Health Card Number Research Articles

New Home, New Prognosis? Reduced Hypertension Risk after Moving to a High-Walkability Neighborhood.

The impact of the built environment on health is still a fairly new research field, and many investigations have relied on the use of cross-sectional data, a research model that carries the risk of incorrectly suggesting reverse causation. 1 A study in this issue of EHP, however, uses a more robust longitudinal design and reports that residents of Ontario, Canada, who moved from a low-walkability neighborhood to a high-walkability neighborhood had a 54% lower likelihood of developing hypertension than those who moved from one low-walkability neighborhood to another. 2 “It’s a very strong study,” says Jana A. Hirsch, a postdoctoral fellow with the Carolina Population Center at the University of North Carolina at Chapel Hill. That’s especially true, she says, because there is so little research in the field, conducted in a population-based sample, that assesses a long-term outcome such as hypertension. Hirsch was not involved in the research. The walkability of a neighborhood is determined not just by spatial factors, such as block length, but also aesthetic factors, such as shade and availability of sidewalks. The investigators used data from Statistics Canada’s Canadian Community Health Surveys. Participants had to be Ontario residents aged 20 years or older with a valid Ontario health card number and no previous hypertension. They also had to have moved to a new home within the study period. This was a key element of the study, because moving can be stressful, and the ability to move can be associated with both positive and negative confounders. Neighborhood walkability was determined using Walk Score®, a proprietary measure that scores neighborhoods between 0 and 100 based on factors including block length and distance to amenities (e.g., shops, parks, and restaurants). 3 All the participants started out in neighborhoods with a Walk Score® below 90. Those who moved to a new neighborhood with a score of 90 or higher were put in the high-walkability group, while the low-walkability group moved to a new neighborhood that also had a score below 90. The high- and low-walkability populations differed greatly in terms of income, race, smoking rates, psychosocial stress, diet, and other factors associated with hypertension risk. To adjust for these differences, the researchers used a statistical method called propensity score matching to narrow down the two groups to individuals who were the most similar except in terms of their built environment. “We did this so that we could compare like with like,” says lead author Maria Chiu, a scientist at the Institute for Clinical Evaluative Sciences in Toronto. “Then we could say confidently that the hypertension risk is independent of all these other factors.” The authors ended up with a cohort of 1,057 individuals in each group. Participants were followed for up to 10 years, with a median followup of 4.3 years. Although it was necessary to set cut points in order to divide the study populations into two comparable groups, Chiu acknowledges that Walk Score® 90 was a high threshold. However, she says additional analyses conducted by the authors, which were not included in this report, showed clear dose–response relationships with cut points of 70 and 50. “So the biggest difference in hypertension rates was in [people who moved to] 90-plus [neighborhoods], less so in 70, and even less so in 50,” she says. Hirsch agrees that it doesn’t take moving to a Walk Score® 90 neighborhood to see positive behavioral and health changes. “What if a person moves from a 0 to a 69 walkability? That’s a pretty big jump,” she says. “In the research that I’ve done, 4 we find increases in walking and decreases in obesity for people who move to places that are just 10 points higher on Walk Score®.” As a composite measure that combines destinations and street characteristics, Walk Score® doesn’t capture some of the aesthetic features that might affect a person’s decision to walk, such as sidewalks, shade, and snow removal. Other research has indicated that people’s perception of their neighborhood is just as important as the actual features of the neighborhood—possibly even more so. 5 Although Walk Score® is not an easy measurement for urban planners to act upon, Chiu says the results of the study show that planners need to keep walkability in mind when they’re developing neighborhoods. That way, she says, “walking becomes the obvious choice and the more enjoyable choice rather than hopping in a car and driving to your destination.”

A population-based study of the epidemiology of pancreatic cancer: a brief report.

