Canadian Community Health Survey Research Articles

Inequities in Mental Health Care Facing Racialized Immigrant Older Adults With Mental Disorders Despite Universal Coverage: A Population-Based Study in Canada.

Contemporary immigration scholarship has typically treated immigrants with diverse racial backgrounds as a monolithic population. Knowledge gaps remain in understanding how racial and nativity inequities in mental health care intersect and unfold in midlife and old age. This study aims to examine the joint impact of race, migration, and old age in shaping mental health treatment. Pooled data were obtained from the Canadian Community Health Survey (2015-2018) and restricted to respondents (aged ≥45 years) with mood or anxiety disorders (n = 9,099). Multivariable logistic regression was performed to estimate associations between race-migration nexus and past-year mental health consultations (MHC). Classification and regression tree (CART) analysis was applied to identify intersecting determinants of MHC. Compared to Canadian-born Whites, racialized immigrants had greater mental health needs: poor/fair self-rated mental health (odds ratio [OR] = 2.23, 99% confidence interval [CI]: 1.67-2.99), perceived life stressful (OR = 1.49, 99% CI: 1.14-1.95), psychiatric comorbidity (OR = 1.42, 99% CI: 1.06-1.89), and unmet needs for care (OR = 2.02, 99% CI: 1.36-3.02); in sharp contrast, they were less likely to access mental health services across most indicators: overall past-year MHC (OR = 0.54, 99% CI: 0.41-0.71) and consultations with family doctors (OR = 0.67, 99% CI: 0.50-0.89), psychologists (OR = 0.54, 99% CI: 0.33-0.87), and social workers (OR = 0.37, 99% CI: 0.21-0.65), with the exception of psychiatrist visits (p = .324). The CART algorithm identifies three groups at risk of MHC service underuse: racialized immigrants aged ≥55 years, immigrants without high school diplomas, and linguistic minorities who were home renters. To safeguard health care equity for medically underserved communities in Canada, multisectoral efforts need to guarantee culturally responsive mental health care, multilingual services, and affordable housing for racialized immigrant older adults with mental disorders.

Influence of the Social Environment on Ideal Cardiovascular Health.

Background The environment plays a large role in the health of individuals; however, more research is needed to better understand aspects of the environment that most influence health. Specifically, our study examines how the social environment influences cardiovascular health (CVH). Methods and Results The social environment was characterized using measures of belonging and life and work stress in individuals, as well as nationally derived measures of marginalization, deprivation, economic status, and community well-being in neighborhoods. CVH was defined by the American Heart Association's Cardiovascular Health Index-a summed score of 7 clinical and behavioral components known to have the greatest impact on CVH. Data were obtained from the Canadian Community Health Survey 2015 to 2016 and multiple national data sources. Multilevel regression models were used to analyze the associations between CVH and the social environment. Overall, 27% of Canadians reported ideal CVH (6-7 score points), 68% reported intermediate CVH (3-5 score points), and 5% reported poor CVH (0-2 score points). The neighborhood environment contributed up to 7% of the differences in CVH between individuals. Findings indicated that residing in a neighborhood with greater community well-being (odds ratio [OR], 1.33 [95% CI, 1.26-1.41]) was associated with achieving higher odds of ideal CVH, while weaker community belonging (OR, 0.67 [95% CI, 0.62-0.72]) and residing in a neighborhood with greater marginalization (OR, 0.87 [95% CI, 0.82-0.91]) and deprivation (OR, 0.67 [95% CI, 0.64-0.69]) were associated with achieving lower odds of ideal CVH. Conclusions Aspects of individual-level social environment and residing in a neighborhood with a more favorable social environment were both independently and significantly associated with achieving ideal CVH.

Mortality among Canadian population with multimorbidity: A retrospective cohort study.

