Changes in mortality for the general population and individuals with pre-pandemic acute care for alcohol or opioids during the COVID-19 pandemic in Ontario, Canada.
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ABSTRACT:
SUBMITTER: Myran DT
PROVIDER: S-EPMC9931873 | biostudies-literature | 2023 Nov
REPOSITORIES: biostudies-literature
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Changes in mortality for the general population and individuals with pre-pandemic acute care for alcohol or opioids during the COVID-19 pandemic in Ontario, Canada.
Myran Daniel Thomas DT Friesen Erik Loewen EL Pugliese Michael M Milani Christina C Tanuseputro Peter P
Canadian journal of psychiatry. Revue canadienne de psychiatrie 20230214 11
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Project description:BackgroundMathematical and statistical models are used to project the future time course of infectious disease epidemics and the expected future burden on health care systems and economies. Influenza is a particularly important disease in this context because it causes annual epidemics and occasional pandemics. In order to forecast health care utilization during epidemics-and the effects of hospitalizations and deaths on the contact network and, in turn, on transmission dynamics-modellers must make assumptions about the lengths of time between infection, visiting a physician, being admitted to hospital, leaving hospital, and death. More reliable forecasts could be be made if the distributions of times between these types of events ("delay distributions") were known.MethodsWe estimated delay distributions in the province of Ontario, Canada, between 2006 and 2010. To do so, we used encrypted health insurance numbers to link 1.34 billion health care billing records to 4.27 million hospital inpatient stays. Because the four year period we studied included three typical influenza seasons and the 2009 influenza pandemic, we were able to compare the delay distributions in non-pandemic and pandemic settings. We also estimated conditional probabilities such as the probability of hospitalization within the year if diagnosed with influenza.ResultsIn non-pandemic [pandemic] years, delay distribution medians (inter-quartile ranges) were: Service to Admission 6.3 days (0.1-17.6 days) [2.4 days (-0.3-13.6 days)], Admission to Discharge 3 days (1.4-5.9 days) [2.6 days (1.2-5.1 days)], Admission to Death 5.3 days (2.1-11 days) [6 days (2.6-13.1 days)]. (Service date is defined as the date, within the year, of the first health care billing that included a diagnostic code for influenza-like-illness.) Among individuals diagnosed with either pneumonia or influenza in a given year, 19% [16%] were hospitalized within the year and 3% [2%] died in hospital. Among all individuals who were hospitalized, 10% [12%] were diagnosed with pneumonia or influenza during the year and 5% [5%] died in hospital.ConclusionOur empirical delay distributions and conditional probabilities should help facilitate more accurate forecasts in the future, including improved predictions of hospital bed demands during influenza outbreaks, and the expected effects of hospitalizations on epidemic dynamics.
| S-EPMC6731609 | biostudies-literature
Project description:ObjectiveTo compare changes in outpatient and acute care visits due to alcohol during the COVID-19 pandemic between individuals with and those without a history of alcohol-related health service use (AHSU).MethodsWe conducted a cross-sectional analysis of health administrative data in Ontario, Canada. The Ontario population was stratified into those with and those without 1+ health service encounter(s) due to alcohol in the past 2 years. We compared age- and sex-standardized rates of alcohol-related outpatient visits, emergency department (ED) visits, and hospitalizations during the first 15 months of the pandemic (March 2020-May 2021) to those during the same 15-month period prior to the pandemic (March 2018-May 2019).ResultsOf 13,450,750 eligible Ontarians on March 11, 2022, 129,434 (1.0%) had AHSU in the previous 2 years. Overall, rates of alcohol-related outpatient visits and hospitalizations increased, while rates of alcohol-related ED visits decreased during the pandemic. There was a similar relative increase in rates of alcohol-related outpatient visits and hospitalizations between those with and those without prior AHSU. However, the absolute increase in rates of alcohol-related outpatient visits and hospitalizations was higher among those with prior AHSU (outpatient rate difference (RD) per 10,000 population: 852.3, 95% confidence interval (CI): 792.7, 911.9; inpatient RD: 26.0, 95% CI: -2.3, 54.2) than among those without (outpatient RD: 6.5, 95% CI: 6.0, 6.9; inpatient RD: 0.4, 95% CI: 0.2, 0.7).ConclusionRates of alcohol-related outpatient and inpatient care increased during the COVID-19 pandemic, and high rate of recurrent harm among individuals with pre-pandemic AHSU was an important contributor to this trend.
