Rates In Canada Research Articles

Trends in hip fracture rates in Canada: An age-period-cohort analysis

Age-standardized rates of hip fracture in Canada declined during the period 1985 to 2005. We investigated whether this incidence pattern is explained by period effects, cohort effects, or both. All hospitalizations during the study period with primary diagnosis of hip fracture were identified. Age- and sex-specific hip fracture rates were calculated for nineteen 5-year age groups and four 5-year calendar periods, resulting in 20 birth cohorts. The effect of age, calendar period, and birth cohort on hip fracture rates was assessed using age-period-cohort models as proposed by Clayton and Schiffers. From 1985 to 2005, a total of 570,872 hospitalizations for hip fracture were identified. Age-standardized rates for hip fracture have progressively declined for females and males. The annual linear decrease in rates per 5-year period were 12% for females and 7% for males (both p < 0.0001). Significant birth cohort effects were also observed for both sexes (p < 0.0001). Cohorts born before 1950 had a higher risk of hip fracture, whereas those born after 1954 had a lower risk. After adjusting for age and constant annual linear change (drift term common to both period and cohort effects), we observed a significant nonlinear birth cohort effect for males (p = 0.0126) but not for females (p = 0.9960). In contrast, the nonlinear period effect, after adjustment for age and drift term, was significant for females (p = 0.0373) but not for males (p = 0.2515). For males, we observed no additional nonlinear period effect after adjusting for age and birth cohort, whereas for females, we observed no additional nonlinear birth cohort effect after adjusting for age and period. Although hip fracture rates decreased in both sexes, different factors may explain these changes. In addition to the constant annual linear decrease, nonlinear birth cohort effects were identified for males, and calendar period effects were identified for females as possible explanations.

The New 'Normal' for Interest Rates in Canada: The Implications of Long-Term Shifts in Global Saving and Investment

How far and how fast Canada’s record-low interest rates will rise in the coming years is a vital question for consumers and businesses. In New 'Normal' for Interest Rates in Canada: The Implications of Long-Term Shifts in Global Saving and Investment, authors Paul Beaudry and Philippe Bergevin find that the normal or neutral rate is likely lower than its historical average, and likely will remain at relatively lower levels over the next decade.

Lethal Firearm-Related Violence Against Canadian Women: Did Tightening Gun Laws Have an Impact on Women’s Health and Safety?

Domestic violence remains a significant public health issue around the world, and policy makers continually strive to implement effective legislative frameworks to reduce lethal violence against women. This article examines whether the 1995 Firearms Act (Bill C-68) had a significant impact on female firearm homicide victimization rates in Canada. Time series of gender-disaggregated data from 1974 to 2009 were examined. Two different analytic approaches were used: the autoregressive integrated moving average (ARIMA) modelling and the Zivot-Andrews (ZA) structural breakpoint tests. There was little evidence to suggest that increased firearms legislation in Canada had a significant impact on preexisting trends in lethal firearm violence against women. These results do not support the view that increasing firearms legislation is associated with a reduced incidence of firearm-related female domestic homicide victimization.

Risk indicators of suicide ideation among on-reserve First Nations youth

Despite the known disparity in suicide rates in Canada, there is limited information on the independent risk indicators of suicide ideation among First Nations youth living on reserve. To determine the prevalence and adjusted risk indicators for suicide ideation among on-reserve First Nations youth. Saskatoon Tribal Council (Saskatchewan) First Nations students enrolled in grades 5 through 8 who were living on reserve were asked to complete a health survey using validated questionnaires. In total, 75.3% of the students completed the survey. The study was led by the Saskatoon Tribal Council with assistance from three departments at the University of Saskatchewan (Saskatoon, Saskatchewan). Among on-reserve First Nations youth, 23% experienced suicide ideation within the past 12 months. In comparison, 8.5% of Saskatoon urban youth and 19% of Saskatoon urban Aboriginal youth within the same grades experienced suicide ideation. Wanting to leave home (OR 13.91 [95% CI 3.05 to 63.42]), having depressed mood (OR 2.98 [95% CI 1.16 to 7.67]) and not feeling loved (OR 3.85 [95% CI 1.49 to 9.93]) were independently associated with suicide ideation among on-reserve youth. None of the children with a father who was professionally employed reported suicide ideation. Understanding the independent risk indicators associated with suicide ideation among First Nations youth living on reserve will hopefully aid in appropriate interventions.

