Age In Canada Research Articles

Socioeconomic inequities in alcohol-attributable mortality by sex/gender and age in Canada: A 13-year population-representative cohort study.

Individuals with low socioeconomic position (SEP) experience greater rates of alcohol-attributable mortality, contributing to health inequities in mortality and life expectancy. We examined the association between SEP and alcohol-attributable mortality by sex/gender and age in Canada. Census records from the 2006 Canadian Census Health and Environment Cohort (ages 12+; n=5,038,790) were linked to mortality data from 2006-2019. SEP was measured by educational attainment and household income. Poisson and Fine and Gray sub-distribution hazard models estimated rate differences (RD) per 100,000 person-years and hazard ratios (HR). Both educational attainment and household income were inversely associated with alcohol-attributable mortality. Absolute SEP inequities were greater among men than women, with a RD of 30.81 (95% CI: 28.04, 33.57) for men and 9.86 (95% CI: 8.49, 11.22) for women when comparing the lowest to the highest income quintile. Age-stratified analyses showed absolute SEP inequities were most pronounced in middle and older adulthood, above age 30 for women and age 50 for men, with smaller RDs in ages 12-29. Relative SEP inequities were similar in women and men, with greater HRs at younger ages. Public health policies addressing social determinants and population-level alcohol policies should consider patterning of SEP inequities by sex/gender and age group.

Dental Insurance Coverage, Dentist Visiting, and Oral Health Status among Asian Immigrant Women of Childbearing Age in Canada: A Comparative Study.

This study examined the dental insurance coverage, dentist visits, self-perceived oral health status, and dental problems among Asian immigrant women of childbearing age in contrast to Canadian women of childbearing age and non-Asian immigrant women of childbearing age. Potential barriers to dental care services among Asian immigrant women were explored. This analysis utilized data from the combined Canadian Community Health Survey from 2011 to 2014. The analytical sample consisted of 5737 females whose age was between 20 and 39 years. Multivariable logistic regression models assessed immigrant status and other factors in relation to the indicators of dental health (i.e., dental visit, self-perceived oral health, acute teeth issue, and teeth removed due to decay). Amongst Asian women immigrants of childbearing age, there was a significantly lower frequency of dentist visits compared to non-immigrant counterparts (OR = 0.53; 95% CI: 0.37-0.76). The most commonly reported reason for not seeking dental care in the last three years was that the "respondent did not think it was necessary". Relative to Canadian born women of same age bracket, Asian women of childbearing age reported fewer acute teeth issues (OR = 0.67; 95% CI: 0.49-0.91) and had a greater risk of tooth extracted due to tooth decay (OR = 3.31; 95% CI: 1.64-6.68). Furthermore, for Asian women immigrants, their major barriers to dental care included low household income (≤$39,999 vs. $40,000-$79,999 OR = 0.26) and a lack of dental insurance (no vs. yes OR = 0.33). Asian immigrant women showed lower utilization of dental services than non-immigrant women. A perceived lack of necessity, lower household income, and dental insurance coverage were major barriers to professional dental usage for most Asian immigrants of childbearing age.

92 Trends in COVID-19 Vaccination Coverage among Children <5 Years of Age in Canada

Abstract Introduction/Background COVID-19 vaccinations for those aged 6 months to 5 years were announced in the summer of 2022. Specifically, Moderna Spikevax and Pfizer-BioNTech Comirnaty were authorized on July 14, 2022, and September 9, 2022, respectively. Given that this was the last age group to become eligible for vaccination against COVID-19, promoting and measuring vaccination coverage in this vulnerable population is of public health significance. Objectives This analysis describes and compares the trend in vaccination coverage (VC) over the initial weeks of eligibility in those 0-17 years old. Design/Methods Data were obtained from the Canadian COVID-19 Vaccination Coverage Surveillance System and were analyzed to describe and compare VC of those <5, 5-11, and 12-17-year-olds over the first 16 weeks of eligibility. VC is defined as the percent of the population that have received at least 1 dose of a COVID-19 vaccine. Results Sixteen weeks after those <5 years became eligible for vaccination, coverage was 10.9% in those aged 2-4 and 6.3% in those aged <2. Compared to other paediatric age groups, VC in those <5 is markedly lower, where, after 16 weeks of eligibility, coverage in those aged 5–11 was 54.4% and 81.5% in those 12-17. There was an immediate spike in coverage for both 5–11-year-olds and 12–17-year-olds over the first 4 weeks following eligibility, where VC was 40.1% and 63.3%, respectively. A similar increase was not observed 4 weeks following eligibility in those aged <5, where VC was 7.4% in those aged 2-4 and 4.0% in those <2. The weekly increase in VC decreased more rapidly as age groups decreased; weekly increase in VC slowed to less than 1% in 28 weeks, 20 weeks, and 16 weeks after eligibility in those aged 12-17, 5-11, and <5, respectively. Conclusion These data suggest that VC over time in the <5 population has been slow and has not followed the trajectory of other paediatric populations, when compared to the 5-11 and 12-17 age groups. Reasons for this may include but are not limited to parents and guardians’ knowledge, attitudes, and beliefs toward getting their infant children vaccinated, as well as pandemic fatigue, as eligibility for the infant population occurred after the other paediatric age groups.

