Provincial Database Research Articles

Pregnancy-Associated MyocardialInfarction in Alberta: A Population-Based Study.

Cardiac disease is the leading cause of maternal mortality in developed countries, and myocardial infarction (MI) is an important cause of pregnancy-associated morbidity and mortality. These infrequent, but very serious, events are not optimally described in the medical literature. This study describes a 15-year consecutive, retrospective cohort of confirmed pregnancy-associated MIs (PAMIs) identified in Alberta, Canada (2003-2017). Utilizing a provincial administrative database, a cohort of women with PAMI were identified using a validated algorithm. Additional cases were identified by reviewing provincial maternal mortality records. Medical record review was conducted on each case with further details obtained via linkage with a provincial coronary heart disease registry. Available angiographic images were also reviewed. Forty-three cases of PAMI were identified in Alberta between 2003 and 2017, providing a crude incidence of ∼5.64/100,000 births. Rates of PAMI increased over the study period. Of the identified MIs, 16.3% occurred antepartum (mean gestational age of 18weeks), while 30.2% were peripartum and 53.4% occurred within 6months postpartum (at a mean of 7.8weeks after delivery). The most common mechanism of PAMI was spontaneous coronary artery dissection (44.2%) and this mechanism predominated postpartum. Coronary artery disease was a frequent antepartum cause of MI, whereas demand ischemia was the leading cause of peripartum MI. Maternal mortality was approximately 9%. PAMI is an increasing cause of maternal morbidity and mortality in Alberta. Clinicians should have a high index of suspicion for PAMI and ensure optimal management of this dangerous complication of pregnancy.

Real-world analysis of the impact of timing of biomarker testing on first-line treatment choice in patients with metastatic colorectal cancer in British Columbia.

253 Background: The treatment landscape for metastatic colorectal cancer (mCRC) has evolved significantly, shifting from chemotherapy alone to more personalized approaches that include immune checkpoint inhibitors and targeted therapies. Treatment decisions in mCRC are driven by molecular characteristics, and current guidelines recommend a minimum standard of biomarker testing, such as mismatch repair (MMR) status, and RAS and BRAF mutations, at the time of metastatic disease diagnosis to guide treatment selection. This study aimed to assess the real-world implementation of biomarker testing in a contemporary cohort of mCRC patients in British Columbia (BC) and its impact on treatment decisions by medical oncologists. Methods: We conducted a retrospective chart review of patients who received first-line systemic therapy for mCRC in BC between January 2022 and December 2023. Patient demographics, tumour characteristics, and treatment details were obtained from the BC Cancer provincial pharmacy database. Medical oncology documentation and pathology reports were reviewed to determine the availability of biomarkers, including MMR status, and RAS and BRAF mutations (OncoPanel), at the time of initial medical oncology consultation, and to assess how these results influenced treatment plan. Results: To date, 71 eligible patients have been identified, with data collection ongoing. Of these, 82% had proficient MMR status, 17% had deficient MMR status, and 1% had incomplete data. RAS mutations were present in 55% of cases, while BRAF mutations were found in 21% (Table). At the time of the initial medical oncology consultation, MMR status was unavailable in 14 patients (20%), two of whom were later found to have deficient MMR status. OncoPanel results were unavailable for 63 patients (88%) at the time of the initial consultation, and in 16 of these cases (25%), the systemic therapy plan was modified once the results were received. Conclusions: Even in contemporary practice with publicly funded biomarker testing, the results for RAS and BRAF mutations were not available at the time of initial medical oncology consultation for most patients. Biomarker testing is an essential tool for guiding therapeutic decisions in mCRC. This subsequently led to treatment plan changes in one-quarter of cases after results were received. These findings highlight the importance of timely biomarker testing to ensure optimal and efficient treatment decision-making for all mCRC patients. Metastatic colorectal cancer biomarker testing. Proficient/WT Deficient/Mutated Incomplete MMR 58 12 1 RAS 29 39 3 BRAF 53 15 3

Increased Respiratory Syncytial Virus-Associated Hospitalizations and Ambulatory Visits in Very Preterm Infants in the First Year of Life following Discontinuation of Access to Palivizumab.