An International View of How Recent‐onset Atrial Fibrillation Is Treated in the Emergency Department

This study was conducted to determine if there is practice variation for emergency physicians' (EPs) management of recent-onset atrial fibrillation (RAF) in various world regions (Canada, United States, United Kingdom, and Australasia). The authors completed a mail and e-mail survey of members from four national emergency medicine (EM) associations. One prenotification letter and three survey letters were sent to members of the Canadian Association of Emergency Physicians (CAEP; Canada-1,177 members surveyed), American College of Emergency Physicians (ACEP; United States-500), College of Emergency Medicine UK (CEM; United Kingdom-1,864), and Australasian College for Emergency Medicine (ACEM; Australasia-1,188) as per the modified Dillman technique. The survey contained 23 questions related to the management of adult patients with symptomatic RAF (either a first episode or paroxysmal-recurrent) where onset is less than 48 hours and cardioversion is considered a treatment option. Data were analyzed using descriptive and chi-square statistics. Response rates were as follows: overall, 40.5%; Canada, 43.0%; United States, 50.1%; United Kingdom, 38.1%; and Australasia, 38.0%. Physician demographics were as follows: 72% male and mean (±SD) age 41.7 (±8.39) years. The proportions of physicians attempting rate control as their initial strategy are United States, 94.0%; Canada, 70.7%; Australasia, 61.1%; and United Kingdom, 43.1% (p < 0.0001). Diltiazem is the predominant agent for rate control in Canada (65.36%) and the United States (95.22%), while metoprolol is used in Australasia (65.94%) and the United Kingdom (67.64%). Cardioversion is attempted at varying rates in Canada (65.9%), Australasia (49.9%), United Kingdom (49.5%), and the United States (25.9%) (p < 0.0001). Pharmacologic cardioversion is attempted first in all regions, with the preferred drug being procainamide in Canada (61.93%) and amiodarone in Australasia (63.39%), the United Kingdom (47.97%), and the United States (22.41%; p < 0.0001). If drugs fail, electrical cardioversion is then attempted in Canada (70.64%), Australasia (46.19%), the United States (29.69%), and the United Kingdom (27.78%; p < 0.0001). There is much variation in emergency department (ED) management of RAF among world regions, most markedly for use of rate versus rhythm control, choice of drugs, and use of electrical cardioversion. Canadians are more likely to use an aggressive approach for management of RAF, whereas Americans are more likely to employ conservative management. U.K. and Australasian EPs fall somewhere in the middle. These differences demonstrate the need for better evidence, or better synthesis of existing knowledge, to create guidelines to guide ED management of this common dysrhythmia.

DEVELOPING MUNICIPAL POLICY AND PROGRAMS TO ACCELERATE MARKET TRANSFORMATION IN THE BUILDING SECTOR

INTRODUCTION Edmonton's cold climate and strong economic connections to the energy sector have made energy vital to the city's quality of life. The fossil fuel industry has helped the city's economy grow and Edmonton boasts one of the lowest unemployment rates in Canada at just over four percent. But Edmonton's economic prosperity does not shelter it from the realities of global environmental challenges. Just like other jurisdictions, climate change and the possibility of future energy constraints means that Edmonton must reevaluate its sources and use of energy across all sectors, including its buildings. To this end, on June 20, 2012, the Edmonton City Council approved the Green Building Plan and Policy, designed to help accelerate the greening of Edmonton's building stock. The policy outlines the strong role the city of Edmonton can play in supporting a green building sector to improve the environmental, health, and socioeconomic performance of all existing and new commercial, institutional, industrial...

An examination of different smoking patterns among Canadian youth: New insight for tobacco control programming

