Manitoba Centre For Health Policy Research Articles

Turning Research Ideas into Reality: A Guide to Developing a Simulated Research Protocol using Administrative Data

Objectives Demonstrate the translation of a research idea into a protocol with an analytic plan, including discussion on requirements for administrative data (AD) analysis, e.g., governance, time estimation. Foster discussion on processes for conducting AD research to enable learning and collaboration. ApproachParticipants were guided through three sections, and each alternated between presentations, group participation and discussion sessions. An overview of the Manitoba Centre for Health Policy (MCHP) Data Repository was presented to use as the framework for the AD discussion. Our chosen topic of discussion was: “How do health history and family history affect risk of poor outcomes for people with diabetes?” In small groups, participants discussed issues arising from translating the idea into a research plan. For example, define a cohort of people with diabetes, examine cardiovascular events as the outcome using survival analysis, and control for demographics, treatment compliance and family history of diabetes and cardiovascular events. We evaluated the feasibility of using AD to measure these variables. We discussed a method to estimate the time to conduct this proposed using AD, i.e., time for programming and analysis. Finally, we discussed data approvals and requirements when conducting research using AD. Conclusions and ImplicationsWe discussed the benefits and cautions of using AD and shared knowledge regarding research opportunities and obstacles across jurisdictions to identify commonalities and areas of opportunity for growth. The workshop was informative and interactive. It generated much discussion and was well-received among participants, with many asking for further information after the workshop concluded.

Health selection in three cohorts of outmigrants, return migrants and non-migrants

Abstract Background The two main hypotheses behind the healthy migrant effect are selection of healthier migrants and the salmon bias. However, these hypotheses have not been thoroughly and simultaneously investigated in distinct cohorts due to data limitations. Methods Linking national and provincial immigration registers with health care utilization datasets at the Manitoba Centre for Health Policy, we assembled a cohort of 816,185 adults who resided in Manitoba, Canada and were followed up for at least one year between 1985 to 2023 to outmigration, return migration or death. We included three subcohorts of international immigrants (16.4%), interprovincial migrants (10.8%) and all other Manitobans (AOM) (72.8%). Within each subcohort, we matched ‘stayers’ who never migrated, outmigrants and returnees on sex, birth year and place of residence and compared their hospitalization rates and Charlson and Elixhauser comorbidity scores 1-year before outmigration and 1-year after return migration. Results Outmigrants had lower hospitalization rates than stayers among AOM [Adjusted Relative Rate (RR): 0.80; 95% confidence interval (CI): 0.78, 0.82] and in the other two subcohorts. Comorbidity scores were also consistently lower among outmigrants compared to stayers in all three subcohorts, even after restricting to hospitalized cases. Outmigrants whose destination was another country were healthier than those who migrated to other provinces. Returnees had better health status than stayers upon return in the AOM subcohort only but lower than those who did not return at the time of outmigration in all three subcohorts. Conclusions Contrary to common belief, health selection is not restricted to international immigrants but also among interprovincial migrants and the local population. Migration dynamics may bias comparisons between population subgroups. Key messages • Migration is not only associated with positive health selection among international immigrants but also among interprovincial migrants and the local population. • Selective migration may represent a source of bias in health-related population-based studies.

Bariatric surgery decreases prescription drug costs for metabolic syndrome: a Canadian population-based cohort study.

Obesity is a chronic disease that is significantly linked to metabolic syndrome. Bariatric surgery is considered the most effective treatment for obesity resulting in long-term weight loss and comorbidity resolution. Prior studies have demonstrated the overall cost effectiveness of bariatric surgery; however, there is little data regarding direct pharmaceutical costs. The objective of this population-based study is to compare the cost of dispensed common prescription medications for metabolic syndrome before and after bariatric surgery. All patients that were enrolled in the Center for Metabolic and Bariatric Surgery who underwent gastric bypass or sleeve gastrectomy between 2013 and 2019 in Manitoba were included. Basic demographic information and outpatient prescription dispensation data were obtained from the Manitoba Population Research Data Repository, which is housed at the Manitoba Centre for Health Policy. Specific drug categories that were reviewed for costs 5years before and after surgery included Antihypertensives, Lipid Lowering Agents, Insulin and Non-insulin Diabetic Drugs. One thousand one hundred and eighty four patients were included in this review. Comparing the 5-yearpre- and post-surgery, there was a decrease in the overall amount of drug dispensed and the overall cost for all drug categories in the 5years following surgery. These categories included Antihypertensives ($506,268.8), Lipid Lowering Agents ($173,866.48), Insulin ($549,305.92), and Other Diabetes Drugs ($513,371.1). Additionally, older patients experienced a larger proportion of cost savings compared to younger patients, with the exception of non-insulin diabetic medications which trended to have more cost savings in the 30-49year old grouping. This is the first Canadian study to use accurate dispensing data from a provincial administrative prescription database to capture long-term cost savings for metabolic prescriptions after bariatric surgery. The results are consistent with the existing literature for prescriptions post-bariatric surgery. Future study will include subgroup analysis by patient age, gender, income quintile, and geography.