From 2002 to 2023, palivizumab was the only intervention to reduce respiratory syncytial virus (RSV)-associated hospitalizations in high-risk infants in Canada but advances in RSV prevention are drastically changing this landscape. Eligibility criteria for this monoclonal antibody for preterm infants varied over time across each of 10 Canadian provinces and 3 territories. The National Professional Pediatric Association (Canadian Pediatric Society) revised its eligibility recommendations in 2015, removing access for preterm infants 30 to 32 weeks gestation (WG). The province of Nova Scotia followed these recommendations the next season. This study aimed to determine if the removal of access to palivizumab in these previously eligible infants was associated with a change in hospital admissions, deaths, or ambulatory visits associated with RSV. We identified a retrospective cohort of Nova Scotia infants born between 30 and 32 WG, without other risk factors for RSV-H, from April 2012 to September 2019 by linking six population-based provincial databases, and followed each infant through the first year of life. Episodes of RSV-associated hospitalization (RSV-H), ambulatory visits (RSV-A), or death were identified by the International Statistical Classification of Diseases and Related Health Disorders (ICD) RSV-associated diagnostic codes. Of 4,835 infants born during the study period, 250 were 30 to 32 WG and eligible for the cohort. RSV-H increased approximately 10-fold following restricted access to palivizumab (from no RSV-H (0/123) to 9.4%; 95% CI 5.0, 15.9; risk difference 9.4), but no RSV-associated deaths occurred. RSV-A also increased from 5.7 to 17.3% (risk difference 11.6). Discontinuation of access to a prophylactic anti-RSV monoclonal antibody in very preterm infants was associated with a higher risk of RSV-H and RSV-A. Evaluation of health care policy change on patient well-being is essential to assess the impact and guide future decision-making at the population level. · Discontinuation of access to a prophylactic anti-RSV monoclonal antibody in very preterm infants 30 to 32 WG was associated with a higher risk of RSV-H and RSV-A. Evaluation of changes to health care policy on patient well-being is essential to assess impact and guide future decision-making at the population level.. · Removing access to palivizumab led to higher RSV admissions in 30 to 32 WG infants.. · The effect of health care policy changes on child well-being should be assessed routinely.. · No deaths associated with RSV were identified prior to or after the policy change..

Specialty-specific Evaluation of Virtual care Outcomes: A retrospective QUality and safety analysis (S-EVOQUe).

The objective was to compare specialty-specific 7- and 30-day outcomes between virtual care visits and in-person visits which occurred during the SARS-CoV-2 pandemic. Using administrative data from provincial databases in Ontario, ambulatory care visits occurring virtually and in-person during specific timeframes within the pandemic were analyzed. Virtual care visits were matched with corresponding in-person visits based on multiple baseline patient characteristics. We assessed short-term patient outcomes at 7 and 30 days, including subsequent visits, hospital and ICU admissions, surgeries, and mortality and compared them using multivariate logistic regression. Odds ratios were calculated as measures of association between populations. For statistical significance, we used 99% confidence intervals to account for the increased likelihood of chance findings due to the multiple comparisons conducted. Overall, 9,340,519 visits were compared between populations using a 1:1 match on a 20% random sample of the available eligible visits. Over 70% of patients included were seen by a General Practitioner. With few exceptions and across almost all specialties, revisits, ED visits, admissions, ICU and OR use, and mortality were found to be more frequent for patients seen in person. When using the administrative data available to policy makers, there is no evidence to suggest that, in the short-term, virtual care is less safe than in person care. The causes for worse in-person outcomes are not yet clear although are likely related to the streaming of more acutely unwell patients towards in-person care.

636. Pneumocystis Pneumonia Outcomes in Solid Organ Transplant Recipients and Patients Living with HIV: A Population-Based Study Over 20 Years (2002-2022) in Ontario, Canada

Abstract Background While it is well established that HIV-positive and non-HIV immunocompromised patients are susceptible to Pneumocystis pneumonia (PCP), comparing PCP outcomes between patients with different underlying immunocompromising conditions is critically important to optimize chemoprophylaxis strategies. Methods In this population-based cohort, we determined contributing factors to 90-day all-cause mortality following PCP diagnosis among patients living with HIV (PLWH) and solid organ transplant recipients (SOTRs) hospitalized in Ontario, Canada between Apr/1/2002 and Dec/31/2022. We linked data from provincial health administrative databases using unique encoded identifiers and included all adult patients hospitalized with PCP based on diagnostic codes from hospital discharge abstracts. We used logistic regression models to estimate unadjusted and adjusted odds ratios (uOR and aOR) and 95% confidence intervals (95%CI) for the associations between underlying immunocompromising conditions and PCP outcomes. Results A total of 879 patients were hospitalized with PCP, including 121 SOTRs (13.7%) and 758 PLWH (86.2%). 90-day mortality rates were 19.8% in SOTRs and 13.2% in PLWH. In the unadjusted model, 90-day mortality was not significantly associated with organ transplantation (OR=1.58; 95%CI, 0.96-2.62) or HIV infection (OR=0.62; 95%CI, 0.38-1.03). Comparing HIV patients to liver SOTRs, liver SOTRs experienced higher mortality (uOR=8.54, 95%CI=3.11-23.46). In the adjusted model, liver transplantation was associated with an increased risk of 90-day mortality (aOR=4.36; 95%CI, 1.40-13.59). Among SOTRs, in the unadjusted analysis, liver transplant recipients had an increased risk of 90-day mortality (uOR=9.18; 95%CI, 3.00-28.09). Conclusion Among SOTRs, liver transplant recipients are at particularly higher risk of mortality following PCP diagnosis. Our findings may prompt a re-evaluation of current PCP prophylactic strategies in liver transplant patients. Disclosures All Authors: No reported disclosures

