Canadian Census Research Articles

Socioeconomic Status, Length of Stay, and Postoperative Complications in Oral Cavity Squamous Cell Carcinoma.

Background: Despite universal healthcare in Canada, low socioeconomic status (SES) has been associated with worse survival in oral cavity squamous cell carcinoma (OCSCC) patients. However, the relationship between SES and outcomes during the acute postoperative period is poorly defined. Hamilton, Ontario, presents a unique population with widely varying SES within the same geography. The objective of this study was to examine the relationship between SES, length of hospital stay (LOHS), and postoperative complications in OCSCC. Methods: Newly diagnosed OCSCC patients receiving primary surgical treatment from 2010 to 2014 were identified within a prospectively collected database. Inclusion criteria included age >18 years old, pathological diagnosis of oral cavity cancer, and primary surgical treatment with curative intent. Patients were excluded if they were undergoing palliative treatment or had previous head and neck surgery/radiotherapy. Postal codes were used to identify neighborhood-level socioeconomic variables via 2011 Canada Census data. Income quartiles were defined from groups of neighboring municipalities based on Canada Census definitions. Demographic, social, pathological, staging, and treatment data were collected through chart review. Results: One hundred and seventy-four patients were included in the final analysis. OCSCC patients with lower SES were more likely to be younger (P = .041), male (P = .040), have significant tobacco and alcohol use (P = .001), higher Charlson Comorbidity Index (CCI; P = .014), lower levels of education (P = .001), and have lower employment levels (P = .001). Lower SES patients had higher clinical tumor (P = .006) and clinical nodal (P = .004) staging and were more likely to receive adjuvant therapy (P = .001) and G-tubes (P = .001). Multivariable regression analysis showed that low SES was a statistically significant predictor of postoperative complications [β 2.50 (95% confidence interval (CI) 0.200, 3.17); P = .014] and LOHS [β 2.03 (95% CI 1.06, 2.99); P = .0001]. Tobacco and alcohol use, clinical tumor, and nodal stage, CCI, and planned adjuvant therapy were also statistically significant predictors of postoperative complications and LOHS (P < .05). Conclusion: Patients with lower SES have more advanced OCSCC disease with increased comorbidities that owes itself to more acute postoperative complications and LOHS within this study population. Patients with low SES should be identified as patients that require more support during their cancer treatment.

Geographic Accessibility to Pelvic Health Physiotherapy Services Across Ontario: A Geographic Information System Analysis

Purpose: The purpose of this study was to explore the distribution and geographic accessibility of pelvic health physiotherapist services for females in Ontario across an urban–rural gradient. Method: A geographic information system-based observational study was conducted. Physiotherapists’ practice locations (supply) were obtained from the College of Physiotherapists of Ontario registrant pelvic health roster. Dissemination area centroids (demand) were calculated based on 2021 Statistics Canada census data for females in Ontario. Locations were geocoded and mapped, and an accessibility score was computed using an enhanced two-step floating catchment area method. A choropleth map was generated with accessibility scores, and results were stratified using an urban–rural gradient. Results: Geographic locations of 1172 pelvic health physiotherapists across Ontario were retrieved. The provincial average accessibility score was 1.84 pelvic health physiotherapists (PHPTs) per 10,000 females (range, min-max, 0–26.27 PHPTs). Access to a PHPT is more limited in rural areas and municipalities with weak to no metropolitan influence and higher in census metropolitan areas and larger urban centres. Conclusions: Regional disparities in accessibility to PHPT services for females in Ontario exist and should be considered in planning and policy development, particularly to enhance accessibility to females living in rural areas.

Prospective associations between neighborhood features and body mass index in Montreal adolescents.

