ICES Data Research Articles

Linking Community-based Substance Use Disorder Treatment to Health Administrative Data: understanding vulnerable populations.

IntroductionMost substance use disorder (SUD) treatment occurs in community settings. Community-based SUD treatment information is rarely captured or utilized. The objective of this study was to examine the efficiency of a data linkage of community-based SUD treatment to health administrative data holdings in Ontario, Canada, and to describe sociodemographic and clinical characteristics of individuals accessing SUD services. MethodsData from community-based SUD service providers (>180) from April 2015 to March 2022 were linked to administrative data holdings at ICES. Linkage rates were evaluated. Sociodemographic (age, sex, neighbourhood-level income) and clinical (substance use, physician visits, Emergency Department (ED) visits and hospitalizations) characteristics were evaluated. ResultsThe linkage rate of DATIS ICES data holdings was >92% for all years (2015-2022). Of the 234,501 individuals admitted to a DATIS program, 36.1% were female, 46.2% were 25-44 years old, and 51.6% resided in the two lowest neighbourhood income quintiles. Alcohol (33.4%) was the most common substance identified. For outpatient care occurring within 1 year prior to admission, around 56.0% and 23.3% had Mental Health and Addictions (MHA) related primary care and psychiatrist visits, respectively. For acute health services, 29.8% and 14.2% had a MHA- related ED visit or hospitalization, respectively. DiscussionSUD treatment data from community settings can be successfully linked to other health administrative data. Individuals with SUD have a high rate of acute health care use, and a relatively low access to psychiatrists. SUD treatment data linkage should be used to understand how to optimize access to care for vulnerable individuals.

Leveraging Fuzzy Match: Building an Automated Record Linkage Template in SAS Dataflux

Background ICES has conducted Probabilistic Record Linkage (PRL) for heath and non-health data for over 15 years. The PRL process has made data linkable to many ICES data holdings. However, due to the manual gray area resolution, record linkages for large datasets are time consuming with inconsistent results. ApproachAdapting from many years of experience with PRL methodology, record linkage templates were built in SAS Dataflux. By using combination of deterministic linkage and fuzzy match algorithms, the multi-pass linkage strategy is maintained by passing unlinked records in subsequent linkage comparison cycles. The new template uses personal identifiers of multiple given names, surnames, date of birth, death date (if applicable) and sex. In each pass, the pool of possible matched pairs is created by merging on low sensitive matchcodes with different conditions. Then, using a rule-based approach, possible pairs are examined, flags are assigned, and survival rules are applied to select the best matched records. ResultsBy feeding a pre-prepared linkage file along with updating the input and output file names, the record linkage job will be conducted automatically in SAS Dataflux through submitting a “run” command. It significantly reduces the turnaround time with no clerical review required, achieves a similar linkage rate as PRL consistently, and is utilized by various research projects. ConclusionThe automated SAS Dataflux record linkage template is more efficient than the traditional PRL process. It eliminates the human intervention of gray area resolution, while reducing project turnaround times, and maintaining a comparable accuracy and linkage rate.

The ICES Indigenous Health Data Training Program: Building knowledge and strengthening capacity within Indigenous communities and organizations

Objective and ApproachThe responsible use of population-level health data requires equitable access, and considerations of Indigenous data sovereignty. There is often a baseline level of knowledge and understanding required to access data. To facilitate data access and strengthen capacity within Indigenous communities and organizations, we created the ICES Indigenous Health Data Training Program (IHDTP). ResultsThe IHDTP provides learning opportunities for Indigenous communities and organizational members to gain a better understanding of ICES data with a focus on Indigenous health. It provides an opportunity to gain practical knowledge on the research process, including how to develop a research question, understanding and interpreting research outputs, and knowledge translation. The program offers ongoing one-on-one technical support to participants, as well as the opportunity to submit a research project request for participating communities and organizations. ConclusionsThe IHDPT has been run several times, including both virtually and in-person, with a range of Indigenous partners. The materials presented in each administration of the program were tailored to the partner. Recorded sessions have also been created to allow a greater number of additional Indigenous partners to take the course flexibly. Program participants have indicated that the information learned would be used to advance issues that are important to their communities via policy, advocacy, and planning. ImplicationsThe IHDTP has enabled a variety of Indigenous partners to strengthen their understanding of health data and research to ultimately facilitate equitable and inclusive public health data access.

