Canadian Network Research Articles

Satisfaction in surgically treated patients with degenerative cervical myelopathy: an observational study from the canadian spine outcomes and research network

Background ContextHealthcare reimbursement is evolving towards a value-based model, entwined and emphasizing patient satisfaction. Factors associated with satisfaction after degenerative cervical myelopathy (DCM) surgery have not been previously established. PurposeOur primary objective was to ascertain satisfaction rates and satisfaction predictors at 3 and 12 months following surgical treatment for DCM. DesignThis is a prospective cohort study within Canadian Spine Outcomes and Research Network (CSORN). Patient SamplePatients in the study were surgically treated for DCM patients who completed 3-month and 12-month follow-ups within CSORN between 2015 and 2021. Outcome MeasuresData analyzed included patient demographic, surgical variables, patient-reported outcomes (NDI, NRS-NP, NRS-AP, SF-12-MCS, SF-12-PCS, ED-5Q, PHQ-8), MJOA and self-reported satisfaction on a Likert scale. MethodsMultivariable regression analysis was conducted to identify significant factors associated with satisfaction, address multicollinearity and ensure predictive accuracy. This process was conducted separately for the 3-month and 12-month follow-ups. ResultsSix hundred and sixty-three patients were included, with an average age of 60, and an even distribution across MJOA scores (mild, moderate, severe). At 3-month and 12-month follow-up, satisfaction rates were 86% and 82%, respectively. At 12 months, logistic regression showed the odds of being satisfied varied by +24%, −3%, −10%, −14%, +3%, and +12% for each 1-point change between baseline and 12 months in MJOA, NDI, NRS-NP, NRS-AP, SF-12-MCS, SF-12-PCS. Satisfaction increased 11-fold for each 0.1-point increased in ED-5Q from baseline to 12 months. At baseline, for every 1-point increase in SF-12-MCS, the odds of being satisfied increased by 7%. At 3 months, all PROs (except for NRS-AP change and baseline SF-12-MCS) predicted satisfaction. All logistic regression analyses demonstrated excellent predictive accuracy, with the highest 12-month AUC of 0.86 (95%CI = 0.81–0.90). No patient demographic or surgical factors influenced satisfaction. ConclusionImprovement in Patient Reported Outcomes and MJOA are strongly associated with patient satisfaction after surgery for DCM. The only baseline PRO associated with 12-months satisfaction was SF-12-MCS. No modifiable patient baseline characteristic or surgical variables were associated with satisfaction.

Development of a dictionary of information items inspired by common data models to support health research data access requests

A network of organizations collaborates to provide services to facilitate multi-regional research across Canada. To streamline the data access process, the network is developing a dictionary of information items (InfoItems), providing a label and definition that represent a semantic sourced from an ontology (e.g., “human birth date” from a demography ontology). This allows for a standardized and shareable means to express data requirements. Inspired by health-research common data models (CDMs) like those from the Observational Medical Outcomes Partnership (OMOP) and the Canadian Network for Observational Drug Effects (CNODES), approximately 60 InfoItems were developed by the network. As a pilot exercise, four data centres mapped their data assets to the InfoItems to ensure they are relevant to the Canadian health data context. This has laid the foundation for InfoItems as a basic data harmonization mechanism. The new InfoItems-based data dictionary promotes the standardization of data asset contents across the network’s data centres. Researchers can use the dictionary to specify a project’s data requirements, establishing details like data availability across multiple regions, for inclusion in their data access request. The InfoItems dictionary is pivotal in simplifying data access requests, promoting multi-regional research in Canada. This resource can simultaneously safeguard the quality of analytical results and optimize data extraction into existing data models (e.g., health-research CDMs). Ongoing improvements in this area aim to enhance user experience and facilitate quality research.

Exposure to Valsartan Products Containing Nitrosamine Impurities in the United States, Canada, and Denmark.