PurposeTo investigate the association between the neighborhood built environment and trajectories of body mass index (BMI) in youth. MethodsData were collected in a prospective study of 1293 adolescents in Montreal. Built environment variables were obtained from public databases for road networks, land use, and the Canadian Census. Anthropometric data were collected when participants were ages 12.5, 15 and 17 years. We undertook hierarchical cluster analysis to identify contrasting neighborhood types based on features of the built environment (e.g., vegetation, population density, walkability). Associations between neighborhood type and trajectories of BMI z-score (BMIz) were estimated using multivariable linear mixed regression analyses, stratified by sex. ResultsWe identified three neighborhood types: Urban, Suburban, and Village. In contrast to the Urban type, the Suburban type was characterized by more vegetation, few services and low population density. Village and Suburban types were similar, but the former had greater land use diversity, population density with more parks and a denser food environment. Among girls, living in Urban types was associated with decreasing BMIz trajectories. Living in Village types was associated with increasing BMIz trajectories. No associations were observed among boys. ConclusionsNeighborhoods characterized by greater opportunities for active living appear to be less obesogenic, particularly among girls.

Within-city spatial variations in PM2.5 magnetite nanoparticles and brain cancer incidence in Toronto and Montreal, Canada.

Magnetite nanoparticles are small, strongly magnetic iron oxide particles which are produced during high-temperature combustion and friction processes and form part of the outdoor air pollution mixture. These particles can translocate to the brain and have been found in human brain tissue. In this study, we estimated associations between within-city spatial variations in concentrations of magnetite nanoparticles in outdoor fine particulate matter (PM2.5) and brain cancer incidence. We performed a cohort study of 1.29 million participants in four cycles of the Canadian Census Health and Environment Cohort in Montreal and Toronto, Canada who were followed for malignant brain tumour (glioma) incidence. As a proxy for magnetite nanoparticle content, we measured the susceptibility of anhysteretic remanent magnetization (χARM) in PM2.5 samples (N = 124 in Montreal, N = 110 in Toronto), and values were assigned to residential locations. Stratified Cox proportional hazards models were used to estimate hazard ratios (per IQR change in volume-normalized χARM). ARM was not associated with brain tumour incidence (HR = 0.998, 95% CI 0.988, 1.009) after adjusting for relevant potential confounders. Although we found no evidence of an important relationship between within-city spatial variations in airborne magnetite nanoparticles and brain tumour incidence, further research is needed to evaluate this understudied exposure, and other measures of exposure to magnetite nanoparticles should be considered.

Semantically Interoperable Census Data: Unlocking the Semantics of Census Data Using Ontologies and Linked Data

The Canadian Census of Population is a survey that collects statistical information on the Canadian population. These censuses contain valuable socioeconomic data that is often used by both the public and private sectors for project planning and decision-making. However, there are a few issues that may arise when using census data. Firstly, data wrangling, which is often a time-consuming process, needs to be conducted in order to clean and prepare the data for integration and use. Secondly, different datasets across different census years may be using different terms to describe the same concept/entity, hence creating a problem of referential equivalence (i.e., how do we know whether two different datasets are referring to the same concepts/entities?). Lastly, the data found in a census is often described using natural language that isn't easily interpreted by machines and can be difficult to break down or deconstruct. In this paper, we develop and propose the use of an ontology for representing the data from the Canadian Census of Population as linked data in order to address the aforementioned issues, evaluate the ontology using competency questions based on real world use cases, and discuss the advantages of census linked data for integration and visualisation uses.

Marriage, cohabitation, and institutional context: Household specialization among same‐sex and different‐sex couples

AbstractObjectiveThis study examines how marriage‐cohabitation gaps in household specialization (labor supply and earnings) vary across institutional contexts for same‐sex couples (SSCs) and different‐sex couples (DSCs) in Canada.BackgroundPrior research suggests that marriage‐cohabitation gaps are smaller in contexts where cohabitation is more prevalent, but it has overlooked how legal protections (at the contextual level) and gender composition (at the couple level) moderate this association. As a result, little is known about whether differences in household specialization stem from heightened gendered expectations attached to marriage or stronger legal protections for married couples. This study posits that marriage‐cohabitation gaps will be larger in contexts where legal protections for cohabitors are less marriage‐like.MethodsUsing the 2006 and 2016 Canadian Census and the 2011 National Household Survey, I estimate ordinal and fractional logit models to examine marriage‐cohabitation gaps in specialization among all couples (N = 2,788,055) and couples with young children (N = 826,305).ResultsAmong DSCs, marriage‐cohabitation gaps were larger in Québec than in English Canada vis‐à‐vis earnings but not labor supply. Patterns among SSCs were more heterogeneous: gaps in labor supply were larger in English Canada for female couples but larger in Québec for male couples. Gaps in earnings were generally larger in Québec, with few exceptions. However, DSCs consistently specialized more than SSCs.ConclusionWhile existing research suggests marriage‐cohabitation gaps in household specialization are largely explained by the prevalence of cohabitation, my results indicate that legal protections (at the contextual level) and gender composition (at the couple level) play a more decisive role.