Community perspectives on structural barriers to dying well at home in Canada.

To analyze how structural determinants and barriers within social systems shape options for dying well at home in Canada, while also shaping preferences for dying at home. To inform a descriptive thematic analysis, 24 Canadian stakeholders were interviewed about their views, experiences, and preferences about dying at home. Participants included compassionate community advocates, palliative care professionals, volunteers, bereaved family caregivers, residents of rural and remote regions, service providers working with structurally vulnerable populations, and members of francophone, immigrant, and 2SLGBTQ+ communities. Analysis of stakeholders' insights and experiences led to the conceptualization of several structural barriers to dying well at home: inaccessible public and community infrastructure and services, a structural gap in death literacy, social stigma and discrimination, and limited access to relational social capital. Aging in Canada, as elsewhere across the globe, has increased demand for palliative care and support, especially in the home. Support for people wishing to die at home is a key public health issue. However, while Canadian policy documents normalize dying in place as ideal, it is uncertain whether these fit with the real possibilities for people nearing the end of life. Our analysis extends existing research on health equity in palliative and end-of-life care beyond a focus on service provision. Results of this analysis identify the need to expand policymakers' structural imaginations about what it means to die well at home in Canada.

Is Canada’s commuter bicycling population becoming more representative of the general population over time? A national portrait of bicycle commute mode share 1996–2016.

Despite equity gaining increasing attention in Canadian bicycling practice and research, the demographics of who is bicycling have not been documented nationally in Canada. This study uses Canadian census data to provide a nationwide portrait of: 1) how bicycle commute mode share varies by gender, race, income, and age in Canada; 2) how the sociodemographic characteristics of bicycle commuters in Canada have shifted between 1996 and 2016; and 3) how bicycle commuting and the demographics of bicycle commuters vary across metropolitan regions in Canada. We find that men, people who are not visible minorities and low-income populations commute by bicycle at double the rates of women, visible minorities, and other income groups, respectively. Women comprise an increasing share of bicycling commuters over the 20 years, whereas bicycling is increasing at similar rates across race and income groups. Cycling distinctly decreases with age. Cycling rates vary by region and there is some evidence that low-income and visible minority groups bicycle more in smaller, more car-centric metropolitan areas. These findings identify differences in bicycling across socio-demographic groups and geographic regions, which sets a foundation for research to uncover why these differences are occurring, in order to point policymakers toward targeted solutions that specifically address inequities in bicycle commuting between population groups.

Prevalence and sociodemographic correlates of food insecurity among post-secondary students and non-students of similar age in Canada

