Manitoba Centre For Health Policy Research Articles

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).&#x0D; 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.&#x0D; 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.&#x0D; 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.

Early Childhood Exposure to Intimate Partner Violence and Developmental Vulnerability at Kindergarten: Linking Canadian Population-Level Administrative Data.

ObjectiveThe objective was to examine the relationship between maternal intimate partner violence (IPV) victimization and children’s developmental health using linked population-wide administrative datasets. We examined developmental vulnerability (DV) at kindergarten of children exposed to maternal IPV victimization aged 0 to 5 using provincial prosecution records compared to unexposed counterparts.&#x0D; ApproachThis retrospective cohort study linked administrative datasets (legal, health, education, social services) from the Population Research Data Repository at the Manitoba Centre for Health Policy. Exposed mother-child pairs with 1+ prosecution records of maternal IPV victimization during early childhood (child aged 0 to 5) between 2003-2018 in Manitoba (n = 5,728) were matched to unexposed pairs (1:3) based on sex/birthdate of child and neighbourhood income. DV at kindergarten was measured across 5 domains (physical, social, emotional, language/cognitive [LC], communication/general knowledge) using the Early Developmental Instrument (EDI). Children without eligible EDI scores were excluded. Multiple logistic regression models were conducted.&#x0D; ResultsThe cohort included 5321 children (exposed n=1365, unexposed n=3956). 32.98% of the cohort was developmentally vulnerable in one or more domains (1/+) and 19.60% was developmentally vulnerable in two or more domains (2/+). Unadjusted relationships between maternal IPV victimization from age 0 to 5 and developmental vulnerability at kindergarten were statistically significant across all 5 domains (e.g., LC OR=2.76 [2.36, 3.23]) and in 1/+ (OR=2.72 [2.39, 3.09]) as well as 2/+ (OR=2.89 [2.51, 3.34]) domains. After adjusting for covariates, children who were exposed to maternal IPV victimization from ages 0 to 5 had increased odds of being developmentally vulnerable in social competence (aOR=1.33 [1.07, 1.66]) and emotional maturity (aOR=1.29 [1.03, 1.62]), also in 2/+ domains (aOR=1.42 [1.15, 1.73]) at kindergarten, compared to unexposed counterparts.&#x0D; ConclusionThe study provided Canadian population-wide evidence of the association between maternal IPV victimization and early childhood development, specifically later socio-emotional vulnerability. Interventions and support systems for this population of families should be developed and implemented, with an emphasis on mitigating long-term socio-emotional developmental risks in children exposed to IPV.

Prenatal Exposure to Intimate Partner Violence and Developmental Health in Children at Kindergarten: Linking Canadian Population-Level Administrative Data.

ObjectiveUsing population-wide administrative data, the objective was to provide Canadian evidence on the longitudinal relationship between maternal intimate partner violence (IPV) victimization and children’s developmental health. Using provincial prosecution records, we examined developmental vulnerability (DV) at kindergarten of children prenatally exposed to maternal IPV victimization compared to unexposed counterparts.&#x0D; ApproachThis retrospective cohort study linked administrative datasets (legal, health, education, social services) from the Population Research Data Repository at the Manitoba Centre for Health Policy. Exposed mother-child pairs with 1+ prosecution record of maternal IPV victimization during pregnancy between 2003 and 2018 in Manitoba (n = 1,117) were matched to unexposed pairs (1:3) based on sex/birthdate of child and neighbourhood income. DV at kindergarten was measured across 5 domains (physical, social, emotional, language/cognitive [LC], communication/general knowledge) using the Early Developmental Instrument (EDI). Children without eligible EDI scores were excluded. Multiple logistic regression models were conducted to address the objective.&#x0D; ResultsThe eligible cohort included 927 children (exposed n=229, unexposed n=698); 31.07% of the cohort was developmentally vulnerable in one or more domains (1/+) and 19.53% was developmentally vulnerable in two or more domains (2/+). Children who were prenatally exposed to maternal IPV victimization had increased odds of vulnerability across all 5 developmental domains (e.g., physical health/wellness: OR=2.83[1.95,4.10]; LC development: OR=2.45[1.65,3.64]). Unadjusted ORs showed statistically significant associations between maternal exposure of prenatal IPV victimization and DV in 1/+ (OR=2.70[1.98,3.68]) and 2/+ (OR=2.48[1.75,3.50]). When adjusted for covariates (e.g., maternal income assistance, mental health, child abuse history), no statistically significant relationship was found for any of the domains (e.g., LC development: aOR=0.98[0.53,1.81]), 1/+ (aOR=1.17[0.72,1.88]), and 2/+ (aOR=1.14[0.67,1.95]).&#x0D; ConclusionThe unadjusted, statistically significant associations suggest children exposed to maternal IPV victimization prenatally may face associated social/health risks. The finding highlights the need to consider potential factors that put children at risk of DV when developing and implementing support systems/interventions for children exposed to maternal IPV victimization.

