Morbidity In Canada Research Articles

Pediatric Morbidity Among Black Haitians in Canada: A Longitudinal Cohort Study.

In the U.S., Black children have disproportionately elevated rates of pediatric morbidity compared with White children, but data are lacking for other countries. We studied the extent to which Black Haitians were at risk of pediatric morbidity in Canada. We analyzed a retrospective cohort of 736,498 children born in Quebec between 2008 and 2020. We identified Black Haitians using the mother tongue and birth country of parents. The outcome was mortality or hospitalization for infectious diseases, allergy, cancer, and other morbidity between birth and 12years of age. We estimated hazard ratios (HR) and 95% confidence intervals (CI) for these outcomes, comparing Haitians with non-Haitians in Cox regression models adjusted for patient characteristics. Compared with non-Haitians, Haitians tended to have a greater risk of pediatric mortality, especially before age 2years (HR 1.56, 95% CI 1.00-2.45). However, Haitian children had a lower risk of hospitalization than non-Haitian children (HR 0.61, 95% CI 0.59-0.63). Haitians were less likely to be hospitalized for infectious diseases, allergies, appendicitis, cancers, fractures, dental caries, and ophthalmologic conditions. Hospitalization rates were low throughout childhood, even though Haitian children were more likely to be born preterm, develop severe neonatal morbidity, and have other adverse outcomes at birth. Haitian children have an elevated risk of neonatal morbidity and early childhood mortality, but lower risk of hospitalization compared with non-Haitians in Canada. The reasons for the disparity are unclear, but greater effort is needed to address potential gaps in healthcare among Black children.

Prepregnancy Emergency Department Use and Risks of Severe Maternal and Neonatal Morbidity in Canada

Emergency department (ED) use during pregnancy may be associated with worse obstetrical outcomes, possibly because of differences in access to health care. It is not known whether ED use before pregnancy is associated with serious adverse maternal and perinatal outcomes. To study the association between prepregnancy ED use and adverse maternal and perinatal outcomes. This population-based cohort study was conducted in Ontario, Canada, and included all livebirths and stillbirths from April 2003 to January 2020. Main exposure was any ED encounter within 90 days preceding the start of the index pregnancy. Primary outcome was a composite of severe maternal morbidity (SMM) from 20 weeks' gestation to 42 days' post partum. Secondary outcomes included severe neonatal morbidity (SNM) from 0 to 27 days, neonatal death, and stillbirth. Relative risks (RRs) were adjusted for maternal age, income, and rurality. Of 2 130 245 births, there were 2 119 335 livebirths (99.5%) and 10 910 stillbirths (0.5%). The mean (SD) maternal age was 29.6 (5.4) years, 212 478 (9.9%) were rural dwelling, and 498 219 (23%) had 3 or more comorbidities. Among all births, 218 011 (9.7%) had a prepregnancy ED visit. The rate of SMM was higher among women with a prepregnancy ED visit than those without (22.3 vs 16.5 per 1000 births), with an RR of 1.34 (95% CI, 1.30-1.38) and an adjusted RR (aRR) of 1.37 (95% CI, 1.33-1.42). Compared with no prepregnancy ED visit, the aRR was higher in those with 1 (1.29; 95% CI, 1.24-1.34), 2 (1.51; 95% CI, 1.42-1.61), and 3 or more (1.74; 95% CI, 1.61-1.90) ED visits. Prepregnancy ED visits for a hematological (aRR, 13.60; 95% CI, 10.48-17.64), endocrine (aRR, 4.96; 95% CI, 3.72-6.62), and circulatory (aRR, 2.27; 95% CI, 1.68-3.07) conditions were associated with the highest aRRs for SMM. The rate of SNM was higher among newborns whose mother visited the ED within 90 days before pregnancy (68.2 vs 55.4 per 1000 births; aRR, 1.24; 95% CI, 1.22-1.26) as was the risk of neonatal death (aRR, 1.26; 95% CI, 1.16-1.37) and stillbirth (aRR, 1.18; 95% CI, 1.11-1.25). In this study, ED use was common before pregnancy. These findings suggest that ED use may not only reflect a woman's access to prepregnancy care but also higher future risk of severe maternal and perinatal morbidity, potentially offering a useful trigger for health system interventions to decrease adverse pregnancy outcomes.