Hip fracture rate and osteoporosis treatment in Ontario: A population-based retrospective cohort study

SummaryThis population-based study analyzes hip fracture and osteoporosis treatment rates among older adults, stratified by place of residence prior to fracture. Hip fracture rates were higher among older adults living in the community and discharged to long-term care (LTC) after fracture, compared to LTC residents and older adults living in the community. Only 23% of LTC residents at high fracture risk received osteoporosis treatment.PurposeThis population-based study examines hip fracture rate and osteoporosis management among long-term care (LTC) residents > 65 years of age compared to community-dwelling older adults at the time of fracture and admitted to LTC after fracture, in Ontario, Canada.MethodsHealthcare utilization and administrative databases were linked using unique, encoded identifiers from the ICES Data Repository to estimate hip fractures (identified using the Public Health Agency of Canada algorithm and International Classification of Diseases (ICD)-10 codes) and osteoporosis management (pharmacotherapy) among adults > 66 years from April 1, 2014 to March 31, 2018. Sex-specific and age-standardized rates were compared by pre-fracture residency and discharge location (i.e., LTC to LTC, community to LTC, or community to community). Fracture risk was determined using the Fracture Risk Scale (FRS).ResultsAt baseline (2014/15), the overall age-standardized hip fracture rate among LTC residents was 223 per 10,000 person-years (173 per 10,000 females and 157 per 10,000 males), 509 per 10,000 person-years (468 per 10,000 females and 320 per 10,000 males) among the community to LTC cohort, and 31.5 per 10,000 person-years (43.1 per 10,000 females and 25.6 per 10,000 males). During the 5-year observation period, the overall annual average percent change (APC) for hip fracture increased significantly in LTC (AAPC = + 8.6 (95% CI 5.0 to 12.3; p = 0.004) compared to the community to LTC group (AAPC = + 2.5 (95% CI − 3.0 to 8.2; p = 0.248)) and the community-to-community cohort (AAPC − 3.8 (95% CI − 6.7 to − 0.7; p = 030)). However, hip fracture rate remained higher in the community to LTC group over the study period. There were 33,594 LTC residents identified as high risk of fracture (FRS score 4 +), of which 7777 were on treatment (23.3%).ConclusionOverall, hip fracture rates have increased in LTC and among community-dwelling adults admitted to LTC after fracture. However, hip fracture rates among community-dwelling adults have decreased over time. A non-significant increase in osteoporosis treatment rates was observed among LTC residents at high risk of fracture (FRS4 +). Residents in LTC are at very high risk for fracture and require individualized based on goals of care and life expectancy.

P.097 Glioblastoma treatment, end-of-life resource utilization, and outcomes in Ontario

Background: The end-of-life (EoL) phase of care is pivotal for glioblastoma (GBM) patients. While early integration of palliative care has shown benefits in various cancer types, its role in GBM care remains underexplored. This study aims to characterize EoL care patterns in GBM patients, assessing their temporal evolution, regional disparities, and socioeconomic influences. Methods: This is retrospective study of all patients with GBM treated in Ontario between 1994 and 2018 using the ICES data repository. Variables analyzed included patient demographics, comorbidities, palliative care utilization, and aggressive/supportive care components. Results: We identified 9,013 GBM patients within the study period. There was a gradual increase in palliative care utilization over time, accompanied by a decrease in in-hospital deaths. However, the proportion of patients receiving chemotherapy in the last 14 days of life increased. Multivariate logistic regression found socioeconomic status influenced palliative care access and rural patients also had a higher rate of in-hospital deaths, possibly due to limitations in outpatient palliative care services. Conclusions: The findings in this study clarify the status of EoL care for GBM patients within Ontario, and demonstrates key areas for future research, underscoring the need for standardized EoL care practices to enhance the quality of care for GBM patients.

Design and implementation of the Our Health Counts (OHC) methodology for First Nations, Inuit, and Metis (FNIM) health assessment and response in urban and related homelands.