Administrative data are used to describe the pancreatic cancer (pcc) population. The analysis examines demographic details, incidence, site, survival, and factors influencing mortality in a cohort of individuals diagnosed with pcc. Incident cases of pcc diagnosed in Ontario between 1 January 2004 and 31 December 2011 were extracted from the Ontario Cancer Registry. They were linked by encrypted health card number to several administrative databases to obtain demographic and mortality information. Descriptive, bivariate, and survival analyses were conducted. During the period of interest, 9221 new cases of pcc (4548 in men, 4673 in women) were diagnosed, for an age-adjusted standardized annual incidence in the range of 8.6-9.5 per 100,000 population. Mean age at diagnosis was 70.3 ± 12.5 years (standard deviation). Five-year survival was 7.2% (12.8% for those <60 years of age and 3.6% for those >80 years of age). Survival varied by sex, older age, rural residence, lower income, site of involvement in the pancreas, and presence of comorbidity. The mortality rate in pcc is exceptionally high. With an increasing incidence and a mortality positively associated with age, additional support will be needed for this highly fatal disease as demographics in Ontario continue to trend toward a higher proportion of older individuals.

Migraine headache and risk of self-harm and suicide: A population-based study in Ontario, Canada.

Migraine has been associated with mental illness, and may also be associated with increased risk of suicidal behavior. The aim of this article was to examine the association between migraine headache and self-harm and suicide mortality using population-based health administrative data from Ontario, Canada. The sample included 101,114 participants in a population-based health survey in the province of Ontario, Canada, who responded to the survey in 2003, 2005, or 2007, and provided health card numbers for linkage to population-based health administrative data. Participants self-reported a physician diagnosis of migraine headache. Heath administrative data were used to calculate (1) Follow-up time until first presentation to the emergency department for intentional self-harm; (2) Follow-up time until death by suicide. Proportional subdistribution hazards regression was used to compare time until death among those with and without history of migraine, after accounting for competing risks of death and adjusting for confounders. Physician diagnosis of migraine was reported by 11.2% of the sample (11,314 individuals). Mean follow-up time was 7.3 years. Emergency department visits for self-harm during the follow-up period were almost 50% more likely in those with migraine (76.4 vs 35.7 per 100,000 person years; adjusted hazard ratio = 1.48; 95%CI: 1.11,1.96). Death by suicide was rare with only 55 suicides in the follow-up period (7.45 per 100,000 person-years). Risk of suicide was similar for both those with and without history of migraine headache (adjusted hazard ratio=0.60; 95%CI: 0.22,1.65). Physician diagnosis of migraine headache was found to be prospectively associated with increased risk of deliberate self-harm, but there was no evidence linking it to suicide mortality. Definitively linking migraine to death by suicide may require very large samples. Health care professionals should consider monitoring suicidal risk in individuals with migraine headache.

THE COST OF HOSPITALIZATION AND LENGTH OF STAY FOR CHRONIC HEART FAILURE CASES IN CANADA

s S273 Canadian Cardiovascular Society (CCS) Oral CARE DELIVERY FOR HEART FAILURE PATIENTS Monday, October 26, 2015 517 THE COST OF HOSPITALIZATION AND LENGTH OF STAY FOR CHRONIC HEART FAILURE CASES IN CANADA N Zaour, M Barbeau, N Liu, R Borrelli, A Fischer Mississauga, Ontario BACKGROUND: Heart failure affects more than 600,000 patients in Canada and is associated with high rates of hospitalization and mortality. There is a lack of recent research on the real world Canadian hospitalization costs of chronic heart failure (CHF), which is critical in evaluating the economic burden of CHF. The objective of this study is to evaluate the costs and length of stay (LOS) of CHF inpatient hospitalizations that either resulted in death or survival prior to discharge. METHODS: 2009-2013 hospital abstracts from the Canadian Institute for Health Information (CIHI)’s Discharge Abstract Database (DAD) and National Ambulatory Care Reporting System (NACRS) were analyzed using a cross-sectional design. Patient hospitalization abstracts were eligible if patients had a principal diagnosis of chronic (congestive) heart failure (International Classification of Diseasese10 I50.0), were 18 years of age, did not leave the hospital against medical advice or prior to being seen, and had a valid health card number. Non-parametric statistical tests were used. RESULTS: 156,847 hospitalization abstracts were included, 140,900 and 15,947 survival and death cases respectively. Overall, 86% of cases were 65 years and 49% female. The mean cost of a CHF inpatient hospitalization was $10,123. Patients who survived hospitalization incurred a mean cost of $9,222, while patients who died during hospitalization incurred a mean cost of $18,087. The costs associated with hospitalization survival were statistically different (p 75 years compared to those who were young (20-64 years old). A history of cancer, stroke, myocardial infarction, renal failure, and dementia were independent predictors of mortality after index HF hospitalization (Table 1). CONCLUSION: Overall mortality and HF re-hospitalization rates have failed to improve from 2007 to 2012. HF admissions continue to be associated with high rates of re-hospitalizations and death. The strongest factors associated with 1-year mortality and re-hospitalization were increasing age and medical comorbidities, such as CVA, renal failure, and cancer.