Integrating Gender Identity and Sexual Orientation in Population-Based Administrative Data

Information regarding biological sex is collected for administrative and clinical purposes, and often is conflated with gender in clinical encounters as well as in population-based data studies. Sex is collected as either ‘male’ or ‘female’, adhering to the colonial notion of binary sex and gender identities. Meaningful information on sexual/romantic orientation is also absent from these datasets. Sex, gender, and sexual/romantic (SR) orientation are key aspects informing how people experience the world and how we interpret administrative data. SOGI-HE (Sexual Orientation and Gender Identity – Health Equity) will be the first 2SLGBTQIA+ dataset at the Manitoba Centre for Health Policy by using a novel survey tool to collect information on gender identity, and SR orientation. The data from this survey will be linked into the Population Health Data Repository housed at the Manitoba Centre for Health Policy, enabling analyses that incorporate constructs of sex, gender, and SR orientation. These data will make visible the experiences of the 2SLGBTQIA+ community that have been historically absent from population-based data studies. Data equity and 2SLGBTQIA+ visibility within data play an important role in advancing the field and lays the groundwork for future data linkage projects. In this presentation we will discuss the development of SOGI-HE through community-based research principles and the implications it has on future 2SLGBTQIA+ research conducted in the province of Manitoba (Canada). Further, we will discuss the ethical implications associated with queer data sovereignty in a precarious political climate for 2SLGBTQIA+ people and their rights.

Health selection among outmigrants, return migrants and non-migrants in three subcohorts of international, interprovincial migrants and non-migrants in Manitoba, Canada

Objective and ApproachLinking national and provincial immigration registers with health care utilization datasets at the Manitoba Centre for Health Policy, we assembled a cohort of 816,185 adults who resided in Manitoba, Canada and were followed up for at least one year between 1985 to 2023 to outmigration, return migration or death. The cohort included three subcohorts of international immigrants (16.4%), interprovincial migrants (10.8%) and all other Manitobans (AOM) (72.8%). Within each subcohort, we matched ‘stayers’ who never migrated, outmigrants and returnees on sex, birth year and place of residence and compared their hospitalization rates and Charlson and Elixhauser comorbidity scores 1-year before outmigration and 1-year after return migration. ResultsOutmigrants had lower hospitalization rates than stayers among AOM [Adjusted Relative Rate (RR): 0.80; 95% confidence interval (CI): 0.78, 0.82] and in the other two subcohorts. Comorbidity scores were also consistently lower among outmigrants compared to stayers in all three subcohorts, even after restricting to hospitalized cases. Outmigrants whose destination was another country were healthier than those who migrated to other provinces. Returnees had better health status than stayers upon return in the AOM subcohort only but lower than those who did not return at the time of outmigration in all three subcohorts. ConclusionsMigration is associated with positive health selection among international immigrants, interprovincial migrants and the local population. ImplicationsContrary to common belief, health selection is not restricted to international immigrants. Selective migration may represent a source of bias in health-related population-based studies (e.g., sampling and informative censoring).