Relieving the Burden of Cardiovascular Disease in Canada Using Current Therapies: A Literature Review

Introduction: Cardiovascular disease (CVD) is a leading cause of mortality and morbidity in Canada. In 2016 alone, 91,524 Canadians died of cardiac conditions, strokes, or other vascular cognitive impairments. As a major contributor to reduced quality of life, CVDs are characterized by their effect on the heart or blood vessels and consist of many diseases, including ischemic heart disease, stroke, and heart failure. The established Canadian burden of CVD demands a need for more effective management and reduction of CVD prevalence. This review investigates the current, evidence-based therapies used to combat CVD in patients across Canada. Methods: A literature search was conducted in PubMed using MeSH terms and keywords such as “cardiovascular disease”, “therapy”, “Canada”, and “adult”. Clinical trials and independent studies in English that were published in the last two decades and investigated current therapies for alleviating symptoms or slowing CVD progression were selected and reviewed. Results: Various therapies are used to prevent, manage, or treat CVD, and are often individually reported in literature. However, these therapeutic interventions can be classified into distinct groups such as medication, rehabilitation, lifestyle changes, and surgical devices. Some CVD therapies have been proven to be more effective than others and it is important to apply the findings of these studies to make evidence-based treatment and management decisions. By synthesizing findings about common CVD therapies, a limitation of current literature can be addressed. Discussion: The revision and appraisal of CVD therapies will allow for a more accurate assessment of their clinical applicability, and hence the identification of optimal treatment strategies. Doing so will also improve the feasibility of achieving shared and informed decision-making in a patient-centered care framework. Ultimately, this review can facilitate discussion around cardiovascular health, and provide a comprehensive approach for developing evidence-based health policies targeted towards the global management of CVD. Conclusion: There is a need for evidence-based implementation of therapies to effectively address the burden of CVD. Lack of evidence or knowledge translation will have significant consequences on patient health outcomes. Future research should address other variables such as culture, gender, age, and geography, to expand generalizability

A decade of extreme oscillations in opioid control and availability: implications for public health in a Canadian setting.

We comment on developments in and impacts of medical opioid control and availability in the province of British Columbia (Canada). Population-level dispensing of (strong) prescription opioids doubled in 2005-2011, yet subsequently declined by half 2011-2018 following implementation of various opioid control measures. Notwithstanding this inversion, BC has featured the highest population rates of opioid-related mortality and morbidity in Canada. The erratic opioid availability patterns presumably facilitated major increases in opioid misuse, morbidity, and mortality. Tangible benefits for pain care from increased medical opioid availability remain un-evidenced. Rather, recent decreases in medical opioid dispensing have not been matched by equivalent reductions in demand for (non-)medical use yet have coincided with widespread proliferation of toxic, illicit opioid supply and related major increases in opioid-related mortality. These developments appear to have undermined rather than benefitted public health and offer a poignant case study in ineffective psychotropic drug control and public health policy towards preventing similar experiences elsewhere.

Measuring Maternal Mortality in Canada: An Update on the Establishment of a Confidential Enquiry System for Preventing Maternal Deaths #savingmoms #savingbabies.

A reduction in maternal mortality has traditionally been used as a critical measure of progress in improving maternal health, and the maternal mortality ratio is one of the main indicators of a country's status in the area. In Canada, maternal mortality is infrequent yet devastating. In many cases, there were no interventions that could have saved the mother's life, but in others, there were opportunities for prevention. There is absolute consensus that the upper limit for a preventable maternal death is zero. The World Health Organization's 2010 report indicated a rise in Canada's maternal mortality and prompted the Society of Obstetricians and Gynaecologists of Canada to work with partners to review national maternal mortality surveillance. Since then, efforts have begun and stalled. We are now in the fortunate position to work with experts and provincial leaders to implement a national system of confidential enquiry into maternal deaths and severe maternal morbidity in Canada. Canada's existing data do not tell the true story of maternal deaths; we cannot learn from each death and its circumstance to identify measures for prevention in the future. Dedicated leaders have been working hard to leverage their collective expertise. Recommendations for definitions, processes, knowledge translation tools, and programs that raise awareness about maternal mortality in Canada have been developed and are being piloted. It is anticipated that, with the appropriate support and appropriate leadership, Canada will have the foundation of a national confidential enquiry system into maternal deaths very soon. This is an update on progress.