Describing COVID-19 immunizations for First Nations people on-reserve in Alberta using real-time integration of point of care and provincial data.

COVID-19 profoundly impacted First Nation peoples. Historically, records of on- and off-reserve vaccine delivery have been fragmented. For the first time in Canada, we aimed to describe complete immunization rates, on- and off-reserve vaccine delivery, for COVID-19 in Alberta, Canada among First Nations on-reserve. Fifteen First Nations in Alberta, Canada participated in this prospective, descriptive cohort study whereby real-time integration (RTI) was deployed to reconcile COVID-19 vaccine delivery records on-reserve (local database) to those reported off-reserve (provincial database) between January 3, 2021-December 1, 2022. Immunization data (individuals ≥6months) were aggregated into 100 one-week intervals. Weekly immunization rates were assessed by age, sex, community size, and location of vaccine administration (on- or off-reserve) using multiple linear regressions and chi2 tests. 50,758 First Nation people were included, approximately 50% of whom were female. RTI data showed that 64% received at least one dose of vaccine with higher rates in older First Nation adults. No sex differences were observed. Nearly half received their first dose off-reserve and would have been missed by local public health on-reserve (local database) without the implementation of RTI. First dose immunization rates rapidly increased with graduated First Nation-specific eligibility and provincial incentives promoting uptake (p<0.001). We accurately assessed complete immunization rates among First Nation people receiving services on-reserve irrespective of delivery of immunizations on- or off-reserve through deployment of an innovative RTI approach. Without these RTI advances, immunization rates would have been substantially under-reported and may have misdirected public health initiatives around vaccine uptake. RTI should be a priority for all provinces in Canada to ensure accurate coverage rates for First Nation people.

Characterizing the services provided by family physicians in Ontario, Canada: A retrospective study using administrative billing data.

Family physicians in Ontario provide most of the primary care to the healthcare system. However, given their broad scope of practice, they often provide additional services including emergency medicine, hospital medicine, and palliative care. Understanding the spectrum of services provided by family physicians across different regions is important for health human resource planning (HHRP). We investigated the services provided by family physicians in Ontario, Canada using a provincial physician database and administrative physician billing data from 2017. Billing codes were used to define 18 general services that family physicians may provide. We then evaluated variation in the services provided by different physicians based on the physicians' geographic location (north-urban, north-rural, south-urban, and south-rural) and career stage (i.e., years in practice). Ontario had 14,443 family physicians in 2017, with most practicing in urban communities in southern Ontario and only 6.5% practicing in any setting in northern Ontario. In general, rural physicians provided a greater range of services than their urban colleagues. Their practices most often included clinic medicine, mental health services, emergency medicine, palliative care, and hospital medicine. Physicians in urban southern Ontario and those at a more advanced career stage were more likely to provide a narrower range of services. Overall, our findings have the potential to shape HHRP, medical education curriculum development, and clinical services planning in Ontario and elsewhere. Moreover, our results provide policy- and decision-makers with a basis for integrating knowledge of the specific clinical services delivered by family physicians into their future planning, with the goal of ensuring a fit-for-purpose workforce able to meet community healthcare needs.

Trends in Real-World Clinical Outcomes of Patients with Anaplastic Lymphoma Kinase (ALK) Rearranged Non-Small Cell Lung Cancer (NSCLC) Receiving One or More ALK Tyrosine Kinase Inhibitors (TKIs): A Cohort Study in Ontario, Canada.