Neighborhood material versus social deprivation in Canada: different patterns of associations with child and adolescent mental health problems.

In a nationwide study, we aimed to study the association of neighborhood deprivation with child and adolescent mental health problems. We used data from the Canadian Health Survey on Children and Youth (N = 47,871; age range: 1-17years) and linked these to Neighborhood Material and Social Deprivation data calculated using Canada's Census of Population. Using a series of logistic regressions, we studied the association between living in deprived areas and mental health problems among children and youth. We used bootstrap replicate weights for all analyses and adjusted them for individual sociodemographic characteristics. In the adjusted model, the parent-reported developmental disorder was associated with more socially deprived neighborhoods (OR 1.29; 95% CI 1.07, 1.57 for most vs. least deprived quintiles). However, mental health service need or use was associated with living in less materially deprived areas (OR 0.78; 95% CI 0.63, 0.96 for most vs. least deprived quintiles). Among mental health problemsreported by the youth (12-17years old), poor/fair general mental health, alcohol drinking, and cannabis use were associated with neighborhood social deprivation in the adjusted models. In contrast, poor/fair general mental health, suicide ideas, alcohol drinking, and cannabis use were all negatively associated with higher materially deprived quintiles. Our study provides further support for the existing evidence on the association between neighborhood deprivation, particularly social deprivation, and the mental health of children and adolescents. The findings can help public health policymakers and service providers better understand and address children's mental health needs in their neighborhoods.

Leaving the Big City: New Patterns of Migration in Canada

Big cities have always been attractive places for people to settle. However, recent trends, including work-from-home and hybrid work arrangements, along with the rising cost of housing in big cities, mean more Canadians of all age groups are relocating to smaller communities. Much of this movement is to smaller areas within the same province, so that communities which traditionally saw an out-migration of population are now dealing with the challenges createdby a significant influx of new residents. Focusing on the exodus from the three largest Canadian Census Metropolitan Areas (CMAs) of Montreal, Toronto and Vancouver, this paper examines the challenges and consequences for smaller communities. The proportion of people living in these three CMAs has grown from 28.9 per cent in 1981 to35.5 per cent in 2021. This increase reflects the fact that the fastest growing industries, suchas finance, technology and communications, are located in major urban areas. However, the pandemic, combined with the technology that allows people to work from anywhere, means that more people are moving to smaller communities where they can enjoy lower housing costs and other benefits that less dense places offer. While younger people willing to tolerate the occasional commute to the city in hybrid working arrangements are relocating to smaller communities, some retirees are downsizing and also leaving the big city behind. This out-migration has created challenges for big cities. With workers resisting a return to the downtown office, urban cores are left with vast amounts of empty office space. Companies are thus reducing the size of their leased space or not renewing current leases. Public transit and shopping malls have seen usage drop, and a subsequent rise in crime and social disorder in some cities is encouraging even more people to consider moving elsewhere. The COVID-19 pandemic certainly contributed to the increasing exodus from the largest cities.A post-pandemic return to normal economic activity could slow departures from the big cities. The largest CMAs are still growing, due to an increasing number of immigrants, many of whom prefer to settle in big cities where people who arrived previously from their homelands have located. Canada’s commitment to expanded immigration has meant continued growth for major urban centres while the exodus of people from those centres has renewed the growth of mid-size and smaller communities. For the community of Cowansville, Quebec, for example, the flow of people out of Montrealhas produced renewed growth. The newcomers, especially those who bring significant resources with them, stimulate the local economy. Greater demand for products and services helps local businesses and can create employment opportunities for local residents. It will be important to monitor these migration trends in the coming years in order to ensure that infrastructure, funding and services adapt to the challenges so that everyone, whether they choose to live in a big city or in a small community, has access to the services and infrastructure they need in order to enjoy an optimum quality of life.