Methods for enumeration and population-based health assessment for First Nations, Inuit, and Metis (FNIM) living in Canadian cities are underdeveloped, with resultant gaps in essential demographic, health, and health service access information. Our Health Counts (OHC) was designed to engage FNIM peoples in urban centres in "by community, for community" population health assessment and response. The OHC methodology was designed to advance Indigenous self-determination and FNIM data sovereignty in urban contexts through deliberate application of Indigenous principles and linked implementation strategies. Three interwoven principles (good relationships are foundational; research as gift exchange; and research as a vehicle for Indigenous community resurgence) provide the framework for linked implementation strategies which include actively building and maintaining relationships; meaningful Indigenous community guidance, leadership, and participation in all aspects of the project; transparent and equitable sharing of project resources and benefits; and technical innovations, including respondent-driven sampling, customized comprehensive health assessment surveys, and linkage to ICES data holdings to generate measures of health service use. OHC has succeeded across six urban areas in Ontario to advance Indigenous data sovereignty and health assessment capacity; recruit and engage large population-representative cohorts of FNIM living in urban and related homelands; customize comprehensive health surveys and data linkages; generate previously unavailable population-based FNIM demographic, health, and social information; and translate results into enhanced policy, programming, and practice. The OHC methodology has been demonstrated as effective, culturally relevant, and scalable across diverse Ontario cities.

Development of practice-based quality indicators for the primary care of older adults: a RAND/UCLA Appropriateness Method study protocol

IntroductionOlder adults have high rates of primary care utilisation, and quality primary care has the potential to address their complex medical needs. Family physicians have different levels of knowledge and...

The Impact of Sex and Gender on Prescribing Cascades in Older Adults.

Prescribing cascades occur when an adverse drug event is misinterpreted as a new medical condition, leading clinicians to prescribe an additional medication. Studies using ICES data have detected a number of common prescribing cascades, particularly among older adult populations. These findings have contributed to international initiatives aimed at optimizing prescribing practices in this population, with the goal of minimizing the risk of drug-related harms. Examining prescribing cascades through a sex and gender lens will better inform guidelines and recommendations tailored to older men and women.

Re-Imagining Care for Older Adults with Heart Failure and Other Serious Illnesses.

Most patients with heart failure prefer to die at home and want to avoid unnecessary or aggressive treatments as they approach the end of life. Collaborative care models that provide coordinated, linked services from palliative and subspecialty practitioners may enable more effective heart failure-specific palliation in the home setting. Using both administrative health data at ICES and qualitative data from interviews with cardiology and palliative care physicians and nurse practitioners, researchers have found new evidence that collaborative care integrated into a regionally organized system of palliation positively impacts outcomes for people with heart failure and meets quality indicators for end-of-life heart failure care across Ontario.

Dangerous "Toys": The Burden of Non-Powdered Firearm Injuries in Canadian Children and Youth.

Injuries in children and youth from non-powdered firearms are a significant public health concern in Canada and other high-income countries. Injury burden, healthcare utilization and costs related to non-powdered firearm use in Ontarians under 25 years of age were analyzed using ICES data. They demonstrate the need for effective policy interventions and awareness campaigns to improve the safety of these popular "toys."

ICES Data and Analytic Services: Eight Years Young.

ObjectiveIn March 2014, ICES launched Data & Analytic Services (DAS), expanding the access to ICES data and analytics beyond ICES scientists and analytic staff. In eight years, DAS has grown and evolved to increase high quality services offered to an expanding client base of external researchers.
 ApproachAt the inception of DAS, two services were offered to public sector researchers: data access and analytics. Data access enabled researchers to analyze coded record-level data through a secure virtual environment. Analytics, conducted by DAS staff in ICES analytic environment, provided researchers with risk-cleared summary level reports. In response to growing demand from an increasingly diverse range of researchers, ICES engaged in extensive consultations with internal and external stakeholders to re-evaluate and operationalize new services. Compliance with contractual obligations and Ontario law, organizational capacity to scale up, alignment with ICES’ mission, vision and values, were cornerstones in establishing new offerings.
 ResultsAnalytic services became available to private sector researchers in June 2016. In March 2017, support for cohort and longitudinal follow-up studies became the newest service offering (researchers provided with a list of applicable individuals defined for the purposes of conducting publicly funded research). As more data assets become available to researchers, requests continue to increase in volume and complexity, particularly of projects seeking to import external data for linkage to ICES data. A second high performance computing virtual environment onboarded researchers September 2021 while the original analytic environment has undergone multiple upgrades, and will soon be fully refreshed. Regular solicitation of feedback has enabled DAS to increase staffing and diversify resources available which improves the client experience at all stages.
 ConclusionsSince its inception, DAS has expanded from five to thirty personnel, grown and diversified its new and returning client base and has responded to demand for new services. DAS continues to provide high quality services which enable impactful research and is responsive to new opportunities for collaboration and service provision.