Cyberspace Identity Theft: Some Legal Issues under the Iranian Law

The advent of the Internet has introduced many new forms of crimes. It has also transformed old forms of crimes, which are now being committed in new ways. In effect, cyberspace not only offers new and highly sophisticated opportunities for criminal misconduct, but also creates the potential to commit traditional crimes in a modern way. It has opened the door to criminal behavior in ways that would never have been possible in the past. The identity thief uses information relating to the identity of another person’s such as name, address, telephone number, mother’s maiden name, social security number, social insurance number, health card number, bank account information, driver’s license number and date of birth. It is stealing someone’s identity information to commit theft, fraud or other crimes. This paper aims to identify the legal issues on the cyberspace theft of identity in Iran, and to identify and analyze the laws relating to theft in Iran.

Cyberspace Identity Theft: The Conceptual Framework

The present age of technological advances has extended the reach of crimes into the Internet. Nevertheless, while the Internet may have led to the emergence of wholly new crimes, it has mostly brought about new ways of committing preexisting crimes. (Garner, 2000) For example, although it is often called a 21st century phenomenon, (Hoar, 2001) cyberspace identity theft is, in fact, not a new type of crime. (United Nations, Handbook on Identity Related Crime, 2011)Long before the emergence of the Internet, identity thieves stole people’s identities through dumpster diving by searching for personal identifying information such as social security and bank account numbers in the trash left outside people’s homes. The identity thief uses information relating to the identity of another person’s such as name, address, telephone number, mother’s maiden name, social security number, social insurance number, health card number, bank account information, driver’s license number and date of birth. It is stealing someone’s identity information to commit theft, fraud or other crimes. DOI: 10.5901/mjss.2015.v6n4s3p595

Cyberspace Identity Theft: An Overview

The present age of technological advances have boosted the crime of cyberspace identity theft. Although this crime is not new, the Internet has expanded its scope and created innovative ways of committing it, leading to a new variant called cyberspace identity theft. The identity thief uses information relating to the identity of another person’s such as name, address, telephone number, mother’s maiden name, social security number, social insurance number, health card number, bank account information, driver’s license number and date of birth. It is stealing someone’s identity information to commit theft, fraud or other crimes. This paper aims to reviews the historical, international and regional background to the law relating to cyberspace identity theft. Also addressed, are the national, regional, and international approaches to combating the problem, with a particular focus on the United Kingdom, Malaysia and Iran.Given the above premise, one of the objectives of this chapter is to examine the meaning of cyberspace identity theft from a global perspective. It aims to advance an acceptable definition of cyberspace identity theft (in addition to other related concepts) such that it would be easy to identify the crime, facilitate its investigation, as well as prosecution. DOI: 10.5901/mjss.2015.v6n4s3p290

Population-based utilization of radiation therapy by a Canadian breast cancer cohort.

We examined trends in radiation therapy (rt) utilization by a population-based breast cancer cohort in Ontario. The provincial cancer registry provided a breast cancer cohort based on diagnosis dates from April 1, 2005, to March 31, 2010. Staging information was also available. The cohort was then linked, by encrypted health card number, to linkable administrative datasets, including rt utilization. The average age in the identified female breast cancer cohort (n = 39,656) was 61.6 ± 14.0 years. Almost two thirds of the patients (n = 25,225) received rt, and staging information was available for 22,988 patients (9541 stage i, 8516 stage ii, 4050 stage iii, and 881 stage iv). The average number of rt courses received by the patients was 1.4 ± 0.7 for stage i, 1.8 ± 1.1 for stage ii, 2.5 ± 1.3 for stage iii, and 2.8 ± 2.4 for stage iv. The ratio of conventional rt to intensity-modulated rt was 70.9%:16.6% for stage i, 71.6%:11.3% for stage ii, 74.6%:4.6% for stage iii, and 89.6%:2.2% for stage iv. From 2005 to 2010, almost two thirds of a Canadian female breast cancer cohort received rt, and the average number of courses increased with disease severity. A similar trend was observed with the type of rt (use of conventional rt increased with disease severity). The next step is to apply unit costs to the number of fractions and to obtain rt planning and radiation therapist times.