Global Burden of Disease Study trends for Canada from 1990 to 2016.

The Global Burden of Disease Study represents a large and systematic effort to describe the burden of diseases and injuries over the past 3 decades. We aimed to summarize the Canadian data on burden of diseases and injuries. We summarized data from the 2016 iteration of the Global Burden of Disease Study to provide current (2016) and historical estimates for all-cause and cause-specific diseases and injuries using mortality, years of life lost, years lived with disability and disability-adjusted life years in Canada. We also compared changes in life expectancy and health-adjusted life expectancy between Canada and 21 countries with a high sociodemographic index. In 2016, leading causes of all-age disability-adjusted life years were neoplasms, cardiovascular diseases, musculoskeletal diseases, and mental and substance use disorders, which together accounted for about 56% of disability-adjusted life years. Between 2006 and 2016, the rate of all-cause age-standardized years of life lost declined by 12%, while the rate of all-cause age-standardized years lived with disability remained relatively stable (+1%), and the rate of all-cause age-standardized disability-adjusted life year declined by 5%. In 2016, Canada aligned with countries that have a similar high sociodemographic index in terms of life expectancy (82 yr) and health-adjusted life expectancy (71 yr). The patterns of mortality and morbidity in Canada reflect an aging population and improving patterns of population health. If current trends continue, Canada will continue to face challenges of increasing population morbidity and disability alongside decreasing premature mortality.

Measuring Maternal Mortality and Morbidity in Canada.

Maternal mortality and severe maternal morbidity are devastating for women, their families, and care providers. International efforts have been made to develop and to implement data collection, management, and surveillance systems that capture pregnancy-related information that can be assessed and used to improve health and system outcomes. At present, Canada does not have a national enquiry process to review maternal deaths, severe morbidity, and near misses, and has not set targets for maternal mortality reduction. Maternal mortality rates are critical measures of maternal health and provide important information for analysis of trends and priorities among and within countries. Information about near misses as well as maternal morbidity is crucial to truly understand and to prevent maternal mortality. Canadian experts must work together with governments, provinces, and territories to determine key indicators, measurement, and meaningful data analysis strategies. These data and their comparisons will form the foundation of evidence to guide programs, policies, priorities, and interventions that will ultimately improve the health of mothers and their children.

Evaluating compression or expansion of morbidity in Canada: trends in life expectancy and health-adjusted life expectancy from 1994 to 2010.

The objective of this study was to investigate whether morbidity in Canada, at the national and provincial levels, is compressing or expanding by tracking trends in life expectancy (LE) and health-adjusted life expectancy (HALE) from 1994 to 2010. "Compression" refers to a decrease in the proportion of life spent in an unhealthy state over time. It happens when HALE increases faster than LE. "Expansion" refers to an increase in the proportion of life spent in an unhealthy state that happens when HALE is stable or increases more slowly than LE. We estimated LE using mortality and population data from Statistics Canada. We took health-related quality of life (i.e. morbidity) data used to calculate HALE from the National Population Health Survey (1994-1999) and the Canadian Community Health Survey (2000-2010). We built abridged life tables for seven time intervals, covering the period 1994 to 2010 and corresponding to the year of each available survey cycle, for females and males, and for each of the 10 Canadian provinces. National and provincial trends were assessed at birth, and at ages 20 years and 65 years. We observed an overall average annual increase in HALE that was statistically significant in both Canadian females and males at each of the three ages assessed, with the exception of females at birth. At birth, HALE increased an average of 0.2% (p = .08) and 0.3% (p < .001) annually for females and males respectively over the 1994 to 2010 period. At the national level for all three age groups, we observed a statistically non-significant average annual increase in the proportion of life spent in an unhealthy state, with the exception of men at age 65, who experienced a non-significant decrease. At the provincial level at birth, we observed a significant increase in proportion of life spent in an unhealthy state for Newfoundland and Labrador (NL) and Prince Edward Island (PEI). Our study did not detect a clear overall trend in compression or expansion of morbidity from 1994 to 2010 at the national level in Canada. However, our results suggested an expansion of morbidity in NL and PEI. Our study indicates the importance of continued tracking of the secular trends of life expectancy and HALE in Canada in order to verify the presence of compression or expansion of morbidity. Further study should be undertaken to understand what is driving the observed expansion of morbidity in NL and in PEI.