Following the mass recall of valsartan products with nitrosamine impurities in July 2018, the number of patients exposed to these products, the duration of exposure, and the potential for cancer remains unknown. Therefore, we assessed the extent and duration of use of valsartan products with a nitrosamine impurity in the United States, Canada, and Denmark. We conducted a retrospective cohort study using administrative healthcare data from the US FDA Sentinel System, four Canadian provinces that contribute to the Canadian Network for Observational Drug Effect Studies (CNODES), and the Danish National Prescription Registry. Patients, 18 years and older between May 2012 and December 2020 with a valsartan dispensing were identified in each database. Patients were followed from the date of valsartan dispensing until discontinuation. We defined four valsartan exposure categories based on nitrosamine impurity status; recalled generic products with confirmed NDMA/NDEA levels (recalled-tested); recalled generic products that were not tested (recalled); non-recalled generic and non-recalled branded products. In Denmark, the recalled-tested category was not included due to absence of testing data. The proportion and duration of use of valsartan episodes stratified by nitrosamine-impurity status was calculated. We identified 3.3 and 2.8 million (United States) and 51.3 and 229 thousand (Canada) recalled-tested and recalled valsartan exposures. In Denmark, where valsartan exposure was generally low, there were 10 747 recalled exposures. Immediately after the recall notices were issued, there was increased rates of switching to a non-valsartan ARB. The mean duration of use of the recalled-tested products was 167 (±223.1) and 146 (±255.8) days in the United States and Canada respectively. For the recalled products, mean cumulative duration of use was 178 (±249.6), 269 (±397.3) and 166 (±251.0) days in the United States, Canada, and Denmark, respectively. In this cohort study, despite widespread use of recalled generic valsartan between 2012 and 2018, the duration of use was relatively short and probably did not pose an elevated risk of nitrosamine-induced cancer. However, since products with nitrosamine impurity could have been on the market over a 6-year period, patients exposed to these products for longer durations could have a potentially different risk of cancer.

Oméga-3 et psychiatrie : que dit la littérature ?

Psychiatry is faced with a lack of new treatments despite a great deal of research and is re-exploring the use of old molecules and dietary supplements. Our aim here is to present a narrative review of the indications for omega-3 supplementation in various psychiatric disorders. Omega-3s belong to the family of polyunsaturated fatty acids (PUFAs). The 3 important omega-3 PUFAs in psychiatry are α-linolenic acid (ALA): C18:3n-3, eicosapentaenoic acid (EPA) C20:5n-3 and docosahexaenoic acid (DHA) C22:6n-3. In psychosis, a distinction must be made between 3 categories of patients: patients who have chronic schizophrenia (SCZ), patients with a first psychotic episode (FEP) and patients at ultra-high risk of psychosis (UHR).The data in the literature indicate that omega-3 supplementation is well tolerated. However, there is an increased risk of atrial fibrillation at doses over 4g/d, mainly in people over the age of 65.Omega-3 supplementation is not recommended for eating disorders, attention deficit hyperactivity disorder or autism spectrum disorders. Omega-3 supplementation could be beneficial in borderline personality disorder and psychotic disorders, particularly in patients at ultra-high risk of psychotic transition (UHR) to prevent psychotic transition and FEP to improve remission, and in bipolar disorder. It is now recommended for unipolar depression by the World Federation of Societies of Biological Psychiatry (WFSBP) and the Canadian Network for Mood and Anxiety Treatments (CANMAT) Taskforce. There are a large number of clinical trials of omega-3 supplementation. However, these trials use different types of supplementation (EPA alone, DHA alone, EPA+DHA, etc.) with different dosages and EPA/DHA ratios and over variable durations. In addition, the origin of the omega-3s may vary, although most of the studies used omega-3s of marine origin (fish). Finally, it has not been studied whether the time of day (fasting, during a meal, morning, evening, etc.) impacts the efficacy of the treatment.Confounding factors are often not taken into account. For example, some studies suggest a link between the response to omega-3 supplementation and the inflammation or oxidative stress level. Omega-3 supplementation acts on numerous biological pathways: inflammation, oxidative stress, monocarbon metabolism (vitamin B9, B12, homocysteine), myelination,... For psychotic disorders, meta-analyses tend not to distinguish between UHR, PEP and schizophrenic patients.There have not been enough studies to validate the doses and duration of supplementation. The doses and durations in the recommendations are based solely on incomplete data from published studies. Further studies are needed to optimize these recommendations. Except for UHR patients and those with borderline personality disorder, omega-3 supplementation is always used as a complement to psychotropic treatment.In conclusion, the results of clinical trials, meta-analyses and recommendations are heterogeneous and may be divergent. Omega-3 supplementation in psychiatry is still extensively studied, with numerous studies and meta-analyses published recently. Omega-3 supplementation could be part of the goal of personalized medicine, as some studies are already suggesting. In the future, the efficacy of omega-3 supplementation could be improved by targeting sub-groups of patients: patients with inflammatory profiles, high levels of oxidative stress and low blood omega-3 concentrations. Due to the increasing number of studies published on omega-3 supplementation in psychiatric disorders, the conclusions of this review are provisional and will need to be updated.