Using linked administrative data to describe a cohort of young people who have a parent with a history of homelessness (Study 1)

ObjectiveLittle is known about the children of parents who experience homelessness. The At Home/Chez Soi (AHCS) Research Demonstration Project, launched in 2009, was a Canadian multi-site, multi-year study that tested the effectiveness of Housing First. In Winnipeg, 513 people were enrolled, of whom 47% were parents. Our objective was to determine how the children were faring with respect to their health and social situations at a time their parent was experiencing homelessness. ApproachThe cohort, created using the Manitoba Centre for Health Policy’s familial linkage methodology, consisted of 405 individuals (< 30 years old) who were the offspring of the Winnipeg AHCS cohort. We descriptively summarized the socioeconomic characteristics and indicators of their involvement (or lack thereof) in various government systems at or in a period up to their parent’s study enrolment date. ResultsApproximately half of the cohort were female (51%) and under 13 years (52%). Most (76%) resided in a household that had received income assistance. At least 50% had been placed into care at or near birth and only 17% had not been involved with the child welfare system. Of those school aged, 81% were enrolled in school and of those older than school aged, 53% had graduated. Nearly half (49%) had been diagnosed with a mental health disorder and/or with asthma (47%). Conclusions and ImplicationsThis study is the first in a series seeking to identify ways to prevent multigenerational experiences of homelessness. Findings will generate valuable insights for upstream intervention across various systems.

Expanding data resources beyond “health care”: exploring options and implications

BackgroundPopulation data science has a long history with health care data. Some data centres are expanding to include “health-related” data, including information on other publicly funded services (e.g. education, income and housing supports), and systems (e.g. criminal justice, children in care). We describe what enabled this expansion through three examples from Health Data Research Network Canada. MethodsHDRN Canada members include data centres that provide access to linkable data sets for approved research projects. We use case studies to identify similarities, differences, and lessons learned from the process of expansion in the provinces of Manitoba, New Brunswick and British Columbia. ResultsThe Manitoba Centre for Health Policy has 30+ years of experience with linked data, with a consistent focus on population health. Data sets expanded incrementally, through partnerships across government agencies. Population Data BC has a nearly 30-year history, with recent expansion to health-related data through partnership with a program of one government ministry that operates under distinct legislative authority. The New Brunswick Institute for Research, Data and Training is newer, and helped advocate for legislation changes that enabled an expanded set of linked data to be made available for research. All embed Five Safes principles, and commitments to inclusion, diversity, equity and accessibility and Indigenous data sovereignty in data governance. ConclusionA greater variety of data enables research to answer complex research questions. This kind of expansion can be accomplished through different mechanisms, but in all cases requires attention to ethical and legal principles of population data science.

Urban Trail Exposure in Winnipeg, Canada: Longitudinal Cohort Development for a 20-Year Difference-in-Differences Analysis of a Natural Experiment with Varied Duration of Exposure Times

ObjectiveDevelop a cohort to evaluate a real-world experiment of the built environment on the incidence of disease, accounting for movement of people, postal codes, incidence of disease and changing demographics. ApproachThe City of Winnipeg, Canada built multi-use trails in 2010-2012. We used the administrative data housed at the Manitoba Centre for Health Policy to evaluate the effect of this change in the built environment on the incidence of cardiovascular disease events (CVDE) and risk factors (CVDRF) before (2000-2009) and after (2012-2019) the trails were built. The Manitoba Health Insurance Registry contains postal code and demographic information on nearly all city residents and was utilized for cohort creation and person-time exposure. Individuals’ residential postal codes were linked to geo-spatial data to determine proximity to built trails at 400m, 800m and 1200m. Semi-annual postal code changes accounted for movement within/outside city limits or exclusion from the cohort. Diagnoses from hospital abstract and physician visit data and outpatient prescription dispensations were used to access prevalence and incidence of a CVDE composite measure of congestive heart failure, ischemic heart disease and stroke and a CVDRF composite measure of diabetes, dyslipidemia and hypertension. Conclusions and ImplicationsLeveraging a diverse set of administrative databases, we built a cohort evaluate the effect of building multi-use trails in Winnipeg on the reduction on CVDE and CVDRF. This demonstrates how administrative data can be used to evaluate natural, real-world experiments with minimal direct data measurement or public intrusion, resulting in actionable results to inform public policy.

Characterizing school-linked and non-school linked SARS-CoV-2 cases in children and households: a retrospective cohort study using linked population-level administrative data from Manitoba, Canada