Evaluation of the Enhanced Invasive Pneumococcal Disease Surveillance System (eIPDSS) Pilot Project.

Invasive pneumococcal disease (IPD) causes significant morbidity in Canada, yet even with routine surveillance, it is difficult to interpret current IPD trends in serotype distribution and antimicrobial resistance. The enhanced Invasive Pneumococcal Disease Surveillance System (eIPDSS) pilot project was designed to facilitate a better understanding of IPD trends at the national level by linking epidemiologic and laboratory (epi-lab) data. To evaluate the eIPDSS by assessing five attributes (usefulness, data quality, simplicity, acceptability and timeliness) and to develop recommendations for future national IPD surveillance. An evaluation was developed that assessed the five key attributes through a qualitative survey sent to eight eIPDSS users as well as a quantitative analysis of the eIPDSS database. Recommendations were based on the results of both the survey and the analysis. The response rate to the survey was 100%. The majority of the survey respondents found the eIPDSS to be useful (75%), simple (100%) and acceptable (86%). Analysis of the eIPDSS database revealed that the majority of IPD cases (61%) were assessed as timely. Data quality and data management mechanisms were identified as issues by both survey respondents and the analysis of the database. Consultation with public health, regular audits and upgrades to the platform are recommended to address data quality and management issues. The epi-lab linked data of the eIPDSS enables the detection and analysis of IPD serotype distribution and antimicrobial resistance trends. This web-based system facilitates data collection and is simple, acceptable and timely. With improvements that address data quality and management issues, it is feasible to develop a national surveillance system that links epi-lab data.

Breast cancer screening disparities among urban immigrants: a population-based study in Ontario, Canada.

BackgroundBreast cancer is one of the leading cause of mortality and morbidity in Canada. Screening is the most promising approach in identification and treatment of the disease at early stage of its development. Research shows higher rate of breast cancer mortality among ethno-racial immigrant women despite their lower incidence which suggests disparities in mammography screening. This study aimed to compare the prevalence of appropriate mammography screening among immigrant and native borne women and determine predicators of low mammography screening.MethodsWe conducted secondary data analyses on Ontario linked social and health databases to determine the proportion of women who were screened during the two- year period of 2010–2012 among 1.4 million screening-eligible women living in urban centres in Ontario. We used multivariate Poisson regression to adjust for various socio-demographic, health care-related and migration related variables.Results64 % of eligible women were appropriately screened. Screening rates were lowest among new and recent immigrants compared to referent group (Canadian-born women and immigrant who arrived before 1985) (Adjusted Rate Ratio (ARR) (0.87, 95 % CI 0.85 –0.88 for new immigrants and 0.90, 95 % CI 0.89–0.91 for recent immigrants. Factors that were associated with lower rates of screening included living in low- income neighborhoods, having a male physician, having internationally- trained physician and not being enrolled in primary care patient enrolment models. Those not enrolled were 22 % less likely to be screened compared to those who were (ARR 0.78, 95 % CI 0.77–0.79).ConclusionTo enhance immigrant women screening rates efforts should made to increase their access to primary care patient enrolment models and preferably female health professionals. Support should be provided to interventions that address screening barriers like language, acculturation limitations and knowledge deficit. Health professionals need to be educated and take an active role in offering screening guidelines during health encounters.

