downtown Eastside and neighboring communities.     

Immigration,ethnicity, and avoidable mortality in Canada, 1991–2006

Objective. Avoidable mortality is a well-recognized, but less studied indicator of the performance of the health system. First, the study seeks to establish whether immigrants overall and selected foreign-born ethnic groups (Western Europeans, South Asians, Chinese, and Filipinos) have an advantage over nonimmigrants in avoidable mortality. Second, it assesses the effect of sociodemographic and socioeconomic factors on any observed differences by duration of residence.

Design. Deaths grouped by cause of death and by behavioral risk factors, namely smoking-related and alcohol-related, were derived from the 1991 Canadian Census Cohort: Mortality and Cancer Follow-up. The analysis estimated age-standardized mortality rates (ASMRs), rate ratios, and rate differences and also fitted hazard regression models for the overall Canadian-born population and for selected foreign-born ethnicities by sex. Predictors were assessed at baseline.

Results. Compared to the Canadian-born persons, foreign-born men and women had lower ASMRs for overall avoidable mortality and also for selected causes of avoidable mortality. The only exception to this overall trend was for ischemic heart disease among South Asian women. Except for the order of prominence, the three leading causes of death for nonimmigrant and immigrant men and women overall were ischemic heart diseases, smoking-related diseases, and neoplasms. A similar pattern was observed among the ethnic groups, except for circulatory heart diseases replacing ischemic heart diseases and smoking-related diseases among Chinese and Filipino women, respectively. In the hazard regression analysis, the risk of avoidable mortality was lower for immigrants overall and selected ethnicities irrespective of the duration in Canada compared to nonimmigrants. These differences persisted even with adjustment for sociodemographic and socioeconomic factors.

Conclusion. Immigrants overall and the selected ethnicities enjoy an advantage over nonimmigrants in avoidable mortality. However, for certain causes of death especially ischemic heart disease mortality among South Asian women, immigrants appeared worse-off than nonimmigrants. The results suggest differential access to and use of health services, differences in protective health-related behavior, and the healthy immigrant effect.     

Measures of reproductive success and polychlorinated biphenyl residues in eggs and chicks of Forster's terns on Green Bay,Lake Michigan,Wisconsin—1988

Data on reproductive success of Forster's tern (Sterna forsteri) from Green Bay, Lake Michigan in 1983 are compared with data collected in 1988. In 1988 measures of reproductive performance (hatching success, number of young fledged, and length of incubation) were improved. Concentrations of total polychlorinated biphenyls (PCBs) and planar PCB congeners in the eggs were compared between years. Median total PCB residue was 67% lower in 1988 ( =7.3 μg/g). This corresponds to a 42% reduction in tetrachlorodibenzo-p-dioxin equivalents (TCDD-EQ) from 1983 to 1988. We suggest that contaminant reduction and improved reproductive performance were due to low river flows in 1988 and associated reduced PBC loading into Green Bay. Forty-two percent of the matured chicks died before fledgling, and their body weight growth curves were much lower than normal. Young accumulate total PCBs at a rate of 17.6 μg/day. A no-observable-adverse-effects level (NOAEL) of 40–84 μg/kg/day was estimated from the two year results using the least observable adverse effects level (LOAEL)/NOAEL rating values.     

Population-based incidence of invasive pneumococcal disease in children and adults in Ontario and British Columbia, 2002–2018: A Canadian Immunization Research Network (CIRN) study

BackgroundInvasive pneumococcal disease (IPD) burden, evaluated in Canada using reported confirmed cases in surveillance systems, is likely underestimated due to underreporting. We estimated the burden of IPD in Ontario and British Columbia (BC) by combining surveillance data with health administrative databases.MethodsWe established a cohort of 27,525 individuals in Ontario and BC. Laboratory-confirmed IPD cases were identified from Ontario’s integrated Public Health Information System and the BC Centre for Disease Control Public Health Laboratory. Possible IPD cases were identified from hospitalization data in both provinces, and from emergency department visit data in Ontario. We estimated the age and sex adjusted annual incidence of IPD and pneumococcal conjugate/polysaccharide vaccine (PCV/PPV) serotype-specific IPD using Poisson regression models.ResultsIn Ontario, 20,205 overall IPD cases, including 15,299 laboratory-confirmed cases, were identified with relatively stable age- and sex-adjusted annual incidence rates ranging from 13.7/100,000 (2005) to 13.6/100,000 (2018). In BC, 7,320 overall IPD cases, including 5,932 laboratory-confirmed cases were identified; annual incidence rates increased from 10.9/100,000 (2002) to 13.2/100,000 (2018). Older adults aged ≥ 85 years had the highest incidence rates. During 2007–2018 the incidence of PCV7 serotypes and additional PCV13 serotypes decreased while the incidence of unique PPV23 and non-vaccine serotypes increased in both provinces.ConclusionsIPD continues to cause a substantial public health burden in Canada despite publicly funded pneumococcal vaccination programs, resulting in part from an increase in unique PPV23 and non-vaccine serotypes.     