The aim of this study was to examine the effect of multimorbidity and the joint effect of chronic diseases on all-cause mortality among subjects aged 35 years and above. Population-based retrospective cohort study. Multimorbidity was defined by the respondent's self-report of having two or more chronic diseases of the nine considered. The Canadian Community Health Surveys conducted in 2003/2004, 2005/2006 and 2007 to 2014 were linked with the Canadian Vital Statistics Death Database to examine the association between multimorbidity and all-cause mortality in subjects aged 35 years and above. Cox's proportional hazards models were used to estimate risk of multimorbidity on death after adjusting for the confounders in three age groups. Multimorbidity had an increased risk of death in all three age groups with the youngest having the highest risk after adjusting for potential confounders (35 to 54 years: hazard ratio (HR) = 3.77, 95% CI: 3.04, 4.67; 55 to 64 years: HR = 2.64, 95% CI: 2.36, 2.95; 65 years and above: HR = 1.71; 95% CI:1.63,1.80). Subjects with cancer had the highest risk of death in the three age groups. When the interactions between chronic diseases were considered, subjects with COPD and diabetes had a significantly increased risk of death in comparison to those without COPD or diabetes in the 55 to 64 years. (HR = 2.59, 95% CI: 2.01, 3.34). Prevention of multimorbidity should be targeted not only in the older population but also in the younger populations. Synergistic effects of chronic diseases should be considered in the management of multimorbidities.

Well-being of professional older adults’ caregivers in Alberta’s assisted living and long-term care facilities: a cross-sectional study

BackgroundFor the care need of older adults, long-term care (LTC) and assisted living (AL) facilities are expanding in Alberta, but little is known about the caregivers’ well-being. The purpose of the study was to investigate the physical health conditions, mental and emotional health (MEH), health behaviour, stress levels, quality of life (QOL), and turnover and absenteeism (TAA) among professional caregivers in Alberta’s LTC and AL facilities.MethodsThis cross-sectional survey involved 933 conveniently selected caregivers working in Alberta’s LTC and AL facilities. Standardised questions were selected from the Canadian Community Health Survey, Patient Health Questionnaire-9, and Short Form-36 QOL survey revalidated and administered to the participants. The new questionnaire was used to assess the caregivers’ general health condition (GHC), physical health, health behaviour, stress level, QOL, and TAA. Data were analysed using descriptive statistics, Cronbach alpha, Pearson’s correlation, one-way analysis of variance, and multiple linear regression.ResultsOf 1385 surveys sent to 39 facilities, 933 valid responses were received (response rate = 67.4%). The majority of the caregivers were females (90.8%) who were ≥ 35 years (73.6%), worked between 20 to 40 h weekly (67.3%), and were satisfied with their GHC (68.1%). The Registered Nurses had better GHC (mean difference [MD] = 0.18, p = 0.004) and higher TAA than the Health Care Aides (MD = 0.24, p = 0.005). There were correlations between caregivers’ TAA and each of MEH (r = 0.398), QOL (r = 0.308), and stress (r = 0.251); p < 0.001. The most significant predictors of TAA were the propensity to quit a workplace or the profession, illness, job stress, and work-related injury, F (5, 551) = 76.62, p < 0.001, adjusted R2 = 0.998.ConclusionReducing the caregivers’ job stressors such as work overload, inflexible schedule, and poor remuneration, and improving their quality of life, health behaviour, and mental, emotional, and physical health conditions may increase their job satisfaction and reduce turnover and absenteeism.

Indicators of Healthcare Services Utilization among the Syrian Refugee Population in Jordan: An Observational Study.

Sufficient healthcare services utilization among the Syrian refugee population is one of the most important human rights. Vulnerable populations, such as refugees, are often deprived of sufficient access to healthcare services. Even when healthcare services are accessible, refugees vary in their level of utilization of these services and their health-seeking behavior. This study aims to examine the status and indicators of healthcare service access and utilization among adult Syrian refugees with non-communicable diseases residing in two refugee camps. The cross-sectional descriptive design was conducted by enrolling 455 adult Syrian refugees residing in the Al-Za'atari and Azraq camps in northern Jordan, using demographical data, perceived health, and the "Access to healthcare services" module, which is a part of the Canadian Community Health Survey (CCHS). A logistic regression model with binary outcomes was used to explore the accuracy of the variables influencing the utilization of healthcare services. The individual indicators were examined further out of 14 variables, according to the Anderson model. Specifically, the model consisted of healthcare indicators and demographic variables to find out if they have any effect on healthcare services utilization. Descriptive data showed that the mean age of the study participants (n = 455) was 49.45 years (SD = 10.48), and 60.2% (n = 274) were females. In addition, 63.7% (n = 290), of them were married; 50.5% (n = 230) held elementary school-level degrees; and the majority 83.3% (n = 379) were unemployed. As expected, the vast majority have no health insurance. The mean overall food security score was 13 out of 24 (±3.5). Difficulty in accessing healthcare services among Syrian refugees in Jordan's camps was significantly predicted by gender. "Transportation problems, other than fee problems" (mean 4.25, SD = 1.11) and "Unable to afford transportation fees" (mean 4.27, SD = 1.12) were identified as the most important barriers to accessing healthcare services. Healthcare services must imply all possible measures to make them more affordable to refugees, particularly older, unemployed refugees with large families. High-quality fresh food and clean drinking water are needed to improve health outcomes in camps.