Allergic sensitization in Canadian chronic rhinosinusitis patients

BackgroundChronic rhinosinusitis (CRS) is a societal burden and cause of morbidity in Canada; however, the prevalence of allergic sensitization in Canadian CRS patients has remained poorly characterized.ObjectiveIn this study, we used skin prick test (SPT) and specific immunoglobulin E (sIgE) and G (sIgG) titers to regionally relevant allergen sources in order to determine whether allergic sensitization is more prevalent in CRS patients compared to chronic idiopathic urticaria (CIU) control patients.MethodsOne hundred and fifty eight subjects (19–70 years of age) were recruited into the study. 101 subjects had a confirmed diagnostic history of CRS and 57 subjects with a clinical diagnosis of CIU were recruited as controls. Enrolled subjects underwent SPT to a panel of perennial and seasonal allergens and sIgE titers were quantified to selected environmental allergen mixes (grass, mold, and tree species) using Phadia ImmunoCAP. sIgG was additionally quantified to Alternaria alternata, Aspergillus versicolor, Cladosporium herbarum, and Stachybotrys atra. Differences between CRS and control CIU patient SPT and serological data were examined by chi-squared analysis and analysis of variance.ResultsReactivity to at least one SPT extract occurred in 73% of CRS patients. Positive SPT reactivity to A. alternata (odds ratio (OR): 4.34, 95% confidence interval: 1.57, 12.02), cat (OR: 3.23, 95% CI: 1.16, 9.02), and ragweed (OR: 2.31, 95% CI: 1.02, 5.19) extracts were more prevalent in patients with CRS (p < 0.05). Although dust mite and timothy grass sensitization approached statistical significance in the chi-squared analysis of SPT data, other common perennial and seasonal allergens were not associated with CRS. No statistically significant differences were observed between mean sIgE and sIgG titers in CRS and control patients.ConclusionsThis study supports previous data that suggests A. alternata sensitization is associated with CRS; however, these findings additionally highlight the contribution of other regionally important allergens including cat and ragweed.

Screening, detecting and enhancing the yield of previously undiagnosed hepatitis B and C in patients with acute medical admissions to hospital: a pilot project undertaken at the Vancouver General Hospital.

Hepatitis B virus (HBV) and hepatitis C virus (HCV) represent an increasing health burden and morbidity in Canada. Viral hepatitis, specifically HCV, has high prevalence among persons born between 1945 and 1965, with 45% to 85% of infected adults asymptomatic and unaware of their infection. Screening has been shown to be cost effective in the detection and treatment of viral hepatitis. To quantify incidence and identify undocumented HBV and HCV infection in hospitalized patients at a single centre with secondary analysis of risk factors as part of a quality improvement initiative. A one-time antibody test was conducted in patients admitted to the acute medicine and gastroenterology services. Over a 12-week period, hospital screening for HBV and HCV was performed in 37.3% of 995 admitted patients. There was identification of 15 previously undiagnosed cases of HCV (4%) and 36 undocumented cases of occult (ie, antihepatitis B core antigen seropositive) or active (ie, hepatitis B surface antigen seropositive) HBV (9.7%). Among patients with positive screens, 60% of seropositive HCV patients had no identifiable risk factors. The prevalence of HBV and HCV infection among hospitalized patients in Vancouver was higher than that of the general population. Risk factors for contraction are often not identified. These results can be used as part of an ongoing discussion regarding a 'seek and treat' approach to the detection and treatment of chronic blood-borne viral illnesses.

Cardiac Rehabilitation Series: Canada

Cardiovascular disease is among the leading causes of mortality and morbidity in Canada. Cardiac rehabilitation (CR) has a long robust history here, and there are established clinical practice guidelines. While the effectiveness of CR in the Canadian context is clear, only 34% of eligible patients participate, and strategies to increase access for under-represented groups (e.g., women, ethnic minority groups) are not yet universally applied. Identified CR barriers include lack of referral and physician recommendation, travel and distance, and low perceived need. Indeed there is now a national policy position recommending systematic inpatient referral to CR in Canada. Recent development of 30 CR quality indicators and the burgeoning national CR registry will enable further measurement and improvement of the quality of CR care in Canada. Finally, the Canadian Association of CR is one of the founding members of the International Council of Cardiovascular Prevention and Rehabilitation, to promote CR globally.

