Canadian Community Health Survey Data Research Articles

Predictive Modelling of Diabetes Risk in Population Groups Defined by Socioeconomic and Lifestyle Factors in Canada: A Cross-Sectional Study.

This study modelled diabetes risk for population groups in Canada defined by socioeconomic and lifestyle characteristics and investigated inequities in diabetes risk using a validated population risk prediction algorithm. We defined population groups, informed by determinants of health frameworks. We applied the Diabetes Population Risk Tool (DPoRT) to 2017/2018 Canadian Community Health Survey data to predict 10-year diabetes risk and cases across population groups. We modelled a preventive intervention scenario to estimate reductions in diabetes for population groups and impacts on the inequity in diabetes risk across income and education. The population group with at least one lifestyle and at least one socioeconomic/structural risk factor had the highest estimated 10-year diabetes risk and number of new cases. When an intervention with a 5% relative risk reduction was modelled for this population group, diabetes risk decreased by 0.5% (females) and 0.7% (males) and the inequity in diabetes risk across income and education levels was reduced. Preventative interventions that address socioeconomic and structural risk factors have potential to reduce inequities in diabetes risk and overall diabetes burden.

Adherence to Vitamin D Supplementation Recommendations for Breastfed Infants and Young Children: An Analysis of Canadian Community Health Survey Data Cycles From 2015 to 2018

BackgroundIn Canada, nutrition policy, as outlined in the Nutrition for Healthy Term Infants recommendations, includes a daily vitamin D supplement of 10 μg (400 IU) for breastfed infants and young children to support adequate vitamin D status. ObjectivesThis study aimed to report on adherence to vitamin D supplementation recommendations for breastfed infants (≤12 months); and for children breastfed >12 mo. MethodsCanadian Community Health Survey (paired-cycles 2015/2016 and 2017/2018) maternal experiences data for infants born 2012–2018 who received any breastmilk formed the sample (n = 7079). Whether the infant was given a vitamin D supplement (yes/no) and the frequency (daily/almost every day, 1–2/wk, or <1/wk) were surveyed. Weighted data (95% CI) were summarized according to breastfeeding history (exclusive to 6 mo and continuing; partial to 6 mo and continuing; and stopped ≤6 mo). Correlates of supplement adherence were explored using logistic regression. ResultsOverall, 87.1% (95% CI: 85.9%, 88.3%) of participants reported giving their infant (≤12 mo) a vitamin D supplement, and of these, 83.3% (95% CI: 81.9%, 84.7%) did so daily/almost every day, 12.4% (95% CI: 11.1%, 13.7%) did so 1–2/wk, and 4.3% (95% CI: 3.6%, 5.0%) did so <1/wk. Lower adjusted odds of adherence were observed among participants reporting: stopped breastfeeding ≤6 mo, lower education or income, recent immigration, and overweight prepregnancy body mass index; higher odds of adherence were observed in the western provinces. Regarding mothers of children >12 mo and breastfed (n = 2312), 58.0% (95% CI: 54.9%, 61.1%) gave a vitamin D supplement daily/almost every day. ConclusionsAdherence to providing a vitamin D supplement to breastfed infants is high in Canada. Nonetheless, we estimate that ∼27% of mothers are nonadherent to daily/almost every day administration of a vitamin D supplement and that adherence declines in children breastfed >12 mo. Further promotion to support uptake of the current guidance may be necessary, particularly for parents of recent immigration or lower socioeconomic status.