| S-EPMC9888341 | biostudies-literature
Project description:BackgroundThe novel SARS-CoV-2 (COVID-19) pandemic has dramatically altered the delivery of healthcare services, resulting in significant referral pattern changes, delayed presentations, and procedural delays. Our objective was to determine the effect of the COVID-19 pandemic on all-cause mortality in patients awaiting commonly performed cardiac procedures.MethodsClinical and administrative data sets were linked to identify all adults referred for: (1) percutaneous coronary intervention; (2) coronary artery bypass grafting; (3) valve surgery; and (4) transcatheter aortic valve implantation, from January 2014 to September 2020 in Ontario, Canada. Piece-wise regression models were used to determine the effect of the COVID-19 pandemic on referrals and procedural volume. Multivariable Cox proportional hazards models were used to determine the effect of the pandemic on waitlist mortality for the 4 procedures.ResultsWe included 584,341 patients who were first-time referrals for 1 of the 4 procedures, of whom 37,718 (6.4%) were referred during the pandemic. The pandemic period was associated with a significant decline in the number of referrals and procedures completed compared with the prepandemic period. Referral during the pandemic period was a significant predictor for increased all-cause mortality for the percutaneous coronary intervention (hazard ratio, 1.83; 95% confidence interval, 1.47-2.27) and coronary artery bypass grafting (hazard ratio, 1.96; 95% confidence interval, 1.28-3.01), but not for surgical valve or transcatheter aortic valve implantation referrals. Procedural wait times were shorter during the pandemic period compared with the prepandemic period.ConclusionsThere was a significant decrease in referrals and procedures completed for cardiac procedures during the pandemic period. Referral during the pandemic was associated with increased all-cause mortality while awaiting coronary revascularization.
| S-EPMC8481095 | biostudies-literature
Project description: Not available
| S-EPMC8116980 | biostudies-literature
Project description:BackgroundFood insecurity is associated with a wide array of negative health outcomes and higher health care costs but there has been no population-based study of the association of food insecurity and mortality in high-income countries.MethodsWe use cross-sectional population surveys linked to encoded health administrative data. The sample is 90,368 adults, living in Ontario and respondents in the Canadian Community Health Survey (CCHS). The outcome of interest is all-cause mortality at any time after the interview and within four years of the interview. The primary variable of interest is food insecurity status, with individuals classed as "food secure", "marginally food insecure", "moderately food insecure", or "severely food insecure". We use logistic regression models to determine the association of mortality with food insecurity status, adjusting for other social determinants of health.ResultsUsing a full set of covariates, in comparison to food secure individuals, the odds of death at any point after the interview are 1.28 (CI = 1.08, 1.52) for marginally food insecure individuals, 1.49 (CI = 1.29, 1.73) for moderately food insecure individuals, and 2.60 (CI = 2.17, 3.12) for severely food insecure individuals. When mortality within four years of the interview is considered, the odds are, respectively, 1.19 (CI = 0.95, 1.50), 1.65 (CI = 1.37, 1.98), and 2.31 (CI = 1.81, 2.93).InterpretationThese findings demonstrate that food insecurity is associated with higher mortality rates and these higher rates are especially large for the most severe food insecurity category. Efforts to reduce food insecurity should be incorporated into broader public health initiatives to reduce mortality.
| S-EPMC6133286 | biostudies-literature
Project description:BackgroundEarly estimates of excess mortality are crucial for understanding the impact of COVID-19. However, there is a lag of several months in the reporting of vital statistics mortality data for many jurisdictions, including across Canada. In Ontario, a Canadian province, certification by a coroner is required before cremation can occur, creating real-time mortality data that encompasses the majority of deaths within the province.ObjectiveThis study aimed to validate the use of cremation data as a timely surveillance tool for all-cause mortality during a public health emergency in a jurisdiction with delays in vital statistics data. Specifically, this study aimed to validate this surveillance tool by determining the stability, timeliness, and robustness of its real-time estimation of all-cause mortality.MethodsCremation records from January 2020 until April 2021 were compared to the historical records from 2017 to 2019, grouped according to week, age, sex, and whether COVID-19 was the cause of death. Cremation data were compared to Ontario's provisional vital statistics mortality data released by Statistics Canada. The 2020 and 2021 records were then compared to previous years (2017-2019) to determine whether there was excess mortality within various age groups and whether deaths attributed to COVID-19 accounted for the entirety of the excess mortality.ResultsBetween 2017 and 2019, cremations were performed for 67.4% (95% CI 67.3%-67.5%) of deaths. The proportion of cremated deaths remained stable throughout 2020, even within age and sex categories. Cremation records are 99% complete within 3 weeks of the date of death, which precedes the compilation of vital statistics data by several months. Consequently, during the first wave (from April to June 2020), cremation records detected a 16.9% increase (95% CI 14.6%-19.3%) in all-cause mortality, a finding that was confirmed several months later with cremation data.ConclusionsThe percentage of Ontarians cremated and the completion of cremation data several months before vital statistics did not change meaningfully during the COVID-19 pandemic period, establishing that the pandemic did not significantly alter cremation practices. Cremation data can be used to accurately estimate all-cause mortality in near real-time, particularly when real-time mortality estimates are needed to inform policy decisions for public health measures. The accuracy of this excess mortality estimation was confirmed by comparing it with official vital statistics data. These findings demonstrate the utility of cremation data as a complementary data source for timely mortality information during public health emergencies.
