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Ratnayake, Iresha, Pamela Hebbard, Allison Feely, Natalie Biswanger, and Kathleen Decker. "Assessment of Breast Cancer Surgery in Manitoba: A Descriptive Study." Current Oncology 28, no. 1 (January 19, 2021): 581–92. http://dx.doi.org/10.3390/curroncol28010058.
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Background: Variation in breast cancer surgical practice patterns can lead to poor clinical outcomes. It is important to measure and reduce variation to ensure all women diagnosed with breast cancer receive equitable, high-quality care. A population-based assessment of the variation in breast cancer surgery treatment and quality has never been conducted in Manitoba. The objective of this study was to assess the variation in surgical treatment patterns, quality of care, and post-operative outcomes for women diagnosed with invasive breast cancer. Methods: This descriptive study used data from the Manitoba Cancer Registry, Hospital Discharge Abstracts Database, Medical Claims, Manitoba Health Insurance Registry, and Statistics Canada. The study included women in Manitoba aged 20+ and diagnosed with invasive breast cancer between 1 January 2010 and 31 December 2014. Results: Axillary lymph node dissection (ALND) for node-negative disease ranged from 3.4% to 32.6%, timeliness (surgery within 30 days of consult) ranged from 33.3% to 60.2%, and re-excision ranged from 14.7% to 24.6% between health authorities. Women who underwent breast-conserving surgery had the shortest median length of stay and women who underwent mastectomy with immediate reconstruction had the longest median length of stay. In-hospital post-operative complications were higher among women who received mastectomy with immediate reconstruction (9.9%). Conclusion: Variation in surgical treatment, quality, and outcomes exist in Manitoba. The findings from this study can be used to inform cancer service delivery planning, quality improvement efforts, and policy development. Influencing data-driven change at the health system level is paramount to ensuring Manitobans receive the highest quality of care.
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Nickel, Nathan Christopher, Lynne Warda, Leslie Kummer, Joanne Chateau, Maureen Heaman, Chris Green, Alan Katz, et al. "Protocol for establishing an infant feeding database linkable with population-based administrative data: a prospective cohort study in Manitoba, Canada." BMJ Open 7, no. 10 (October 2017): e017981. http://dx.doi.org/10.1136/bmjopen-2017-017981.
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IntroductionBreast feeding is associated with many health benefits for mothers and infants. But despite extensive public health efforts to promote breast feeding, many mothers do not achieve their own breastfeeding goals; and, inequities in breastfeeding rates persist between high and low-income mother–infant dyads. Developing targeted programme to support breastfeeding dyads and reduce inequities between mothers of different socioeconomic status are a priority for public health practitioners and health policy decision-makers; however, many jurisdictions lack the timely and comprehensive population-level data on infant-feeding practices required to monitor trends in breastfeeding initiation and duration. This protocol describes the establishment of a population-based infant-feeding database in the Canadian province of Manitoba, providing opportunities to develop and evaluate breastfeeding support programme.Methods and analysisRoutinely collected administrative health data on mothers’ infant-feeding practices will be captured during regular vaccination visits using the Teleform fax tool, which converts handwritten information to an electronic format. The infant-feeding data will be linked to the Manitoba Population Research Data Repository, a comprehensive collection of population-based information spanning health, education and social services domains. The linkage will allow us to answer research questions about infant-feeding practices and to evaluate how effective current initiatives promoting breast feeding are.Ethics and disseminationApprovals have been granted by the Health Research Ethics Board at the University of Manitoba. Our integrative knowledge translation approach will involve disseminating findings through government and community briefings, presenting at academic conferences and publishing in scientific journals.
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Paul, Julia A., Joanne Chateau, Chris Green, Lynne Warda, Maureen Heaman, Alan Katz, Carolyn Perchuk, Lorraine Larocque, Janelle Boram Lee, and Nathan C. Nickel. "Evaluating the Manitoba Infant Feeding Database: a Canadian infant feeding surveillance system." Canadian Journal of Public Health 110, no. 5 (May 17, 2019): 649–56. http://dx.doi.org/10.17269/s41997-019-00211-6.
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Fedson, David S. "Improving Surveillance of the Impact of Influenza and Its Prevention in Canada." Canadian Journal of Infectious Diseases 4, no. 5 (1993): 257–62. http://dx.doi.org/10.1155/1993/562460.