Prevalence and characteristics of healthcare utilization with different providers among Canadians with chronic back problems: A population-based study

IntroductionUnderstanding healthcare utilization by Canadians with back problems informs healthcare planning nationally. Research questionWhat is the prevalence of utilization of healthcare providers (medical doctors, chiropractors, physiotherapists, nurses), and associated characteristics among Canadians with chronic back problems (2001–2016)? Material and methodsThis population-based study used Canadian Community Health Survey data (2001–2016) restricted to respondents with chronic back problems (aged ≥12 years). We used self-reported consultation with healthcare providers (medical doctors, chiropractors, physiotherapists, nurses) from 2001–2010, and self-reported regular healthcare provider from 2015–2016. We calculated the 12-month prevalence of utilization with providers, and used modified Poisson regression to assess sociodemographic, health-related and behavioural factors associated with utilization of different providers. ResultsFrom 2001 to 2010 and 2015/2016, respectively, prevalence of utilization of medical doctors was 87.9% (95% CI 87.6–88.2) and 86.7% (95% CI 85.9–87.5); chiropractors 24.0% (95% CI 23.6–24.4) and 14.5% (95% CI 13.8–15.3); physiotherapists 17.2% (95% CI 16.9–17.6) and 10.7% (95% CI 10.0–11.4); nurses 14.0% (95% CI 13.7–14.2) and 6.6% (95% CI 6.1–7.0). Females were more likely to see any provider than males. Persons of lower socioeconomic status were less likely to consult chiropractors or physiotherapists (2001–2016), or nurses (2001–2010). Immigrants were less likely to consult chiropractors or nurses. Persons aged >65 years were less likely to consult chiropractors or physiotherapists, and those with fair/poor general health were less likely to consult chiropractors, but more likely to consult other providers. Discussion and conclusionMedical doctors were most commonly consulted by Canadians with back problems, then chiropractors and physiotherapists. Characteristics of healthcare utilization varied by provider. Findings inform the need to strengthen healthcare delivery for Canadians with back problems.

Impaired sleep, multimorbidity, and self-rated health among Canadians: Findings from a nationally representative survey.

Self-rated health (SRH) is a globally recognized measure of health status. Both impaired sleep (IS) and the presence of multimorbidity are related to poorer SRH, but the precise nature of these associations remains unclear. This study explored the association between IS, multimorbidity, and SRH among Canadian adults. We used 2017-18 Canadian Community Health Survey (CCHS) data for this study. The main variable of interest, self-rated health (SRH), measured participants' health on a 5-point Likert scale, later categorized as "good or better" vs. "fair or poor". The primary predictor, IS, was derived from two variables and categorized into four groups: no sleep issues; fewer sleeping hours (<7 hours) only; trouble sleeping only; and fewer hours & trouble sleeping. Multimorbidity was present (yes/no) if a participant indicated being diagnosed with two or more chronic conditions. Just over one in ten Canadians reported fair/poor SRH and approximately one-quarter had multimorbidity or experienced few sleep hours in combination with trouble sleeping. The adjusted model indicated greater odds of fair/poor SRH associated with the 40-64 years age group, male sex, and lower socio-economic status. It also suggested the presence of multimorbidity (AOR= 4.63, 95% CI: 4.06-5.28) and a combination of fewer sleep hours and troubled sleep (AOR= 4.05, 95% CI: 2.86-5.74) is responsible for poor SRH. Forty-four percent of the total effect of IS on SRH was mediated by multimorbidity. This unique finding highlights the mediating role of multimorbidity, emphasizing the importance of addressing it alongside sleep issues for optimal health outcomes.

Association between physical multimorbidity and suicidal ideation in young adults with obesity