Abstract W P331: Management of TIA Patients Referred to Ontario Secondary Stroke Prevention Clinics From the Emergency Department

Background: Previous studies have found that patients with TIA discharged from the emergency department (ED) have low rates of testing and treatment for secondary stroke prevention. Secondary Stroke Prevention Clinics (SPCs) were established in Ontario to increase access to diagnostics, treatment, and risk factor education programs for patients at risk of stroke. We aimed to characterize the management of patients with transient ischemic attack (TIA) and ischemic stroke referred to the SPCs following discharge from the ED. Method: The Ontario Stroke Registry performed a chart audit of 40 of 41 operational SPCs between April 1, 2011 and March 31, 2012. We included patients discharged from the ED and referred to a SPC with a diagnosis of probable stroke or TIA, and evaluated processes of best practice care. Using encrypted health card numbers, we linked to administrative databases to identify 7, 30 and 90 day outcomes after the index event. Results: Our study sample included 8,501 patients discharged from the ED and referred to a SPC with probable stroke/TIA. After evaluation in the SPC, 1,902 were given a final diagnosis of TIA and 1,126 ischemic stroke. The median age was 72 years and 46.6% were female. The median time from ED discharge to clinic visit was 8 days for TIA patients and 7 days for ischemic stroke patients. The majority of patients (&gt;92%) received neuroimaging, carotid imaging and antithrombotic therapy, and rates of treatment were similar in those with TIA and stroke. The rate of death or recurrent stroke admission at 30 days was 3.6% among patients with confirmed ischemic stroke, and 0.4% in those with TIA. Conclusion: Ontario patients with TIA and ischemic stroke discharged from the ED with stroke secondary prevention clinic follow up receive high quality best practice secondary stroke prevention care. Further work will examine whether TIA patients discharged from EDs without SPC follow up have similar care and outcomes.

PCN216 - Population Based Utilization of Radiation Therapy by a Canadian Breast Cancer Cohort

We examined trends in radiation therapy (rt) utilization by a population-based breast cancer cohort in Ontario. The provincial cancer registry provided a breast cancer cohort based on diagnosis dates from April 1, 2005, to March 31, 2010. Staging information was also available. The cohort was then linked, by encrypted health card number, to linkable administrative datasets, including rt utilization. The average age in the identified female breast cancer cohort (n = 39,656) was 61.6 ± 14.0 years. Almost two thirds of the patients (n = 25,225) received rt, and staging information was available for 22,988 patients (9541 stage i, 8516 stage ii, 4050 stage iii, and 881 stage iv). The average number of rt courses received by the patients was 1.4 ± 0.7 for stage i, 1.8 ± 1.1 for stage ii, 2.5 ± 1.3 for stage iii, and 2.8 ± 2.4 for stage iv. The ratio of conventional rt to intensity-modulated rt was 70.9%:16.6% for stage i, 71.6%:11.3% for stage ii, 74.6%:4.6% for stage iii, and 89.6%:2.2% for stage iv. From 2005 to 2010, almost two thirds of a Canadian female breast cancer cohort received rt, and the average number of courses increased with disease severity. A similar trend was observed with the type of rt (use of conventional rt increased with disease severity). The next step is to apply unit costs to the number of fractions and to obtain rt planning and radiation therapist times.

Into the abyss: diabetes process of care indicators and outcomes of defaulters from a Canadian tertiary care multidisciplinary diabetes clinic