Sex and gender aspects in diabetes mellitus: Focus on access to health care and cardiovascular outcomes.

The aim of this study was to elucidate whether sex and gender factors influence access to health care and/or are associated with cardiovascular (CV) outcomes of individuals with diabetes mellitus (DM) across different countries. Using data from the Canadian Community Health Survey (8.4% of respondent reporting DM) and the European Health Interview Survey (7.3% of respondents reporting DM), were analyzed. Self-reported sex and a composite measure of socio-cultural gender was constructed (range: 0-1; higher score represent participants who reported more characteristics traditionally ascribed to women). For the purposes of analyses the Gender Inequality Index (GII) was used as a country level measure of institutionalized gender. Canadian females with DM were more likely to undergo HbA1c monitoring compared to males (OR = 1.26, 95% CI: 1.01-1.58), while conversely in the European cohort females with DM were less likely to have their blood sugar measured compared to males (OR = 0.88, 95% CI: 0.79-0.99). A higher gender score in both cohorts was associated with less frequent diabetes monitoring. Additionally, independent of sex, higher gender scores were associated with higher prevalence of self-reported heart disease, stroke, and hospitalization in all countries albeit European countries with medium-high GII, conferred a higher risk of all outcomes and hospitalization rates than low GII countries. Regardless of sex, individuals with DM who reported characteristics typically ascribed to women and those living in countries with greater gender inequity for women exhibited poorer diabetes care and greater risk of CV outcomes and hospitalizations.

The trends and determinants of seasonal influenza vaccination after cardiovascular events in Canada: a repeated, pan-Canadian, cross-sectional study.

Annual influenza vaccination is recommended for individuals with a history of cardiovascular disease (CVD) events. We aimed to examine (1) the time trends for influenza vaccination among Canadians with a CVD event history between 2009 and 2018, and (2) the determinants of receiving the vaccination in this population over the same period. We used data from the Canadian Community Health Survey (CCHS). The study sample included respondents from 2009 to 2018 who were 30 years of age or more with a CVD event (heart attack or stroke) and who indicated their flu vaccination status. Weighted analysis was used to determine the trend of vaccination rate. We used linear regression analysis to examine the trend and multivariate logistic regression analysis to examine determinants of influenza vaccination, including sociodemographic factors, clinical characteristics, health behaviour and health system variables. Over the study period, in our sample of 42 400, the influenza vaccination rate was overall stable around 58.9%. Several determinants for vaccination were identified, including older age (adjusted odds ratio [aOR] = 4.28; 95% confidence interval [95% CI]: 4.24-4.32], having a regular health care provider (aOR = 2.39; 95% CI: 2.37-2.41), and being a nonsmoker (aOR = 1.48; 95% CI: 1.47-1.49). Factors associated with decreased likelihood of vaccination included working full time (aOR = 0.72; 95% CI: 0.72-0.72). Influenza vaccination is still at less than the recommended level in patients with CVD. Future research should consider the impact of interventions to improve vaccination uptake in this population.

Individual physical activity, neighbourhood active living environment and mental illness hospitalisation among adults with cardiometabolic disease: a Canadian population-based cohort analysis

ObjectivesThis population-based observational study explores the associations between individual-level and neighbourhood-level indices of active living with inpatient mental healthcare use among adults with an underlying chronic cardiometabolic condition.Design and settingData...