Considerations and Consequences when using First Nations Identifiers in Administrative Data Research.

ObjectivesLack of consistent and relevant Indigenous identifiers in Canadian data sources leads to misclassification and under-recognition of the health and social issues impacting Indigenous Peoples, further perpetuating the harms of colonization. We are evaluating and optimizing our approach for identifying First Nations (FN) individuals in administrative data in Manitoba.&#x0D; MethodsIn partnership between the First Nations Health and Social Secretariat of Manitoba and the Manitoba Centre for Health Policy, we sought to evaluate to what extent four distinct Manitoba datasets derived from surveillance and social programs were able to identify FN individuals among a cohort of children in low-income Winnipeg neighbourhoods between 2005-2016. In choosing data sources to identify FNs, the population and research question were considered.&#x0D; We then compared the number of FNs identified in each dataset to the First Nations population research file, considered gold standard, but cognizant of its roots in colonial systems of registration.&#x0D; ResultsThe total cohort comprised N=78,864; among these, n=27,347 children were identified as FN in either the FN registry or at least one of the datasets. The FN registry was the most sensitive dataset and identified 85.7% of these individuals. The two program datasets identified 58.2% and 46.2%, and the surveillance-based datasets each identified less than 10%.&#x0D; The First Nations Registry is critical to accurately identify FN individuals. Our analyses demonstrated that without it we would miss 23.5% of those identified as FN in at least one other dataset. However, using it alone could potentially cause us to miss 15% of FN individuals identified in other datasets.&#x0D; The proportions of FN individuals that would be missed by excluding any of the other datasets were smaller (&lt;6%).&#x0D; ConclusionWe found inconsistent FN identification across the datasets evaluated. Among the issues is that some datasets rely on self-identification. In Manitoba, no single administrative dataset can reliably and comprehensively identify FN individuals, and linking multiple datasets together is currently our best approach.

A Decolonizing Approach in Population Health Research: Examining the Association between the federal maternal evacuation policy on Maternal and Child outcomes in First Nation (FN) Communities in Manitoba.

ObjectivesResponding to the Truth and Reconciliation Commission of Canada’s (TRC) Call to Action #19 to close the gap in maternal/child outcomes, the goal of this study was to provide a baseline for select outcomes and demonstrate how an Indigenous/decolonizing framework can be applied to population health research involving Indigenous people.&#x0D; ApproachThis retrospective cohort study was embedded within a decolonizing and Indigenous framework. Data extracted from administrative data housed at the Manitoba Centre for Health Policy was utilized to create a cohort of low-risk women residing in FN communities delivering a baby between 2005-2015. Two groups of mother/child dyads were compared: those evacuated for birth and those who were not required to leave home. Data were analyzed to assess the association between the evacuation policy on health outcomes.&#x0D; ResultsDecolonizing and Indigenous frameworks are feasible, essential, and necessary in population health research involving Indigenous people. This methodology does not detract from scientific rigor. In keeping with Indigenous methodology, Knowledge Keepers and a Grandmother Advisor informed the research from the onset, including insightful dialogue about the study findings. Using such an approach, this study generated evidence that the present-day OFC policy continues to harm Indigenous women, families, and communities. The OFC policy is associated with increased odds of inadequate PNC (OR 1.64 1.51, 1.79 CI) and small for gestational age births (OR 1.25 1.02, 1.50 CI) and decreased breastfeeding initiation (OR 0.55 0.50, 0.61 CI) and maternal psychological distress diagnoses (OR .43 0.36, 0.51), after adjusting for various confounders.&#x0D; ConclusionThis study documented a journey of an Anishinaabekwe in the space where western and Indigenous methodologies met. In answering the TRC call to improve maternal and infant outcomes, epidemiological and population health research requires epistemological frameworks that adequately incorporate the voices and realities of Indigenous people's lives while remaining scientifically rigorous.