The treatment landscape for patients with advanced ALK-positive NSCLC has rapidly evolved following the approval of several ALK TKIs in Canada. However, public funding of ALK TKIs is mostly limited to the first line treatment setting. Using linked provincial health administrative databases, we examined real-world outcomes of patients with advanced ALK-positive NSCLC receiving ALK TKIs in Ontario between 1 January 2012 and 31 December 2021. Demographic, clinical characteristics and treatment patterns were summarized using descriptive statistics. Kaplan-Meier analysis was performed to evaluate progression-free survival (PFS) and overall survival (OS) among the treatment groups. A total of 413 patients were identified. Patients were administered alectinib (n = 154), crizotinib (n = 80), or palliative-intent chemotherapy (n = 55) in the first-line treatment. There was a significant difference in first-line PFS between the treatment groups. The median PFS (mPFS) was not reached for alectinib (95% CI, 568 days-not reached), compared to 8.2 months (95% CI, 171-294 days) for crizotinib (HR = 0.34, p < 0.0001) and 2.4 months (95% CI, 65-100 days) for chemotherapy (HR = 0.14, p < 0.0001). There was no significant difference in first-line OS between the treatment groups. In patients who received more than one line of treatment, there was a significant difference in mOS between patients who received two or more lines of ALK TKIs compared to those who received one line of ALK TKI (mOS = 55 months (95% CI, 400-987 days) and 26 months (95% CI, 1448-2644 days), respectively, HR = 4.64, p < 0.0001). This study confirms the effectiveness of ALK TKIs in real-world practice and supports the potential benefit of multiple lines of ALK TKI on overall survival in patients with ALK-positive NSCLC.

Increased prehospital mortality in patients with combined burns and trauma in Canada: Analysis of a provincial trauma registry database.

The combination of burns and non-thermal trauma may have a synergistic effect on mortality. Our objective was to determine if burn patients with concomitant trauma are at increased risk of mortality in both the prehospital and in-hospital settings. Data were collected from a population-based provincial trauma registry (2001-2019). Characteristics and outcomes of patients with trauma/burns were compared to isolated burn patients using t-tests, chi-square analysis and Fisher's exact tests. Risk ratios (RRs) were calculated to evaluate the impact of concomitant trauma on mortality, stratified by % total body surface area (TBSA) and injury severity score (ISS). Firth's penalized maximum likelihood estimation (PMLE) approach was used to fit multivariable logistic regression models to the outcomes of prehospital mortality and in-hospital mortality. Of 436 burn patients, 29.8 % (130/436) had combined trauma/burns. Prehospital mortality in the trauma/burns group was 57.7 % (75/130) versus 43.1 % (132/306) in isolated burn patients. Prehospital mortality risk was highest in trauma/burn patients with % TBSA ≥ 70 (RR 3.87, 95 % CI 2.99-4.99) or ISS ≥ 25 (RR 2.49, 95 % CI 1.84-3.36). Concomitant trauma was associated with increased odds of prehospital mortality (OR 2.42, 95 % CI 1.27-4.69), but had no impact on in-hospital mortality. Prehospital mortality was increased in patients with combined burns and trauma.

Estimating Potential Eligibility for Disease Modifying Therapies for Alzheimer’s Disease Using Population‐Based Data in Alberta, Canada

AbstractBackgroundDisease modifying therapies (DMTs) for Alzheimer’s disease (AD) have been approved in some countries although these treatments will require substantial health resources for their implementation. Initial capacity planning to identify the resources required to support DMTs begins with estimating the number of people with dementia who may be eligible for DMTs. We estimated the potential number of individuals with dementia who are eligible for DMTs using population‐based data in Alberta, Canada.MethodWe used provincial administrative health databases in Alberta, Canada (population ∼4.5 million) to identify all people newly identified with dementia between April 1, 2013 and March 31, 2022 using a validated dementia case ascertainment algorithm. The characteristics of this population were then described at the time of diagnosis including demographics, conditions potentially contributing to the diagnosis of dementia (e.g. stroke, parkinsonism), and medical contraindications to treatment (e.g. cancer, seizures). The characteristics of individuals with dementia were then compared to the inclusion criteria used in AD DMT trials to estimate the proportion of individuals with dementia who may be eligible for DMTs. We then compared the characteristics of individuals who were determined to be eligible for DMTs compared to those who were not eligible.ResultA total of 77,479 individuals were identified with incident dementia during the study period with a mean age of 80.6 years and 58% were female. In this group, 15,044/77,479 (19%) had conditions other than AD as a potential cause of their dementia. Medical contraindications to DMTs were present in 24,580/62,435 (39%) of all individuals who had AD as their probable cause of dementia. Overall, 37,855/77,479 (49%) of the entire dementia population could potentially go on to receive biomarker testing to determine DMT eligibility. Individuals who were younger and women were more likely to be potentially eligible for DMTs at the time of dementia diagnosis.ConclusionApproximately half of all people diagnosed with dementia in Alberta could be eligible for DMTs based on their health history. Additional information on cognitive test scores, neuroimaging, and biomarker results are required to further refine estimates of the number of individuals potentially eligible to receive DMTs in Canada.