ObjectiveTo identify directionality of SARS-CoV-2 cases within households and schools, and characterize school, household, and neighbourhood factors associated with school and non-school linked cases. ApproachUsing linked administrative data housed at the Manitoba Centre for Health Policy, a cohort of 449,425 individuals from 126,670 households with school-aged children enrolled in Manitoba public schools between September 1, 2020-June 30, 2021 was created. Using population-based SARS-CoV-2 laboratory test results, education enrolment and household composition data, index and transmission cases were counted and categorized at an individual and household level as school or non-school linked. Logistic regression models examined school, household and neighbourhood factors associated with school- and non-school linked households. Results143280 individuals were tested for SARS-CoV-2 during the study period; 14712 individuals (10.3%) tested positive. Amongst positive cases, 1695 (11.5%) were school-linked; the remaining 13017 (88.5%) were non-school linked. 13.7% of SARS-CoV-2 positive households had ≥1 case linked to school; 86.3% did not. Preliminary results found higher incomes quintiles had lower odds of being a school-linked household, as did living outside the Winnipeg region. Having more children in a grade and more household members resulted in higher odds of being a school-linked transmission household. No associations were observed for having a child under age five in the household. ConclusionsTaken together, these data suggest schools were not a large source of SARS-CoV-2 cases in Manitoba and factors associated with school-linked households largely mirrored broader community transmission patterns. ImplicationsThese findings may influence public health approaches to future pandemic control.

Navigating Indigenous Data Sovereignty: A Decolonizing Approach to Understanding Opioid Use Amongst First Nations in Manitoba

First Nations (FN) and Indigenous Peoples around the world face significant challenges in navigating the complexities of Western research systems, particularly in the context of data sovereignty and research about their people and communities; the same can be said for Western researchers navigating Indigenous research space. We examine the intersection of Western research and FN data to explore opioid use amongst FN in Manitoba and highlight the ethical imperative of utilizing decolonizing frameworks when working with Indigenous data. Indigenous researchers led a retrospective cohort study linking the Manitoba FN research file to population-level data held at the Manitoba Centre for Health Policy. We centred Indigenous voices, knowledge, protocols, and contextually informed interpretation and fostered meaningful partnerships with academic researchers to ensure we utilized robust statistical methods while prioritizing community-driven questions, needs, and aspirations. Study period from 2015 to 2019 and included all Manitobans eligible for Manitoba Health Services. We found downward trends in opioid-related use, dispensation, hospitalization, and mortality rates for both FN and all other Manitobans (AOM), but a significant gap was found between FN and AOM for most indicators. Indigenous governance, ownership, engagement, collaboration, reciprocity, and respect for cultural and intellectual property rights are key concepts in ethical research practices that prioritize Indigenous self-determination and data sovereignty. We underscore the transformative potential of Indigenous-led research and use of decolonizing frameworks in fostering community empowerment to address opioid use in First Nation communities. We upheld the rights of Indigenous peoples to govern their data and undertake their own research.

Trend in Prescription Medication Utilization for Opioid Use Disorder and Alcohol Use Disorder From 2015 to 2021: A Population-wide Study in a Canadian Province.

To examine the quarterly incidence and prevalence of medications for opioid use disorder (OUD) and alcohol use disorder (AUD) from 2015 to 2021. A retrospective population-wide observational study in Manitoba, Canada, was conducted using administrative claims data from the Manitoba Centre for Health Policy to examine the incidence and prevalence of OUD (methadone, buprenorphine-naloxone, buprenorphine) or AUD medications (naltrexone, acamprosate, disulfiram) per 10,000 individuals in each quarter between January 1, 2015, and December 31, 2021. There were 1179 and 451 individuals who received at least one prescription for OUD and AUD, respectively, in the first quarter of 2020. The prevalence of OUD medications more than doubled from 6.3 to 14.3 per 10,000 from January 1, 2015, to December 31, 2021. Likewise, AUD medication prevalence increased almost 10-fold from 0.68 to 6.5 per 10,000 from January 1, 2015, to December 31, 2021, primarily due to naltrexone. The incidence of AUD prescription use increased 8.6-fold from 0.29 to 2.51 per 10,000 during the study period. In contrast, the incidence of opioid agonist therapy declined from 2.1 per 10,000 in the first quarter of 2015 to 0.53 per 10,000 the first quarter of 2016, primarily due to methadone. Whereas methadone incidence declined, buprenorphine-naloxone incidence increased almost 15-fold during the study period. An increase in both AUD medication prevalence and incidence in addition to an increase in buprenorphine-naloxone incidence was observed. These findings reflect an increase in the uptake of medications for treating AUD and OUD following changes to improve coverage and access to these medications.