BackgroundObesity is associated with multimorbidity and both, have an impact on physical and mental health. Previous studies suggested a possible relationship between obesity, multimorbidity and suicidal spectrum, but few studies focused on this association notably in young adults. The aim of the present study was to examine the co-occurring effect of multimorbidity and obesity on suicidal ideation. MethodsCross-sectional analysis of the Canadian Community Health Survey data was conducted. Data from a sample of young adults (18 to 30 years-old) with obesity, of the 2005 (n = 394) and 2015–2016 (n = 295) cycles were analyzed. Multimorbidity, suicidal ideation, and health behaviours were self-reported. ResultsThe prevalence of physical multimorbidity was 12 % in 2005 and 16 % in 2015–2016. Logistic regressions showed an association between multimorbidity and suicidal ideation (2005: OR 3.05, 95 % CI 1.56–5.98; 2015–2016: OR 2.85, 95 % CI 1.40–5.78). Among covariates, the significant association of sex (OR 1.89; 95 % CI 1.11–3.21) and educational status (OR 3.19; 95 % CI 1.47–6.94) in the 2005 cycle, were not replicated in the 2015–2016 cycle (sex: OR 1.01; 95 % CI 0.55–1.85; education: OR 0.97; 95 % CI 0.48–1.96). Finally, no consistent association between health behaviours and suicidal ideation was found. LimitationsData were self-reported, consequently, we cannot discard the possibility of a reporting bias. The study was cross-sectional so no directional conclusion or causality can be drawn. ConclusionMultimorbidity is associated with suicidal ideation among those with obesity. Attention should be given to chronic disease prevention in young people, as the development of suicidal ideation may also be prevented.

Effects of chiropractic use on medical healthcare utilization and costs in adults with back pain in Ontario, Canada from 2003 to 2018: a population-based cohort study

BackgroundAdults with back pain commonly consult chiropractors, but the impact of chiropractic use on medical utilization and costs within the Canadian health system is unclear. We assessed the association between chiropractic utilization and subsequent medical healthcare utilization and costs in a population-based cohort of Ontario adults with back pain.MethodsWe conducted a population-based cohort study that included Ontario adult respondents of the Canadian Community Health Survey (CCHS) with back pain from 2003 to 2010 (n = 29,475), followed up to 2018. The CCHS data were individually-linked to individual-level health administrative data up to 2018. Chiropractic utilization was self-reported consultation with a chiropractor in the past 12 months. We propensity score-matched adults with and without chiropractic utilization, accounting for confounders. We evaluated back pain-specific and all-cause medical utilization and costs at 1- and 5-year follow-up using negative binomial and linear (log-transformed) regression, respectively. We assessed whether sex and prior specialist consultation in the past 12 months were effect modifiers of the association.ResultsThere were 6972 matched pairs of CCHS respondents with and without chiropractic utilization. Women with chiropractic utilization had 0.8 times lower rate of cause-specific medical visits at follow-up than those without chiropractic utilization (RR5years = 0.82, 95% CI 0.68-1.00); this association was not found in men (RR5years = 0.96, 95% CI 0.73–1.24). There were no associations between chiropractic utilization and all-cause physician visits, all-cause emergency department visits, all-cause hospitalizations, or costs. Effect modification of the association between chiropractic utilization and cause-specific utilization by prior specialist consultation was found at 1-year but not 5-year follow-up; cause-specific utilization at 1 year was lower in adults without prior specialist consultation only (RR1year = 0.74, 95% CI 0.57–0.97).ConclusionsAmong adults with back pain, chiropractic use is associated with lower rates of back pain-specific utilization in women but not men over a 5-year follow-up period. Findings have implications for guiding allied healthcare delivery in the Ontario health system.

How does Canada's new vitamin D fortification policy affect the high prevalence of inadequate intake of the vitamin?

The 2023 vitamin D fortification policy may significantly reduce inadequacies in non-supplement consumers; however, the policy is far from eliminating population-level vitamin D inadequacies and supplementation should still be encouraged.