Monitoring inequities using routine administrative data: a case study of cancer screening in Ontario, Canada

Abstract Routine cancer screening is a critical primary care service to reduce cancer morbidity and mortality, through early detection, diagnosis, and treatment. We evaluated longitudinal changes in socioeconomic inequities in cancer screening in Ontario, Canada, by using linked provincial health administrative databases including 15.9 million records eligible for cancer screening. The rate of colorectal cancer screening increased between 2011 and 2020 (54% to 62%) with a reduction in the indices of inequity (slope index, SII: from 0.36 to 0.33; relative index of inequity, RII: from 0.69 to 0.54). However, the rate of cervical cancer screening decreased (from 76% to 68%), particularly in deprived areas (RII increasing from 0.47 to 0.54). Access to cancer screening is a challenge in deprived areas. Understanding the socio-economic determinants in access to screening across the life course can help develop tailored interventions to increase health equity.

Prosthesis-patient mismatch is associated with long-term mortality following surgical aortic valve replacement

Abstract Background Prosthesis-patient mismatch (PPM) refers to a situation where the indexed effective orifice area (iEOA) of an implanted prosthetic valve is too small relative to the patient's body size, resulting in hemodynamic compromise. Studies examining the long-term consequences of PPM after surgical aortic valve replacement (SAVR) have yielded conflicting results. Purpose To evaluate the impact of PPM on long-term outcomes in patients undergoing primary isolated SAVR. Methods All patients who underwent isolated first-time SAVR from 1990-2014 were included in this observational, single-center study. PPM was defined as a predicted iEOA &amp;lt;0.85 cm2/m2 and severe PPM was defined as an iEOA &amp;lt;0.65 cm2/m2. Patient demographics, surgical details, and in-hospital outcomes were prospectively collected in our institutional database. Cases were linked to provincial administrative databases at an independent, non-profit research institute whose legal status allows it to collect and analyze health care and demographic data. The primary outcome of interest was all-cause mortality. Secondary outcomes were aortic valve reoperation (surgical or transcatheter) and post-operative hospitalization for heart failure. Multivariable Cox regression analysis identified risk factors for long-term mortality. Kaplan-Meier curves were generated for long-term survival and cumulative incidence functions for aortic valve reoperation and heart failure hospitalization. Results A total of 1,798 patients were included (no PPM: 770 [43%]; moderate PPM: 943 [52%]; and severe PPM: 85 [5%]). Mean age was 64±13 years, and 750 (42%) were female. 451 (25%) patients received a mechanical valve, and 1347 (75%) received a stented bioprosthetic valve. Concomitant aortic root enlargement was performed in 492 (27%) patients. At 20 years, survival was 47.8% (95% CI: 43.2%–52.2%) in the "no PPM group" compared with 29.5% (95% CI: 25.6%–33.5%) and 24.7% (95% CI: 12.7%–38.8%) in the moderate and severe PPM groups, respectively (p&amp;lt;0.001) (Figure 1). On multivariable analysis, iEOA was independently associated with long-term mortality (HR 0.95 per 0.10 increase in iEOA, 95% CI [0.91–0.98]; p=0.007). In a pre-specified subgroup analysis, iEOA was found to be associated with late mortality in patients younger than 65 years (p&amp;lt;0.001) but not in patients 65 years and older (p=0.23). Readmission for heart failure was more frequent among patients who had PPM than those who did not (Figure 2). There was no difference in aortic valve reintervention in patients with or without PPM (p=0.654). Conclusions Prosthesis-patient mismatch is common after SAVR and is associated with late mortality and hospitalization for heart failure. The deleterious impact of PPM on survival appears more pronounced in young patients. These findings may have important implications for the lifetime management of patients with aortic valve disease.Survival post SAVRHeart failure hospitalization post SAVR

38 Disparities in health outcomes by the age of five among preterm children in rural versus urban communities in British Columbia