Effect of expanded US recommendations for seasonal influenza vaccination: comparison of two pediatric emergency departments in the United States and Canada

Starting in the 2006/2007 influenza season, the US Advisory Committee on Immunization Practices expanded its recommendations for seasonal influenza vaccination to include healthy children aged 24-59 months. The parallel Canadian organization, the National Advisory Committee on Immunization, did not at that time issue a similar recommendation, thereby creating a natural experiment to evaluate the effect of the policy in the United States. We examined data for 2000/2001 through 2008/2009 and estimated relative changes in visits to the emergency department for influenza-like illness at two pediatric hospitals, one in Boston, Massachusetts, and the other in Montréal, Quebec, following the US policy change. Models were adjusted for virologic factors, seasonal trends and all-cause utilization of the emergency department. Of 1 043 989 visits to the emergency departments of the two hospitals for any reason during the study period, 114 657 visits were related to influenza-like illness. Adjusted models estimated a 34% decline in rates of influenza-like illness among children two to four years old in the US hospital relative to the Canadian hospital (rate ratio 0.66, 95% confidence interval 0.58-0.75) following the 2006 policy change of the Advisory Committee on Immunization Practices. This was accompanied by more modest declines of 11% to 18% for the other age groups studied. The divergence in influenza rates among children in the US and Canadian sample populations after institution of the US policy to vaccinate children two to four years of age is evidence that the recommendation of the US Advisory Committee on Immunization Practices resulted in a reduction in influenza-related morbidity in the target group and may have indirectly affected other pediatric age groups. Provincial adoption of the 2010 recommendation of the National Advisory Committee on Immunization in Canada to vaccinate children two to four years of age might positively affect influenza morbidity in Canada.

Maternal Mortality and Severe Maternal Morbidity Surveillance in Canada

The Canadian Perinatal Surveillance System has provided a comprehensive review of maternal mortality and severe maternal morbidity in Canada, and has identified several important limitations to existing national maternal data collection systems, including variability in the detail and quality of mortality data. The Canadian Perinatal Surveillance System report recommended the establishment of an ongoing national review and reporting system, as well as consistency in definitions and classifications of maternal mortality and severe maternal morbidity, in order to enhance surveillance of maternal mortality and severe maternal morbidity. Using review articles and studies that examined maternal mortality in general as opposed to maternal mortality associated with particular management strategies or conditions, maternal mortality and severe morbidity classifications, terminology, and comparative statistics were reviewed and employed to evaluate deficiencies in past and current methods of data collection and to seek solutions to address the need for enhanced and consistent national surveillance of maternal mortality and severe maternal morbidity in Canada.

Knowledge of Breast Cancer and Screening Practices Among Iranian Immigrant Women in Toronto

Breast cancer is a leading cause of mortality and morbidity in Canada. Secondary prevention through screening may enable early identification and treatment, but this is suboptimal among all Canadian women, particularly minority immigrant women. This cross-sectional exploratory study assessed breast health knowledge and practices among Iranian immigrant women residing in Toronto. Our sample included 50 adult women with no history of breast cancer. Results showed that, overall, participants had limited knowledge of breast cancer and screening practices. More than two-thirds had low knowledge scores; 22% did not know that the risk of breast cancer increases with age; about 50% did not know the recommended time interval for screening mammography; 72% did not know how frequently to undergo a clinical breast examination. Length of stay in Canada was associated with self-reported breast health practices. These findings highlight the need to educate Iranian immigrants about the role of screening to promote early identification of breast cancer in the absence of symptoms. Culturally sensitive educational materials should be developed to address their specific needs. Healthcare providers should also be educated about how to communicate breast health information effectively to immigrant women. Opportunistic teaching during each health encounter should be encouraged and reinforced.

Temporal Trends and Regional Variations in Severe Maternal Morbidity in Canada, 2003 to 2007

ObjectiveTo identify temporal trends and regional variations in severe maternal morbidity in Canada using routine hospitalization data. MethodsWe used a previously identified set of International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10CA) and Canadian Classification of Interventions (CCI) codes to estimate rates of severe maternal morbidity in Canada (excluding Quebec) for 2003 to 2007 using the Discharge Abstract Database of the Canadian Institute for Health Information (CIHI). Rates and 95% confidence intervals were calculated by year and within each province and territory and contrasted using the chi-square or Fisher exact test. ResultsThe overall rate of severe maternal morbidity was 13.8 per 1000 deliveries (95% CI 13.6 to 14.0). Five provinces or territories had rates that were significantly higher than those in the rest of the country: Newfoundland and Labrador (19.0 per 1000; 95% CI 17.2 to 20.8), Saskatchewan (16.9 per 1000; 95% CI 15.9 to 18.0), Alberta (15.4 per 1000; 95% CI 14.9 to 15.9), Northwest Territories (22.5 per 1000; 95% CI 18.0 to 27.7), and Nunavut (20.2 per 1000; 95% CI 14.2 to 27.8). Rates of some illnesses declined (e.g., eclampsia rates decreased from 12.4 in 2003 to 5.7 per 10 000 deliveries in 2007, P < 0.001), while others increased (e.g., postpartum hemorrhage with blood transfusion rates increased from 36.6 in 2003 to 44.3 per 10 000 deliveries in 2007, P < 0.001). Interprovincial/ territorial contrasts showed several disparities with respect to specific maternal illnesses. ConclusionThe observed temporal trends and regional disparities in severe maternal morbidity may represent important population health phenomena, and further investigation is required to assess their importance.