Factors affecting management of children's low-risk distal radius fractures in the emergency department: a population-based retrospective cohort study.

Background:Ten randomized controlled trials over the last 2 decades support treating low-risk pediatric distal radius fractures with removable immobilization and without physician follow-up. We aimed to determine the proportion of these fractures being treated without physician follow-up and to determine whether different hospital and physician types are treating these injuries differently.Methods:We conducted a retrospective population-based cohort study using ICES data. We included children aged 2–14 years (2–12 yr for girls and 2–14 yr for boys) with distal radius fractures having had no reduction or operation within a 6-week period, and who received treatment in Ontario emergency departments from 2003 to 2015. Proportions of patients receiving orthopedic, primary care and no follow-up were determined. Multivariable log-binomial regression was used to quantify associations between hospital and physician type and management.Results:We analyzed 70 801 fractures. A total of 20.8% (n = 14 742) fractures were treated without physician follow-up, with the proportion of physician follow-up consistent across all years of the study. Treatment in a small hospital emergency department (risk ratio [RR] 1.86, 95% confidence interval [CI] 1.72–2.01), treatment by a pediatrician (RR 1.22, 95% CI 1.11–1.34) or treatment by a subspecialty pediatric emergency medicine–trained physician (RR 1.73, 95% CI 1.56–1.92) were most likely to result in no follow-up.Interpretation:While small hospital emergency departments, pediatricians and pediatric emergency medicine specialists were most likely to manage low-risk distal radius fractures without follow-up, the majority of these fractures in Ontario were not managed according to the latest research evidence. Canadian guidelines are required to improve care of these fractures and to reduce the substantial overutilization of physician resources we observed.

Fragility fracture identifies patients at imminent risk for subsequent fracture: real-world retrospective database study in Ontario, Canada

BackgroundThe secondary fracture prevention gap in the osteoporosis field has been previously described as a ‘crisis’. Closing this gap is increasingly important in the context of accumulating evidence showing that an incident fragility fracture is associated with an increased risk of subsequent fracture within 1–2 years, known as imminent fracture risk. The objective of this study was to use health services data to characterize the time between index fragility fractures occurring at different osteoporotic sites and subsequent fractures.MethodsThis retrospective observational study used de-identified health services data from the publicly funded healthcare system in Ontario, the largest province of Canada. Patients aged > 65 with an index fragility fracture occurring between 2011 and 2015 were identified from the ICES Data Repository using International Classification of Diseases (ICD)-10 codes. We examined median time to subsequent fragility fractures for osteoporotic fracture sites until the end of follow-up (2017). BMD assessment and use of osteoporosis therapies following index fracture were also characterized.ResultsAmong 115,776 patients with an index fragility fracture, 17.8% incurred a second fragility fracture. Median time between index and second fracture occurring at any site was 555 days (interquartile range: 236–955). For each index fracture site examined, median time from index to second fracture was < 2 years. The proportion of patients with BMD assessment was 10.3% ≤1 year prior to and 16.4% ≤1 year post index fracture. The proportion of patients receiving osteoporosis therapy was 29.8% ≤1 year prior, 34.6% ≤1 year post, and 25.9% > 3 years post index fracture.ConclusionsThis cohort of Canadian patients aged > 65 years who experienced a fragility fracture at any site are at imminent risk of experiencing subsequent fracture within the next 2 years and should be proactively assessed and treated.