Association of hepatitis B virus treatment with all-cause and liver-related mortality among individuals with HBV and cirrhosis: a population-based cohort study

We evaluated the association of hepatitis B virus (HBV) treatment with all-cause, and liver-related mortality among individuals with HBV and cirrhosis in British Columbia (BC), Canada. This analysis included people diagnosed with HBV and had cirrhosis in the BC Hepatitis Testers Cohort, including data on all individuals diagnosed with HBV from 1990 to 2015 in BC and integrated with healthcare administrative data. We followed people with cirrhosis from the first cirrhosis diagnosis date until death or December 31, 2020. We compared all-cause and liver related mortality between those who received treatment and those who did not. HBV treatment was considered a time-varying variable. We performed multivariable Cox proportional hazards model and competing risk regression models to assess the association of HBV treatment with all causes, and liver-related mortality respectively using inverse probability of treatment weighted population. Among 4962 individuals with HBV and cirrhosis, 48.1% received HBV treatment. Treated individuals had a median follow-up of 2.97 years, compared to 2.87 years for untreated individuals. The treated group was older (median age 57 vs 54 years), had higher proportion of treated of males [1802 (75.50%) vs 1766 (68.8%)], from urban area [2318 (97.2%) vs 2355 (91.8%)], and from East and South Asian ethnicity [1506 (63.1%) vs 709 (27.5%)] compared to untreated group. Untreated people experienced higher all-cause mortality (115.47 vs. 35.72 per 1000 person-years) and liver-related mortality (49.86 vs. 11.39 per 1000 person-years). Multivariable models showed that HBV treatment significantly lowered the risk of all-cause mortality (adjusted hazard ratio (aHR) 0.74; 95% CI: 0.65, 0.84) and liver-related mortality (adjusted subdistribution hazard ratio (asHR) 0.72; 95% CI: 0.58, 0.89) compared to untreated individuals. Among untreated individuals with HBV, those with HCV coinfection had a higher risk of both all-cause and liver-related mortality (aHR 1.57; 95% CI: 1.22, 2.04, and asHR 1.60; 95% CI: 1.25, 2.05, respectively). HBV treatment was associated with a significant reduction in all-cause and liver-related mortality among individuals with cirrhosis. The findings highlight the need for treatment among individuals with HBV related cirrhosis especially those with coinfection with hepatitis C virus. This work was supported by the BC Centre for Disease Control and the Canadian Institutes of Health Research (CIHR) [Grant # NHC-142832, PJT-156066, and SC1 -178736]. JDM has received doctoral fellowship from the Canadian Network on Hepatitis C (CanHepC). DJ has received Doctoral Research Award (#201910DF1-435705-64343) from the Canadian Institutes of Health Research (CIHR) and doctoral fellowship from the CanHepC. CanHepC is funded by a joint initiative of the Canadian Institutes of Health Research (CIHR) (NHC-142832) and the Public Health Agency of Canada (PHAC).

Commentary on the Canadian Network for Mood and Anxiety Treatments 2023 Clinical Guidelines for Management of Major Depressive Disorder in Adults - Capturing the State of the Art.

Commentary on the Canadian Network for Mood and Anxiety Treatments 2023 Clinical Guidelines for Management of Major Depressive Disorder in Adults - Capturing the State of the Art.

Canadian Network for Mood and Anxiety Treatments (CANMAT) 2023 Update on Clinical Guidelines for Management of Major Depressive Disorder in Adults: Réseau canadien pour les traitements de l'humeur et de l'anxiété (CANMAT) 2023 : Mise à jour des lignes directrices cliniques pour la prise en charge du trouble dépressif majeur chez les adultes.