Severe Maternal Morbidity in Canada, 2003 to 2007: Surveillance Using Routine Hospitalization Data and ICD-10CA Codes

ObjectiveTo examine the feasibility of using routine labour and delivery hospitalization data and international classification of diseases (ICD-10CA) codes for carrying out surveillance of severe maternal morbidity in Canada. MethodsWe identified ICD-10CA diagnosis codes and Canadian Classification of Interventions (CCI) procedure codes associated with severe maternal illness. Severe maternal morbidity rates in Canada (excluding Quebec) for the period 2003 to 2007 were estimated using the Discharge Abstract Database of the Canadian Institute for Health Information. Rates were compared across maternal age, parity, plurality, labour induction, delivery by Caesarean section, and other factors. Case fatality rates and length of hospitalization were also estimated. ResultsAmong the 1 336 356 women who delivered between 2003 and 2007, the rate of severe maternal morbidity was 13.8 per 1000 deliveries. The mean length of hospital stay for women with and without a severe illness was 5.4 days vs. 2.5 days, while the frequency of prolonged hospital stay (≥7 days) was 19.8% vs. 1.8%, respectively (rate ratio 9.3; 95% CI 9.0 to 9.6). Case fatality rates differed significantly between women with and without a severe illness at 2.98 vs. 0.008 per 1000, respectively (rate ratio 392.8; 95% CI 200.3 to 700.4). Rates of severe maternal morbidity were higher among deliveries to older and nulliparous women and to those delivering twins or triplets. ConclusionDisease frequency, case fatality, and length of hospitalization patterns suggest that comprehensive and timely surveillance of severe maternal morbidity in Canada is feasible using the Canadian Institute for Health Information hospitalization data and ICD-10CA/CCI codes.

Child Injury at home: exploring a connection between household rules about safety, sibling harm and child injury

Child injury is the leading cause of child mortality and morbidity in Canada. Several factors that increase a child's risk of injury have been identified, including but not limited to:...

Illegal drug‐attributable morbidity in Canada 2002

Use of illegal drugs is an important behavioral risk factor for burden of morbidity in developed countries. The objective was to estimate the number of diagnoses in acute care hospitals, psychiatric hospitalizations, admissions in specialized treatment, and number of days in treatment attributable to use of illegal drugs for Canada in 2002. The number of diagnoses in acute care hospitals, psychiatric hospitalizations, and hospital days were obtained from the Canadian Institute for Health Information (CIHI). Number of admissions and number of days in specialized inpatient and outpatient treatment of illegal drug dependency were obtained from provincial ministerial officials or drug addiction program coordinators. Except for effects of maternal use of drugs of addiction on the newborn, and suicide, drug-attributable fractions (DAFs) were estimated directly from available statistics in published literature. There were 61,026 illegal drug-related diagnoses in acute care hospitals, 1,517 psychiatric hospitalizations, and 139,773 admissions to specialized treatment attributable to illegal drug use in Canada. The largest contributors were mental and behavioral disorders due to psychoactive substance use in acute care hospitals, and drug psychoses in psychiatric hospitalizations. Length of stay amounted to 352,121 days in acute care hospitals, 31,508 days in psychiatric hospitals, and 2,851,829 days in specialized treatment. Drug use constitutes a major contributor to burden of morbidity in Canada. Compared to 1992, the total number of illegal drug-attributable days in 2002 increased, especially in acute hospitals by a factor of 9.6. A mixture of prevention and harm reduction measures is proposed to reduce the burden of morbidity associated with drug use.