Quebec Population Research Articles

Gene-by-environment interactions in urban populations modulate risk phenotypes

Uncovering the interaction between genomes and the environment is a principal challenge of modern genomics and preventive medicine. While theoretical models are well defined, little is known of the G × E interactions in humans. We used an integrative approach to comprehensively assess the interactions between 1.6 million data points, encompassing a range of environmental exposures, health, and gene expression levels, coupled with whole-genome genetic variation. From ∼1000 individuals of a founder population in Quebec, we reveal a substantial impact of the environment on the transcriptome and clinical endophenotypes, overpowering that of genetic ancestry. Air pollution impacts gene expression and pathways affecting cardio-metabolic and respiratory traits, when controlling for genetic ancestry. Finally, we capture four expression quantitative trait loci that interact with the environment (air pollution). Our findings demonstrate how the local environment directly affects disease risk phenotypes and that genetic variation, including less common variants, can modulate individual’s response to environmental challenges.

The economic benefits of reducing cardiovascular disease mortality in Quebec, Canada.

ObjectivesWe assess how different scenarios of cardiovascular disease (CVD) prevention, aimed at meeting targets set by the World Health Organization (WHO) for 2025), may impact healthcare spending in Quebec, Canada over the 2050 horizon.MethodsWe provide long-term forecasts of healthcare use and costs at the Quebec population level using a novel dynamic microsimulation model. Using both survey and administrative data, we simulate the evolution of the Quebec population’s health status until death, through a series of dynamic transitions that accounts for social and demographic characteristics associated with CVD risk factors.ResultsA 25% reduction in CVD mortality between 2012 and 2025 achieved through decreased incidence could contain the pace of healthcare cost growth towards 2050 by nearly 7 percentage points for consultations with a physician, and by almost 9 percentage points for hospitalizations. Over the 2012–2050 period, the present value of cost savings is projected to amount to C$13.1 billion in 2012 dollars. The years of life saved due to improved life expectancy could be worth another C$38.2 billion. Addressing CVD mortality directly instead would bring about higher healthcare costs, but would generate more value in terms of years of life saved, at C$69.6 billion.ConclusionsPotential savings associated with plausible reductions in CVD, aimed at reaching a World Health Organization target over a 12-year period, are sizeable and may help address challenges associated with an aging population.

Utilisation des bases de données médico-administratives du Québec pour des études en santé mentale : opportunités, défis méthodologiques et limites – cas de la dépression chez les personnes diabétiques

The use of medico-administrative databases for studies on mental health issues is very common because of the large number of people in these databases and the possibility to carry out long-term studies. Several challenges, such as identifying people with a disease of interest or being exposed to a risk factor, have to be overcome through validation studies to ensure an optimal use of these resources. Moreover, limits (lack of certain relevant information) and the coverage of about 40% of Quebec's population by the public drug plan are to be considered in the interpretation and generalization of research results based on these data sources. In the specific case of depression, we used these databases to determine the incidence of depression among diabetic individuals in Quebec. This required the use of a previously validated algorithm (validated in another province) that we modified to define and identify the cases of depression in the RAMQ databases. We observed an incidence of depression of 9.47 persons years over a follow-up of 8 years. Finally, we assessed the impact of depression on adherence and persistence with antidiabetic drugs as well as the factors that affect patients' use of these drugs. Our results suggest that depression has a negative impact on the use of antidiabetic drugs and allow the identification of possible solutions.

Utilisation de l’urgence au Québec des patients avec des troubles mentaux incluant les troubles liés aux substances psychoactives