Mortality in older adults following a fragility fracture: real-world retrospective matched-cohort study in Ontario

BackgroundRecent studies are lacking reports on mortality after non-hip fractures in adults aged > 65.MethodsThis retrospective, matched-cohort study used de-identified health services data from the publicly funded healthcare system in Ontario, Canada, contained in the ICES Data Repository. Patients aged 66 years and older with an index fragility fracture occurring at any osteoporotic site between 2011 and 2015 were identified from acute hospital admissions, emergency and ambulatory care using International Classification of Diseases (ICD)-10 codes and data were analyzed until 2017. Thus, follow-up ranged from 2 years to 6 years. Patients were excluded if they presented with an index fracture occurring at a non-osteoporotic fracture site, their index fracture was associated with a trauma code, or they experienced a previous fracture within 5 years prior to their index fracture. This fracture cohort was matched 1:1 to controls within a non-fracture cohort by date, sex, age, geography and comorbidities. All-cause mortality risk was assessed.ResultsThe survival probability for up to 6 years post-fracture was significantly reduced for the fracture cohort vs matched non-fracture controls (p < 0.0001; n = 101,773 per cohort), with the sharpest decline occurring within the first-year post-fracture. Crude relative risk of mortality (95% confidence interval) within 1-year post-fracture was 2.47 (2.38–2.56) in women and 3.22 (3.06–3.40) in men. In the fracture vs non-fracture cohort, the absolute mortality risk within one year after a fragility fracture occurring at any site was 12.5% vs 5.1% in women and 19.5% vs 6.0% in men. The absolute mortality risk within one year after a fragility fracture occurring at a non-hip vs hip site was 9.4% vs 21.5% in women and 14.4% vs 32.3% in men.ConclusionsIn this real-world cohort aged > 65 years, a fragility fracture occurring at any site was associated with reduced survival for up to 6 years post-fracture. The greatest reduction in survival occurred within the first-year post-fracture, where mortality risk more than doubled and deaths were observed in 1 in 11 women and 1 in 7 men following a non-hip fracture and in 1 in 5 women and 1 in 3 men following a hip fracture.

Exploring the Collection and Use of Health Data for Smart Cities Initiatives

IntroductionICES is an entity in Ontario, Canada that collects and uses the personal health information (PHI) of individuals for evaluation, planning and monitoring of the provincial health system. It currently does not have legal authority to collect PHI from, or disclose PHI to, municipalities for the purpose of supporting evidence-based policymaking and enabling “Smarter Cities”.&#x0D; Objectives and ApproachTo assess how ICES could allow municipalities to access PHI, while maintaining strong privacy and security data protection, we first: (i) explored the legal data trust model as a vehicle for broader collection and use of municipal data, and (ii) analyzed the regulatory changes and type of framework that would enable broader access and use of PHI by municipalities. Following this and to demonstrate the value of access to ICES data for municipal planning, we identified a case project involving a municipal health stakeholder. Leveraging ICES’ remote access model, two local public health analysts performed analytics on de-sensitized, individual-level data in a secure analytic environment.&#x0D; ResultsWe determined that a legal data trust is not the appropriate model for the type of data sharing envisioned, but rather, a data governance and ethical use framework complimentary to a new legal regime for Smart Cities would be optimal. In Phase II the local municipal partner was able to identify several use cases for the ICES data that would support local policy making; access to these data was considered a critical enabler to improved evidence-based decision making.&#x0D; Conclusion / ImplicationsAllowing municipal policy makers to use data under a complimentary framework to a new legal regime, may improve policy and produce direct economic impact for municipalities where evidence needed for decision-making is lacking; representing a practical step forward towards Smart Cities.

MASK: A Success Story for An International Collaboration

IntroductionA significant amount of valuable information in Electronic Health Records (EHR) such as laboratory test results or echocardiogram interpretations is embedded in lengthy free-text fields. Often patients’ personal information is also included in these narratives. Privacy legislation in different jurisdictions requires de-identification of this information prior to making it available for research. This process can be challenging and time-consuming. In particular, rule-based algorithms may lead to over-masking of essential medical terms, conditions, or devices that are named after individuals.&#x0D; Objectives and ApproachWe aimed to enhance ICES’ existing rule-based application to make it contextually-driven by applying Artificial Intelligence (AI). The ICES team collaborated with computer scientists at the University of Manchester who had already published work in this area and Evenset, a Toronto-based software company. Based on the Manchester University de-identification framework for name entity recognition, three machine learning-based algorithms for name entity recognition were implemented: CRF, BiLSTM recurrent neural networks with GLoVe and ELMo word embeddings. The models were trained on three different types of ICES data: Laboratory results, Electronic Medical Record (EMR) and echocardiogram data. Evenset developed the user interface and the masking modules.&#x0D; ResultsPreliminary tests have generated very promising results. To improve accuracy of the models, additional data annotation to expand the training datasets is currently being undertaken at ICES. The final framework will be available as an open-source tool for public.&#x0D; Conclusion / ImplicationsA collaborative approach for solving complex problems like de-identification of text-based medical data is highly efficient, especially where there are unique sets of expertise, resources, data and clinical knowledge among stakeholders.