Trends in socioeconomic inequalities in pancreatic cancer mortality in Canada: Evidence from the Canadian Vital Statistics Death Database

BackgroundPancreatic cancer is one of the leading causes of death in Canada and is projected to be the second leading cause of cancer death by 2030. This study sought to evaluate education and income inequalities in pancreatic cancer mortality in Canada between 1990 and 2019. MethodsUsing a unique census division level dataset (n = 280) constructed from the Canadian Vital Statistics Death Database, Canadian Census of Population (1991, 1996, 2001, 2006, 2016), and National Household Survey (2011) we assess socioeconomic inequalities in pancreatic cancer in Canada. Age-standardized Concentration index was used to quantify income and education inequalities in pancreatic cancer mortality. Trends analyses were conducted to assess changes in income and education inequalities in pancreatic cancer mortality over time. ResultsOur results show that crude pancreatic cancer mortality in Canada increased significantly from 10.23 for males and 9.65 for females in 1990, to 15.99 for males and 14.28 for females in 2019, per 100,000 people. The statistically significant negative values of age-standardized Concentration indices suggest persistent income and education inequalities in pancreatic cancer mortality in Canada. Trend analyses indicates reductions in income and education inequalities in pancreatic cancer mortality over time, particularly among females. ConclusionsSignificant income and education inequalities in pancreatic cancer mortality in Canada warrant public policy concern and action. Further research is required to understand whether differential access to treatment across socioeconomic groups played a role in the observed socioeconomic inequalities.

Life Expectancy at Birth and Infant Mortality Rates of Indigenous Populations in Canada from 2004 to 2016

Life expectancy and infant mortality rates are two important indicators of the well-being of a population. However, it is not possible to compute these indicators for specific Indigenous populations in Canada from vital statistics databases because information about the identity of individuals is lacking. We use alternative data sources, linkages between the long-form census questionnaire and the Canadian Vital Statistics, namely the Canadian Census Health and Environment Cohorts and the Canadian Birth Census Cohorts, to compute life expectancy at birth and infant mortality rates among Indigenous populations. We describe the data, explain the methodology, and analyze the results to demonstrate the usefulness of these databases for the regular reporting of these health outcomes and monitoring of trends.

HealthyPlan.City: A Web Tool to Support Urban Environmental Equity and Public Health in Canadian Communities

Urban environmental factors such as air quality, heat islands, and access to greenspaces and community amenities impact public health. Some vulnerable populations such as low-income groups, children, older adults, new immigrants, and visible minorities live in areas with fewer beneficial conditions, and therefore, face greater health risks. Planning and advocating for equitable healthy urban environments requires systematic analysis of reliable spatial data to identify where vulnerable populations intersect with positive or negative urban/environmental characteristics. To facilitate this effort in Canada, we developed HealthyPlan.City (https://healthyplan.city/), a freely available web mapping platform for users to visualize the spatial patterns of built environment indicators, vulnerable populations, and environmental inequity within over 125 Canadian cities. This tool helps users identify areas within Canadian cities where relatively higher proportions of vulnerable populations experience lower than average levels of beneficial environmental conditions, which we refer to as Equity priority areas. Using nationally standardized environmental data from satellite imagery and other large geospatial databases and demographic data from the Canadian Census, HealthyPlan.City provides a block-by-block snapshot of environmental inequities in Canadian cities. The tool aims to support urban planners, public health professionals, policy makers, and community organizers to identify neighborhoods where targeted investments and improvements to the local environment would simultaneously help communities address environmental inequities, promote public health, and adapt to climate change. In this paper, we report on the key considerations that informed our approach to developing this tool and describe the current web-based application.