The Canadian Network for Mood and Anxiety Treatments (CANMAT) last published clinical guidelines for the management of major depressive disorder (MDD) in 2016. Owing to advances in the field, an update was needed to incorporate new evidence and provide new and revised recommendations for the assessment and management of MDD in adults. CANMAT convened a guidelines editorial group comprised of academic clinicians and patient partners. A systematic literature review was conducted, focusing on systematic reviews and meta-analyses published since the 2016 guidelines. Recommendations were organized by lines of treatment, which were informed by CANMAT-defined levels of evidence and supplemented by clinical support (consisting of expert consensus on safety, tolerability, and feasibility). Drafts were revised based on review by patient partners, expert peer review, and a defined expert consensus process. The updated guidelines comprise eight primary topics, in a question-and-answer format, that map a patient care journey from assessment to selection of evidence-based treatments, prevention of recurrence, and strategies for inadequate response. The guidelines adopt a personalized care approach that emphasizes shared decision-making that reflects the values, preferences, and treatment history of the patient with MDD. Tables provide new and updated recommendations for psychological, pharmacological, lifestyle, complementary and alternative medicine, digital health, and neuromodulation treatments. Caveats and limitations of the evidence are highlighted. The CANMAT 2023 updated guidelines provide evidence-informed recommendations for the management of MDD, in a clinician-friendly format. These updated guidelines emphasize a collaborative, personalized, and systematic management approach that will help optimize outcomes for adults with MDD.

Annual Meeting of the Canadian Association for the Study of the Liver (CASL), the Canadian Network on Hepatitis C (CANHEPC) and the Canadian Association of Hepatology Nurses (CAHN) 2024 Abstracts.

Annual Meeting of the Canadian Association for the Study of the Liver (CASL), the Canadian Network on Hepatitis C (CANHEPC) and the Canadian Association of Hepatology Nurses (CAHN) 2024 Abstracts.

Incentive Auction Design Alternatives: A Simulation Study

This paper revisits the descending clock “reverse” auction design used in the U.S. Federal Communications Commission’s 2016–2017 “incentive auction.” We use extensive computational simulations to investigate the quantitative significance of various aspects of the design, leveraging a reverse auction simulator and realistic models of bidder values. This paper was accepted by Gabriel Weintraub, revenue management and market analytics. Funding: This work was supported by the Defense Advanced Research Projects Agency [Grant FA8750-19-2-0222 CFDA\# 12.910], the Canadian Institute for Advanced Research [Canada AI Research Chair at the Alberta Machine In], the National Science Foundation [Grant 1525730], and the Canadian Network for Research and Innovation in Machining Technology, Natural Sciences and Engineering Research Council of Canada [Discovery Grant, Discovery Grant Supplement]. Supplemental Material: The data files are available at https://doi.org/10.1287/mnsc.2020.02489 .

Treatment of HCV with direct-acting antivirals on reducing mortality related to extrahepatic manifestations: a large population-based study in British Columbia, Canada

HCV infection is associated with mortality due to extrahepatic manifestations (EHM). Sustained virologic response (SVR) following direct-acting antiviral (DAA) therapy has been linked to decreased all-cause and liver-related mortality. However, evidence regarding the impact of DAA on EHM-related deaths is lacking. This study aimed to assess the impact of DAA and SVR on EHM-related mortality. The British Columbia Hepatitis Testers Cohort comprises ∼1.7 million people tested for HCV between 1990 and 2015 and is linked with administrative health data. Among individuals diagnosed with HCV by 12/31/2020, those who received at least one DAA treatment were matched to those who never received treatment by the year of their first HCV RNA positive date. We compared three groups: treated & SVR, treated & no-SVR, and untreated; and generated EHM mortality rates and incidence curves. To account for differences in baseline characteristics, we used inverse probability of treatment weights (IPTW). IPTW-weighted multivariable cause-specific Cox regression models were adjusted for competing risk and confounders. Study population included 12,815 treated (12,287 SVR, 528 no-SVR) and 12,815 untreated individuals (median follow-up 3.4 years, IQR 2.9). The untreated group had the highest EHM mortality rate (30.9 per 1000 person-years [PY], 95% CI 29.2-32.8), followed by the treated & no-SVR group (21.2 per 1000 PY, 95% CI 14.9-30.1), while the treated & SVR group had the lowest EHM mortality rate (7.9 per 1000 PY, 95% CI 7.1-8.7). In the multivariable model, EHM mortality in the treated & SVR group was significantly decreased (adjusted cause-specific hazard ratio [acsHR] 0.20, 95% CI 0.18-0.23). The treated & SVR group had significant reductions in mortality related to each of the EHMs (78-84%). Treatment of HCV with DAA was associated with significant reductions in EHM-related mortality. These findings emphasize the critical importance of timely diagnosis and treatment of HCV to prevent deaths associated with EHM, and have important implications for clinical practice and public health. This work was supported by the BC Centre for Disease Control and the Canadian Institutes of Health Research (CIHR) [Grant # NHC-348216, PJT-156066, and PHE-337680]. DJ has received Doctoral Research Award (#201910DF1-435705-64343) from the Canadian Institutes of Health Research (CIHR) and Doctoral fellowship from the Canadian Network on Hepatitis C (CanHepC). CanHepC is funded by a joint initiative of the Canadian Institutes of Health Research (CIHR) (NHC-142832) and the Public Health Agency of Canada (PHAC).