Patterns of smoking can vary among youth smokers. The purpose of this study was to examine three different patterns of smoking among youth (daily smoking, smoking sporadically on weekdays and weekends, and smoking during weekdays only), and to examine the sociodemographic characteristics that are associated with each smoking pattern in a representative sample of Canadian youth smokers. Data were collected as part of the 2010/2011 Youth Smoking Survey (YSS) from 31,396 students in grades 9 to 12 from secondary schools in 9 Canadian provinces. Data from the YSS were used to assess smoking behaviors and sociodemographic factors that are associated with smoking patterns among youth. We used logistic regression models to examine factors associated with week day only and some day smoking patterns relative to daily smoking patterns. Results indicate that among current youth smokers, the majority are daily smokers (62.0%), followed by some day (23.5%) and week day only (13.5%) smokers. Students who smoke some days were more likely than daily smokers to share cigarettes with others; however, they were less likely than daily smokers to have a parent, step-parent or guardian who smokes cigarettes and less likely to have close friends who smoke cigarettes. Conversely, students who smoke week days only were less likely than daily smokers to have a sibling who smokes cigarettes. These data suggest that the school environment continues to play an important role in reducing youth smoking rates in Canada, especially among youth who only smoke week days. The high percentage of week day only smokers suggests that current school-level tobacco control initiatives may be insufficient for preventing youth smoking onset.

Determinants of the real exchange rate in a small open economy: Evidence from Canada

This study develops a theoretical monetary model of the real exchange rate and shows that over the long run the real exchange rate is a function of real money supply, domestic and foreign interest rate, real GDP, real government expenditure, deficit per GDP, domestic and foreign outstanding debt per GDP, domestic and foreign externally financed debt per GDP and commodity price. The model was tested on Canadian data (1972Q1–2010Q3 period). It was found that all variables, except real money supply, domestic and foreign interest rate and domestic externally financed debt have a statistically significant impact on the real exchange rate in Canada. However, the domestic fiscal variables do not have any impact on the real exchange rate over the short run. The change in interest rate, the growth of money supply, the commodity price and the US debt per GDP have a negative impact on the growth of the real exchange rate over the short run.

Linoleic Acid Augments Oxidative Damage and Initiates Fibrosis in Cardiomyocytes and Fibroblasts

Cardiac fibrosis following the demise of cardiomyocytes is pivotal to cardiac remodeling and heart failure. Considering the rising rates of cardiovascular disease (CVD) and the preponderance of linoleic acid (LA) in the Canadian diet, we hypothesized that excess LA could initiate cell death and fibrosis in the heart. Four-month-old female C57/Bl6 mice were fed a high LA diet (HLA; corn oil rich) for 5 weeks, and a separate low LA diet group (LLA, canola oil rich) was kept as the isocaloric, isonitrogenous control. HLA feeding increased cardiac TUNEL positivity as amarker of cell death, protein expression of matrix metalloproteases (MMP-2 and -9) and downregulated tissue inhibitor of metalloproteases (TIMP-1 and -2). Sirius red and Masson's Trichrome staining of heart sections demonstrated augmented collagen deposition. Oxidative stress biomarkers such as nitrotyrosine and 4-hydroxynonenal also increased, whereas antioxidants including glutathione and superoxide dismutase were downregulated. To confirm that LA specifically plays a causative role, NIH-3T3 fibroblasts and differentiated H9c2 cardiomyoblasts were incubated with oleic, palmitic, or linoleic acid at concentrations from 0.1 to 1.0 mM over 24 hours. Mitochondrial redox potential in H9c2 cardiomyocytes was decreased with both palmitic acid and LA, but not oleic acid. Only incubation with LA demonstrated a dose-dependent reduction in cell viability in H9c2 cardiomyocytes. These results suggest that excess LA, a common dietary omega-6 PUFA, can augment cell death, oxidative damage, and loss of mitochondrial membrane potential in the heart and can contribute to current CVD rates in Canada.

When Symbols Clash: Legitimacy, Legality and the 2010 Winter Olympics

In February 2010, the Olympics descended on Vancouver, British Columbia. Between athletes competing for gold and a provincial venue with the highest poverty rate in Canada, a clash of symbols arose: those deemed legitimate by the Vancouver Olympic Organizing Committee (VANOC) and those deemed illegitimate. The Games not only transformed the city's landscape, municipal laws, infrastructure, and social relations but also resulted in the concurrent transformation of the city's visual culture. As an explicit tactic, Aboriginal; antipoverty; environmental; anarchist; and lesbian, gay, bisexual, and transgender activists employed countersymbols to disrupt VANOC's plans. Through qualitative discourse analysis of photos and visual imagery, this article addresses social, historical, political, and economic issues tied to this clash of symbols, including the use of Aboriginal cultures in representations of Canadian nationalism; infringements upon civil liberties and freedom of speech that resulted from surveillance of activists and constraints to the arts; and visual counter-discourse produced by activists through demonstrations, posters, and art.