Abstract Background Health disparities exist between than urban and rural communities, as rates of preterm birth, severe maternal morbidity and severe neonatal morbidity are higher in rural areas. There are limited population-based studies on early childhood health outcomes among those born preterm by geographical area. Objectives To compare health service use, morbidity, and medication use for up to five years of age between preterm children in rural versus urban residences. Design/Methods The study included liveborn infants at 22-44 weeks’ gestational age (GA) in British Columbia (BC), Canada, 2004-2014. Follow-up data to December 2019 included linked health information from four provincial databases (perinatal database, outpatient visits, hospitalizations, and outpatient prescriptions). Urban-rural status was based on maternal residence at birth. Rate ratios (RR) of health service use, childhood morbidity and medication use were compared within GA categories (22-27, 28-33, 34-36, 37-44) by rural vs. urban region using Poisson regression. Results There were 49,555 (10.9%) rural and 406,149 (89.1%) urban children included in this study. 42,789 children were born at &amp;lt;37 weeks GA, and the preterm birth rate was 9.4%. Compared to urban areas, children in rural regions had more hospitalizations (28-33 weeks: RR 1.35, 95% CI: 1.19-1.51; 34-36 weeks: RR 1.35, 95% CI 1.27-1.44; 37-44 weeks: RR 1.32, 95% CI 1.29-1.34) by five years of age; and significantly fewer outpatient visits (22-27 weeks: RR 0.90, 95% CI: 0.87-0.93; 28-33 weeks: RR 0.81, 95% CI: 0.80-0.82; 34-36 weeks: RR 0.75, 95% CI 0.74-0.75; 37-44 weeks: RR 0.71, 95% CI 0.71-0.71). Rural children born at 34-36 weeks had significantly higher rates of bronchiolitis (RR: 1.35, 95% CI: 1.16-1.56) compared to urban children. They were prescribed more antibiotics and bronchodilators (RR: 1.15, 95% CI: 1.13-1.17, and RR: 1.12, 95% CI: 1.05-1.19, respectively). Conclusion Compared with urban areas, preterm children living in rural regions of BC had higher rates of hospitalization, higher rates of bronchiolitis and more frequent prescriptions of antibiotics and bronchodilators by five years of age. These disparities in health status and service use warrant further research and public health interventions.

56 Iron deficiency is common in extreme preterm infants despite prophylactic iron supplementation

Abstract Background Iron deficiency (ID) in childhood is linked to adverse neurodevelopmental outcomes in the long-term. Extremely premature infants (EPI; born &amp;lt; 28 weeks gestation) are more susceptible to ID due to a multitude of factors including lower iron reserves at birth, rapid growth, immature erythropoiesis, and multiple phlebotomy tests during hospital stay. Therefore, professional societies advise prophylactic iron therapy for these infants from 2-6 weeks age until 6-12 months. However, there is paucity of data on the iron status in EPI receiving this prophylactic iron supplementation. Objectives To investigate the prevalence and risk factors associated with ID in EPI. Design/Methods A retrospective cohort study analyzed a Provincial database of EPIs born between 2005-2018. Infants with congenital malformations, chromosomal anomalies and blood disorders were excluded. All included infants received prophylactic iron supplementation from 2-4 weeks of chronological age that was recommended to continue at discharge until 9-12 months corrected age (CA). At 4-6 months CA, these infants underwent blood testing. ID was defined as serum ferritin &amp;lt; 20mcg/L at 4 months CA or SF &amp;lt; 12mcg/L at 6 months CA. Through a univariate analysis using single-variable logistic regression, factors linked to ID were identified. Those with a p-value &amp;lt; 0.20 progressed to a multivariable model, retaining variables with a p-value &amp;lt; 0.05. Results Of 146 infants, 45.9% had ID. ID group had lower mean ferritin (16.4 µg/L vs 50.0 µg/L, p &amp;lt; .001) and reticulocyte hemoglobin equivalent (28.4pg vs 31.6pg, p &amp;lt; .001) compared to the non-ID group. ID prevalence reduced from 59.7% in 2005-2011 to 40.3% in 2012-2018 cohort. Exclusive or partial breastfeeding at 4-6 months CA was protective against ID (Odds: 0.2, p = 0.003). Iron therapy at 4-6 months CA was not protective in the final model. Notably, 27.4% stopped iron therapy before 4-6 months CA, and exclusive formula-fed infants had notably lower iron intake than breastfed infants (66.1% vs 99.1%, p = 0.006). Conclusion Nearly half of the EPI exhibited ID at 4-6 months CA despite prophylactic iron supplementation. About a quarter discontinued therapy before reaching this age. Breastfeeding at this age was protective against ID. This high prevalence of ID in EPI underscores the need of future studies to discern strategies to mitigate ID in this vulnerable population.