Maternity Service Delivery in Manitoba, Canada: A Retrospective Analysis of Three Maternity Care Provider Types

Background: Alleviating shortages in health workforce and delivery of efficient maternity care models are unresolved policy issues in Canada. In the province of Manitoba, obstetricians do the majority of maternity care, family practice physicians take care of low-risk women, and midwives continue to deliver care to about 5% of the low-risk pregnant women. The purpose of this study was to describe how maternity care is provided in Manitoba, based on a revised definition of Most Responsible Provider, and to compare maternal and perinatal outcomes by provider type. Methods: Administrative data were used from the Manitoba Centre for Health Policy (MCHP) to select women who had a low-risk pregnancy. Descriptive statistics and logistic regression were used to examine differences in types of intervention, mode of delivery, and outcomes by provider type among low-risk women. Logistic regression models controlled for socio-demographic and birth-related covariates. Results: From 2004/05 to 2012/13, there were a total of 132,918 births in Manitoba. Of those births, 47,083 were identified as high risk (35%), and 85,835 (65%) were identified as low risk. Key findings demonstrate midwifery care compared to obstetrical care was associated with lower odds of interventions such as cesarean section (0.47 [0.40–0.54]), induction (0.42 [0.39–0.49]), and episiotomy (0.48 [0.41–0.55]), but higher odds of postpartum hemorrhage (1.35 [1.18–1.55]), and shorter lengths of stay in hospital (-0.58 [-0.61-0.56]). Family practice physicians also had decreased odds of assisted vaginal delivery (0.82 [0.76–0.89]), epidural use (0.59 [0.57–0.62]) and third- and fourth-degree tears (0.82 [0.73–0.92]), but higher odds of augmentation (1.06 [1.01–1.11]). Results reported for midwives and family practice are compared to obstetricians. Conclusions: A health workforce strategy that optimizes how to address the maternity care needs in the province of Manitoba is needed. There is suboptimal integration of midwifery services that could meet the low-risk population needs. Human health workforce development requires a good understanding of each provider’s role, opportunities for collaboration and integration to be strengthened, and the potential to optimize the outcomes for mothers and infants. This article has been peer reviewed.

Investigating social determinants of child health and their implications in reducing pediatric traumatic injury: A framework and 17-year retrospective case-control study protocol.

Traumatic physical injuries are the number one cause of hospitalization and death among children in Canada. The majority of these injuries are preventable. The burden from injury can be reduced through prevention programs tailored to at-risk groups, however, existing research does not provide a strong explanation of how social factors influence a child's risk of injury. We propose a theoretical framework to better understand social factors and injury in children and will examine the association between these social factors and physical traumatic injury in children using large population-wide data. We will examine data from 11,000 children hospitalized for traumatic physical injury and 55,000 matched uninjured children by linking longitudinal administrative and clinical data contained at the Manitoba Centre for Health Policy. We will examine 14 social determinants of child health measures from our theoretical framework, including receipt of income assistance, rural/urban status, socioeconomic status, children in care, child mental disorder, and parental factors (involvement with criminal justice system, education, social housing, immigration status, high residential mobility, mother's age at first birth, maternal Axis I mental disorder, maternal Axis II mental disorder and maternal physical disorder) to identify groups and periods of time when children are at greatest risk for traumatic physical injury. A conditional multivariable logistic regression model will be calculated (including all social determinant measures) to determine odds ratios and adjusted odds ratios (95% confidence interval) for cases (injured) and controls (non-injured). Health Information Privacy Committee (HIPC No. 2017/2018-75) and local ethics approval (H2018-123) were obtained. Once social measures have been identified through statistical modelling, we will determine how they fit into a Haddon matrix to identify appropriate areas for intervention. Knowing these risk factors will guide decision-makers and health policy.

Prescription drug usage as measure of comorbidity resolution after bariatric surgery: a population-based cohort study.