Wage Growth Over the Past 30 Years: Changing Wages by Age and Education

This article in the Economic Insights series examines two questions: (1) Which groups of Canadian workers have experienced stronger real wage growth over the past three decades?; and (2) To what extent do individuals’ acquisition of education, general work experience, and seniority within firms, as well as their movements into higher-wage or lower-wage occupations and industries, account for differences in real wage growth observed across groups of workers? This article uses data from various Statistics Canada surveys and focuses on the real (hourly or weekly) wages earned by full-time workers. It is based on research carried out at Statistics Canada aimed at providing information on how wage rates of Canadian workers have changed over the past three decades. Wages are expressed in 2010 dollars. Since the early 1980s, real wages of various groups of workers have grown at markedly different rates in Canada and in many industrialized Western countries. Technological changes, growth in international trade, institutional factors (e.g., de-unionization, changes in minimum wages, and changes in the incidence of pay-for-performance), movements in group-specific labour supplies, and changes in social norms have been cited as potential drivers of this differential wage growth. To help shed some light on this matter, the article examines how real wages of Canadian workers evolved across age groups and education levels from 1981 to 2011.

Sense of Belonging and Mental Health in Hamilton, Ontario: An Intra-Urban Analysis

This paper examines geographic variations in sense of community belonging in Hamilton, Ontario. It also identifies the most significant health and social factors associated with belonging in the city. The research employs data from the 2007/08 Canadian Community Health Survey for respondents aged 18 or over living in the Hamilton Census Metropolitan Area. The primary unit of geography is the forward sortation area (FSA), which correspond with the boundaries comprising the first three digits of the postal code. The paper found that, overall, residents of Hamilton enjoy a strong sense of belonging to their community, one of the highest rates in Canada. Consistent with research at the national level, the paper revealed a strong and clear association between lower sense of belonging and lower self-perceived mental health. Age (45–64) and household type (couples with children) were associated with higher sense of belonging. The mapping analysis revealed that sense of belonging was generally strongest among residents of rural Hamilton and became weaker moving towards the city centre, with particularly low levels evident in the Lower City. The presence of lower sense of belonging and lower mental health was clearly visible in three FSAs comprising the central portion of the Lower City.

The aging Canadian population and hospitalizations for acute myocardial infarction: projection to 2020

BackgroundThe risk of experiencing an acute myocardial infarction (AMI) increases with age and Canada's population is aging. The objective of this analysis was to examine trends in the AMI hospitalization rate in Canada between 2002 and 2009 and to estimate the potential increase in the number of AMI hospitalizations over the next decade.MethodsAggregated data on annual AMI hospitalizations were obtained from the Canadian Institute for Health Information for all provinces and territories, except Quebec, for 2002/03 and 2009/10. Using these data in a Poisson regression model to control for age, gender and year, the rate of AMI hospitalizations was extrapolated between 2010 and 2020. The extrapolated rate and Statistics Canada population projections were used to estimate the number of AMI hospitalizations in 2020.ResultsThe rates of AMI hospitalizations by gender and age group showed a decrease between 2002 and 2009 in patients aged ≥ 65 years and relatively stable rates in those aged < 64 years in both males and females. However, the total number of AMI hospitalizations in Canada (excluding Quebec) is projected to increase by 4667 from 51847 in 2009 to 56514 in 2020, a 9.0% increase. Inflating this number to account for the unavailable Quebec data results in an increase of approximately 6200 for the whole of Canada. This would amount to an additional cost of between $46 and $54 million and sensitivity analyses indicate that it could be between $36 and $65 million.ConclusionsDespite projected decreasing or stable rates of AMI hospitalization, the number of hospitalizations is expected to increase substantially as a result of the aging of the Canadian population. The cost of these hospitalizations will be substantial. An increase of this extent in the number of AMI hospitalizations and the ensuing costs would significantly impact the already over-stretched Canadian healthcare system.