The CANMAT and ISBD Guidelines for the Treatment of Bipolar Disorder: Summary and a 2023 Update of Evidence.

Bipolar disorder is a complex and heterogeneous psychiatric condition that affects more than 2% of the population. The assessment and treatment of bipolar disorder can be a challenge for clinicians, given its clinical complexity and the rapidly changing treatment landscape with the growing range of treatment options that are becoming available for various phases of the illness. To help clinicians navigate the complexity involved in the assessment and management of bipolar disorder, the guidelines of the 2018 Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) synthesized the evidence on the efficacy, safety, and tolerability of treatments for bipolar disorder and translated it into first-, second-, and third-line treatment recommendations. The main objective of this contribution is to provide clinicians with a summary of the 2018 CANMAT/ISBD guideline recommendations with the addition of any new evidence for the treatment of bipolar disorder across the lifespan.

Measuring the Uptake of Pharmacoepidemiologic Research Through Qualitative Analysis of Citations: A Case Study from a Canadian Network of Researchers

ABSTRACT Health research, including drug safety research, is communicated, in part, by being cited; understanding these citations can help determine its reach and impact. We analyzed the uptake of a Canadian Network for Observational Drug Effect Studies study of the heart failure risk of incretin-based drugs using quantitative and qualitative bibliometric approaches. A Scopus® search (2016–2020) returned 127 citing articles, mostly single studies and review articles. Many were also high impact journals, with intended audiences of other researchers, policy makers, and practitioners. Using the Becker Model, 93% contributed to “advancing knowledge.” Research impact can be difficult to establish. We have demonstrated one comprehensive approach that can be further adapted and automated; researchers and funders need to determine the best indicators, tools, and frameworks to use that are feasible and context relevant.

'Introduction'

The aim and scope of the Journal of Australian, Canadian, and Aotearoa New Zealand Studies (JACANZS) is to publish articles in various disciplines (history, politics, literature, law, anthropology, and Indigenous studies) on one or more of the the following countries: Australia, Canada, and Aotearoa New Zealand, with a core focus on articles that are comparative in their geographic remit, for example Australia and Aotearoa New Zealand, or Australia and Canada. The creation of the journal responds to a lack of journals that collectively publish across the fields of Australian, Canadian, and Aotearoa New Zealand Studies from multi and interdisciplinary perspectives. It also followed the creation of the Australian, Canadian, and New Zealand Studies Network (ACNZSN) to reflect the work and membership of the network.

North: the Canadian shared print network/Nord: Réseau canadien de conservation partagée des documents imprimés

PurposeThis paper was presented at the Kuopio 2022 Conference in Vienna, Austria on September 7, 2022, to show the work in Canada to create a Canadian shared print network and to share information about the projects that new group is working on with their partners.Design/methodology/approachThis was a case study giving information about the North/Nord Canadian Shared Print network, the history of the group and where the group will go next. The author has been part of this project since it began and continues to work on this at the time of publication.FindingsThis paper shares information about the network and three projects they are working on along with information about shared print projects in Canada and shows that this Canadian network has a unique approach among other current shared print networks.Originality/valueThis is the first international presentation about this new shared print network and their original approach to shared print because of their focus on Canadiana.

External validity in distributed data networks.