Obesity is a chronic and progressive disease associated with significant morbidity, mortality, and health-care costs. Bariatric surgery is the most effective intervention for sustainable weight loss and resolution of obesity-related comorbidities. Studies examining comorbidity resolution largely rely on individual self-reported outcomes and electronic record reviews. We present a population-based study looking at prescription medication utilization before and after bariatric surgery as a measure of comorbidity resolution. All patients enrolled in the Center for Metabolic and Bariatric Surgery who underwent either gastric bypass or sleeve gastrectomy between 2013 and 2019 in Manitoba were included. Demographic information, follow up, and outpatient prescription dispensation data were obtained from the Manitoba Population Research Data Repository housed at the Manitoba Centre for Health Policy for 5years pre- and post-surgery. A total of 1184 patients were included. Antidepressants and selective serotonin reuptake inhibitors were the most commonly prescribed classes, and along with thyroid medication, utilization remained stable after bariatric surgery. Proton pump inhibitors and opioid class drugs increased at 1year after surgery then returned to baseline. Glucose and lipid-lowering medications, including statins, biguanides, sulfonylureas, and insulin, were decreased. Antihypertensives, including ACE inhibitors, calcium channel blockers, angiotensin receptors blockers, thiazides, and beta blockers, similarly decreased. This is the first Canadian study employing a provincial-wide prescription database to measure long-term comorbidity resolution after bariatric surgery. The use of administrative data eliminates potential biases and inaccuracies in follow up and self-reported outcomes. Consistent with the literature, prescriptions for the treatment of metabolic syndrome all decreased and were sustained at long-term follow up.Further studies are needed to delineate the effects of altered pharmaceutical utilization on patient quality of life and health-care expenditures.

Evaluation of administrative case definitions for hypertension in Canadian children

Hypertension is increasing in children and warrants disease surveillance. We therefore sought to evaluate the validity of case definitions to identify pediatric hypertension in administrative healthcare data. Cases of hypertension in children 3–18 years of age were identified utilizing blood pressures recorded in the Manitoba Primary Care Research Network (MaPCReN) electronic medical record from 2014 to 2016. Prevalence of hypertension and associated clinical characteristics were determined. We then evaluated the validity of 18 case definitions combining outpatient physician visits (ICD9CM codes), hospital claims (ICD9CM/ICD10 codes) and antihypertensive use within 1–3 years of data housed at the Manitoba Centre for Health Policy. The MaPCReN database identified 241 children with hypertension and 4090 without (prevalence = 5.6%). The sensitivity of algorithms ranged between 0.18 and 0.51 and the specificity between 0.98 and 1.00. Pharmaceutical use increased the sensitivity of algorithms significantly. The algorithms with the highest sensitivity and area under the ROC curve were 1 or more hospitalization OR 1 or more physician claim OR 1 or more pharmaceutical record. Evaluating 2 years of data is recommended. Administrative data alone reflects diagnosis of hypertension with high specificity, but underestimate the true prevalence of this disease. Alternative data sources are therefore required for disease surveillance.

Investigating the effect of early life antibiotic use on asthma and allergy risk in over 600 000 Canadian children: a protocol for a retrospective cohort study in British Columbia and Manitoba

IntroductionAllergic conditions, such as asthma, hay fever and eczema, are some of the most common conditions impacting children globally. There is a strong incentive to study their determinants to improve...

Magnitude of the Potential Screening Gap for Fabry Disease in Manitoba: A Population-Based Retrospective Cohort Study.

Fabry disease is a rare disorder caused by the deficient activity of α-galactosidase A (GLA) that often leads to organ damage. Fabry disease can be treated with enzyme replacement or pharmacological therapy, but due to its rarity and nonspecific manifestations, it often goes undiagnosed. Mass screening for Fabry disease is impractical; however, a targeted screening program for high-risk individuals may uncover previously unknown cases. Our objective was to use population-level administrative health databases to identify patients at high risk of Fabry disease. Retrospective cohort study. Population-level health administrative databases housed at the Manitoba Centre for Health Policy. All residents of Manitoba, Canada, between 1998 and 2018. We ascertained the evidence of GLA testing in a cohort of patients at high risk of Fabry disease. Individuals without a hospitalization or prescription indicative of Fabry disease were included if they had evidence of 1 of 4 high-risk conditions for Fabry disease: (1) ischemic stroke <45 years of age, (2) idiopathic hypertrophic cardiomyopathy, (3) proteinuric chronic kidney disease or kidney failure of unknown cause, or (4) peripheral neuropathy. Patients were excluded if they had known contributing factors to these high-risk conditions. Those who remained and had no prior GLA testing were assigned a 0% to 4.2% probability of having Fabry disease depending on their high-risk condition and sex. After applying exclusion criteria, 1386 individuals were identified as having at least 1 high-risk clinical condition for Fabry disease in Manitoba. There were 416 GLA tests conducted during the study period, and of those, 22 were conducted in individuals with at least 1 high-risk condition. This leaves a screening gap of 1364 individuals with a high-risk clinical condition for Fabry disease in Manitoba who have not been tested. At the end of the study period, 932 of those individuals were still alive and residing in Manitoba, and if screened today, we expect between 3 and 18 would test positive for Fabry disease. The algorithms we used to identify our patients have not been validated elsewhere. Diagnoses of Fabry disease, idiopathic hypertrophic cardiomyopathy, and peripheral neuropathy were only available via hospitalizations and not physician claims. We were only able to capture GLA testing processed through public laboratories. Patients identified to be at high risk of Fabry disease by the algorithm did not undergo GLA testing due to a clinical rationale that we were unable to capture. Administrative health databases may be a useful tool to identify patients at higher risk of Fabry disease or other rare conditions. Further directions include designing a program to screen high-risk individuals for Fabry disease as identified by our administrative data algorithms.