An Analysis of Antenatal Hospitalization in Canada, 1991–2003

Objectives: To examine the incidence and temporal trends of hospitalization during pregnancy, and provide additional information on maternal morbidity among Canadian women. Methods: A population-based cohort study was conducted using the Canadian Institute for Health Information’s Discharge Abstract Database between fiscal year 1991/92 and 2002/03. This database included antenatal hospitalizations for all hospital deliveries (N=3,103,365) in Canada except for those occurring in Manitoba and Quebec. Temporal trends, and variations in the non-delivery antenatal hospitalization ratio (per 100 deliveries) by maternal age and province or territory were quantified. Primary causes for antenatal hospitalization, the lengths of in-hospital stay, and changing pattern by maternal age and time period were compared. Results: The overall antenatal hospitalization ratio declined by 43%, from 24.0 per 100 deliveries in 1991/92 to 13.6 in 2002/03. Younger women tended to be hospitalized more frequently than older women: 27.1 per 100 deliveries for women aged less than 20 years and 21.5 per 100 deliveries for 20–24 years, respectively, compared to 11.5 per 100 for women aged 35–39 years. The antenatal hospitalization ratio varied greatly by province/territory – from 12.2 per 100 deliveries in Ontario to 30.7 in the Yukon. Threatened preterm labour, antenatal hemorrhage, hypertensive disorders, severe vomiting and diabetes remained the five most common causes for antenatal hospitalization, although the trends for the first four declined dramatically from 1991/92 to 2002/03. Younger women were more likely to be admitted for threatened preterm labour and severe vomiting, while older women were more likely to be admitted for antenatal hemorrhage and hypertensive disorders. Conclusions: The decline in antenatal hospitalization may reflect changes in management of pregnancy complications, e.g., transition from in-hospital care to out-of-hospital care, and introduction of antepartum home care programs. Information on interprovincial/territorial variations in antenatal hospitalization may be helpful in directing future maternal health care.     

Conduct of vaccination in hard-to-reach areas to address potential polio reservoir areas, 2014–2015

Background

The Global Vaccine Action Plan (GVAP) seeks to achieve the total realization of its vision through equitable access to immunization as well as utilizing the immunization systems for delivery of other primary healthcare programs. The inequities in accessing hard-to-reach areas have very serious implications for the prevention and control of vaccine-preventable diseases, especially the polio eradication initiative.The Government of Nigeria implemented vaccination in hard-to-reach communities with support from the World Health Organization (WHO) to address the issues of health inequities in the hard-to-reach communities. This paper documents the process of conducting integrated mobile vaccination in these hard-to-reach areas and the impact on immunization outcomes.

Methods

We conducted vaccination using mobile health teams in 2311 hard-to-reach settlements in four states at risk of sustaining polio transmission in Nigeria from July 2014 to September 2015.

Results

The oral polio vaccine (OPV)3 coverage among children under 1 year of age improved from 23% at baseline to 61% and OPV coverage among children aged 1–5 years increased from 60 to 90%, while pentavalent vaccine (penta3) coverage increased from 22 to 55%. Vitamin A was administered to 78% of the target population and 9% of children that attended the session were provided with treatment for malaria.

Conclusions

The hard-to-reach project has improved population immunity against polio, as well as other routine vaccinations and delivery of child health survival interventions in the hard-to-reach and underserved communities.

     

The rapidly changing location of death in Canada, 1994–2004

This 2008 study assessed location-of-death changes in Canada during 1994–2004, after previous research had identified a continuing increase to 1994 in hospital deaths. The most recent (1994–2004) complete population and individual-level Statistics Canada mortality data were analyzed, involving 1,806,318 decedents of all Canadian provinces and territories except Quebec. A substantial and continuing decline in hospitalized deaths was found (77.7%–60.6%). This decline was universal among decedents regardless of age, gender, marital status, whether they were born in Canada or not, across urban and rural provinces, and for all but two (infrequent) causes of death. This shift occurred in the absence of policy or purposive healthcare planning to shift death or dying out of hospital. In the developed world, recent changing patterns in the place of death, as well as the location and type of care provided near death appear to be occurring, making location-of-death trends an important topic of investigation. Canada is an important case study for highlighting the significance of location-of-death trends, and suggesting important underlying causal relationships and implications for end-of-life policies and practices.