Hockey babies: National Hockey League outcomes and short-term fertility spikes in Canada

Previous research shows that mood-altering events, such as sports results, elections outcomes and natural disasters, impact fertility, crime rate, and investor behaviour. In this paper, we use recent Canadian Birth Statistics and the National Hockey League (NHL) results to examine the link between sports events and short-term fertility spikes. In addition, using betting odds, we differentiate among unexpected wins, unexpected losses, and expected outcomes, as a test for the relevance of the Prospect Theory to this context. Our dataset is a daily panel, following all the seven Canadian Census Metropolitan Areas with a team in the NHL, from 2008 to 2019. In our panel fixed effects estimations, we account for the day of the week and all statutory federal and provincial holidays of Canada. In the estimations with raw NHL results, the coefficients of interest ultimately lose their statistical significance. In the specifications accounting for expectations, we find a statistically significant association with fertility for unexpected wins, and statistically insignificant coefficients for unexpected losses as well as expected NHL outcomes. In light of the results, we propose the greater likelihood of pre-game social gatherings on sports nights and celebratory sex after the euphoria of an unexpected win, as the possible channels of impact.

Race and ethnicity reporting and representation in hemophilia clinical trials

AbstractRacial and ethnic representativeness in clinical trials is crucial to mitigate disparities in outcomes; however, diversity among hemophilia trials is unknown. The aim of this study is to examine the reporting and representation of race and ethnicity in trials of people with hemophilia (PwH). In this cross-sectional study, the ClinicalTrials.gov database was queried in April 2023 for interventional clinical trials involving PwH between 2007 and 2022. The distribution of participants (observed) was compared with expected proportions based on US Hemophilia Treatment Center (HTC) and country-specific census data with observed-to-expected ratios (OERs). Of 129 trials included, 94.6% were industry sponsored, with a mean of 62 participants and mean age of 26.8 years. Overall, 52.0% (n = 66) of trials reported data on race and ethnicity, increasing from 13.9% in 2007-2012 to 22.5% in 2013-2016 to 100% in 2017-2022 (P = .001). Among these 66 trials, 65.8%, 22.8%, 5.1%, 3.9% of participants were White, Asian, Hispanic, and Black, respectively. OERs were 10% to 20% lower for White participants vs US HTC, and US, UK, and Canadian census populations and ∼75% lower for Black or Hispanic participants when compared with US HTC and US census population. OERs for Asian participants were 1.6 to 3 times higher than Canada, US, and UK census populations. The reporting of race and ethnicity in hemophilia trials has drastically improved; however, Black and Hispanic PwH remain especially underrepresented. To address these disparities, stakeholders across the clinical trial enterprise need to implement strategies to ensure equitable participation.

Environmental Injustice in Peel Region: A Cross-Sectional Analysis of Air Pollution and Social Vulnerability

Background: Nitrogen dioxide (NO2), a traffic-related air pollutant, is co-emitted with greenhouse gasses that contribute to climate change and negatively affect health. This research examines the relationship between air pollution exposure and social vulnerability to determine whether communities at a social disadvantage experience environmental injustice. Methods: The 2016 census measures for Peel Region were assessed. Peel Region has 1,381,739 people across Mississauga, Brampton, and Caledon; the spatial unit of analysis was the dissemination area (DA) with an average size of 837 people in Peel. Average ambient NO2 concentrations for 2016 came from the Canadian Urban Environmental Health Research Consortium and resampled to DAs. Social disadvantage was defined by the Ontario Marginalization Index (ON-Marg). Measures within index components came from the Canadian census. Environmental injustice was identified through correlation analysis between ON-Marg and NO2 exposure and an analysis of index components with exposure. Results: The 2016 annual NO2 concentrations were positively correlated with the overall ON-Marg quintiles (Spearman: 0.34, p &lt; .001, 95% CI 0.29 to 0.37). The components and their correlations with NO2 were residential instability (Spearman: 0.37, p &lt; .001, 95% CI 0.33 to 0.42), material deprivation (Spearman: 0.15, p &lt; .001, 95% CI 0.10 to 0.19), dependency (Spearman: 0.31, p &lt; .001, 95% CI 0.26 to 0.35), and ethnic concentration (Spearman: −0.06, p = .02, 95% CI −0.11 to −0.01). Conclusions: In Peel Region, a correlation exists between social vulnerability and air pollution, indicating inequitable exposure to NO2. Marginalized communities may not be able to choose their living environment. Environmental justice research in the context of NO2 will support policy aiming to reduce inequitable exposure.