SPATIAL VARIABILITY IN THE PREVALENCE OF HYPERTENSION: A CANADIAN PERSPECTIVE

Objective: Despite significant improvements in hypertension treatment, high blood pressure (HBP) still affects 22.6% of Canadians (Hypertension Canada, 2016). However, disparities associated with risk factors like, age, sex, and lifestyle can impact global prevalence in population. It is also a well-known fact that prevalence varies geographically. Thus, spatial location can give us a different perspective of hypertension in population. Reliable information about trends in hypertension rate is needed at regional scale to support the development of health programs. Geographic information systems (GIS) can provide that information by detecting spatial clusters of high or low HTN rate at health regions scale. The objectives of the study were to identify health regions with significantly high or low HTN rate using geostatistics and compare evolution from 2005 to 2019. It also seeks out to identify their populations’ characteristics using statistical analysis. Canadian Community Health Survey (2005, 2015 &amp; 2019) data were used for the analysis. Design and method: For the analysis, we used Canadian Community Health Survey from 2005, 2015 and 2019. The 130,000 respondents representing the whole population are located according to health regions and data can be analyzed using a GIS. Using age and gender as subgroups criteria creation, we applied spatial autocorrelation analysis and Getis-Ord hot analysis to identify geographically contiguous health regions with high or low HTN rates. We then extracted the records in CCHS database for all respondents living in these regions for supplemental statistical analysis. Results: HTN is still a problem in Canada. This is especially true for people aged 65 and older although 72.9% considered themselves in good health. Increase in HTN rate is spread all over Canada, although some regions showed a rate decrease. Getis-ord analysis located regions with low HTN rates while regions with high rates were also located. Cluster of health regions with high HTN rates shows more diabetes and more obese people even though 38.4% declared being in good health. Conclusions: Hypertension is still a major problem in Canada. Age and gender are still significant risk factors. Geographical variations in HTN rate are presents at health regions scale.

Vaping and Health Service Use: A Canadian Health Survey and Health Administrative Data Study.

Rationale: Emerging research suggests that e-cigarette (EC) use may have detrimental health effects, increasing the burden on healthcare systems. Objectives: To determine whether young EC users had increased asthma, asthma attacks, and health services use (HSU). Methods: This cohort study used the linked Canadian Community Health Survey (cycles 2015-16 and 2017-18) and health administrative data (January 2015-March 2018). A propensity score method matched self-reported EC users to up to five control subjects. Matched multivariable logistic and negative binomial regressions were used to calculate odds ratios, rate ratios (RRs), and 95% confidence intervals (CIs) with EC use as the exposure and asthma, asthma attacks, and all-cause HSU as the outcomes. Results: Analyses included 2,700 matched Canadian Community Health Survey participants (15-30 yr), 505 (2.4% of 20,725 participants) EC users matched to 2,195 nonusers. After adjusting for confounders, EC users with asthma had over twofold higher odds of having an asthma attack in the last 12 months (odds ratio, 2.30; 95% CI, 1.29-4.12). Dual EC and conventional tobacco users had a twofold increased all-cause HSU rate compared with nonusers who never smoked tobacco (RR, 2.13; 95% CI, 1.53-2.98). This rate was greater than that for EC users who never smoked tobacco (RR, 1.73; 95% CI, 1.00-3.00) and non-EC users who regularly smoke tobacco (RR, 1.72; 95% CI, 1.29-2.29). Compared with male nonusers, female EC users had the highest increased all-cause HSU (RR, 1.94; 95% CI, 1.39-2.69) over male EC users and female nonusers (RR, 1.13; 95% CI, 0.86-1.48; RR, 1.41; 95% CI, 1.16-1.71, respectively). Conclusions: Current EC use is associated with significantly increased odds of having an asthma attack. Furthermore, concurrent EC use and conventional cigarette smoking are associated with a higher rate of all-cause HSU. The odds of asthma attack and all-cause HSU were highest among women. Thus, EC use may be an epidemiological biomarker for youth and young adults with increased health morbidity.

Sex, Immigration, and Patterns of Access to Primary Care in Canada

Access to primary care is crucial to immigrant health and may be shaped by sex and gender, but research is limited and inconclusive. We identified measures that reflect access to primary care using 2015–2018 Canadian Community Health Survey data. We used multivariable logistic regression models to estimate adjusted odds of primary care access and to explore interaction effects between sex and immigration group (recent immigrant: < 10 years in Canada, long-term immigrant: 10 + years, non-immigrant). Recency of immigration and being male were negatively associated with access to primary care, with significantly lower odds of having a usual place for immediate care among male recent immigrants (AOR: 0.36, 95% CI 032–0.42). Interaction effects between immigration and sex were pronounced, especially for having a regular provider or place of care. Results underscore the need to examine approachability and acceptability of primary care services, especially for male recent immigrants.