BackgroundThe results of several recent campus-based studies indicate that over half of post-secondary students in Canada are food insecure, but the vulnerability of this group has not been considered in research on predictors of food insecurity in the Canadian population. Our objectives were to (1) compare the prevalence of food insecurity among post-secondary students and non-students of similar age; (2) examine the relationship between student status and food insecurity among young adults while accounting for sociodemographic characteristics; and (3) identify the sociodemographic characteristics associated with food insecurity among post-secondary students.MethodsUsing data from the 2018 Canadian Income Survey, we identified 11,679 young adults aged 19–30 and classified them into full-time postsecondary students, part-time post-secondary students, and non-students. Food insecurity over the past 12 months was assessed with the 10-item Adult Scale from the Household Food Security Survey Module. Multivariable logistic regression analyses were used to estimate the odds of food insecurity by student status while accounting for sociodemographic characteristics, and to identify sociodemographic characteristics predictive of food insecurity among post-secondary students.ResultsThe prevalence of food insecurity was 15.0% among full-time postsecondary students, 16.2% among part-time students, and 19.2% among non-students. After adjusting for sociodemographic factors, full-time postsecondary students had 39% lower odds of being food insecure as compared to non-students (aOR 0.61, 95% CI 0.50–0.76). Among postsecondary students, those with children (aOR 1.93, 95%CI 1.10–3.40), those living in rented accommodation (aOR 1.60, 95%CI 1.08–2.37), and those in families reliant on social assistance (aOR 4.32, 95%CI 1.60-11.69) had higher adjusted odds of food insecurity, but having at least a Bachelor’s degree appeared protective (aOR: 0.63, 95% CI 0.41–0.95). Every $5000 increase in adjusted after-tax family income was also associated with lower adjusted odds of food insecurity (aOR 0.88, 95%CI 0.84–0.92) among post-secondary students.ConclusionsIn this large, population-representative sample, we found that young adults who did not attend post-secondary school were more vulnerable to food insecurity, particularly severe food insecurity, than full-time post-secondary students in Canada. Our results highlight the need for research to identify effective policy interventions to reduce food insecurity among young, working-age adults in general.

Severity of All-Terrain Vehicle–Related Injuries by Age in Canada, 2002-2019

Rates of pediatric hospitalizations following an injury while riding an all-terrain vehicle (ATV) are increasing. Few studies have compared the rates of severe injuries among children, adolescents, and adults. To investigate whether younger ATV riders are at risk for more severe ATV-related injuries. This cross-sectional study was conducted using administrative data from hospitals in 9 provinces in Canada. Participants included patients admitted to hospitals with ATV-related injuries between 2002 and 2019. Statistical analysis was performed from June 2020 to September 2021. The primary exposure was age younger than 16 years. Comparison groups were youths aged 16 to 20 years and adults aged 21 years and older. The main outcomes of interest were death, spinal cord injury, and an Injury Severity Score (ISS) greater than 25. Secondary outcomes were less severe injuries, including head injuries, crush type injuries, and fractures. Among 52 745 patients with complete data, 15% were youths younger than 16 years, 13% were youths aged 16 to 20 years, 82% were male, and 47% lived in rural areas. After adjusting for covariates, the odds of dying were higher among youths aged 16 to 20 years (adjusted odds ratio [aOR], 1.64; 95% CI, 1.04-2.60) compared with those younger than 16 years. Youths aged 16 to 20 years also had higher odds of spinal cord injury (aOR, 2.72; 95% CI, 1.80-4.20) and an injury severity score greater than 25 (aOR, 1.63; 95% CI, 1.36-1.96) compared with youths 16 years of age or less. Sex-specific analyses revealed these associations were greater for male youths aged 16 to 20 years (spinal cord injury: aOR, 3.81; 95% CI, 1.38-11.10, and dying in a hospital: aOR, 4.37; 95% CI, 1.19-21.02) than female youths aged 16 to 20 years. In this cross-sectional study of patients hospitalized for ATV injuries in Canada, youths aged 16 to 20 years and adults aged 21 years and older were at an increased risk of death and severe injuries compared with youths younger than 16 years. The increased risk of death and severe injuries was most evident among male patients.

Randomized controlled trial evaluating a virtual parenting intervention for young children at risk of obesity: study protocol for Parenting Addressing Early Years Intervention with Coaching Visits in Toronto (PARENT) trial