| S-EPMC8862761 | biostudies-literature
Project description:Recent evidence suggests there may be no safe level of alcohol use as even low levels are associated with increased risk for harm. However, the magnitude of the population-level health burden from lower levels of alcohol use is poorly understood. The objective was to estimate the distribution of alcohol-attributable healthcare encounters (emergency department (ED) visits and hospitalizations) across the population of alcohol users aged 15+ in Ontario, Canada. Using the International Model of Alcohol Harms and Policies (InterMAHP) tool, wholly and partially alcohol-attributable healthcare encounters were estimated across alcohol users: (1) former (no past-year use); (2) low volume (≤67.3 g ethanol/week); (3) medium volume (>67.3-134.5 g ethanol/week for women and >67.3-201.8 g ethanol/week for men); and (4) high volume (>134.5 g ethanol/week for women and >201.8 g ethanol/week for men). The alcohol-attributable healthcare burden was distributed across the population of alcohol users. A small population of high volume users (23% of men, 13% of women) were estimated to have contributed to the greatest proportion of alcohol-attributable healthcare encounters, particularly among men (men: 65% of ED visits and 71% of hospitalizations, women: 49% of ED visits and 50% of hospitalizations). The 71% of women low and medium volumes users were estimated to have contributed to a substantial proportion of alcohol-attributable healthcare encounters (47% of ED visits and 34% of hospitalizations). Findings provide support for universal alcohol policies (i.e., delivered to the entire population) for reducing population-level alcohol-attributable harm in addition to targeted policies for high-risk users.
| S-EPMC10491731 | biostudies-literature
Project description:ImportanceReasons for elevated suicide risks among autistic people are unclear, with insufficient population-based research on sex-specific patterns to inform tailored prevention and intervention.ObjectivesTo examine sex-stratified rates of self-harm events and suicide death among autistic individuals compared with nonautistic individuals, as well as the associated sociodemographic and clinical risk factors.Design, setting, and participantsThis population-based matched-cohort study using linked health administrative databases in Ontario, Canada included all individuals with physician-recorded autism diagnoses from April 1, 1988, to March 31, 2018, each matched on age and sex to 4 nonautistic individuals from the general population. Self-harm events resulting in emergency health care from April 1, 2005, to December 31, 2020, were examined for one cohort, and death by suicide and other causes from April 1, 1993, to December 31, 2018, were examined for another cohort. Statistical analyses were conducted between October 2021 and June 2023.ExposurePhysician-recorded autism diagnoses from 1988 to 2018 from health administrative databases.Main outcomes and measuresAutistic and nonautistic individuals who were sex stratified a priori were compared using Andersen-Gill recurrent event models on self-harm events, and cause-specific competing risk models on death by suicide or other causes. Neighborhood-level income and rurality indices, and individual-level broad diagnostic categories of intellectual disabilities, mood and anxiety disorders, schizophrenia spectrum disorders, substance use disorders, and personality disorders were covariates.ResultsFor self-harm events (cohort, 379 630 individuals; median age at maximum follow-up, 20 years [IQR, 15-28 years]; median age of first autism diagnosis claim for autistic individuals, 9 years [IQR, 4-15 years]; 19 800 autistic females, 56 126 autistic males 79 200 nonautistic females, and 224 504 nonautistic males), among both sexes, autism diagnoses had independent associations with self-harm events (females: relative rate, 1.83; 95% CI, 1.61-2.08; males: relative rate, 1.47; 95% CI, 1.28-1.69) after accounting for income, rurality, intellectual disabilities, and psychiatric diagnoses. For suicide death (cohort, 334 690 individuals; median age at maximum follow-up, 19 years [IQR, 14-27 years]; median age of first autism diagnosis claim for autistic individuals, 10 years [IQR, 5-16 years]; 17 982 autistic females, 48 956 autistic males, 71 928 nonautistic females, 195 824 nonautistic males), there was a significantly higher crude hazard ratio among autistic females (1.98; 95% CI, 1.11-3.56) and a nonsignificantly higher crude hazard ratio among autistic males (1.34; 95% CI, 0.99-1.82); the increased risks were associated with psychiatric diagnoses.Conclusions and relevanceThis cohort study suggests that autistic individuals experienced increased risks of self-harm events and suicide death. Psychiatric diagnoses were significantly associated with the increased risks among both sexes, especially for suicide death, and in partially sex-unique ways. Autism-tailored and autism-informed clinical and social support to reduce suicide risks should consider multifactorial mechanisms, with a particular focus on the prevention and timely treatment of psychiatric illnesses.