Objectives This study investigated emergency department (ED) use, reasons for emergency visits, hospitalization rates, and duration of hospitalization in 2014-15 for a cohort of patients with mental disorders (MDs) including substance use disorders (SUDs), regarding sex, age and residential areas. Results were compared with data from patients without MDs for 2014-15, and with another cohort from 2000-01, which marked the beginning of primary care reform in Quebec and elsewhere, with the aim of measuring ED use over time. Methods Based on data from the Quebec Integrated Chronic Disease Surveillance System (QICDSS), participants included patients age 12 and over, diagnosed with at least one MD (or SUD) during an ED visit, hospitalization, or outpatient consultation in 2014-15 and 2000-01. Frequency distributions for ED visits and hospitalizations were produced, as well as for MDs or SUDs exclusively, or for co-occurring MDs-SUDs, and among high or very high ED users (4 to 11 visits/year, ≥12 visits/year), by gender, age (12-17, 18-24, 25-44, 45-64, and 65 and over) and residential area (Montreal, urban areas:>100,000, semi-urban areas: <100,000, and rural areas: <10,000). The age-standardized method based on the age structure of the 2014-15 population was used to compare data from 2014-15 to 2000-01. Frequency distributions for patients with and without MDs, and on ED and hospitalization rates were also produced for 2014-15. Results For the Quebec population, 12% had MDs including SUDs, of whom 39% had visited an ED, a decrease of 6% since 2000-01. Approximately twice as many patients with MDs had ED visits or hospitalizations, compared to patients without MDs. Nearly 17% of patients were high or very high ED users; and 34% were hospitalized. ED use was higher among patients 65 years and older, and those living in rural areas. Sixty-eight percent of ED visits for MDs exclusively were made by patients affected by anxiety-depression; whereas 51% of visits for SUDs exclusively were alcohol-related. Physical illnesses were the main reason for ED visits and hospitalizations; yet patients with severe MDs, co-occurring MDs and SUDs as well as those with more frequent ED visits tended to use EDs more for MD reasons. Conclusion This study demonstrated a very high volume of ED visits and hospitalizations among patients with MDs, including SUDs, compared to patients without MDs. Co-occurring disorders, especially physical conditions and multiple and severe MDs, contributed to frequent ED use and hospitalizations. Better care management, including more comprehensive personal care, for patients with MDs including SUDs and co-occurring disorders is needed, as well as the deployment of strategies that provide integrated mental health and medical care, particularly in Montreal where ED use by patients with predominantly severe and co-occurring MDs and physical illnesses, is more frequent.

Polygenic risk scores distinguish patients from non-affected adult relatives and from normal controls in schizophrenia and bipolar disorder multi-affected kindreds.

Recent studies have used results on SNP association with schizophrenia (SZ) and bipolar disorder (BD) to create polygenic risk scores (PRS) discriminating non-familial unrelated patients from controls. Little is known about the role of PRS in densely affected multigenerational families. We tested PRS differences between affected SZ and BD family members from their non-affected adult relatives (NAARs) in Eastern Quebec Kindreds and from controls. We examined 1227 subjects: from 17 SZ and BD kindreds, we studied 153 patients (57 SZ, 13 schizoaffective, and 83 BD) and 180 NAARs, and 894 unrelated controls from the Eastern Quebec population. PRS were derived from published case-control association studies of SZ and BD. We also constructed a combined SZ and BD PRS by using SNPs from both SZ and BD PRS. SZ patients had higher SZ PRS than controls (p = 0.0039, R2 = 0.027) and BD patients had higher BD PRS than controls (p = 0.013, R2 = 0.027). Differences between affected subjects and NAARs and controls were significant with both SZ and BD PRS. Moreover, a combined SZ-BD PRS was also significantly associated with SZ and BD when compared to NAARs (p = 0.0019, R2 = 0.010) and controls (p = 0.0025, R2 = 0.028), revealing a SZ-BD commonality effect in PRS at the diagnosis level. The SZ and the BD PRS, however, showed a degree of specificity regarding thought disorder symptoms. Overall, our report would confirm the usefulness of PRS in capturing the contribution of common genetic variants to the risk of SZ and BD in densely affected families.

Descriptive study of interprofessional collaboration between physicians and osteopaths for the pediatric population in Quebec, Canada