BackgroundContinuity of care is essential for good quality diabetes management. We recently found that 46% of patients defaulted from care (had no contact with the clinic for 18 months after a follow-up appointment was ordered) in a Canadian multidisciplinary tertiary care diabetes clinic. The primary aim was to compare characteristics, diabetes processes of care, and outcomes from referral to within 1 year after leaving clinic or to the end of the follow-up period among those patients who defaulted, were discharged or were retained in the clinic.MethodsRetrospective cohort study of 193 patients referred to the Foustanellas Endocrine and Diabetes Center (FEDC) for type 2 diabetes from January 1, 2005 to June 30, 2005. The FEDC is the primary academic referral centre for the Ottawa Region and provides multidisciplinary diabetes management. Defaulters (mean age 58.5 ± 12.5 year, 60% M) were compared to patients who were retained in the clinic (mean age 61.4 ± 10.47 years, 49% M) and those who were formally discharged (mean age 61.5 ± 13.2 years, 53.3% M). The chart audit population was then individually linked on an individual patient basis for laboratory testing, physician visits billed through OHIP, hospitalizations and emergency room visits using Ontario health card numbers to health administrative data from the Ministry of Health and Long-Term Care at the Institute for Clinical and Evaluative Sciences (ICES).ResultsRetained and defaulted patients had significantly longer duration of diabetes, more microvascular complications, were more likely to be on insulin and less likely to have a HbA1c < 7.0% than patients discharged from clinic. A significantly lower proportion of patients who defaulted from tertiary care received recommended monitoring for their diabetes (HbA1c measurements, lipid measurements, and periodic eye examinations), despite no difference in median number of visits to a primary care provider (PCP). Emergency room visits were numerically higher in the defaulters group.ConclusionsPatients defaulting from a tertiary care diabetes hospital do not receive the recommended monitoring for their diabetes management despite attending PCP appointments. Efforts should be made to minimize defaulting in this group of individuals.

Rubella immunity among prenatal women in Ontario, 2006–2010

BackgroundCountries of the Americas have been working towards rubella elimination since 2003 and endemic rubella virus transmission appears to have been interrupted since 2009. To contribute towards monitoring of rubella elimination, we assessed rubella seroprevalence among prenatal screening tests performed in Ontario.MethodsSpecimens received for prenatal rubella serologic testing at the Public Health Ontario Laboratory, the provincial reference laboratory, between 2006 and 2010 were analyzed. A patient-based dataset was created using all tests occurring among 15–49 year-old females, where prenatal screening was indicated. Multiple tests were assigned to the same patient on the basis of health card number, name and date of birth. Only unique tests performed at least nine months apart were included. SAS version 9.2 was used for analysis.ResultsBetween 2006 and 2010, we identified 459,963 women who underwent 551,160 unique prenatal screening tests for rubella. Of these, 81.6%, 17.1% and 1.4% had one, two and three or more tests respectively.Rubella immunity remained stable at approximately 90% overall; the proportion of susceptible women was 4.4%. Additionally, 0.6% of women were initially susceptible and subsequently developed immunity. Across the province, susceptibility was highest in the north and declined with increasing age (p < 0.0001). Among women with multiple tests, the proportion who remained susceptible declined as the number of years between tests increased (p < .0001). Based on age at first test, younger women had the highest susceptibility (4.2% among 15–19 year-olds) and were significantly more likely to develop immunity if previously susceptible (p < .0001).ConclusionRubella susceptibility among prenatal women in Ontario supports elimination goals as population immunity in this group is relatively high. Higher susceptibility among young women and women living in the north highlights an opportunity for greater focus on identification and immunization of susceptible women in these groups.

Variación temporal y distribución geográfica de las cardiopatías congénitas en la Comunitat Valenciana

ObjectivesThe objective of this study is to estimate the prevalence of congenital heart defects (CHD) in the Comunitat Valenciana (CV) in children less than one year old and identify whether there are temporal and geographic variations within this prevalence. MethodsThe minimum basic data set from hospital discharge reports was used to select patients, who were born between 1999-2008, were less than one year old, and who lived in the CV with at least one hospital admission in which the primary diagnosis and/or any of the events were coded as CHD (codes 745-747 of the International Classification of Diseases 9th Revision Clinical Modification). The first hospital discharge report with CHD was selected, using the health card number to detect duplication. The prevalence and 95% confidence intervals were calculated, and the prevalence ratio (PR) and smoothed PR was obtained for each municipality to identify geographic patterns. ResultsIn the period 1999-2008 there were 6.377 patients younger than one year with some CHD, representing the 43.2% of cases of congenital anomalies. The prevalence was 134.3 per 10.000 live births (95% CI: 131.1-137.6). There was a significant increase in the prevalence, from 115.8 in the 1999-2003 period to 149.5 in the 2004-2008 period. A higher risk was identified in the north of the CV, and in some municipalities of the province of Alicante, in the south. ConclusionsThe observed increase in CHD agrees with the findings in other countries and it can be explained, at least in part, by improved diagnostic techniques. The geographic pattern identified requires a more detailed analysis that could explain the geographic variations found.