Effect of Retirement on Life Satisfaction in Canada: Evidence from the 2008–2009 Canadian Community Health Survey–Healthy Aging

Parce qu’elle représente une transition majeure dans la vie de la population âgée, la retraite peut avoir une incidence sur le bienêtre, en raison des changements liés au mode de vie, aux émotions et aux finances qui l’accompagnent. Dans cette étude, nous étudions empiriquement l’effet de la retraite sur la satisfaction à l’égard de la vie au Canada, à l’aide des données de l’Enquête sur la santé dans les collectivités canadiennes – Vieillissement en santé de 2008–2009. Isoler l’effet de la retraite sur la satisfaction à l’égard de la vie présente des difficultés intrinsèques : autosélection, causalité inverse et hétérogénéité non observée propre à la personne pouvant avoir une incidence à la fois sur la satisfaction à l’égard de la vie et sur la décision de prendre sa retraite. Pour tenir compte de ces facteurs, nous étudions les seuils pour l’âge de la retraite déterminés par la Sécurité de la vieillesse et du Régime de pensions du Canada/Régime de rentes du Québec en tant que variables instrumentales dans la décision de prendre sa retraite. Les estimations qui résultent de nos analyses donnent à penser que la retraite a un effet positif et important sur la satisfaction à l’égard de la vie de la population âgée au Canada. Cet effet demeure significatif après contrôle des variables de l’âge, du sexe, de l’état matrimonial, du niveau de scolarité, du revenu du ménage, de la race, du statut d’immigrant et des effets fixes à l’échelle provinciale.

Differential Participation, a Potential Cause of Spurious Associations in Observational Cohorts in Environmental Epidemiology.

Differential participation in observational cohorts may lead to biased or even reversed estimates. In this article, we describe the potential for differential participation in cohorts studying the etiologic effects of long-term environmental exposures. Such cohorts are prone to differential participation because only those who survived until the start of follow-up and were healthy enough before enrollment will participate, and many environmental exposures are prevalent in the target population and connected to participation via factors such as geography or frailty. The relatively modest effect sizes of most environmental exposures also make any bias induced by differential participation particularly important to understand and account for. We discuss key points to consider for evaluating differential participation and use causal graphs to describe two example mechanisms through which differential participation can occur in health studies of long-term environmental exposures. We use a real-life example, the Canadian Community Health Survey cohort, to illustrate the non-negligible bias due to differential participation. We also demonstrate that implementing a simple washout period may reduce the bias and recover more valid results if the effect of interest is constant over time. Furthermore, we implement simulation scenarios to confirm the plausibility of the two mechanisms causing bias and the utility of the washout method. Since the existence of differential participation can be difficult to diagnose with traditional analytical approaches that calculate a summary effect estimate, we encourage researchers to systematically investigate the presence of time-varying effect estimates and potential spurious patterns (especially in initial periods in the setting of differential participation).

Trends in population characteristics associated with mental health service use among youth and emerging adults in Canada from 2011 to 2016.

Despite the high prevalence of mental disorders among youth (age 12 to 17) and emerging adults (age 18 to 24), few receive mental health (MH) services. Using a cross-sectional study design, we examined population characteristics associated with MH service use in this age group from 2011 to 2016. Data were from six cycles of the Canadian Community Health Survey (2011-2016). Population characteristics associated with service use were analyzed using logistic regression models for each year. Changes in odds ratios over time were used to examine trends. Presence of a mood or anxiety disorder had the largest magnitude of association on MH service use in every year. Trends suggested an increased association size between self-rated MH status and service use; lower self-rated MH was associated with a 62% increase in odds of service use in 2011 and an 83% increase in 2016. Being female was associated with increased odds of MH service use (range: 59-107%). Compared with white respondents, individuals who were East and Southeast Asian or South Asian had decreased odds of MH service use. While the association size varied for South Asians, there was a trend toward decreasing likelihood of accessing care (55% decreased odds in 2011, 74% in 2016) for East and Southeast Asians. Trends suggest changes in population characteristics associated with access to MH care (e.g., self-rated MH status) as well as persistent inequity in MH service use in Canada for males and individuals from Asian ethnic groups.

Canadians Adults Fail Their Dietary Quality Examination Twice.