While much has been written about how distributed networks address internal validity, external validity is rarely discussed. We aimed to define key terms related to external validity, discuss how they relate to distributed networks, and identify how three networks (the US Food and Drug Administration's Sentinel System, the Canadian Network for Observational Drug Effect Studies [CNODES], and the National Patient Centered Clinical Research Network [PCORnet]) deal with external validity. We define external validity, target populations, target validity, generalizability, and transportability and describe how each relates to distributed networks. We then describe Sentinel, CNODES, and PCORnet and how each approaches these concepts, including a sample case study. Each network approaches external validity differently. As its target population is US citizens and it includes only US data, Sentinel primarily worries about lack of external validity by not including some segments of the population. The fact that CNODES includes Canadian, United States, and United Kingdom data forces them to seriously consider whether the United States and United Kingdom data will be transportable to Canadian citizens when they meta-analyze database-specific estimates. PCORnet, with its focus on study-specific cohorts and pragmatic trials, conducts more case-by-case explorations of external validity for each new analytic data set it generates. There is no one-size-fits-all approach to external validity within distributed networks. With these networks and comparisons between their findings becoming a key part of pharmacoepidemiology, there is a need to adapt tools for improving external validity to the distributed network setting.

A Semismooth Newton-Type Method for the Nearest Doubly Stochastic Matrix Problem

We study a semismooth Newton-type method for the nearest doubly stochastic matrix problem where the nonsingularity of the Jacobian can fail. The optimality conditions for this problem are formulated as a system of strongly semismooth functions. We show that the nonsingularity of the Jacobian does not hold for this system. By exploiting the problem structure, we construct a modified two step semismooth Newton method that guarantees a nonsingular Jacobian matrix at each iteration, and that converges to the nearest doubly stochastic matrix quadratically. Funding: This work was supported by Canadian Network for Research and Innovation in Machining Technology. The research of H. Hu, H. Im, and H. Wolkowocz was supported by The Natural Sciences and Engineering Research Council of Canada. The research of X. Li was supported by the National Natural Science Foundation of China [No. 11601183] and Natural Science Foundation for Young Scientist of Jilin Province [No. 20180520212JH].

Approach to Balancing Risk in Multiple Sclerosis Management: a Worldwide Practice Survey (P14-3.013)

Approach to Balancing Risk in Multiple Sclerosis Management: a Worldwide Practice Survey (P14-3.013)

Clinical Guideline (CANMAT 2016) Discordance of Medications for Patients with Major Depressive Disorder in China.

This survey aims to explore the current medical treatment of major depressive disorder (MDD) in China and match its degree with Canadian Network for Mood and Anxiety Treatments (CANMAT). A total of 3275 patients were recruited from 16 mental health centers and 16 general hospitals in China. Descriptive statistics presented the total number and percentage of drugs, as well as all kinds of treatments. Selective serotonin reuptake inhibitors (SSRIs) accounted for the largest proportion (57.2%), followed by serotonin-noradrenaline reuptake inhibitors (SNRIs) (22.8%) and mirtazapine (7.0%) in the first therapy, while that of SNRIs (53.9%) followed by SSRIs (39.2%) and mirtazapine (9.8%) in the follow-up therapy. An average of 1.85 medications was administered to each MDD patient. SSRIs were the first choice in the first therapy, while the proportion of those drugs decreased during the follow-up therapy and were replaced by SNRIs. Plenty ofcombined pharmacotherapies were directly selected as the first trial of patients, which was inconsistent with guideline recommendations.

Incidence of HIV and hepatitis C virus among people who inject drugs, and associations with age and sex or gender: a global systematic review and meta-analysis