Physicians' Warnings for Unfit Drivers and the Risk of Trauma from Road Crashes

BackgroundPhysicians' warnings to patients who are potentially unfit to drive are a medical intervention intended to prevent trauma from motor vehicle crashes. We assessed the association between medical warnings and the risk of subsequent road crashes.MethodsWe identified consecutive patients who received a medical warning in Ontario, Canada, between April 1, 2006, and December 31, 2009, from a physician who judged them to be potentially unfit to drive. We excluded patients who were younger than 18 years of age, who were not residents of Ontario, or who lacked valid health-card numbers under universal health insurance. We analyzed emergency department visits for road crashes during a baseline interval before the warning and a subsequent interval after the warning.ResultsA total of 100,075 patients received a medical warning from a total of 6098 physicians. During the 3-year baseline interval, there were 1430 road crashes in which the patient was a driver and presented to the emergency department, as compared with 273 road crashes during the 1-year subsequent interval, representing a reduction of approximately 45% in the annual rate of crashes per 1000 patients after the warning (4.76 vs. 2.73, P<0.001). The lower rate was observed across patients with diverse characteristics. No significant change was observed in subsequent crashes in which patients were pedestrians or passengers. Medical warnings were associated with an increase in subsequent emergency department visits for depression and a decrease in return visits to the responsible physician.ConclusionsPhysicians' warnings to patients who are potentially unfit to drive may contribute to a decrease in subsequent trauma from road crashes, yet they may also exacerbate mood disorders and compromise the doctor–patient relationship. (Funded by the Canada Research Chairs program and others.)

The association between childhood overweight and obesity and otitis media

The objective of this study was to examine the association between otitis media and childhood obesity in a population-based sample of elementary school children in the Canadian province of Nova Scotia. The study design is a prospective cohort study, linking data from a population-based survey of Grade 5 students (aged 10-11 years) in the Canadian province of Nova Scotia in 2003 with Nova Scotia administrative health data. Measured body mass index was used to define weight status based on the age- and gender-specific cut-off points of the International Obesity Task Force. Health administration data for each child was linked via Health Card numbers. The primary outcome was healthcare utilization (physician visits and costs) for suppurative otitis media (International Classification of Diseases [ICD]9: 382; ICD10: H65-66) with no previous diagnosis of otitis in the last 30 days. Relative to normal weight children, obese children had more healthcare provider contacts for otitis media (adjusted incidence rate ratio 2.03, 95% confidence interval [CI] 1.66-2.49), incurred more costs per otitis media-related visit ($47 vs. $24, P = 0.0001) and had higher odds to have repeated otitis media (adjusted odds ratio 2.27, 95% CI 1.54-3.35). Socioeconomic factors, a history of breastfeeding, presence of an allergic disorder or chronic adenoid/tonsil disorder did not change the association between obesity and otitis media. There is a clear association between childhood obesity and otitis media that cannot be explained by confounding by socioeconomic factors or clinically associated disorders.

Population-Based Health Care Cost Estimates Related to Non-Hodgkin Lymphoma (NHL)