For many years, dietary quality among Canadians has been assessed using an index that gives criticized scores and does not allow for comparison with Americans. In Canadians aged ≥19 years, we aimed to (1) determine the dietary quality by using a more widely used evidence-based index that has shown associations with health outcomes, the alternative Healthy Eating Index (aHEI-2010); (2) assess changes in aHEI-2010 score and its components between 2004 and 2015; and (3) identify factors associated with aHEI-2010 score. We relied on the Canadian Community Health Survey 2004 (n = 35,107) and 2015 (n = 20,487). We used adjusted linear models with a time effect to compare the total aHEI-2010 score and its components. The overall aHEI-2010 score increased from 36.5 (95%CI: 36.2-36.8) in 2004 to 39.0 (95%CI: 38.5-39.4) in 2015 (p < 0.0001). Participants with less than a high school diploma showed the lowest score and no improvement from 2004 to 2015 (34.8 vs. 35.3, p = 0.4864). In each period, higher scores were noted among immigrants than non-immigrants (38.3 vs. 35.9 in 2004, p < 0.0001; 40.5 vs. 38.5 in 2015 p < 0.0001), and lower scores were observed in current smokers (33.4 vs. 37.1 in 2004, p < 0.0001; 34.5 vs. 39.9 in 2015, p < 0.0001). The use of the aHEI-2010 tool suggests a lower score among Canadians than the previous index, more comparable to the score among Americans.

Rates of and factors associated with exclusive and any breastfeeding at six months in Canada: an analysis of population-based cross-sectional data

BackgroundBreastfeeding has many health, economic and environmental benefits for both the infant and pregnant individual. Due to these benefits, the World Health Organization and Health Canada recommend exclusive breastfeeding for the first six months of life. The purpose of this study is to examine the prevalence of exclusive and any breastfeeding in Canada for at least six months, and factors associated with breastfeeding cessation prior to six months.MethodsWe performed a secondary analysis of breastfeeding-related questions asked on the cross-sectional 2017–2018 Canadian Community Health Survey. Our sample comprised 5,392 females aged 15–55 who had given birth in the five years preceding the survey. Descriptive statistics were carried out to assess the proportion of females exclusively breastfeeding and doing any breastfeeding for at least six months by demographic and behavioural factors. We also assessed, by baby’s age, trends in the introduction of solids and liquids, breastfeeding cessation and the reasons females stopped breastfeeding. Multivariate log binominal regression was used to examine the association between breastfeeding at six months and selected maternal characteristics hypothesized a priori to be associated with breastfeeding behaviour.ResultsOverall, for at least six months, 35.6% (95% confidence interval (CI): 33.3%-37.8%) of females breastfed exclusively and 62.2% (95% CI: 60.0%-64.4%) did any breastfeeding. The largest decline in exclusive breastfeeding occurred in the first month. Factors most strongly associated with breastfeeding for at least six months were having a bachelor’s or higher degree, having a normal body mass index, being married and daily co-sleeping. Insufficient milk supply was given as the most common reason for breastfeeding cessation irrespective of when females stopped breastfeeding.ConclusionSix-month exclusive breastfeeding rates in Canada remain below targets set by the World Health Assembly. Continued efforts, including investment in monitoring of breastfeeding rates, are needed to promote and support exclusive breastfeeding, especially among females vulnerable to early cessation.

The prevalence and predictors of household food insecurity among adolescents in Canada

ObjectivesHousehold food insecurity is almost four times more prevalent among adolescents than among older adults in Canada, and it adversely affects their health. Our objective was to describe the sociodemographic and geographic patterning of household food insecurity among adolescents.MethodsOur analytic sample comprised all 12–17-year-old respondents to the 2017–2018 Canadian Community Health Survey with complete data on household food insecurity (n = 8416). We used bivariate and multivariable logistic regression models to identify respondent- and household-level sociodemographic characteristics associated with household food insecurity.ResultsThe prevalence of household food insecurity among adolescents was 20.7%. The adjusted odds of food insecurity were significantly elevated among adolescents who identified as Black or Indigenous (aOR 1.80), those living with a single parent (aOR 1.60), those living with a greater number of children ≤ 5 years (aOR 1.45) or 12–17 years (aOR 1.25), those in rented accommodation (aOR 1.98), those in households with only secondary school education (aOR 1.38), and those in households reliant on social assistance (aOR 2.03). Higher before-tax income was protective (aOR 0.99). In comparison with Ontario, the adjusted odds of food insecurity among adolescents were higher in Nunavut (aOR 6.77), Northwest Territories (aOR 2.11), and Alberta (aOR 1.48), and lower in Manitoba (aOR 0.66).ConclusionThe markedly higher odds of exposure to household food insecurity among adolescents who are Black or Indigenous and those living in households characterized by markers of social and economic disadvantage highlight the need for more effective policy interventions to protect vulnerable families from this hardship.