67 A population-based cohort study of endocrine outcomes within the first 5 years of life in children born preterm

Abstract Background Preterm birth (&amp;lt;37 weeks’ gestational age [GA]) occurs in 8% of live births in Canada. While advancements in neonatal medicine have led to increased survival in preterm births, infants born preterm continue to sustain short- and long-term health sequelae. There is paucity of large population studies evaluating childhood health care outcomes, including endocrine-related outcomes, in recent birth cohorts. Objectives To evaluate the rates of endocrine conditions during the first 5 years of life in children born preterm and term. Design/Methods The study cohort included liveborn infants at 22-44 weeks’ GA in British Columbia, Canada between 2004-2014. Follow-up data to December 2019 included linked health services use information from four BC provincial databases (perinatal database, hospitalizations, outpatient services, and outpatient prescriptions). Rates of outcomes were compared by GA at birth (37-44 weeks reference category) using robust Poisson regression. Results There were 455,960 children included in this study with 42,820 (9.4%) born at &amp;lt;37 weeks GA. Results are summarized in Table 1 and Table 2. Compared to children born at 37-44 weeks’ gestations, infants born at 36 weeks’ gestation or younger have an increased rate of thyroid disorders between 0 months and 5 years (rate ratio [RR]: 1.45, 95% confidence interval [CI]: 0.78-2.43; RR: 1.83, 95% CI 1.51-2.20; RR: 1.41 95% CI 1.26-1.57 for 22-27 weeks, 28-33 weeks and 34-36 weeks GA, respectively). Similarly, infants born at 36 weeks’ gestation or younger have a higher rate of conditions in growth and development (RR: 3.05, 95% CI: 0.76-7.96; RR: 3.20, 95% CI 2.04-4.76; RR: 1.42 95% CI 1.02-1.94 for 22-27 weeks, 28-33 weeks and 34-36 weeks gestations, respectively) and bone health conditions (RR: 1.38, 95% CI: 1.27-1.49; RR: 1.04, 95% CI 1.00-1.08; RR: 1.05 95% CI 1.03-1.07 for 22-27 weeks, 28-33 weeks and 34-36 weeks gestations, respectively). There was no difference in rates of conditions related to glucose metabolism such as diabetes mellitus or hypoglycemia. Conclusion Children born preterm have increased rates of endocrine conditions by age 5. Disorders of thyroid, growth and development are increased in infants born preterm. Children born preterm have an increase rate of bone-related disorders, including those born late-preterm. These results provide useful prognostic information for follow-up care for preterm children and for healthcare resource planning. Furthermore, these results highlight areas of future research in endocrine health among preterm infants.

Vaginal Uncomplicated Delivery Rate as a Quality Indicator Compared to Cesarean Delivery Rate: A Quantitative Analysis of a Population Database

ObjectivesThe objective of this study is to compare the vaginal uncomplicated delivery (VUD) rate, defined as all vaginal deliveries (including forceps and vacuum) without an adverse maternal or neonatal labour outcome, to the cesarean delivery (CD) rate, as a performance indicator. MethodsThis is a retrospective cohort analysis from a provincial database of all term deliveries by an obstetrician in a single year, excluding diagnoses preventing active labour. Most obstetricians in this jurisdiction practice consultative obstetrics, focused on supporting primary maternity care. We investigated the association of adverse delivery (AD), measured by the adverse outcome index, with CD and VUD rates. ResultsWe report 16 620 deliveries by 210 obstetricians, with a vaginal delivery rate of 39.6%, of which 36.6% were operative vaginal delivery. The overall AD rate was 9.9%, and the overall VUD rate was 34%. While the CD and VUD both correlated with the mode of delivery, only the VUD rate was correlated to the AD rate. ConclusionsQuality assurance in obstetrics must balance the needs of 2 patients based on limited data. Our data shows the shortcomings of the prevailing performance indicator, CD rate, which does not correlate with birth outcomes for the pregnant patient or infant. The VUD rate provides an alternative that assesses both mode of delivery and labour outcomes. Shifting the quality lens to focus on the VUD rate will provide a better metric that measures optimal outcomes for pregnant people and their babies.

Metabolic, cardiac, and bone health testing in patients with prostate cancer on androgen-deprivation therapy: A population-based assessment of adherence to therapeutic monitoring guidelines.