PS-BPP04-2: GEOSTATISTICAL ANALYSIS OF HYPERTENSION IN CANADIAN POPULATION

Objective: A quarter of the population is affected by hypertension in Canada and, around the world, it is the second most common conditions for consultation in primary care. Substantial improvement has been achieved in HTN control in Canada over the past twenty-five years. However, as noted in many studies, disparities associated with factors like sex, ethnicity, home location and health care access remain. Reliable information about trends in hypertension is needed at national and regional scale for the development of health policies and programs. Health geography and geographic information systems can provide a better understanding of the distribution HTN and its risk factors by detecting clusters using spatial analysis and mapping rates of HTN. The objectives of the study were to identify health regions with significantly high or low HTN rate using geostatistics and compare evolution from 2005 to 2015 and 2015 to 2019. It also seeks out to identify their populations characteristics using conventional statistical analysis. Canadian Community Health Survey (2005, 2015 &amp; 2019) data were used for the analysis. Design and Method: Canadian Community Health Survey CCHS (2005, 2015, 2019) data were used for the analysis. The 130,000 respondents representing the whole population are located according to health regions and data can be analyzed using a geographic information system. Using age and gender as subdividing criteria for subgroups creation, we applied Moran I spatial autocorrelation analysis and Getis-Ord hot spot/cold analysis to identify geographically contiguous health regions with high or low HBP rates. We then extracted the records in CCHS database for all respondents living in these regions for further statistical analysis. Results and Conclusion: HTN is still a major problem in Canadian population, especially for people aged 65 years and older although 72.9% considered themselves in good, very good or excellent health in 2015. Increase in HTN rate in health regions is spread all over Canada, although some regions showed a decrease in HTN rate. Getis-ord analysis located a cold spot region in western Canada while a hot spot was located in Ontario, central Canada. Cluster of health regions with high HTN rates shows more diabetes and more obese people even though 38.4% declared being in good, very good or excellent health. In final conclusion, this approach could also be used in other countries seeking a better understanding of socio-demographic and geographic factors affecting hypertension rate in the country.

Perceived mental health, work, and life stress in association with the amount of weekly alcohol consumption among Canadian adults who have ever drank

BackgroundExcess alcohol consumption has multifaceted adverse impacts at individual, household, and community levels. The study primarily aims at assessing the role of perceived health and stress in alcohol consumption among adults in Canada who have ever drank.MethodsThe study was conducted based on a total of 35,928 Canadian adults aged 18 and above who have ever drank, extracted from the 2017–2018 Canadian Community Health Survey (CCHS) data. A mixed-effect Negative Binomial (NB) regression model was used to determine the effects of three key risk factors (perceived mental health, life stress, and work stress) in association with the self-reported number of weekly alcohol consumption, controlling for other variables in the model.ResultsThe study found that regular alcohol consumption among ever drank Canadian adults is high, with the self-reported number of weekly alcohol consumption ranging from 0 to 210. The results of adjusted mixed-effect NB regression showed that the expected mean of alcohol consumption was significantly higher among those with a poorer perception of mental health, higher perceived work, and life stress. Nonsmokers have a much lower mean score of alcohol consumption compared to those who smoke daily. There was a significant interaction between racial background and the three key predictors (perceived mental health, life stress, and work stress).ConclusionGiven the reported perceived health and stress significantly impacts alcohol consumption, the findings suggested improving individual/group counseling, and health education focusing on home and work environment to prevent and manage life stressors and drivers to make significant program impacts.