BackgroundThe prevalence of overweight (15%) and obesity (6%) in children under 5 years of age in Canada are high, and young children with overweight and obesity are at increased risk of the development of chronic disease(s) in adulthood. Prior research has demonstrated very few published trials on effective obesity prevention interventions in young children at risk of obesity, within primary healthcare settings. The aim of this study is to determine if 18–48-month-old children at risk for obesity, who are randomized to receive the Parents Together program (i.e., intervention group), have reduced body mass index z-score (zBMI), compared to those not receiving the intervention, at a 12-month follow-up. Secondary clinical outcomes between the intervention and control groups will be compared at 12 months.MethodsA pragmatic, parallel group, 1:1, superiority, randomized control trial (RCT) through the TARGetKids! Practice Based Research Network will be conducted. Young children (ages 18–48 months) who are at increased risk for childhood obesity will be invited to participate. Parents who are enrolled in the intervention group will participate in eight weekly group sessions and 4–5 coaching visits, facilitated by a trained public health nurse. Children and parents who are enrolled in the control group will receive the usual health care. The primary outcome will be compared between intervention arms using an analysis of covariance (ANCOVA). Feasibility and acceptability will be assessed by parent focus groups and interviews, and fidelity to the intervention will be measured using nurse-completed checklists. A cost-effectiveness analysis (CEA) will be conducted.DiscussionThis study will aim to reflect the social, cultural, and geographic diversity of children in primary care in Toronto, Ontario, represented by an innovative collaboration among applied child health researchers, community health researchers, and primary care providers (i.e., pediatricians and family physicians in three different models of primary care). Clinical and implementation outcomes will be used to inform future research to test this intervention in a larger number, and diverse practices across diverse geographic settings in Ontario.Trial registrationClinicalTrials.gov NCT03219697. Registered on June 27, 2017.

Relationships to land as a determinant of wellness for Indigenous women, two-spirit, trans, and gender diverse people of reproductive age in Toronto, Canada.

Disparities in Indigenous reproductive health reflect Canada's historic and ongoing colonial relationship with Indigenous peoples, which includes persistent inequities in health and social services. Reproductive justice scholars and activists advocate for intersectional approaches to enhancing Indigenous health equity that recognize land as a central determinant of wellness. The purpose of this study is to examine the association between relationships to land and wellness in a study of urban Indigenous women, two-spirit, trans, and gender diverse people of reproductive age in Canada's largest city, Toronto. Data were obtained from the cross-sectional Our Health Counts (OHC) Toronto study, which employed respondent-driven sampling methods (n = 323) and acommunity-directed comprehensive health assessment survey. In an exploratory analysis, we took an Indigenous reproductive justice theoretical approach to multivariable logistic regression. After adjusting for covariates, there was a statistically significant positive association between relationships to the land and wellness that was estimated with good precision (OR 3.7, 95% CI 2.5-5.3). Our findings indicate that among urban Indigenous women, two-spirit, trans, and gender diverse people of reproductive age there is a positive association between feeling strong in their relationships to land and feeling balanced in the four domains of health (physical, spiritual, mental, and emotional). The community-based, community-directed design of OHC Toronto was congruent with a reproductive justice approach to research. Reproductive justice theories are adaptable to quantitative research on Indigenous reproductive health and can yield novel insights for supporting Indigenous wellness.

Omega-3 Fatty Acids for the Management of Osteoarthritis: A Narrative Review.

Osteoarthritis (OA) is a disease which results in degeneration of cartilage within joints and affects approximately 13.6% of adults over 20 years of age in Canada and the United States of America. OA is characterized by a state of low-grade inflammation which leads to a greater state of cellular catabolism disrupting the homeostasis of cartilage synthesis and degradation. Omega-3 polyunsaturated fatty acids (PUFAs) have been postulated as a potential therapeutic treatment option for individuals with OA. Omega-3 PUFAs are recognized for their anti-inflammatory properties, which could be beneficial in the context of OA to moderate pro-inflammatory markers and cartilage loss. The purpose of this narrative review is to outline recent pre-clinical and clinical evidence for the use of omega-3 in the management of OA.

Enabling Healthy Aging to AVOID Frailty in Community Dwelling Older Canadians.

The Canadian population is aging. With aging, biological and social changes occur increasing the risk of developing chronic conditions and functional loss leading to frailty. Older adults living with frailty are more vulnerable to minor stressors, take longer to recover from illness, and have difficulty participating in daily activities. The Canadian Frailty Network’s (CFN) mission is to improve the lives of older adults living with frailty. In September 2019, CFN launched the Activity & Exercise, Vaccination, Optimization of medications, Interaction & Socialization, and Diet & Nutrition (AVOID) Frailty public health campaign to promote assessing and reducing risk factors leading to the development of frailty. As part of the campaign, CFN held an Enabling Healthy Aging Symposium with 36 stakeholders from across Canada. Stakeholders identified individual and community-level opportunities and challenges for the enablement of healthy aging and frailty mitigation, as part of a focused consultative process. Stakeholders ranked the three most important challenges and opportunities at the individual and community levels for implementing AVOID Frailty recommendations. Concrete actions, further research areas, policy changes, and existing resources/programs to enhance the AVOID Frailty campaign were identified. The results will help inform future priorities and behaviour change strategies for healthy aging in Canada.