BackgroundOsteopathy is an increasingly popular healthcare approach that uses a wide variety of therapeutic manual techniques to address pain and somatic dysfunction. In Quebec, Canada, osteopathy is the complementary medicine most often recommended by family physicians. However, factors fostering the development of interprofessional collaboration (IPC) between physicians and osteopaths are unknown. This study aimed to describe the current situation in terms of IPC among practitioners working with pediatric patients.MethodsA self-administered questionnaire was sent to osteopaths, family physicians, and pediatricians involved with pediatric patients in the province of Quebec. The postal questionnaire captured general knowledge about osteopathy and its practice parameters and role, sources of information, communication aspects including having a professional relationship and referrals, and influence of the upcoming government regulation. Quantitative data from the questionnaires were analyzed using descriptive statistics. Logistic regression model for factors associated with osteopathic referrals and multiple linear regression analyses for the number of correct answers about general osteopathic practice parameters were performed.ResultsA total of 274 physicians (155 family physicians (response rate 13%) and 119 pediatricians (17%)) and 297 osteopaths (42%) completed the survey. According to physicians, osteopathy was most appropriate for musculoskeletal pain (241; 91%) and plagiocephaly (235; 88%). Osteopathic referral was positively associated with having a professional relationship (odds ratio [OR] 4.10 (95% confidence interval [CI] 2.12; 7.95), p < 0.001), personal consultation (OR 2.58 (95% CI 1.35; 4.93), p = 0.004), community-based practice (OR 1.89 (95% CI 1.03; 3.47), p = 0.040), and belief in the active role of osteopathy for pediatric conditions (OR 1.22 (95% CI 1.01; 1.47), p = 0.042). The majority of physicians (72%) and osteopaths (62%) considered the upcoming government regulation of osteopathy a positive factor for collaboration.ConclusionSome collaboration already exists among these practitioners, including mutual referrals, but optimizing this collaboration still poses some challenges.

Self-reported versus health administrative data: implications for assessing chronic illness burden in populations. A cross-sectional study.

Various data sources may be used to document the presence of chronic medical conditions. This study examined the agreement between self-reported and health administrative data. A randomly selected cohort of participants aged 25-75 years recruited by telephone from the general population of Quebec reported on the presence of 1 or more chronic conditions from a candidate list of 12 conditions: diabetes, hypertension, thyroid disorder, any cardiac disease, cancer diagnosis in the previous 5 years (including melanoma but excluding other skin cancers), asthma, osteoarthritis, rheumatoid arthritis or lupus, osteoporosis, chronic obstructive pulmonary disease, intestinal disease and hypercholesterolemia. We also used health administrative data from Quebec's universal health insurance provider to identify participants' chronic conditions. Unique identifiers allowed linkage of both data sources to the individual participant. The frequencies of the 12 conditions and the prevalence of multimorbidity (≥ 2, ≥ 3 and ≥ 4 conditions) were analyzed for each data source. We analyzed data for 1177 participants (mean age 53 [standard deviation 12.4] yr; 684 women [58.1%]). We found low (but varied) agreement between the 2 data sources, with the poorest agreement for hypercholesterolemia (κ = 0.04 [95% confidence interval (CI) 0.01 to 0.07]) and the best for diabetes (κ = 0.82 [95% CI 0.76 to 0.88]). Prevalence estimates of multimorbidity obtained with health administrative data were lower than those obtained with self-reported data regardless of the operational definition used. Most participants with multimorbidity were identified by self-report. We argue for the use of self-reported chronic conditions in the study of multimorbidity, as health administrative data based on the billing system in Quebec seem to underestimate the prevalence of many chronic conditions, which results in biased estimates of multimorbidity.

Performance of an allele-level multi-locus HLA genotype imputation tool in hematopoietic stem cell donors from Quebec.

IntroductionDonor‐recipient HLA compatibility is an important determinant of transplant outcomes. Allele‐group to allele‐level imputations help assign HLA genotypes when allele‐level genotypes are not available during donor selection.MethodsWe evaluated the performance of HaploStats, an allele‐level multi‐locus HLA genotype imputation tool from the National Marrow Donor Program, in a cross‐sectional study including hematopoietic stem cell donors (HSCD) from Quebec, Canada. A total of 144 self‐identified Caucasian HSCD genotyped at the allele‐group and allele‐level for HLA‐A, ‐B, ‐C, ‐DRB1, and ‐DQB1 loci were studied. We compared allele‐level genotypes imputed by HaploStats to those obtained by the reference standard, sequenced‐based typing (SBT).ResultsImputation performance, determined by allele‐level genotype recall (fraction of matching imputed and sequenced genotypes) was 97%, 96%, 95%, 84%, and 81% for HLA‐A, ‐B, ‐C, ‐DRB1, and ‐DQB1 loci, respectively. Our sample deviated from Hardy‐Weinberg equilibrium only at the HLA‐DRB1 locus. Residual ambiguity, determined by typing resolution scores (TRS), was greatest for HLA class II loci (average TRS 0.65 and 0.80 for DRB1 and DQB1, respectively). In contrast, average TRS of 0.88, 0.84, and 0.92 was observed for HLA‐A, ‐B, and ‐C, respectively.ConclusionsHLA allele imputation from ambiguous genotypes demonstrate satisfactory prediction accuracy for HLA class I but modest prediction accuracy for HLA class II loci in self‐identified Caucasian HSCD from Quebec. While consideration of high‐resolution allele and haplotype frequencies in the Quebec population may improve the performance of available allele‐level multi‐locus genotype imputation tools in Quebec, this study suggests that genotyping at the first two field level should be conducted whenever possible.