A Longitudinal Cohort Study of Participation in the Boys &amp; Girls Clubs of Winnipeg

IntroductionOut-of-school or after-school programs are designed to support healthy behaviours, boost academic achievement and strengthen social skills. The Boys and Girls Clubs of Winnipeg (BGCW) in Manitoba, Canada, have been offering out-of-school programs to children and adolescents in low-income neighbourhoods for more than 40 years. Many BGCW participants face considerable risk of poor health, social and educational outcomes due to challenges they experience at home, in school and in their communities. ObjectiveWe examined whether BGCW participation among children and adolescents aged 5-18 is associated with improved school outcomes and lower risk of justice system encounters and adverse health outcomes. MethodsWe linked de-identified data on BGCW participation for children and adolescents born 1987-2010 to administrative data from the healthcare system, education system, and social services in the Population Research Data Repository, Manitoba Centre for Health Policy. The exposure group (n = 8,990$) included children and adolescents who visited BGCW at least once from 2005—2016. The comparison group (n = 69,980) comprised children and adolescents matched on school year and neighbourhood who had never participated in BGCW. ResultsParticipation in BGCW was significantly associated with better scores in grade 3 numeracy and grade 7 student engagement assessments. The risk of justice system encounters among adolescents (aged 12—17) dropped as the frequency of BGCW participation increased, as did justice system encounters among young adults (aged 18—24) who had participated in BGCW as adolescents. The likelihood of teen pregnancy among female adolescents (aged 13—19) and sexually transmitted infections among adolescents (aged 13—19) also declined as the frequency of participation in BGCW increased. ConclusionsThe findings suggest that participation in BGCW is associated with positive outcomes for children and adolescents in multiple domains and despite socioeconomic and family challenges faced by many in this population.

Education Outcomes of Children Born Late Preterm: A Retrospective Whole-Population Cohort Study.

Early life exposures can have an impact on a child's developmental trajectory and children born late preterm (34-36weeks gestational age) are increasingly recognized to have health and developmental setbacks that extend into childhood. The purpose of this study was to assess whether late preterm birth was associated with poorer developmental and educational outcomes in the early childhood period, after controlling for health and social factors. We conducted a retrospective cohort study using administrative databases housed at the Manitoba Centre for Health Policy, including all children born late preterm (34-36weeks gestational age (GA)) and at full-term (39-41weeks GA) between 2000 and 2005 in urban Manitoba (N = 28,100). Logistic regression was used to examine the association between gestational age (GA) and outcomes, after adjusting for covariates. Adjusted analyses demonstrated that children born late preterm had a higher prevalence of attention deficit hyperactivity disorder (ADHD) (aOR = 1.25, 95% CI [1.03, 1.51]), were more likely to be vulnerable in the language and cognitive (aOR = 1.29, 95% CI [1.06, 1.57]), communication and general knowledge (aOR = 1.24, 95% CI [1.01, 1.53]), and physical health and well-being (aOR = 1.27, 95% CI [1.04, 1.53]) domains of development at kindergarten, and were more likely to repeat kindergarten or grade 1 (aOR = 1.52, 95% CI [1.03, 2.25]) compared to children born at term. They did not differ in receipt of special education funding, in social maturity or emotional development at kindergarten, and in reading and numeracy assessments in the third grade. Given that the late preterm population makes up 75% of the preterm population, their poorer outcomes have implications at the population level. This study underscores the importance of recognizing the developmental vulnerability of this population and adequately accounting for the social differences between children born late preterm and at term.

Closing the loop: From system-based data to evidence-influenced policy and practice.

For more than 30 years, the Manitoba Centre for Health Policy has been conducting research and evaluation to provide timely and critical evidence to answer real-world policy questions. Our experienced team of research scientists, analysts and other staff work extensively with policy-makers at the macro, meso and micro levels of government to support evidence-informed policy and program development in an effort to ensure that policy initiatives provide the greatest benefit possible to individuals and society as a whole. Using the widely recognized whole-population Manitoba Population Research Data Repository, which comprises approximately 100 different datasets from multiple sectors, we employ sophisticated and state-of-the-art research methods and data science technologies, and then translate the results into meaningful insights or recommendations for policy-makers.Our long and productive history of working with policy-makers has taught us much about making our research relevant to policy-makers. In this article, we outline some examples of how research evidence has been used to influence policy in Manitoba, and the key lessons we have learned about what makes relationships between researchers and policy-makers work. In essence, policy-makers have supported the growth of the Repository over the last 30 years, because researchers have “closed the loop” by sharing valuable and policy-relevant research results with them. This ability to inform policies, programs and service delivery with scientific evidence continues to benefit individuals, communities and our society as a whole.

A longitudinal cohort study of participation in the Boys & Girls Clubs of Winnipeg.