Androgen-deprivation therapy (ADT) remains a cornerstone in treatment for patients with advanced prostate cancer. ADT is associated with several adverse effects, including osteoporosis, metabolic syndrome, and cardiovascular events, leading to guidelines recommending routine testing to monitor for these toxicities. There is a lack of data assessing adherence to these recommendations. The authors conducted a retrospective cohort study using administrative data from Ontario, Canada between 2008 and 2021. They identified all older men (aged 65 years and older) who received ADT for prostate cancer using comprehensive provincial health databases. The primary outcomes were the use of testing for lipids, dysglycemia (glucose), bone health serum, and bone density between 6 weeks before and 1 year after the initiation of ADT. In total, 29,097 patients were examined, of whom 52.8% were prescribed ADT by urologists, 37.9% were prescribed ADT by radiation oncologists, 2.8% were prescribed ADT by medical oncologists, and 2.4% were prescribed ADT by other physicians. Adherence to guidelines was low: only 21.3% of patients received a bone density scan, 41.2% underwent bone health-related serum tests, 51.3% completed a lipid profile, and 65.9% underwent dysglycemia testing within 1 year of diagnosis. Overall, only 11.9% of patients received all of the recommended investigations. Adherence to testing did not appear to improve over time (2008-2021) or with guideline publication. Patient (age) and physician (specialty) factors had important associations with adherence to testing. Most patients receiving ADT for prostate cancer do not receive recommended testing to monitor for treatment-related toxicity. Further study is required to address barriers to therapeutic monitoring of men on ADT and to reduce treatment-associated adverse events.

Three Versus Six Months of Adjuvant Oxaliplatin-Containing Chemotherapy for Patients With Stage III Colorectal Cancer: A Contemporary Real-World Analysis.

Based on the International Duration Evaluation of Adjuvant Chemotherapy analysis, 3 months of adjuvant chemotherapy with capecitabine and oxaliplatin (CAPOX) is an option for stage III colorectal cancer (colorectal cancer [CRC]), with cost and toxicity benefits. We examined the patterns of uptake of CAPOX versus fluorouracil, leucovorin, and oxaliplatin (FOLFOX) and chemotherapy duration in a contemporary real-world cohort of patients in Canada. The provincial pharmacy database was used to identify patients with resected stage III CRC receiving adjuvant chemotherapy between January 2021 and December 2022. Demographic, tumor, and treatment information was collected and compared. Of 452 patients, 234 (52%) and 218 (48%) were planned to receive 3 and 6 months of chemotherapy, respectively. Within the 3-month group, 226 (97%) received CAPOX. Within the 6-month group, there was a 51%-49% split between CAPOX and FOLFOX. Age >70 years (P = .039), well/moderately differentiated (P = .005), and low-risk disease (P < .0001) were significantly associated with 3 months. Performance status, ileostomy, or preexisting neuropathy did not affect treatment choice. Of patients planned for 6 months, 29% had low-risk disease, with 52% of these receiving CAPOX. Patients receiving 6 months were more likely to report neuropathy (68 v 36%, P < .0001) and to stop oxaliplatin early (54 v 31%, P < .0001). The most likely reason for early adjuvant discontinuation was neuropathy in the 6-month group and gastrointestinal toxicity in the 3-month group (P < .0001). Irrespective of duration, mean time from consult to starting chemotherapy was longer for FOLFOX versus CAPOX (24 v 19 days, P = .007). In this contemporary cohort, 6 months chemotherapy is still being offered to patients with low-risk disease and is associated with more neuropathy. Exploration of patient preferences and resource costs may improve adoption of reduced duration adjuvant CAPOX in stage III CRC.

Increased access to pediatric specialist healthcare using eConsult: A retrospective observational cohort and case–control study

ABSTRACT Objectives Primary care practitioners (PCPs) report that using the Champlain BASE™ eConsult service (eConsult) averts one-third of face-to-face (FTF) specialist referrals, however, there are concerns about duplication of services and adverse patient outcomes. Following an eConsult, we evaluated patient healthcare utilization and associated treatment costs. Methods Retrospective cohort study (2014 to 2018) of patients (&amp;lt;18 years old) for whom an eConsult visit averted a FTF specialist referral. Patients were linked to provincial health administrative databases and hospital electronic medical records for healthcare use for the same diagnosis and specialty for the 18 months following the eConsult. Concurrently, a retrospective case–control study compared utilization and costs between an eConsult versus a matched FTF visit for the same diagnosis. We also assessed PCP satisfaction. Results In follow-up, &amp;lt;5% of the study cohort of eConsult patients (n = 242) later accessed the healthcare system for the identical diagnosis and specialty type. FTF visits generate more frequent outpatient visits (12.6 times more [95% CI: 2.28 to 69.66, P = 0.002]) and higher costs compared to eConsult visits. There were no hospital admissions or deaths in patients with eConsult. PCPs (98%) described eConsult as an excellent service. Conclusions Using eConsult is associated with &amp;lt;5% of patients subsequently having a FTF visit for the same reason. Matched FTF visits generated more healthcare utilization and higher costs compared with eConsult. eConsult in pediatrics is safe and can minimize FTF specialist visits in elective cases and increase capacity, towards a more efficient and cost-effective healthcare system.

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.