Measuring the Health Co-Benefits of Air Pollution Interventions on Premature Deaths in Canadian Cities

Background: Climate change has significant consequences on human health. Cities are especially vulnerable, where air pollution is a major environmental health risk. Premature mortality (i.e., deaths before age 75) is a robust population health outcome amenable to targeted policy and programmatic interventions. We used the Premature Mortality Population Risk Tool augmented with environmental data (PreMPoRT-ENV) to predict the 5-year incidence of premature deaths under air pollution reduction policies. Methods: PreMPoRT-ENV is a sex-specific Weibull accelerated failure time survival model that uses the Canadian Community Health Survey (CCHS) linked to the Canadian Vital Statistics Death Database and environmental data. We applied PreMPoRT-ENV to the 2016–2017 CCHS cycles and simulated Canadian Ambient Air Quality Standards targets to predict their impact on premature mortality across Canadian census metropolitan areas. We simulated capping annual mean particulate matter 2.5 microns or less in diameter (PM2.5) and nitrogen dioxide (NO2), as well as reducing air pollutants by 10% and 25% plus capping. Results: The weighted sample included 9,240,000 females and 9,260,000 males. Capping PM2.5 to 8.8 μg/m3 and NO2 to 12.0 ppb resulted in 12 per 100,000 fewer predicted premature deaths than observed exposures over 5 years (1,110 fewer absolute premature deaths). Reducing air pollutants by 10% and 25% plus capping resulted in even fewer predicted premature deaths. Conclusion: Our study highlights how to use a model that predicts premature mortality to provide estimates of the health impacts of environmental vulnerabilities. Results suggest that more aggressive targets may be needed to further realize population health benefits.

The projected health and economic impact of increased colorectal cancer screening participation among Canadians by income quintile

ObjectivesDisparities in colorectal cancer (CRC) screening uptake by socioeconomic status have been observed in Canada. We used the OncoSim-Colorectal model to evaluate the health and economic outcomes associated with increasing the participation rates of CRC screening programs to 60% among Canadians in different income quintiles.MethodsBaseline CRC screening participation rates were obtained from the 2017 Canadian Community Health Survey. The survey participants were categorized into income quintiles using their reported household income and 2016 Canadian Census income quintile thresholds. Within each quintile, the participation rate was the proportion of respondents aged 50–74 who reported having had a fecal test in the past two years. Using the OncoSim-Colorectal model, we simulated an increase in CRC screening uptake to 60% across income quintiles to assess the effects on CRC incidence, mortality, and associated economic costs from 2024 to 2073.ResultsIncreasing CRC screening participation rates to 60% across all income quintiles would prevent 69,100 CRC cases and 36,600 CRC deaths over 50 years. The improvement of clinical outcomes would also translate to increased person-years and health-adjusted person-years. The largest impact was observed in the lowest income group, with 22,200 cases and 11,700 deaths prevented over 50 years. Increased participation could lead to higher screening costs ($121 million CAD more per year) and lower treatments costs ($95 million CAD less per year), averaged over the period 2024–2073.ConclusionIncreased screening participation will improve clinical outcomes across all income groups while alleviating associated treatment costs. The benefits of increased participation will be strongest among the lowest income quintile.

Trends in socioeconomic inequalities in breast cancer mortality in Canada: 1992-2019.