Measuring the incidence of HIV and hepatitis C virus (HCV) infection among people who inject drugs (PWID) is key to track progress towards elimination. We aimed to summarise global data on HIV and primary HCV incidence among PWID and associations with age and sex or gender. In this systematic review and meta-analysis, we updated an existing database of HIV and HCV incidence studies among PWID by searching MEDLINE, Embase, and PsycINFO, capturing studies published between Jan 1, 2000, and Dec 12, 2022, with no language or study design restrictions. We contacted authors of identified studies for unpublished or updated data. We included studies that estimated incidence by longitudinally re-testing people at risk of infection or by using assays for recent infection. We pooled incidence and relative risk (RR; young [generally defined as ≤25 years] vs older PWID; women vs men) estimates using random-effects meta-analysis and assessed risk of bias with a modified Newcastle-Ottawa scale. This study is registered with PROSPERO, CRD42020220884. Our updated search identified 9493 publications, of which 211 were eligible for full-text review. An additional 377 full-text records from our existing database and five records identified through cross-referencing were assessed. Including 28 unpublished records, 125 records met the inclusion criteria. We identified 64 estimates of HIV incidence (30 from high-income countries [HICs] and 34 from low-income or middle-income countries [LMICs]) and 66 estimates of HCV incidence (52 from HICs and 14 from LMICs). 41 (64%) of 64 HIV and 42 (64%) of 66 HCV estimates were from single cities rather than being multi-city or nationwide. Estimates were measured over 1987-2021 for HIV and 1992-2021 for HCV. Pooled HIV incidence was 1·7 per 100 person-years (95% CI 1·3-2·3; I2=98·4%) and pooled HCV incidence was 12·1 per 100 person-years (10·0-14·6; I2=97·2%). Young PWID had a greater risk of HIV (RR 1·5, 95% CI 1·2-1·8; I2=66·9%) and HCV (1·5, 1·3-1·8; I2=70·6%) acquisition than older PWID. Women had a greater risk of HIV (RR 1·4, 95% CI 1·1-1·6; I2=55·3%) and HCV (1·2, 1·1-1·3; I2=43·3%) acquisition than men. For both HIV and HCV, the median risk-of-bias score was 6 (IQR 6-7), indicating moderate risk. Although sparse, available HIV and HCV incidence estimates offer insights into global levels of HIV and HCV transmission among PWID. Intensified efforts are needed to keep track of the HIV and HCV epidemics among PWID and to expand access to age-appropriate and gender-appropriate prevention services that serve young PWID and women who inject drugs. Canadian Institutes of Health Research, Fonds de recherche du Québec-Santé, Canadian Network on Hepatitis C, UK National Institute for Health and Care Research, and WHO.

A44 A 1000 PATIENT CANADIAN NETWORK FOR AUTOIMMUNE LIVER DISEASE EVALUATION OF CLINICAL AND DEMOGRAPHIC PATTERNS OF AUTOIMMUNE HEPATITIS

Abstract Background We sought to understand how the demographics of autoimmune hepatitis (AIH) have changed over time in Canada. Purpose Using a large multi-centre Canadian cohort of patients with AIH, we describe the trends in patient and disease characteristics at presentation across 30 years of clinical practice. Method Patients from the Canadian Network for Autoimmune Liver Disease with a confirmed diagnosis of AIH (simplified score ≥6) were included for analysis. Patients were grouped into five cohorts according to the year of diagnosis (i.e., <2000, 2000-2004, 2005-2009, 2010-2014, ≥2015). Patient demographics and baseline clinical and biochemistry features of disease activity were investigated using Chi-square tests and Kruskal-Wallis tests adjusted for multiple comparisons. Logistic and linear regression models with estimated means were utilized to further investigate relationships with time and to adjust for confounding. Result(s) 1016 patients followed across 10 Canadian health centres with AIH were diagnosed between November 1965 and December 2021. Overall, 76.4% (n=776) of patients were female, and the median age at diagnosis was 46 years (IQR 28.2 - 58.3). Cirrhosis at presentation was seen in 20.6% of patients (n=209). The median age at diagnosis increased significantly from 31.8 years [IQR 17.9 - 46.8] pre-2000 to 54 years [IQR 9.0 - 95.2] after 2014 (p<0.001; Figure 1a). This effect of time persisted after adjusting for sex and cirrhosis status at diagnosis. Female sex and the presence of cirrhosis at diagnosis were factors independently associated with older age at presentation (p<0.0001). The proportion of patients that presented with cirrhosis at diagnosis increased significantly over calendar time, from 13.7% (n=23) pre-2000 to 30.8% (n=69) after 2014 (p=0.003; Figure 1b). Male sex was independently associated with an increased odds of having cirrhosis at presentation (OR= 1.46, CI 1.02 - 2.07) and higher baseline ALT levels compared to females (p=0.036). The proportion of patients that identified as non-white ethnicity increased significantly from 15.2% (n= 24) pre-2000, to 32% (n= 86) after 2014 (p<0.001, Figure 1b). This effect of time on ethnicity was most pronounced after the year 2010 (OR= 2.32, CI 1.39 - 3.98) and persisted after adjusting for sex. There was no significant pattern of change in sex over calendar time. Image Conclusion(s) In Canada, patients with AIH at presentation are now older, have more advanced disease, and are more ethnically diverse than when compared to 30 years ago. Please acknowledge all funding agencies by checking the applicable boxes below Other Please indicate your source of funding; industry Disclosure of Interest None Declared