Linking Spinal Cord Injury Data Sets to Describe the Patient Journey Following Injury: A Protocol.

To optimize traumatic spinal cord injury (tSCI) care, administrative and clinical linked data are required to describe the patient's journey. To describe the methods and progress to deterministically link SCI data from multiple databases across the SCI continuum in British Columbia (BC) and Ontario (ON) to answer epidemiological and health service research questions. Patients with tSCI will be identified from the administrative Hospital Discharge Abstract Database using International Classification of Diseases (ICD) codes from Population Data BC and ICES data repositories in BC and ON, respectively. Admissions for tSCI will range between 1995-2017 for BC and 2009-2017 for ON. Linkage will occur with multiple administrative data holdings from Population Data BC and ICES to create the "Admin SCI Cohorts." Clinical data from the Rick Hansen SCI Registry (and VerteBase in BC) will be transferred to Population Data BC and ICES. Linkage of the clinical data with the incident cases and administrative data at Population Data BC and ICES will create subsets of patients referred to as the "Clinical SCI Cohorts" for BC and ON. Deidentified patient-level linked data sets will be uploaded to a secure research environment for analysis. Data validation will include several steps, and data analysis plans will be created for each research question. The creation of provincially linked tSCI data sets is unique; both clinical and administrative data are included to inform the optimization of care across the SCI continuum. Methods and lessons learned will inform future data-linking projects and care initiatives.

Differences in lipid treatment patterns in women versus men in a large cohort of patients with atherosclerotic cardiovascular disease in Ontario, Canada

Abstract Background/Introduction The prevalence of ischaemic heart disease is lower in women vs men in Canada. Studies have shown that women are more likely to be underdiagnosed and less likely to receive guideline-recommended treatments than men. Women receiving lipid-lowering therapies (LLTs) are also less likely to attain treatment goals vs men. Purpose We analysed use of LLTs and attainment of low-density lipoprotein cholesterol (LDL-C) treatment goals in a recent longitudinal cohort of patients with ASCVD with public drug coverage in Ontario to describe differences observed between female and male patients. Methods Patients ≥65 years with a primary ASCVD event/procedure between 1 Apr 2005 and 31 Mar 2016, treated with an LLT and with index and follow up LDL-C values were identified from claims data at the Institute for Clinical Evaluative Sciences data repository. Patients were assessed over a 1 year follow up period for LDL-C goal attainment (&amp;lt;2.0 mmol/L or 50% reduction from index LDL-C as per Canadian Cardiovascular Society Guidelines) and analysed by LLT category. Results 143,302 patients with ASCVD ≥65 years on LLTs were identified of which 41% were female. A higher proportion of female vs male patients were prescribed low (3% vs 2%) and medium intensity statins (51% vs 44%) compared with high intensity statins (43% vs 52%). A higher proportion of women failed to attain LDL-C goal compared to men (33% vs 24%) (Figure). When analysed by low, moderate or high intensity statin, 65%, 35%, and 27% of female patients and 49%, 25% and 19% of male patients failed to attain LDL-C goal at follow up. Conclusions In this retrospective study, women with a diagnosis of ASCVD were more frequently treated with low/moderate intensity statins whereas men were more frequently treated with high intensity statins. Approximately 2 of 3 women and 3 of 4 men receiving statin treatment attained LDL-C goal during the 1-year follow up period. Overall, there appear to be treatment differences between female and male patients with ASCVD, with males receiving higher intensity statin therapy and attaining LDL-C goal more frequently. Further research is needed to determine why these discrepancies exist. This study made use of de-identified data from the ICES Data Repository, which is managed by the Institute for Clinical Evaluative Sciences with support from its funders and partners: Canada's Strategy for Patient-Oriented Research (SPOR), the Ontario SPOR Support Unit, the Canadian Institutes of Health Research and the Government of Ontario. The opinions, results and conclusions reported are those of the authors. No endorsement by ICES or any of its funders or partners is intended or should be inferred. Parts of this material are based on data and/or information compiled and provided by CIHI. However, the analyses, conclusions, opinions and statements expressed in the material are those of the author(s), and not necessarily those of CIHI. Figure 1 Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Amgen Canada Inc