Identification of Major Cognitive Disorders in Self-Reported versus Administrative Health Data: A Cohort Study in Quebec

The first imperative in producing the relevant and needed knowledge about major neurocognitive disorder (MNCD) is to identify people presenting with the condition adequately. To document potential disparities between administrative health databases and population-based surveys could help identify specific challenges in this population and methodological shortfalls. To describe and compare the characteristics of community-dwelling older adults according to four groups: 1) No MNCD; 2) Self-reported MNCD only; 3) MNCD in administrative health data only; 4) MNCD in both self-reported and administrative health data. This retrospective cohort study used the Care Trajectories-Enriched Data (TorSaDE) cohort, a linkage between five waves of the Canadian Community Health Survey (CCHS) and health administrative health data. We included older adults living in the community who participated in at least one cycle of the CCHS. We reported on positive and negative MNCD in self-reported versus administrative health data. We then compared groups' characteristics using chi-square tests and ANOVA. The study cohort was composed of 25,125 older adults, of which 784 (3.1%) had MNCD. About 70% of people with an MNCD identified in administrative health data did not report it in the CCHS. The four groups present specific challenges related to the importance of perception, timely diagnosis, and the caregivers' roles in reporting health information. To a certain degree, both data sources fail to consider subgroups experiencing issues related to MNCD; studies like ours provide insight to understand their characteristics and needs better.

Economic burden of chronic pain in Alberta, Canada.

Although chronic pain (CP) is common, little is known about its economic burden in Alberta, Canada. To estimate incremental (as compared to the general population or people without CP) societal (healthcare and lost productivity) costs of CP in Alberta. We applied the prevalence estimated from the Canadian Community Health Survey data to the population retrieved from the Statistics Canada to estimate the number of people with CP in Alberta in 2019. We analyzed the Alberta Health administrative databases to estimate the healthcare costs of person with CP. Finally, we multiplied the number of people with the cost per person. The prevalence of any CP was 20.1% and of activity-preventing CP was 14.5% among people aged > = 12 years. Incremental cost per person with CP per year was CA$2,217 for healthcare services (among people aged > = 12 years) and CA$8,412 for productivity losses (among people aged 18-64 years). Of the healthcare cost, prescription drugs accounted for the largest share (32.8%), followed by inpatient services (31.0%), outpatient services (13.1%), physician services (9.8%), other services (7.4%), and diagnostic imaging (5.8%). Provincially, total incremental cost of CP ranges from CA$1.2 to 1.7 billion for healthcare services (6% to 8% of total provincial health expenditure); and CA$3.4 to 4.7 billion for productivity losses. Considering costs for long-term care services, the total societal cost of CP in Alberta was CA$6.3 to 8.3 billion per year, reflecting 2.0% to 2.7% of Alberta's GDP. Interventions improving CP prevention and management to reduce this substantial economic burden are urgently needed.

Life Satisfaction and Influenza Vaccination Among Older Adults in Canada.

Older adults have an increased risk of complications or death from influenza. Despite the benefits of vaccination for older adults, vaccination coverage among older adults ages 65 years and over is still below Canada's national target of 80 per cent. As health-care-seeking behaviours are influenced by several factors, including life satisfaction, we investigated the relationship between life satisfaction and influenza vaccination among older adults. A sample (n = 22,424) from the 2015-2016 Canadian Community Health Survey data was analysed using descriptive and multinomial logistic regression analyses. Higher life satisfaction was associated with a more recent influenza vaccination history. Vaccination differed by gender, age, and self-reported health status, as women, much older adults, and those with the poorest health status were more likely to be vaccinated. The study suggests an association between life satisfaction and influenza vaccination. More research into the factors that impact influenza vaccination in older adults is needed to increase vaccination coverage in the older adult population.