Underweight in the First Two Years of Life and Growth in Later Childhood

ObjectivesUnderweight in children is defined by the World Health Organization (WHO) as a body mass index z-score (zBMI) < -2. The objective was to evaluate the relationship between underweight in the first two years of life and zBMI, weight-for-age z score (WAZ), and height-for-age-z score (HAZ) from 2 to 10 years of age. Secondly, to explore whether sex and zBMI growth trajectory in the first two years of life modify these associations.MethodsA prospective cohort study was conducted through The Applied Research Group for Kids (TARGet Kids! ) practice-based research network. Healthy children 0–10 years of age in Canada were included. Linear mixed models were used in the primary and secondary analysis to take into account multiple growth measures over time.Results5,803 children were included in the primary analysis. At baseline the mean age was 4.07 months, and 52.2% were male. In adjusted models, underweight in the first two years was associated with lower zBMI, lower WAZ, and higher odds of underweight at 2, 5, 10 years of age (all p values < 0.01). There was evidence that underweight in the first two years was associated with a lower HAZ at 2 years of age (P < 0.01) but not 5 (p = 0.08) and 10 years (p = 0.80). At 10 years of age, females with underweight in the first two years had 0.47 lower zBMI compared to females who did not have underweight, while males with underweight in the first two years had 0.32 lower zBMI compared to males who did not have underweight (all p values < 0.01). Children with underweight and low growth trajectory in the first two years had lower zBMI, WAZ, HAZ, and higher odds of underweight at 2, 5, 10 years of age compared to children who did not have underweight (all p values < 0.05). Children who had underweight and high growth trajectory in the first two years had similar zBMI (p = 0.06), WAZ (p = 0.67), higher HAZ and lower odds of overweight at 10 years of age (P < 0.05), compared to children who did not have underweight.ConclusionsChildren with underweight in the first two years of life had lower zBMI, WAZ, and HAZ in later childhood. These relationships were stronger for females and low growth trajectory in the first two years and were attenuated among children with underweight and high growth trajectory in the first two years of life.Funding SourcesCanadian Institute of Health Research (CIHR).

Estimating the impact of reducing the age of colorectal cancer screening on cancer incidence, mortality, and costs in Canada using OncoSim.

3526 Background: Organized colorectal cancer (CRC) screening programs currently cover Canadians aged ≥50 at average-risk of developing CRC and have contributed to declining CRC incidence. Rising incidence of early-onset CRC in individuals &lt; 50 has led to lowering of the recommended screening start age to 45 rather than 50 in some jurisdictions. We used OncoSim, a publicly-available simulation tool, to model the effects of earlier screening initiation on Canadian CRC incidence, mortality and healthcare costs. Methods: OncoSim uses Canadian population and cancer registry data to simulate a representative sample of individuals from birth to death. We modeled four scenarios: no screening in average-risk individuals, screening initiation at age 50, initiation age lowered to 45 in 2022, and initiation age lowered to 40 in 2022. Each includes 32 million simulated participants. In the model, average-risk screening involves biennial FIT, available to all simulated participants regardless of family history with participation of 60% at the first recruitment attempt and 80% for repeat screening. Participants with a family history in all 4 scenarios were eligible for additional screening by colonoscopy every 5 years. Results: In our model, earlier screening yields reduced CRC incidence and mortality with increasing benefit over time. By 2051, screening initiation at age 45 or 40 reduces age-standardized incidence by 3.4% and 4.8% respectively, and age-standardized mortality by 3.3% and 4.6% respectively, compared to initiation at age 50. Screening initiation at age 45 yields 3,848 additional quality-adjusted life-years (QALYs) in 2051 at a cost of $9,350 per QALY gained and a 5% increase in colonoscopies performed. Initiation at age 40 yields 6,255 additional QALYs at $16,350 per QALY gained and a 9% increase in colonoscopies. The difference in screening costs compared to screening from age 50 is consistent year-to-year after 2024. In 2051 screening costs increase by $75mil and $155mil per year with initiation at ages 45 and 40 respectively, while costs of cancer management (including diagnosis, treatment, recurrence, palliative and end of life care) decrease by $42mil and $57mil respectively. Conclusions: Our model predicts that lowering the CRC screening initiation age for average-risk Canadians to 45 or 40 could reduce CRC incidence and mortality. Costs per QALY gained are high in the first few decades but decrease over time. Costs are modest after 30 years of screening compared to other life-preserving interventions such as dialysis. Our results suggest that lowering the screening age in Canada may be warranted, but further investigation is needed to assess capacity for increased colonoscopy demand.