Contraception use among female youth with disabilities: Secondary analysis of a Canadian cross-sectional survey

BackgroundNon-use of contraception among sexually active youth is an important contributor to unintended pregnancy, but contraception use among disabled youth is poorly understood. ObjectiveTo compare contraception use in female youth with and without disabilities. MethodsWe used data from the 2013–2014 Canadian Community Health Survey on sexually active 15 to 24-year-old females with (n = 831) and without (n = 2,700) a self-reported functional or activity limitation, who reported that it was important to them to avoid getting pregnant. We used log binomial regression to derive adjusted prevalence ratios (aPR) for use of any vs. no contraception, and for oral contraception, injectable contraception, condoms, other contraception methods, and dual methods separately, comparing youth with and without disabilities. Adjusted analyses controlled for age, school enrollment, household income, marital status, race/ethnicity, immigrant status, and health region. ResultsThere were no differences in the use of any contraception (85.4% vs. 84.2%; aPR 1.03, 95% CI 0.998–1.06), oral contraception (aPR 0.98, 95% CI 0.92–1.05), condoms (aPR 1.00, 95% CI 0.92–1.09), or dual methods (aPR 1.02, 95% CI 0.91–1.15), comparing youth with and without disabilities. Those with disabilities were more likely to use injectable contraception (aPR 2.31, 95% CI 1.59–3.38) and other contraception methods (aPR 1.54, 95% CI 1.25–1.90). ConclusionYouth at risk of unintended pregnancy had similar overall use of contraception, regardless of disability status. Future studies should examine the reasons for higher uptake of injectable contraception in youth with disabilities, with possible implications for health care provider education on access to youth-controlled methods for this group.

Workplace mental health characteristics of the Indigenous workforce in Canada: A descriptive study.

The Indigenous workforce in Canada is challenged by a history of Euro-Canadian colonialism that has presented deleterious health outcomes, including those in the workplace. The aim of this study was to describe the mental health of Indigenous workers in the workplace. We used the Canadian Community Health Survey (CCHS) between 2015 to 2016. Data were analyzed using the Public Use Microdata Files to profile the workplace mental health characteristics of First Nation Canadians (n = 6,297) and Canadians (n = 84,155). We utilized secondary data analysis design. The analyses included descriptive statistics (e.g., means and standard deviations) of self-reported mood disorders (depression, bipolar, mania, dysthymia), anxiety (phobia, OCD, panic) and occupational factors (e.g., demographic, days off work due to an acute mental health condition, job type, and job stress) in indigenous peoples living off-reserve and other Aboriginal settlements in the provinces. We examined the indigenous cohort between the ages of 18-64 who were employed. The sample was 53.1% male, married (34.8%), and obtained a post-secondary diploma or university degree (57.9%). The study reported statistically significant gender and age differences across mood and anxiety disorders (p < 0.05), job stress (p < 0.05) and workload (p < 0.05). To the best of our knowledge, this is the first study to describe the work profile of indigenous populations in Canada across various occupational mental health (e.g., mood disorders, anxiety) and demographic (e.g., age, education attainment) outcomes.

Breastfeeding in Canada: predictors of initiation, exclusivity, and continuation from the 2017-2018 Canadian Community Health Survey.