GEOGRAPHICAL ANALYSIS OF HYPERTENSION IN CANADIAN POPULATION

Objective: A quarter of population is affected by hypertension in Canada. Substantial improvement has been achieved in HTN control in Canada over the past twenty-five years. However, disparities associated with factors like sex, ethnicity, location and health care access remain. Reliable information about trends in hypertension is needed at regional scale for the development of health policies and programs. Health geography and geographic information systems can provide a better understanding of HTN and its risk factors by detecting clusters using spatial analysis and mapping rates of HTN. The objectives of the study were to identify health regions with significantly high or low HTN rate using geostatistics and compare evolution from 2005 to 2019. It also seeks out to identify their populations’ characteristics using conventional statistical analysis. Design and method: Canadian Community Health Survey (2005, 2015, 2019) data were used for the analysis. The 130,000 respondents are located according to health regions and data can be analyzed using a geographic information system. Using age and gender as criteria for subgroups creation, we applied spatial autocorrelation analysis and hot spot/cold analysis to identify geographically contiguous health regions with high or low HBP rates. We then extracted the records in CCHS database for all respondents living in these regions for further statistical analysis. Results: HTN is still a major problem in Canadian population, especially for people aged 65 years and older although 72.9% considered themselves in good, very good or excellent health in 2015. Increase in HTN rate in health regions is spread all over Canada, although some regions showed a decrease in HTN rate. Getis-ord analysis located a cold spot region in western Canada while a hot spot was located in Ontario, central Canada. Cluster of health regions with high HTN rates shows more diabetes and more obese people even though 38.4% declared being in good, very good or excellent health. Conclusions: Increase in hypertension rate in health regions is spread all over Canada, even tough some regions showed a decrease in HBP rate. Canadians 65 years and older with HBP where more prone to obesity &amp; diabetes.

Examining the association between work stress, life stress and obesity among working adult population in Canada: findings from a nationally representative data

BackgroundObesity is a priority public health concern in Canada and other parts of the world. The study primarily aims at assessing the role of self-perceived work and life stress on obesity among working adults in Canada.MethodsThe study was conducted based on a total of 104,636 Canadian adults aged 18 and above, extracted from the 2017–2018 Canadian Community Health Survey (CCHS) data. We used a mixed-effect logistic regression model to determine the possible association between two stress variables and obesity, controlling for other variables in the model. The random effect term accounts for the correlation among the observations from the same health region.ResultsA total of 63,815 adult respondents (aged 18 and above) who were working during the 12 months prior to the survey were studied. Of those, 18.7% were obese based on their self-reported BMI > =30.0 kg/m2. More than two-thirds of the respondents reported that their stress level is a bit stressful to extremely stressful. The results of multivariable mixed-effect logistic regression showed that the odds of obesity were 1.432 times (95% CI: 1.248–1.644) among those who reported extremely work-related stress, compared to those who had no work-related stress. Perceived life stress was not significantly associated with obesity risk among working adult population, after adjusting other factors.ConclusionThe study concluded that obesity among Canadian adults is 18.7% of the working adult population being obese. Given the reported high prevalence of stress and its effect on obesity, the findings suggested improving social support systems, individual/group counseling, and health education focusing on work environments to prevent and manage stressors and drivers to make significant program impacts.

Patterns of up-to-date status for colorectal cancer screening in Alberta: a cross-sectional study using survey data

Background:Regular screening for colorectal cancer (CRC) reduces its mortality. We explored patterns of use of different CRC screening modalities and quantified the association between having a regular primary care provider and being up to date for CRC screening in a community-based population in Alberta, Canada.Methods:We conducted a cross-sectional study of adults between 50 and 74 years of age in Alberta, using Canadian Community Health Survey data (2015–2016). We defined being up to date for CRC screening as having completed a fecal occult blood test (FOBT) or fecal immunochemical test (FIT) within the previous 2 years, or having a colonoscopy or sigmoidoscopy in the previous 5 years before the survey. We analyzed data using multivariable logistic regression models.Results:Of 4600 surveyed adults, 62.6% were up to date for CRC screening, with 45.1% having completed a FIT or FOBT (45.1%), and 34.1% having undergone a colonoscopy or sigmoidoscopy. The adjusted odds ratio of being up to date for CRC screening was 0.25 (95% confidence interval 0.17–0.38) and the absolute probability of being up to date for CRC screening was 34.4% lower for adults who had no regular primary care provider, compared with those who had. This pattern was observed in both male and female subgroups.Interpretation:Our findings suggest a suboptimal uptake of CRC screening overall in Alberta, with high disparity between adults with and without a regular primary care provider. The use of customized, multicomponent intervention strategies that are shown to be effective in increasing participation in CRC screening may address this issue.