P.084 5q spinal muscular atrophy Canadian Paediatric Surveillance Program – 2020-2021 results

Background: Spinal muscular atrophy (SMA) is the leading genetic cause of infant death and the second most common autosomal recessive disorder; most cases are due to homozygous deletion of SMN1 gene. Methods: This study uses the Canadian Paediatric Surveillance Program to determine the minimum annual incidence of 5q-SMA from birth to 18 years of age in Canada. The protocol can be accessed at www.cpsp.cps.ca/surveillance. Results: Eighteen cases were reported in 2020-2021. Ten (55%) cases were reported from Ontario and the remaining cases were reported from Atlantic Canada and Western Canada. Their median age was 11 months (IQR 4–21); 61% were male. The most common presenting symptoms were hypotonia and delayed motor milestones in 12 (86%) and 10 (71%) cases respectively. On average, the diagnosis was delayed after onset of symptoms by three months for SMA Type 1, by eight months for Type 2, and by 18 months for Type 3. Twelve (86%) cases received nusinersen as their first disease-modifying treatment. Conclusions: Early recognition and newborn screening are essential to reduce diagnostic delay and enable timely treatment of SMA. Other data sources including the Canadian Neuromuscular Disease Registry and molecular genetic laboratories will be used to estimate the annual incidence of pediatric SMA in Canada.

Identification and engagement of naturally occurring retirement communities to support healthy aging in Canada: A set of methods for replication

BackgroundNaturally occurring retirement communities (NORCs), unplanned communities with a high proportion of older adult residents, offer a model to support older adults to age well in place. The aim of this paper is to provide a comprehensive description of the methods used to identify and engage NORCs appropriate for the development of supportive service programming in Canada.MethodsThree steps were used to identify and select NORCs in which to develop supportive service programming including: 1) identification of potential NORCs using Canadian Census Dissemination Areas, the Ontario Marginalization Index and Google Maps, 2) engagement of property owner/manager to determine the availability of common space for communal programming and willingness of the owner to support programming and, 3) engagement of older adult residents within the NORC to co-design programming.ResultsFour cities in the south-east, south-central, and south-west of Ontario, Canada were identified to develop NORCs with supportive service programming. Using the methods described, six NORCs were identified, landlords and older adult residents were engaged, and programs initiated between April 2018 and March 2019. The sites included two private high-rise apartments, a city-owned low-rise subsidized apartment complex, two multi-building private high-rise complexes and a mobile home community. An average of 35 (min 20, max 78) older adult members were engaged in an average of 20.5 unique activity sessions at each site per month. On average, social (54%) and physical activities (30%) were more common than nutritional (10%) and knowledge-sharing (8%).ConclusionsThe increased prevalence of unplanned, geographically-bound NORCs creates an opportunity for governments, social and health service providers and policy makers to support healthy aging in their communities. Our experience with the creation of six new NORCs with supportive service programming provides a tested set of methods that can be applied in other communities.

The Text4HealthyAging Program: An Evidence-Based Text Messaging Innovation to Support Healthy Urban Aging in Canada and Australia.

Age-friendly cities are crucial to achieve the WHO goal of healthy aging. Such cities promote opportunities for health, participation, and security, thus enhancing quality of life as people age. Older people commonly experience psychosocial challenges such as anxiety, depression, substance abuse, loss of autonomy, grief, fear, and loneliness. Australian and Canadian cities continue to seek innovation to improve healthy urban aging and create more age-friendly environments for older adults. There is increasing evidence on the effectiveness and feasibility of mobile technology in health promotion and closing psychological treatment gaps. Older adults have been demonstrated to engage frequently with mobile devices, particularly text messaging. In this article, we conceptualize the Text4HealthyAging, an evidence-based text messaging innovation to support healthy urban aging in Canadian and Australian cities.