IntroductionOut-of-school or after-school programs are designed to support healthy behaviours, boost academic achievement and strengthen social skills. The Boys and Girls Clubs of Winnipeg (BGCW) in Manitoba, Canada, have been offering out-of-school programs to children and adolescents in low-income neighbourhoods for more than 40 years. Many BGCW participants face considerable risk of poor health, social and educational outcomes due to challenges they experience at home, in school and in their communities.ObjectiveWe examined whether BGCW participation among children and adolescents aged 5-18 is associated with improved school outcomes and lower risk of justice system encounters and adverse health outcomes.MethodsWe linked de-identified data on BGCW participation for children and adolescents born 1987-2010 to administrative data from the healthcare system, education system, and social services in the Population Research Data Repository, Manitoba Centre for Health Policy. The exposure group (n = 8,990) included children and adolescents who visited BGCW at least once from 2005–2016. The comparison group (n = 69,980) comprised children and adolescents matched on school year and neighbourhood who had never participated in BGCW.ResultsParticipation in BGCW was significantly associated with better scores in grade 3 numeracy and grade 7 student engagement assessments. The risk of justice system encounters among adolescents (aged 12–17) dropped as the frequency of BGCW participation increased, as did justice system encounters among young adults (aged 18–24) who had participated in BGCW as adolescents. The likelihood of teen pregnancy among female adolescents (aged 13–19) and sexually transmitted infections among adolescents (aged 13–19) also declined as the frequency of participation in BGCW increased.ConclusionsThe findings suggest that participation in BGCW is associated with positive outcomes for children and adolescents in multiple domains and despite socioeconomic and family challenges faced by many in this population.

Pregestational Diabetes Exposure In Utero: Validation of a Definition for Use in Administrative Data

ObjectiveOur aim in this study was to determine the best administrative data case definition for pregestational diabetes exposure. MethodsWe compared the performance of case definitions for pregestational diabetes exposure within the administrative health data housed in the Manitoba Population Health Research Repository at the Manitoba Centre for Health Policy with an identified population of women in whom the diagnosis of pregestational diabetes was known from the clinical database of the Manitoba Diabetes Education Resource for Children and Adolescents (DER-CA) (August 12, 1989 through January 28, 2015). The DER-CA database contains maternal diabetes status during pregnancy and also includes women diagnosed with type 2 diabetes in childhood whose pregnancies were thus all complicated by pregestational diabetes exposure. Linkage of mother–child dyads is possible within the Repository. Diagnosis codes from the International Classification of Diseases---ninth or tenth revision and physician tariff codes were used to identify diabetes in the biologic mothers of children with type 2 diabetes identified from the DER-CA database. The timing of the diagnosis of diabetes in the mother with respect to the gestational age of the pregnancy was determined. ResultsThe best administrative definition of pregestational diabetes exposure was any incident code for diabetes in the mother before the pregnancy of the index child or within the first 25 weeks of pregnancy (sensitivity: 84.77%; positive predictive value: 92%). ConclusionThe definition cited can be used to define pregestational diabetes exposure in studies utilizing administrative data.

Changes in health indicator gaps between First Nations and other residents of Manitoba.

Background:The Truth and Reconciliation Commission of Canada has called for better reporting of health disparities between First Nations people and other Canadians to close gaps in health outcomes. We sought to evaluate changes in these disparities using indicators of health and health care use over the last 2 decades.Methods:We used linked, whole-population, administrative claims data from the Manitoba Centre for Health Policy for fiscal years 1994/95 to 1998/99 and 2012/13 to 2016/17. We measured indicators of health and health care use among registered First Nations and all other Manitobans, and compared differences between these groups over the 2 time periods.Results:Over time, the relative gap between First Nations and all other Manitobans widened by 51% (95% confidence interval [CI] 42% to 60%) for premature mortality rate. For potential years of life lost, the gap widened by 54% (95% CI 51% to 57%) among women and by 32% (95% CI 30% to 35%) among men. The absolute gap in life expectancy widened by 3.14 years (95% CI 2.92 to 3.36) among men and 3.61 years (95% CI 3.38 to 3.84) among women. Relative gaps widened by 20% (95% CI 12% to 27%) for ambulatory specialist visits, by 14% (95% CI 12% to 16%) for hospital separations and by 50% (95% CI 39% to 62%) for days spent in hospital, but narrowed by 33% (95% CI −36% to −30%) for ambulatory primary care visits, by 22% (95% CI −27% to −16%) for mammography and by 27% (95% CI −40% to −23%) for injury hospitalizations.Interpretation:Disparities between First Nations and all other Manitobans in many key indicators of health and health care use have grown larger over time. New approaches are needed to address these disparities and promote better health with and for First Nations.