Suicide among children and adolescents in Canada: trends and sex differences, 1980–2008

Suicide is the second leading cause of death for young Canadians (10-19 years of age)--a disturbing trend that has shown little improvement in recent years. Our objective was to examine suicide trends among Canadian children and adolescents. We conducted a retrospective analysis of standardized suicide rates using Statistics Canada mortality data for the period spanning from 1980 to 2008. We analyzed the data by sex and by suicide method over time for two age groups: 10-14 year olds (children) and 15-19 year olds (adolescents). We quantified annual trends by calculating the average annual percent change (AAPC). We found an average annual decrease of 1.0% (95% confidence interval [CI] -1.5 to -0.4) in the suicide rate for children and adolescents, but stratification by age and sex showed significant variation. We saw an increase in suicide by suffocation among female children (AAPC = 8.1%, 95% CI 6.0 to 10.4) and adolescents (AAPC = 8.0%, 95% CI 6.2 to 9.8). In addition, we noted a decrease in suicides involving poisoning and firearms during the study period. Our results show that suicide rates in Canada are increasing among female children and adolescents and decreasing among male children and adolescents. Limiting access to lethal means has some potential to mitigate risk. However, suffocation, which has become the predominant method for committing suicide for these age groups, is not amenable to this type of primary prevention.

Abstract 255: Temporal Trends and Factors Associated with Referral for Cardiac Rehabilitation Post Acute Coronary Syndrome: Insights from the Canadian Global Registry of Acute Coronary Events (GRACE)

Introduction: The beneficial effects of cardiac rehabilitation (CR) on morbidity and mortality after an acute coronary syndrome (ACS) are well established. Despite guidelines, CR referral rates have been low. Determining factors associated with CR referral would assist in closing this care gap and improve outcomes. Using the Canadian Global Registry of Acute Coronary Events (GRACE) database, we examined 1) the temporal trends of CR referral rates in Canada and its associated factors in a contemporary setting; 2) use of evidence-based medical therapies after ACS and its relationship with CR referral during index hospitalization. Hypothesis: CR referral rates have increased over time but remain below current guideline recommendations. Methods: From the Canadian GRACE registry, we retrospectively analyzed data from 11 Canadian centers during 2000 - 2007. CR referral rates were established and analyzed over time. We compared the CR Referral group to the Non-CR Referral group using univariate logistic regression in regards to patient characteristics, in-hospital diagnosis, clinical events and investigations. Categorical and continuous variables were compared using the chi-square and the Wilcoxon rank sum tests, respectively, with statistical significance at p&lt;0.05. Data of guideline-recommended medication use at discharge and 6 months post-discharge were also analyzed. Results: In the 8-year period, 3338 patients (median age 64 years, 32% women) were assessed. Initial CR referral rate in 2000 was 2.7% (6/219) and increased to 51.2% (220/430) in 2007 (p&lt;0.0001). Univariate factors for CR referral include younger age, larger infarct size, and a diagnosis of STE-ACS. Univariate factors for non-CR referral include CHF, higher GRACE score, and previous CAD. Hospitals with on-site supervised CR facilities had higher CR referral rates. CR Referral group had higher usage of evidence-based medications at time of discharge as well as 6 months post-discharge (all p&lt; 0.0001). Conclusions: There has been a steady increase in CR referrals; however, contemporary numbers are still below the current recommendation of an 85% referral rate. Higher usage of recommended medications in the CR Referral group were noted, likely reflecting the association of CR referral with overall quality of care. Factors associated with CR referral include younger age, larger infarct size, and STE-ACS. Lack of referral was associated with CHF, previous CAD and high GRACE score. Targeting non-referred populations may improve quality of care and close care gaps in secondary prevention.

The Burgeoning Burden of Respiratory Syncytial Virus Among Children

Respiratory syncytial virus (RSV) was first isolated from infants by Chanock and colleagues in 1957. However, control of this ubiquitous agent has yet to be achieved. RSV is recognized as the primary cause of hospitalization for acute lower respiratory tract illness (LRTI) among infants worldwide. Among children < 5 years old, annual hospitalization rates in the United States (US) is 3/1000 children, and rates in Canada and European countries are similar. In the US the hospitalization rate is 3 times higher than that from influenza or parainfluenza viral infections. Much less appreciated is the clinical and economic burden from RSV outpatients, as few have specific diagnostic testing. Nevertheless, RSV in the US is estimated to cause 1 of 334 hospitalizations, 1 of 38 emergency department visits, but 1 of 13 private practice visits. These outpatient children tend to have moderate to severe illness with approximately three-fourths manifesting labored respirations. RSV burden among outpatients, therefore, is considerable both in size and severity. The global burden of RSV infection is unknown as few studies are from developing countries. Estimates indicate about one-fourth of all acute LRTI occur among children < 5 years, and the greatest burden is among children in developing countries. Currently the only approved means of RSV prophylaxis is passive immunization with humanized F protein monoclonal antibody. Such prophylaxis, however, has limited availability, is expensive, and is recommended only for infants most at risk for severe RSV disease. Only widespread immunization of children is likely to diminish the current burden of RSV infection.