Temporal trends in prevalence, incidence, and mortality for rheumatoid arthritis in Quebec, Canada: a population-based study.

Health administrative data are a potentially efficient resource to conduct population-based research and surveillance, including trends in incidence and mortality over time. Our objective was to explore time trends in incidence and mortality for rheumatoid arthritis (RA), as well as estimating period prevalence. Our RA case definition was based on one or more hospitalizations with a RA diagnosis code, or three or more RA physician-billing codes, over 2years, with at least one RA billing code by a rheumatologist, orthopedic surgeon, or internist. To identify incident cases, a "run-in" period of 5years (1996-2000) was used to exclude prevalent cases. Crude age and sex-specific incidence rates were calculated (using data from 2001 to 2015), and sex-specific incidence rates were also standardized to the 2001 age structure of the Quebec population. We linked the RA cohort (both prevalent and incident patients) to the vital statistics registry, and standardized mortality rate ratios were generated. Negative binomial regression was used to test for linear change in standardized incidence rates and mortality ratios. The linear trends in standardized incidence rates did not show significant change over the study period. Mortality in RA was significantly higher than the general population and this remained true throughout the study period. Our prevalence estimate suggested 0.8% of the Quebec population may be affected by RA. RA incidence appeared relatively stable, and mortality was substantially higher in RA versus the general population and remained so over the study period. This suggests the need to optimize long-term RA outcomes.

Disparities in infant hospitalizations in Indigenous and non-Indigenous populations in Quebec, Canada.

Infant mortality is higher in Indigenous than non-Indigenous populations, but comparable data on infant morbidity are lacking in Canada. We evaluated disparities in infant morbidities experienced by Indigenous populations in Canada. We used linked population-based birth and health administrative data from Quebec, Canada, to compare hospitalization rates, an indicator of severe morbidity, in First Nations, Inuit and non-Indigenous singleton infants (< 1 year) born between 1996 and 2010. Our cohort included 19 770 First Nations, 3930 Inuit and 225 380 non-Indigenous infants. Compared with non-Indigenous infants, all-cause hospitalization rates were higher in First Nations infants (unadjusted risk ratio [RR] 2.05, 95% confidence interval [CI] 1.99-2.11; fully adjusted RR 1.43, 95% CI 1.37-1.50) and in Inuit infants (unadjusted RR 1.96, 95% CI 1.87-2.05; fully adjusted RR 1.37, 95% CI 1.24-1.52). Higher risks of hospitalization (accounting for multiple comparisons) were observed for First Nations infants in 12 of 16 disease categories and for Inuit infants in 7 of 16 disease categories. Maternal characteristics (age, education, marital status, parity, rural residence and Northern residence) partly explained the risk elevations, but maternal chronic illnesses and gestational complications had negligible influence overall. Acute bronchiolitis (risk difference v. non-Indigenous infants, First Nations 37.0 per 1000, Inuit 39.6 per 1000) and pneumonia (risk difference v. non-Indigenous infants, First Nations 41.2 per 1000, Inuit 61.3 per 1000) were the 2 leading causes of excess hospitalizations in Indigenous infants. First Nations and Inuit infants had substantially elevated burdens of hospitalizations as a result of diseases of multiple systems. The findings identify substantial unmet needs in disease prevention and medical care for Indigenous infants.

Object decision test (BORB): normative data for the adult Quebec population and performance in Alzheimer’s disease and the semantic variant of primary progressive aphasia

ABSTRACTObject decision (OD) test is one subtest of the Birmingham Object Recognition Battery (BORB). It is useful for differential diagnosis among several neurodegenerative diseases. However, normative data provided with this battery count on very few subjects and do not control for the effect of age, which limits interpretability. The purpose of Study 1 was to provide normative data for the OD test of the BORB (version A—hard). The objectives of Study 2 were to establish the diagnostic validity of this task and predictive validity of the normative data in the case of the semantic variant of primary progressive aphasia (svPPA) and Alzheimer’s disease (AD).Based on multiple linear regressions, equations to calculate Z-scores corrected for age were provided for 130 participants aged from 47 to 89 years. Performance of 20 healthy participants was compared to that of 14 individuals with svPPA and 18 with AD. After controlling for confounders, participants with svPPA had a lower total score than controls and AD participants. AD participants had a poorer performance than controls only when chimeric objects were considered. Among those with a deficit on the total score of the test, 94% (17/18, including 12 with svPPA) were correctly identified as having a pathological condition (svPPA or AD). This test could help refine differential diagnosis between svPPA and AD patients, especially before the deficits of episodic memory show up.