Mental Disorders Among Mothers of Children Born Preterm: A Population-Based Cohort Study in Canada.

Our aim was to examine the association between preterm delivery and incident maternal mental disorders using a population-based cohort of mothers in Canada. Retrospective matched cohort study using Manitoba Centre for Health Policy (MCHP) administrative data in Manitoba. Mothers who delivered preterm babies (<37 weeks gestational age) between 1998 and 2013 were matched 1:5 to mothers of term babies using socio-demographic variables. Primary outcome was any incident mental disorder within 5 years of delivery defined as any of (a) mood and anxiety disorders, (b) psychotic disorders, (c) substance use disorders, and (d) suicide or suicide attempts. Multivariable Poisson regression model was used to estimate the 5-year adjusted incidence rate ratios (IRRs). Mothers of preterm children (N = 5,361) had similar incidence rates of any mental disorder (17.4% vs. 16.6%, IRR = 0.99, 95% CI, 0.91 to 1.07) compared to mothers of term children (N = 24,932). Mothers of term children had a higher rate of any mental disorder in the first year while mothers of preterm children had higher rates from 2 to 5 years. Being the mother of a child born <28 week (IRR = 1.5, 95% CI, 1.14 to 2.04), but not 28-33 weeks (IRR = 1.03, 95% CI, 0.86 to 1.19) or 34-36 weeks (IRR = 0.96, 95% CI, 0.88 to 1.05), was associated with any mental disorder. Mothers of preterm and term children had similar rates of incident mental disorders within 5-years post-delivery. Extreme prematurity was a risk factor for any mental disorder. Targeted screening and support of this latter group may be beneficial.