The Effect of Back Pain on Health Care Utilization and Costs

Introduction: We assessed the effect of self-reported back pain on health care utilization and costs in a population-based sample of Ontario adults.&#x0D; Methods: We conducted a population-based matched cohort study of Ontarian respondents aged ≥18 years of Canadian Community Health Survey (CCHS) from 2003-2012. CCHS data were individually linked to health administrative data to measure health care utilization and costs up to 2018. We propensity-score matched (hard-matched on sex) adults with self-reported back pain to those without back pain, accounting for sociodemographic, health-related, and behavioural factors. We evaluated back pain-specific and all-cause health care utilization and costs from healthcare payer perspective adjusted to 2018 Canadian dollars. Poisson and linear (log-transformed) models were used to assess healthcare utilization rates and costs. &#x0D; Results: After propensity-score matching, we identified 36,806 pairs (21,054 for women, 15,752 for men) of CCHS respondents with and without back pain (mean age 51 years; SD=18). Compared to propensity-score matched adults without back pain, adults with back pain had two times the rate of back pain-specific visits (women: rate ratio [RR] 2.06, 95% CI 1.88-2.25; men: RR 2.32, 95% CI 2.04-2.64), 1.1 times the rate of all-cause physician visits (women: RR 1.12, 95% CI 1.09-1.16; men: RR 1.10, 95% CI 1.05-1.14), and 1.2 times the costs (women: 1.21, 95% CI 1.16-1.27; men: 1.16, 95% CI 1.09-1.23). Incremental annual per-person costs were higher in adults with back pain versus those without (women: $395, 95% CI $281-$509; men: $196, 95% CI $94-$300), corresponding to $532 million for women and $227 million CAD for men annually in Ontario.&#x0D; Conclusions: Adults with back pain had considerably higher health care utilization and costs compared to adults without back pain. These findings provide the most recent, comprehensive, and high-quality estimates of the health system burden of back pain to inform healthcare policy and decision-making. New strategies to reduce the substantial burden of back pain are warranted.

Associations between Major Health Behaviors and Sleep Problems: Results from the 2015, 2016, 2017 Canadian Community Health Survey

ABSTRACT Background and objectives Key health behaviors including cigarette smoking, alcohol consumption, fruit and vegetable (FV) consumption, and physical activity have been associated with sleep-related problems. This cross-sectional study describes sleep quality and duration by gender in a large adult population and examines whether health behavioral factors are associated with short/long sleep duration and sleep problems (difficulty initiating/maintaining sleep [DIMS], daytime sleepiness, and finding sleep refreshing). Methods Using Canadian Community Health Survey data from cycles 2015, 2016, and 2017, binary and multinomial logistic regression models were computed. Results Of the 44,911 respondents included, only half of respondents met the recommended sleep duration. Fifty-five percent of females and forty-one percent of males reported DIMS. Binge drinking was associated with increased DIMS, with the strongest relationship being among females reporting weekly binge drinking (odds ratio (OR) 2.03 [1.59,2.60]). Binge drinking was also associated with decreased odds of finding sleep refreshing among females only (OR 0.73 [0.56,0.96] in weekly binge drinkers). Compared to respondents who had never smoked, daily smokers had higher odds of short sleep (OR 1.50 [1.30,1.74] and OR 1.39 [1.21,1.60]; females and males, respectively). Similarly, former smokers had higher odds of DIMS (OR 1.18 [1.06,1.31]) and not finding sleep refreshing (OR 0.85 [0.77,0.95]), among females; similar OR among males. Increased FV consumption was associated with increased odds of finding sleep refreshing (OR 1.05 [1.03,1.07] and OR 1.06 [1.04,1.08] in females and males, respectively). Conclusion There is a high prevalence of sleep problems among Canadians. Potential gender differences in the relationships between health behaviors and sleep problems warrant further research.