Liver microbiome of Peromyscus leucopus, a key reservoir host species for emerging infectious diseases in North America

Microbiome studies generally focus on the gut microbiome, which is composed of a large proportion of commensal bacteria. Here we propose a first analysis of the liver microbiome using next generation sequencing as a tool to detect potentially pathogenic strains. We used Peromyscus leucopus, the main reservoir host species of Lyme disease in eastern North America, as a model and sequenced V5-V6 regions of the 16S gene from 18 populations in southern Quebec (Canada). The Lactobacillus genus was found to dominate the liver microbiome. We also detected a large proportion of individuals infected by Bartonella vinsonii arupensis, a human pathogenic bacteria responsible for endocarditis, as well as Borrelia burgdorferi, the pathogen responsible for Lyme disease in North America. We then compared the microbiomes among two P. leucopus genetic clusters occurring on either side of the St. Lawrence River, and did not detect any effect of the host genotype on their liver microbiome assemblage. Finally, we report, for the first time, the presence of B. burgdorferi in a small mammal host from the northern side of the St. Lawrence River, in support of models that have predicted the northern spread of Lyme disease in Canada.

Deep genealogical analysis of a large cohort of participants in the CARTaGENE project (Quebec, Canada)

Background: Genealogical analysis helps to better understand the genetic structure of populations. The population of Quebec (Canada) often serves as a model for this type of analysis, having one of the world’s most complete genealogical databases.Aim: The main objective of this study was to reconstruct, analyse and compare the ascending genealogies of participants to CARTaGENE, a project that aims at building a database on various aspects of public health.Subjects and methods: In total, 5110 genealogies from four Quebec regions were reconstructed. Distribution of ancestors, completeness and depth of the genealogies, characteristics of immigrant ancestors and kinship and inbreeding coefficients were analysed.Results: Most genealogies go back to the 17th century, with a mean genealogical depth of 10 generations. Origins of immigrant ancestors are more diverse in the Montreal region, resulting in lower inbreeding and kinship among the participants from this region. Inbreeding and kinship values are mainly explained by remote genealogical links (from 6 to 11 generations).Conclusion: Deep genealogies allowed for a precise measurement of the geographic origins of the participants’ immigrant ancestors, as well as inbreeding and kinship ties in the population, which may be crucial for studies aiming to identify genetic variations associated with Mendelian or complex diseases.

The heights of French-Canadian convicts, 1780s–1820s

This paper uses a novel dataset of heights collected from the records of the Quebec City prison between 1813 and 1847 to survey the French-Canadian population of Quebec—which was then known either as Lower Canada or Canada East. Using a birth-cohort approach with 10year birth cohorts from the 1780s to the 1820s, we find that French-Canadian prisoners grew shorter over the period. Through the whole sample period, they were short compared to Americans. However, French-Canadians were taller either than their cousins in France or the inhabitants of Latin America (except Argentinians). In addition to extending anthropometric data in Canada to the 1780s, we are able to extend comparisons between the Old and New Worlds as well as comparisons between North America and Latin America. We highlight the key structural economic changes and shocks and discuss their possible impact on the anthropometric data.

Assessing forty years of language planning on the vitality of the Francophone and Anglophone communities of Quebec

AbstractThis article analyses how language laws favouring French improved the vitality of the Francophone majority relative to the declining Anglophone minority of Quebec. Part one provides a review of Canadian Government efforts to provide federal bilingual services to Francophones and Anglophones across Canada. Using the ethnolinguistic vitality framework, part two reviews key language policies adopted in Quebec designed to increase the status of French relative to English in the province, while part 3 assesses the impact of such laws on the demographic vitality of Francophones and Anglophones. Part 4 analyse how such laws succeeded in reducing the institutional vitality of the Anglophone minority especially their English schools. Pro-French laws did succeed in having 95 % of the Quebec population maintain knowledge of French, keeping 82 % of all its citizens as users of French at home, ensured that 90 % of Francophone employees used French at work, increased to 70 % French/English bilingualism amongst Anglophones and reduced the size of their English school system by 60 %. Nationalist discourse highlights threats to French, given that Quebec Francophones remain a linguistic minority in North America. Can Francophones accept a ‘paradigm shift’ by reframing their position from a