Low-density lipoprotein cholesterol goal attainment and treatment patterns in a cohort of &amp;gt;143,000 patients with atherosclerotic cardiovascular disease in Ontario, Canada

Abstract Background/Introduction Limited real-world data are available on attainment of low-density lipoprotein cholesterol (LDL-C) treatment goals in patients with atherosclerotic cardiovascular disease (ASCVD) in Canada. Purpose A retrospective observational study was conducted to describe types of ASCVD events/procedures, time between events and use of lipid lowering treatment (LLT) in patients who did not achieve LDL-C goal. Methods Patients in Ontario ≥65 years with a primary ASCVD event/procedure between 1 Apr 2005 and 31 Mar 2016, treated with an LLT and with index and follow up LDL-C values were identified from claims data at the Institute for Clinical Evaluative Sciences data repository. Patients were assessed over a 1-year follow up period for LDL-C goal attainment (&amp;lt;2.0 mmol/L or 50% reduction from index LDL-C) and analysed by LLT and by index event type. Results Overall, 28% of 143,302 patients ≥65 years on LLT failed to attain LDL-C goal at follow up (Figure). The proportion of patients failing to achieve LDL-C goal decreased from 35% to 22% over the 11-year study period. Mean time between index and follow up LDL-C (based on lowest score &amp;gt;2 weeks and up to 1 year after index LDL-C) was 203±97 days. When analysed by low-, moderate- or high-intensity statin, 57%, 30%, and 22% of patients failed to achieve LDL-C goal at follow up, respectively. Conclusions In this study, more than 1 in 4 patients with ASCVD in Ontario failed to achieve guideline recommended LDL-C goal despite treatment. In particular, ∼1 in 3 patients with cerebral and peripheral arterial disease were not at goal. An opportunity exists to better manage these high risk ASCVD patients with further statin intensification and additional LLTs This study made use of de-identified data from the ICES Data Repository, which is managed by the Institute for Clinical Evaluative Sciences with support from its funders and partners: Canada's Strategy for Patient-Oriented Research (SPOR), the Ontario SPOR Support Unit, the Canadian Institutes of Health Research and the Government of Ontario. The opinions, results and conclusions reported are those of the authors. No endorsement by ICES or any of its funders or partners is intended or should be inferred. Parts of this material are based on data and/or information compiled and provided by CIHI. However, the analyses, conclusions, opinions and statements expressed in the material are those of the author(s), and not necessarily those of CIHI Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Amgen Canada Inc.

Temperature and food-mediated variability of European Atlantic sardine recruitment

The influence of the environmental conditions during larval development on the resulting recruitment strength was investigated for European sardine (Sardina pilchardus) at Atlanto-Iberian waters. Satellite-derived Sea Surface Temperature (SST) and Chlorophyll-a concentration (Chla) data from the previous spawning seasons (January to March/April and October to December of the previous year) were related to recruitment success data in the main recruitment hotspots. Recruitment data was taken from yearly acoustic scientific cruises and from the ICES recruitment index estimated by an age-structured model for the entire stock. A linear discriminant analysis model using SST, Chla, and the abundance of spawners during the spawning season identified years of high and low recruitment for all the recruitment hotspots with an accuracy of ≥79%. In general, high recruitment years were associated with high Chla and low SST, although the most important variables to discriminate between the groups were area-specific. High recruitment years were mostly related to high food availability (Chla), particularly during the last quarter of the previous year. In Western Iberia and in the Gulf of Cadiz, high recruitment years were also associated to lower SST, whereas in the Bay of Biscay, where SST during the winter was generally below the optimal range ≈11–12 °C for sardine larval development, higher recruitment was associated with high SST. For ICES data of the southern European sardine stock, lower SST and higher Chla during the last quarter of the previous year were associated with high recruitment years and SST alone was able to discriminate between the two recruitment groups with 73% accuracy. Although the time-series of available data are still small, these significant relationships are consistent with field and laboratory studies relating larval growth and mortality with main environmental drivers. These relationships should be further investigated in the following years to evaluate if they can be used to construct reliable indicators to predict the level of recruitment and abundance with sufficient advance to help in the management of this important fishing resource.