Abstract 2068 Background:There is limited information on the cost of non-Hodgkin lymphoma (NHL) management. This study provides population-based estimates of the costs for individuals with NHL from a Canadian perspective using provincial administrative databases. Methods:All individuals residing in Ontario with a diagnosis of first incident NHL from the Ontario Cancer Registry (2005–2009) were matched to non-NHL controls. Matching was based on age (same birth year), geography, income quintile, and resource utilization bands (2 years prior to cancer diagnosis). Each NHL case was matched to a maximum 5 controls. NHL cases from the Ontario Cancer registry were linked with their unique and encrypted health card number to provincial health claims databases (Ontario Ministry of Health and Long-Term Care and Cancer Care Ontario). Resources for this analysis included physician visits, hospitalizations, emergency room visits, medications, home care and same day surgeries. Unit costs (in 2009 Canadian dollars) were applied to resources. All costs were inflated to 2009. Costs were presented as the mean annual cost for all patients and by clinical stage. Results:There were 13,336 NHL cases matched to 65,668 controls. The NHL and control groups were demographically similar. For both groups, the median (25th and 75th percentile) age was 68 (56 to 77) years and 55% were male. Geographically, 86% of both groups were from urban areas. Total and disaggregated mean annual costs for NHL and controls are presented in the table. The mean cost difference between the NHL and control groups represents the mean cost attributable to NHL. Inpatient hospitalization and medication costs attributable to NHL represented 51% and 30% respectively, of the total mean annual cost attributable to NHL. Clinical stage at NHL diagnosis was available for a subset of the NHL cases (37%). Total mean annual cost by stage is also presented in the table. For the entire cohort, mean annual cost attributable to NHL was $16,778. In comparison, mean annual cost attributable to NHL by stage at diagnosis ranged from $9,575 (stage I) to $26,099 (stage IV). Conclusion:This study provides total and stage-specific cost estimates for NHL where attributable costs were 3 to 7 fold higher than those for non-NHL controls and increased by stage. Cost drivers included medications and inpatient care. Further work will focus on costing other resources including radiation, other chemotherapies and chronic care.NHLControlsDifference (NHL minus control)Disaggregated CostPhysician$3,400$1,279$2,121Inpatient hospitalizations$10,401$1,811$8,590Emergency room visits$588$231$357Same day surgery$384$189$195Medications including chemotherapy$6,283$1,174$5,109Home care$667$260$407Total CostAll patients$21,722$4,944$16,778Stage I$13,589$4,014$9,575Stage II$20,115$4,232$15,883Stage III$22,615$4,220$18,395Stage IV$30,475$4,376$26,099 Disclosures:No relevant conflicts of interest to declare.

Population-based health care cost estimates related to breast cancer by staging.

6108 Background: This study provides population-based estimates of the costs for women with breast cancer (BC) by disease stage from a Canadian perspective using provincial administrative databases. Methods: All Ontario women with a diagnosis of first incident BC from the Ontario Cancer Registry (2005-2009) were matched to non-BC controls (1:5) based on age (same birth year), geography, income quintile, and the expected resource utilization bands (2 years prior to cancer diagnosis) were linked with their unique and encrypted Health Card Number to provincial health claims (Ontario Ministry of Health and Longterm Care and Cancer Care Ontario). Resources for this preliminary analysis included physician, hospitalizations and same day surgeries (SDS). Unit costs, 2009 Canadian dollars, were applied to resources. Non 2009 costs were inflated to 2009. The cost for BC vs. non-BC was calculated for the entire cohort and by stage of disease for BC cases. Results: There were 39,656 BC cases and 198,280 non-BC controls. Cases and controls were equally matched. The mean age (range) was 61.56 (51-72) years. 87.3% lived in urban areas. The total mean cost per person year (BC vs. non-BC) for physicians was $2,986 vs. $1,155; inpatient $2,972 vs. $1,015; SDS $470 vs. $147. Stage information was available for 15,437 (38.9%) BC cases, where 48.2% were stage I; 34.7% stage II; 10.3% stage III, 6.9% stage IV. Physician costs were $2,894 vs. $1,147 (stage I) for BC vs. non-BC; $3,312 vs. $1,133 (stage II); $4,027 vs. $1,036 (stage III); $5,459 vs. $1,092 (stage IV). Inpatient costs were $1,819 vs. $832 (stage I) for BC vs. non-BC; $3,010 vs. $866 (stage II); $4,774 vs. $816 (stage III); $12,123 vs. $1,009 (stage IV). SDS costs were $462 vs. $143 (stage I) for BC vs. non-BC; $468 vs. $129 (stage II); $455 vs. $124 (stage III); $336 vs. $137 (stage IV). Conclusions: This study provides stage-specific cost estimates for BC, where costs were 2-12 fold higher than those for non-BC and increased by stage for physician and inpatient resources. Further work will focus on costing other resources including medications, home care and radiation.