Human milk is the ideal source of nutrition for infants; however, adherence to breastfeeding recommendations is suboptimal and availability of Canadian breastfeeding data are limited. Using the 2017-2018 Canadian Community Health Survey Public Use Microdata File (Maternal Experiences Module, n=5558, weighted n=1 669 462) we computed breastfeeding indicators and explored sociodemographic, health, and geographical predictors of breastfeeding with univariate logistic regression models. Nationally, of all participants who gave birth in the preceding 5 years, 91% initiated breastfeeding, 43% exclusively breastfed to≥5 months and 35% to≥6 months, 56% reported any breastfeeding at≥6 months, and 31% reported breastfeeding at≥12 months. Breastfeeding cessation was most commonly attributed to insufficient milk supply (25%), but reasons differed significantly by breastfeeding duration. Breastfeeding initiation, exclusivity for≥5 months, and extendedbreastfeeding ≥12 months all differed by geographic region, and by most sociodemographic and health characteristics. Positive breastfeeding outcomes were highest in British Columbia, and lowest in Quebec and the Atlantic region, and generally higher if caregivers had recently immigrated to Canada, were married, were >30 years of age, were not White, were nonsmoking, had completed postsecondary education, and had an annual household income >$40 000. These disparities indicate the need for tailored, equitable approaches to breastfeeding support, and continued regional monitoring of breastfeeding outcomes.

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.

Association between Neighbourhood Deprivation Trajectories and Self-Perceived Health: Analysis of a Linked Survey and Health Administrative Data.

Life course exposure to neighbourhood deprivation may have a previously unstudied relationship with health disparities. This study examined the association between neighbourhood deprivation trajectories (NDTs) and poor reported self-perceived health (SPH) among Quebec's adult population. Data of 45,990 adults with complete residential address histories from the Care-Trajectories-Enriched Data cohort, which links Canadian Community Health Survey respondents to health administrative data, were used. Accordingly, participants were categorised into nine NDTs (T1 (Privileged Stable)-T9 (Deprived Stable)). Using multivariate logistic regression, the association between trajectory groups and poor SPH was estimated. Of the participants, 10.3% (95% confidence interval [CI]: 9.9-10.8) had poor SPH status. This proportion varied considerably across NDTs: From 6.4% (95% CI: 5.7-7.2) for Privileged Stable (most advantaged) to 16.4% (95% CI: 15.0-17.8) for Deprived Stable (most disadvantaged) trajectories. After adjustment, the likelihood of reporting poor SPH was significantly higher among participants assigned to a Deprived Upward (odds ratio [OR]: 1.77; 95% CI: 1.48-2.12), Average Downward (OR: 1.75; CI: 1.08-2.84) or Deprived trajectory (OR: 1.81; CI: 1.45-2.86), compared to the Privileged trajectory. Long-term exposure to neighbourhood deprivation may be a risk factor for poor SPH. Thus, NDT measures should be considered when selecting a target population for public-health-related interventions.

The role of neighbourhood environments in hospitalization risk for diabetes and related conditions: A population-based cohort analysis by remoteness and deprivation indices.

Most socio-epidemiological studies on diabetes incidence, prevalence, or hospitalization focus on individual-level risk factors. This population-based cohort study sought to advance understanding on the associations of contextual characteristics and risk of diabetes-related avoidable hospitalization (DRAH) among at-risk Canadians. A national cohort was compiled from the 2013/2014 Canadian Community Health Survey, representing 5.1 million adults aged 35 years and older, reporting having been diagnosed with diabetes, hypertension, or heart disease. Their information was linked longitudinally to hospitalization data from the 2013/14 to 2017/18 Discharge Abstract Database as well as to measures of geographic variability from the Material and Social Deprivation Index and the Index of Remoteness. Cox regression models were used to examine associations between the contextual indices and first occurrence of a DRAH. Residents in the most rural and remote communities were 50% more likely (hazard ratio (HR): 1.51, 95% confidence interval (95% CI): 1.26 to 1.80) to experience a DRAH than those in the most urbanized and accessible communities, and residents in the most socially deprived areas were significantly more likely (HR: 1.44, 95% CI: 1.26 to 1.65) to be hospitalized than those in the most socially privileged areas, controlling for individuals' sociodemographic characteristics and health behaviours. Neighbourhood material deprivation did not exercise a statistically significant influence on hospitalization risk after adjusting for the other residential characteristics. There is a clear and significant gradient in diabetes-related hospitalization risk among Canadians with an underlying cardiometabolic condition by degree of residential remoteness and of neighbourhood social deprivation, independently of individual characteristics and despite Canada's universal healthcare system.