Severe Grief Tied to Experiencing, Witnessing Overdose

Back to table of contents Previous article Next article Clinical & ResearchFull AccessSevere Grief Tied to Experiencing, Witnessing OverdoseTerri D'ArrigoTerri D'ArrigoSearch for more papers by this authorPublished Online:23 Sep 2022https://doi.org/10.1176/appi.pn.2022.10.10.16AbstractRepeated exposure to overdose events has a cumulative effect on how people who use illicit substances feel grief in response to loss.Experiencing or witnessing multiple overdose events is associated with severe grief among people who inject drugs, a study in Drug and Alcohol Dependence has found.Repeated exposure to overdose events can shape how people who use illicit substances understand the world and violate their sense of safety, says Kathleen S. Kenny, Ph.D.“We know that grief can have significant deleterious effects, and we wanted to understand how it was being experienced by people in the context of the opioid overdose crisis and its unceasing onslaught of overdose deaths and near deaths,” lead author Kathleen S. Kenny, Ph.D., told Psychiatric News. She is a Canadian Institutes of Health Research postdoctoral fellow at the Manitoba Centre for Health Policy in the Department of Community Health Sciences at the University of Manitoba. “A main takeaway from the study is that cumulative, rather than single, overdose events were associated with severity of responses to grief and loss.”Kenny and colleagues examined data from a survey of 244 people who injected drugs in four community-based harm reduction programs in Toronto. Participants were 16 years of age or older and had injected drugs in the past three months. The researchers defined three types of overdose events: the participant’s own overdose, an overdose witnessed by the participant, and the overdose death of a person important to the participant. They then asked whether participants agreed with seven statements about how they were affected by overdose-related losses. The statements included “I feel like I’ve lost parts of myself,” “I feel like life has really changed,” “I feel like things I use to cope don’t help anymore,” “I feel numbed out,” “I’m not sure how to make sense of all the losses I’ve experienced,” “I feel angry,” and “I feel like I’ve lost a lot of my community.” The participants who answered “yes” to a higher number of statements were considered to have more severe responses to grief and loss.Among all participants, 28.7% reported two or more personal overdoses of their own, 70.9% witnessed two or more overdoses in other people, and 28.3% had experienced the loss of two or more people important to them in the previous six months. The researchers found that participants who experienced two or more personal overdoses, witnessed one overdose in someone else, or witnessed two or more overdoses in other people had the greatest likelihood of having severe responses to grief and loss. Severe responses were also more common among participants who were exposed to all three types of overdose events (their own overdose, overdose in other people, and overdose death in other people).Psychiatrists should be careful not to overlook a patient’s grief, even as they seek to treat the patient’s substance use disorder, says Frances R. Levin, M.D.Columbia UniversityKenny said that the results suggest that multiple, repeat exposure to overdose events may lead to a disrupted assumptive world among people who use drugs.“People’s core beliefs around everyday functioning, understanding of the world, and sense of safety are violated due to the continued, repeated experience of overdoses in their own lives, and the unrelenting loss of people in their communities to overdose,” Kenny explained.Frances R. Levin, M.D., the Kennedy-Leavy Professor of Psychiatry at Columbia University Irving Medical Center and chief of the Division on Substance Use Disorders at New York State Psychiatric Institute at Columbia, stressed the need for psychiatrists to create space in which patients who use drugs or have substance use disorder may grieve their losses.“When someone comes in for treatment, we tend to focus on treating the addiction, but it’s important not to overlook the patient’s grief,” said Levin, who was not involved in the research. “Explore with them what they’ve experienced, how they’ve experienced it, and how they have tried to cope with it, and provide support in handling their grief.”This study was supported by funding from the Canadian Institutes of Health Research. One of the researchers is also supported by a postdoctoral fellowship from the Canadian Network on Hepatitis C. ■Resources“Frequency of Fatal and Non-Fatal Overdoses and Response to Grief and Loss Among People Who Inject Drugs: An Unexplored Dimension of the Opioid Overdose Crisis” ISSUES NewArchived

Linking Canadian Administrative Data: Income Trajectories, Residential and School Mobility, and Grade 3 Academic Achievement.

ObjectiveThe objective is to examine the association between trajectories of childhood residential and school mobility and academic achievement (literacy, numeracy) in Grade 3 using linked whole-population administrative data in Manitoba, Canada. Secondarily, we assessed childhood residential/school mobility based on neighbourhood income levels (moving in/out of low- or mid-/high-income neighbourhoods). ApproachThis retrospective cohort study used linkable, de-identified administrative data (health, education, national census, provincial survey) from the provincial Population Research Data Repository housed at the Manitoba Centre for Health Policy (MCHP). Among kindergarteners from 2005 to 2014 (n = 83,894), those not having continuous residency in Manitoba, valid education assessments, and relevant family-level covariates were excluded. We followed this eligible cohort from kindergarten to Grade 3 based on various neighbourhood income trajectories of residential and school mobility. To assess Grade 3 literacy and numeracy scores based on trajectories, log-binomial regression models were conducted using SAS® version 9.4. ResultsThe total cohort included 36,754 children; at the end of kindergarten, 14.2% resided in low-income neighbourhoods, and 84.8% lived in mid-/high-income neighbourhoods. Moving between two low-income neighborhoods between kindergarten to Grade 3 was associated with an increased risk of poor Grade 3 numeracy and literacy scores (numeracy aRR=1.39 [1.16,1.67]; literacy aRR=1.31 [1.08,1.59]). When moving between neighborhood income levels, the association was stronger for children moving into low-income neighbourhoods (e.g., mid-/high-income to low-income: numeracy aRR=1.41 [1.19,1.67]) than children moving into mid/high-income neighbourhoods (e.g., low-income to mid-/high-income: numeracy aRR=1.31 [1.08,1.59]). Changing schools between kindergarten and Grade 3 was also associated with poorer numeracy and literacy scores in Grade 3 (numeracy aRR=1.31 [1.22,1.40]; literacy aRR=1.34 [1.24,1.44]); however, the strength varied based on residential mobility patterns. ConclusionMoving homes/schools can differentially impact children’s educational attainment depending upon the income level of residing neighborhood(s). Stakeholders should recognize different levels of risks related to mobility and provide support accordingly to reduce the adverse impact. Support systems should be tailored to not only children but also families and neighbourhoods.