A Validation Study of the Canadian Organ Replacement Register

Accurate and complete documentation of patient characteristics and comorbidities in renal registers is essential to control bias in the comparison of outcomes across groups of patients or dialysis facilities. The objectives of this study were to assess the quality of data collected in the Canadian Organ Replacement Register (CORR) compared with the patient's medical charts. This cohort study of a representative sample of adult, incident patients registered in CORR in 2005 to 2006 examined the prevalence, sensitivity, specificity, positive and negative predictive values, and κ of comorbid conditions and agreement in coding of patient demographics and primary renal disease between CORR and the patient's medical record. The effect of coding variation on patient survival was evaluated. Medical records on 1125 patients were reviewed. Agreement exceeded 97% for health card number, date of birth, and sex and 71% (range 46.6 to 89.1%) for the primary renal disease. Comorbid conditions were under-reported in CORR. Sensitivities ranged from 0.89 (95% confidence interval 0.80, 0.92) for hypertension to 0.47 (0.38, 0.55) for peripheral vascular disease. Specificity was >0.93 for all comorbidities except hypertension. Hazard ratios for death were similar whether calculated using data from CORR or the medical record. Comorbid conditions are under-reported in CORR; however, the associated risks of mortality were similar whether using the CORR data or the medical record data, suggesting that CORR data can be used in clinical research with minimal concern for bias.

Surname lists to identify South Asian and Chinese ethnicity from secondary data in Ontario, Canada: a validation study

BackgroundSurname lists are useful for identifying cohorts of ethnic minority patients from secondary data sources. This study sought to develop and validate lists to identify people of South Asian and Chinese origin.MethodsComprehensive lists of South Asian and Chinese surnames were reviewed to identify those that uniquely belonged to the ethnic minority group. Surnames that were common in other populations, communities or ethnic groups were specifically excluded. These surname lists were applied to the Registered Persons Database, a registry of the health card numbers assigned to all residents of the Canadian province of Ontario, so that all residents were assigned to South Asian ethnicity, Chinese ethnicity or the General Population. Ethnic assignment was validated against self-identified ethnicity through linkage with responses to the Canadian Community Health Survey.ResultsThe final surname lists included 9,950 South Asian surnames and 1,133 Chinese surnames. All 16,688,384 current and former residents of Ontario were assigned to South Asian ethnicity, Chinese ethnicity or the General Population based on their surnames. Among 69,859 respondents to the Canadian Community Health Survey, both lists performed extremely well when compared against self-identified ethnicity: positive predictive value was 89.3% for the South Asian list, and 91.9% for the Chinese list. Because surnames shared with other ethnic groups were deliberately excluded from the lists, sensitivity was lower (50.4% and 80.2%, respectively).ConclusionsThese surname lists can be used to identify cohorts of people with South Asian and Chinese origins from secondary data sources with a high degree of accuracy. These cohorts could then be used in epidemiologic and health service research studies of populations with South Asian and Chinese origins.

Rates of New or Missed Colorectal Cancers After Colonoscopy and Their Risk Factors: A Population-Based Analysis

The rate of new or missed colorectal cancer (CRC) after colonoscopy and their risk factors in usual practice are unknown. Our objective was to evaluate the rate and risk factors in a population-based study. We analyzed data from the Canadian Institute for Health Information, the Ontario Health Insurance Program, and Ontario Cancer Registry for all patients (> or =20 years of age) with a new diagnosis of right-sided, transverse, splenic flexure/descending, rectal or sigmoid CRC in Ontario from April 1, 1997 to March 31, 2002, who had a colonoscopy within the 3 years before their diagnosis. Patients with new or missed cancers were those whose most recent colonoscopy was 6 to 36 months before diagnosis. We examined characteristics that might be risk factors for new or missed CRC. We identified a diagnosis of CRC in 3288 (right sided), 777 (transverse), 710 (splenic flexure/descending), and 7712 (rectal or sigmoid) patients. The rates of new or missed cancers were 5.9%, 5.5%, 2.1%, and 2.3%, respectively. Independent risk factors for these cancers in men and women were older age; diverticular disease; right-sided or transverse CRC; colonoscopy by an internist or family physician; and colonoscopy in an office. Because having an office colonoscopy and certain patient, procedure, and physician characteristics are independent risk factors for new or missed CRC, physicians must inform patients of the small risk (2% to 6%) of these cancers after colonoscopy. The influence of type of physician and setting on the accuracy of colonoscopy, potentially modifiable risk factors, warrants further study.