Breast cancer is the second leading cause of death from cancer among Canadian females. This study aimed to quantify and assess trends in education and income inequalities in the mortality rate of breast cancer in Canada from 1992 to 2019. We constructed a census division-level dataset pooled from the Canadian Vital Death Statistics Database (CVSD), the Canadian Census of the Population (CCP), and the National Household Survey (NHS) to examine trends in education and income inequalities in the mortality rate of breast cancer in Canada over the study period. The age-standardized Concentration index (C) was used to quantify income and education inequalities in breast cancer mortality over time. The national crude mortality rate of breast cancer has decreased in Canada from 1992 to 2019, with Alberta, British Columbia, Manitoba, Ontario, Prince Edward Island, and Quebec having the greatest decreases in mortality rate. The age-standardized C for education and income inequalities were always negative for all the study years, meaning that the mortality rate of breast cancer was higher among less-educated and poorer females. Moreover, the results indicate a growing trend in the concentration of breast cancer mortality among females with lower income and education from 1992 to 2019. The increasing concentration of breast cancer mortality among low socioeconomic status females remains a challenge in Canada. Continuous efforts are needed within Canadian healthcare systemto improve the prevention and treatment of breast cancer for this population.

Comparative analysis of child protection investigations in Ontario and Quebec, Canada

BackgroundThe Canadian child protection system is a network of provincial, territorial, and federal systems. Each province and territory has unique child protection legislation and service delivery practices. There is significant variation between the legislations and processes which inevitably determines which children and families are investigated. ObjectiveThis study examines the clinical case characteristics to understand the drivers related to the significant difference in child protection investigation rates occurring in Ontario and Quebec, Canada. Relevant legislations and policies are also examined. Participant and settingThe study uses data from four provincial Incidences Studies: 1) the Ontario Incidence Study of Reported Child Abuse and Neglect-2013 (OIS-2013), 2) the Quebec Incidence Study on Investigations of Child Protection-2014 (EIQ-2014); 3) OIS-2018); and 4) EIQ-2019. These studies are cross-sectional and collect de-identified information on child protection investigations which occurred in the relative province and year. MethodsDescriptive tests were conducted to examine differences between clinical case characteristics of the four Incidence Studies. Incidence rates were calculated using Statistics Canada Census data. Confidence intervals were conducted to test for significant differences. ResultsThere is a statistically significant difference in the investigation rates between OIS-2013 and EIQ-2014, and OIS-2018 and EIQ-2019. There is no statistically significant difference in the substantiation rates between OIS-2013 and EIQ-2014, and no clinical difference in the substantiation rates between OIS-2018 and EIQ-2019. ConclusionsIt is a critical time to examine screening procedures and tools to ensure resources are used effectively and reduce negative impacts on children and families unnecessarily investigated. Keywords: child welfare, policy, provincial comparisons, incidence rates.

Socioeconomic inequalities in deaths of despair: Age heterogeneity in Canada's working age population

PurposeAlthough prior literature documented socioeconomic inequalities in deaths of despair among working age population, it is unclear whether and how (a) the link between socioeconomic status and deaths of despair differs by age (b) each measure of socioeconomic status has independent effects on deaths of despair. This study aims to reduce these knowledge gaps. MethodsUsing data from a large scale nationally representative linked dataset (2011 Canadian Census Health and Environment Cohorts), this study employed Fine-Gray subdistribution hazard models to estimate the link between socioeconomic status and deaths of despair due to suicide, drug overdose, and alcoholic liver disease among working age population (N = 4,076,530). Age stratified analysis was conducted to examine age heterogeneity. ResultsSocioeconomic status, such as housing tenure, employment status, household income, and education level, was associated with deaths of despair among working age population. Age differences in the association between socioeconomic status and deaths of despair were found. While education level was pronounced for deaths of despair for younger adults, a combination of socioeconomic status was significantly associated with deaths of despair for those in late adulthood. ConclusionsSocioeconomic inequalities in deaths of despair are manifest among Canadian working age population. This study lends support the social and health policies aimed at reducing gaps in mortalities.

Unintentional injury deaths associated with sport and recreation in Québec, Canada, 2006–2019

ObjectivesThis study examined trends in the frequencies and rates of deaths associated with unintentional injuries in sport and recreation in Québec, Canada, for the period January 2006–December 2019.MethodsIn this descriptive...