| S-EPMC10410481 | biostudies-literature
Project description:BackgroundPremature mortality is a meaningful indicator of both population health and health system performance, which varies by geography in Ontario. We used the Local Health Integration Network (LHIN) sub-regions to conduct a spatial analysis of premature mortality, adjusting for key population-level demographic and behavioural characteristics.MethodsWe used linked vital statistics data to identify 163,920 adult premature deaths (deaths between ages 18 and 74) registered in Ontario between 2011 and 2015. We compared premature mortality rates, population demographics, and prevalence of health-relevant behaviours across 76 LHIN sub-regions. We used Bayesian hierarchical spatial models to quantify the contribution of these population characteristics to geographic disparities in premature mortality.ResultsLHIN sub-region premature mortality rates ranged from 1.7 to 6.6 deaths per 1000 per year in males and 1.2 to 4.8 deaths per 1000 per year in females. Regions with higher premature mortality had fewer immigrants and higher prevalence of material deprivation, excess body weight, inadequate fruit and vegetable consumption, sedentary behaviour, and ever-smoked status. Adjusting for all variables eliminated close to 90% of geographic variation in premature mortality, but did not fully explain the spatial pattern of premature mortality in Ontario.ConclusionsWe conducted the first spatial analysis of mortality in Ontario, revealing large geographic variations. We demonstrate that well-known risk factors explain most of the observed variation in premature mortality. The result emphasizes the importance of population health efforts to reduce the burden of well-known risk factors to reduce variation in premature mortality.
| S-EPMC6670187 | biostudies-literature
Project description:BackgroundThe COVID-19 pandemic has seen the implementation of unprecedented legislation and policy, including drug control measures which in some countries, like Botswana, included a temporary full alcohol sales ban. However, the association of such absolute prohibition of alcohol sales on population drinking, including hazardous drinking, during the COVID-19 period has not yet been determined. This study investigated changes in retrospectively recalled alcohol use and hazardous drinking pre (prior 5th August 2020), during (5th August to 3rd September 2020) and post (after 4th September) the second alcohol sales ban in Botswana. Predictors of hazardous drinking across the three time points were also investigated.MethodsAn online cross-sectional study involving a convenience sample of 1318 adults with a past 12 months drinking history in Botswana was conducted in October 2020 following a month long alcohol sales prohibition. Participants completed a modified Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) alongside demographic questions. Participants were expected to retrospectively recall their alcohol use pre, during and post the second alcohol sales ban.ResultsThe prevalence of alcohol use among participants with a past 12 months drinking history was 91.7% (95%CI= 90.1-93.1) before the second ban, 62.3% (95%CI= 59.7-64.9) during the second ban, and 90.4% (95%CI= 88.7-91.8) after the ban.. Hazardous drinking temporarily decreased by 30% during the second alcohol sales ban, and rose to the pre-ban levels of about 60% after the ban. Significant predictors of hazardous drinking at any of the three time points (pre, during and post the second ban) were being male (AOR ranging from 1.50 to 2.13 for all time points), earning between P3000-P6000 (AOR= 1.69 prior sales ban), being a student (AOR=0.56 during the sales ban), and being employed (AOR= 1.45 post the sales ban).ConclusionThe alcohol sales ban was associated with short-lived changes in alcohol consumption and hazardous drinking thereby likely contributed in providing the anticipated and much needed temporary relief to the health system sought by COVID-19 pandemic measures.
| S-EPMC8788949 | biostudies-literature