Social determinants and spatio-temporal variation of Ischemic Heart Disease in Manitoba

IntroductionThe aim was to study any spatial and/or temporal patterns of ischemic heart disease (IHD) prevalence and measure the effects of selected social determinants on these spatial and space-time patterns.MethodsData were obtained from the Population Research Data Repository housed at the Manitoba Centre for Health Policy to identify persons who were diagnosed with IHD between 1995 and 2018. These persons were geocoded to 96 geographic regions of Manitoba. An area-level socioeconomic factor index (SEFI-2) and the proportion of the population who was Indigenous were calculated for each geographic region using the 2016 Canadian Census data. Associations between these factors and IHD prevalence were measured using Bayesian spatial Poisson regression models. Temporal trends and spatio-temporal trends were measured using Bayesian spatio-temporal Poisson regression models.ResultsUnivariable models showed a significant association with increased regional Indigenous population proportion associated with a higher prevalence of IHD (RR: 0.07, 95% CredInt: (0.05, 0.10)) and for SEFI-2 (RR: 0.17, 95% CredInt: (0.11, 0.23)). Using a multivariable model, after accounting for the proportion of the population that was Indigenous, there was no evidence of an association between IHD prevalence and area-level socioeconomic factor. Spatio-temporal models showed no significant overall temporal trend in IHD prevalence, but there were significant spatially varying temporal trends within the 96 regions.ConclusionsAssociation between Indigenous population proportion and IHD is consistent with previous research. No significant overall temporal trend was measured. However, regions with significantly increasing trends and significantly decreasing trends in IHD prevalence were identified.

CLINICAL OUTCOMES OF EARLY REPATRIATION FOR PATIENTS WITH ST-ELEVATION MYOCARDIAL INFARCTION UNDERGOING PERCUTANEOUS CORONARY INTERVENTION FROM A SINGLE, REGIONAL CARDIAC CARE CENTRE

<h3>BACKGROUND</h3> Centres that perform percutaneous coronary intervention (PCI) have resources specialized in the care of ST-elevation myocardial infarction (STEMI) patients both during and after PCI. Due to limited hospital resources, many centres that perform PCI have adopted protocols where STEMI patients are transferred to a non-PCI capable centre following successful PCI. However, the safety of this practice is not well established. The study objective is to evaluate the clinical outcomes of the current practice of transferring patients to non-PCI capable centres following successful PCI in a single, tertiary care regional PCI centre. <h3>METHODS AND RESULTS</h3> A retrospective analysis was performed of all consecutive STEMI patients presenting to a single, regional cardiac care centre between January 2013 and December 2014. STEMI patients with high-risk features including cardiac arrest, cardiogenic shock, medical complication nof STEMI, requiring transvenous pacing, mechanical ventiliation, mechanical circulatory support or not reperfused by PCI were excluded. Patients who were unable to be linked to the Provincial Population Registry were also excluded. Patients were analyzed based on whether they were transferred to a non-PCI capable centre following PCI for ongoing post-STEMI care. Clinical presentation, comorbidities, angiographic findings, revascularization, and repatriation status data were collected from the electronic medical record and cath lab database. Study data was linked to the Research Repository at the Manitoba Centre for Health Policy for long-term clinical outcomes. Of the 1092 consecutive STEMI patients screened, 337 patients (31%) were excluded (Figure). The final study cohort (n=697) included 397 repatriated patients and 300 non-repatriated patients. The median age of the study cohort was 60 (53-70) years. Baseline characteristics are summarized in the Table. The median length of stay at the PCI-capable hospital was 139 minutes (IQR 97-235 minutes) with 84% of patients transferred within 6 hours. Inverse probability of treatment weighting (IPTW) was used to adjust for unbalanced characteristics between the two study groups. All-cause mortality (12.9% admitted vs 10.4% repatriated patients, adjusted HR 0.90, 95% CI 0.64-1.26, p=0.535) and repeat MI (11.0% admitted vs 5.4% repatriated, adjusted HR 0.71, 95% CI 0.49-1.02, p=0.06) at 5 years were not statistically significant after IPTW adjustment, respectively. <h3>CONCLUSION</h3> This analysis demonstrated that there is no increased risk of mortality or repeat MI at five years in STEMI patients who are transferred to a non-PCI capable centre following successful PCI. This suggests that early repatriation is safe and effective for low-risk STEMI patients.