P.112 5q Spinal Muscular Atrophy Canadian Paediatric Surveillance Program - 2020 Results

Background: Spinal muscular atrophy (SMA) is the leading genetic cause of infant death and the second most common autosomal recessive disorder; the majority of cases are due to homozygous deletion of SMN1 gene. Methods: This study uses the Canadian Paediatric Surveillance Program to determine the minimum annual incidence of 5q-SMA from birth to 18 years of age in Canada. The complete protocol can be accessed at www.cpsp.cps.ca/surveillance. Results: Eleven cases were reported in 2020. Five (45%) cases were reported from Ontario and the remaining cases were reported from Atlantic Canada and Western Canada. Their median age was 12 months (IQR 6–21); 64% were male. The most common presenting symptoms were delayed motor milestone and hypotonia in 7 (64%) cases. On average, the diagnosis was delayed after the onset of symptoms by three months for SMA Type 1, by eight months for Type 2, and by 18 months for Type 3. Eight (73%) cases received nusinersen as their first disease-modifying treatment. Conclusions: Early recognition and newborn screening are essential to reduce diagnostic delay and enable timely treatment of SMA. Other data sources including the Canadian Neuromuscular Disease Registry and molecular genetic laboratories will be used to estimate the annual incidence of pediatric SMA in Canada.

Commentary: The Future of Aging in Canada.

Much is already written on how the COVID-19 pandemic ravaged Canada's frail, elderly population - the impact of the global pandemic turned the decades-long challenges within our nation's long-term care sector into daily news coverage. While no commission or report can ever begin to relieve the pain and suffering of individuals who lived through the pandemic, healthcare leaders owe it to all to respond to the urgent call for action to re-envision elder care for the future. The time to act is now. Our leaders need to collaborate and connect with our seniors to take quick action on their recommendations. Our leaders need to be nimble and creative; they need to work together across the system to rethink how aging seniors can be supported and change the system, its funding models and, ultimately, how we value and care for our aging population now and into the future.

International comparison of spending and utilization at the end of life for hip fracture patients.

ObjectiveTo identify and explore differences in spending and utilization of key health services at the end of life among hip fracture patients across seven developed countries.Data SourcesIndividual‐level claims data from the inpatient and outpatient health care sectors compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC).Study DesignWe retrospectively analyzed utilization and spending from acute hospital care, emergency department, outpatient primary care and specialty physician visits, and outpatient drugs. Patterns of spending and utilization were compared in the last 30, 90, and 180 days across Australia, Canada, England, Germany, New Zealand, Spain, and the United States. We employed linear regression models to measure age‐ and sex‐specific effects within and across countries. In addition, we analyzed hospital‐centricity, that is, the days spent in hospital and site of death.Data Collection/Extraction MethodsWe identified patients who sustained a hip fracture in 2016 and died within 12 months from date of admission.Principal FindingsResource use, costs, and the proportion of deaths in hospital showed large variability being high in England and Spain, while low in New Zealand. Days in hospital significantly decreased with increasing age in Canada, Germany, Spain, and the United States. Hospital spending near date of death was significantly lower for women in Canada, Germany, and the United States. The age gradient and the sex effect were less pronounced in utilization and spending of emergency care, outpatient care, and drugs.ConclusionsAcross seven countries, we find important variations in end‐of‐life care for patients who sustained a hip fracture, with some differences explained by sex and age. Our work sheds important insights that may help ongoing health policy discussions on equity, efficiency, and reimbursement in health care systems.

Prevalence of alcohol use among women of reproductive age in Canada

Introduction Reporting on alcohol use among women of reproductive age in Canada addresses a major gap in evidence. Methods We assessed the prevalence of weekly and heavy alcohol consumption among women aged 15 to 54 years by sociodemographic characteristics, province of residence and concurrent use of other substance(s) using data from the 2019 Canadian Community Health Survey. Results Of the target population, 30.5% reported weekly and 18.3% reported heavy alcohol consumption in the past year. Prevalence varied by sociodemographic characteristics, province and substance use. The most notable and significant differences were to do with cannabis use and smoking. Conclusion This information can guide health care providers in assessing alcohol consumption and in promoting low-risk alcohol drinking to prevent alcohol exposure during pregnancy.