Aboriginal Employment: Improved in 2011, but still has a ways to go

Employment is an important indicator of economic development. The Aboriginal employment rate in Canada increased to 55.8 in 2011, from 53.7 in 2010. This was an increase of 19,700 jobs. It increased more for Aboriginal men than for women in 2011. The strong relationship between higher levels of education and employment highlights a clear path for improving employment rates. Ontario experienced the greatest increase in employment with 8,800 new Aboriginal jobs in 2011, with employment growing in every province except Prince Edward Island, where it was flat. It was basically stable in the three territories. The sectors experiencing the greatest increases in employment were in retail trade and in manufacturing.

Effect of Physician Remuneration Fees on Glaucoma Procedure Rates in Canada

Earlier studies have reported wide regional variability in glaucoma procedure rates, suggesting nonclinical factors influencing procedure rates. This study was designed to investigate the possible influence of fees on procedure rates. Databases were accessed to obtain yearly provincial population, procedure and ophthalmologist numbers, and physician fees for trabeculoplasties, trabeculectomies, and glaucoma drainage device (GDD) implantations from 1992 to 2007. Regression models using generalized estimating equation methods were used to evaluate the influence of fees on procedure rates after adjusting for temporal trends and the number of ophthalmologists per 1000 persons with glaucoma. Trends in glaucoma procedure rates and fees varied widely among provinces: decrease of 98% to an increase of 380% for trabeculoplasties, decrease of 72% to an increase of 42% for trabeculectomies, and decrease of 32% to an increase of 1292% for GDD. In 2007, provincial remuneration varied from $125 to $553 for trabeculoplasties, $370 to $748 for trabeculectomies, and $426 to $956 for GDD. The regression models found for every 1000 persons with glaucoma, a $100 increase in fee was associated with 0.68 more trabeculoplasties (P=0.94), 1.2 fewer trabeculectomies (P=0.17), and 0.18 more GDD implantations (P=0.18); and for every additional ophthalmologist per 1000 persons with glaucoma, 53.8 more trabeculoplasties (P=0.24), 0.34 more trabeculectomies (P=0.86), and 0.79 more GDD implantations (P=0.0004). A regression model examining procedure substitution effect did not find any association between relative remuneration and procedure rate. Our analysis did not show an influence of physician remuneration fee on procedure rates in Canada during the study period.

The ins and outs of unemployment in Canada, 1976–2008

Abstract This paper studies the flows into and out of unemployment in Canada at an aggregate and a number of disaggregated levels. I find that inflows into unemployment are countercyclical and outflows are procyclical. At an aggregate level, changes in the rate at which individuals leave unemployment account for most of the changes in unemployment rates in Canada between 1976 and 2008. However, flows into unemployment matter more at some disaggregated levels. There are also some differences in the contributions of flows into and out of unemployment to changes in unemployment rates across the 1981–82 and 1990–92 recessions.

A review of screening mammography participation and utilization in Canada

Participation rate is an important indicator for a screening program's effectiveness; however, the current approach to measuring participation rate in Canada is not comparable with other countries. The objective of this study is to review the measurement of screening mammography participation in Canada, make international comparisons, and propose alternative methods. Canadian breast cancer screening program data for women aged 50 to 69 years screened between 2004 and 2006 were extracted from the Canadian Breast Cancer Screening Database (CBCSD). The fee-for-services (FSS) mammography data (opportunistic screening mammography) were obtained from the provincial ministries of health. Both screening mammography program participation and utilization were examined over 24 and 30 months. Canada's screening participation rate increases from 39.4% for a 24-month cut-off to 43.6% for a 30-month cut-off. The 24-month mammography utilization rate is 63.1% in Canada, and the 30-month utilization rate is 70.4%. Due to the differences in health service delivery among Canadian provinces, both programmatic participation and overall utilization of mammography at 24 months and 30 months should be monitored.