The Seeds of Divergence: The Economy of French North America, 1688 to 1760

The Seeds of Divergence: The Economy of French North America, 1688 to 1760

Intergenerational Analysis of Patronymic Transformations in the Quebec (Canada) Population Since the Seventeenth Century

Surnames may undergo several transformations over time. Thus, patronymic distributions observed in a population at a given time may hide changes that occurred previously, the extent of which can be estimated with intergenerational data. Using a corpus of 5,100 deep-rooted ascending genealogies from the Quebec (Canada) population, this study compares contemporary surnames with those of founding ancestors in each paternal line and identifies various patronymic mutations occurring over multiple generations. On average, paternal lines go back eight generations. About one-third of all paternal lines presented at least one orthographic difference between the contemporary and the original surnames. Many surnames were transformed several times in a single paternal line, and some changes were different for a given surname along different lines. Most changes occurred among the first generations following that of the founding ancestors. Regional comparisons also show important variations.

Knowledge, beliefs, and attitudes of the Quebec population toward chronic pain: Where are we now?

ABSTRACTBackground: Many chronic pain (CP) awareness and educational initiatives have been achieved, but it is time to take stock of where we are today.Aims: The aim of this study was to describe and identify determinants of knowledge, beliefs, and attitudes of different subgroups of the Quebec population regarding CP and especially toward people suffering from this condition.Methods: A web-based, cross-sectional study was conducted between May and June 2014.Results: A total of 1958 participants responded, among whom 70.9% reported suffering from CP and 14.4% reported being a health care professional (HCP). Almost half of the participants were not aware that the risk of developing CP is increased after undergoing surgery or that CP affects approximately one in five adults. A minority (10.30%) agreed that HCP are well trained in CP treatment. The two most frequent negative beliefs were that people suffering from CP become dependent on their medications as do drug addicts (16.7%) and that consulting a psychologist is useless unless the person with CP is depressed (16.9%). Multiple regression analysis showed that being a woman, being born in Canada, being unemployed, suffering from CP, and being an HCP were predictors of better knowledge and more positive attitudes toward people suffering from CP (all P values < 0.05). Older age and residing in a remote region were associated with poorer knowledge and more negative attitudes.Conclusions: Our results underline the importance of continuing the efforts and the need for more education programs, awareness campaigns, and stigma reduction activities about CP for HCP, patients, and the general public.

Urban English and Scottish Ancestors in the Regional Populations of the Province of Quebec (Canada)

The Quebec population descends in most part from French immigrants who settled in the St Lawrence River valley during the seventeenth century. However, people from other European origins have also contributed to the early settlement of the Canadian province. By means of genealogical data spanning more than three centuries, this study aimed to measure the contributions of English and Scottish immigrants to the peopling of the Quebec regions. More than 5,000 genealogies were reconstructed using the BALSAC population database. These genealogies span more than ten generations on average. Immigrants of each origin were identified and linked to all their descendants in the genealogical samples. Results show that English and Scottish founders appear in the genealogies of all Quebec regions, although in different proportions. These founders and/or their descendants were integrated into the predominant French Catholic population during the eighteenth and nineteenth centuries.

Organizations' choices when implementing an Early Intensive Behavioral Intervention program (EIBI)

The organizations' characteristics and choices are essential components of an action plan that favors quality program implementation, a prelude to effectiveness, especially in natural environment. The objectives of this study are to describe the choices made by rehabilitation centers (CRDITED) in the context of a universal community based on Early Intensive Behavioral Intervention program (EIBI) for 2 to 5 year-old children with autism spectrum disorder (ASD) in Qu&amp;eacute;bec (Canada). Based on a theoretical evaluation model, a questionnaire was filled out by 15 CRDITEDs, covering the large majority of the Quebec territory but also the Quebec population. Results show a great diversity between the different CRDITEDs. Factors that impact implementation quality are identified. Absence of evidence-based implementation practices and the diversity of the approaches to EIBI are discussed.