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The organization of Canada’s provincial health care systems and the administrative databases that sustain them provide physicians, epidemiologists and public health officials with unique opportunities to improve surveillance of influenza and its prevention. These databases can be used to measure the impact of influenza on excess mortality, hospitalization and costs to the health care system. They can also be used to study the epidemiology of influenza vaccination practices. Studies using the administrative database for the province of Manitoba have established the epidemiological rationale for hospital-based vaccination and have evaluated the clinical effectiveness of influenza vaccination. As pneumococcal vaccination becomes widespread in Canada, provincial databases should also prove useful in assessing the impact of the pneumococcal infections and their prevention with pneumococcal vaccine.
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Singer, Alexander, Leanne Kosowan, John Queenan, Roseanne Yeung, Shazhan Amed, and Brandy Wicklow. "DEFINING PEDIATRIC DIABETES USING EMR RECORDS AND VALIDATION FROM LINKABLE MANITOBA COHORT DATA." Paediatrics & Child Health 23, suppl_1 (May 18, 2018): e10-e11. http://dx.doi.org/10.1093/pch/pxy054.027.
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Abstract BACKGROUND The prevalence of paediatric diabetes is increasing. Identifying and describing populations with paediatric diabetes using Primary Care Electronic Medication Records (EMR) can improve surveillance and management. OBJECTIVES To describe the population of children diagnosed with paediatric diabetes in Manitoba using Electronic Medical Record data from Community Paediatricians and Family Physcians in Manitoba. DESIGN/METHODS We applied a previously validated case definition for type 1 and type 2 diabetes to patients aged 1–18 seen by one of the 221 primary care providers participating in the Manitoba Primary Care Research Network (MaPCReN) between 1998–2015. We compared the agreement between the MaPCReN definition and Manitoba’s Diabetes Education Resource for Children and Adolescents (DERCA) clinical database of confirmed cases. Cases were described, including prevalence, patient characteristics, and health system use. RESULTS Our definition identified 166 children (0.4%, 95% CI 0.36% - 0.49%) of whom 53.0% lived in a rural location and 53.6% were female. The mean age at diagnosis was 11.4 years (SD 5.4). There were 90 patients identified by the definition also cared for by a paediatric endocrinologist at DERCA [sensitivity (54.2%), specificity (98.7%), and kappa (0.61, CI 0.54-.069)]. An additional 286 patients had at least one documented HbA1C of 6.5% or higher but did not have a corresponding diabetes diagnosis within the EMR. Of those, 45% had an HbA1c between 6.5 -7.5 and 25.9% had an HbA1c over 8.5%. Most of these patients also had an abnormal fasting glucose in the EMR (76.9%). There were 280 patients with an elevated HbA1c that had no evidence of attending an appointment with a paediatric endocrinologist at DERCA, 70.8% have a rural address. CONCLUSION The inclusion of HbA1c values in identifying paediatric diabetes suggested a large number of patients without a corresponding diabetes diagnosis or record of care from DERCA. Therefore, the DERCA database might be underestimating the true prevalence of diabetes in Manitoba. Understanding further characteristics of this population, is an essential step to inform the development of enhanced services and strategies.
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Khalili, Hamed. "The Changing Epidemiology of Inflammatory Bowel Disease: What Goes Up May Come Down." Inflammatory Bowel Diseases 26, no. 4 (August 23, 2019): 591–92. http://dx.doi.org/10.1093/ibd/izz186.
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Abstract Recent epidemiologic studies have shown that although the incidence of inflammatory bowel disease (IBD) is rapidly increasing in newly industrialized countries, at the turn of the 21st century the incidence had stabilized in the Western world. In this issue of Inflammatory Bowel Diseases, Torabi and colleagues present their findings on the temporal trends and geographic variations in IBD incidence in Manitoba from 1990 to 2012 using the Manitoba Health population registry and the University of Manitoba IBD epidemiology database. Their results demonstrate an overall decrease in the incidence of IBD during the study period. They also found significant regional variations in disease incidence within Manitoba, with rates of new diagnosis of IBD remaining high in several regions. Lastly, the study found that a higher proportion of the indigenous population had a lower rate of IBD. These findings provide new insights on the changing epidemiology of IBD in the Western world. The overall declining incidence of IBD and identification of persistently low and high-risk populations in Manitoba, which traditionally has had some of the highest incidence rates of IBD, is intriguing and can provide new avenues of research for epidemiologists in the field.
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Benoit, Peter, Lana Tennenhouse, Alicia Lapple, Gillian Hill-Carroll, Souradet Shaw, Jared Bullard, and Pierre Plourde. "Congenital syphilis re-emergence in Winnipeg, Manitoba." Canada Communicable Disease Report 47, no. 2-3 (February 24, 2022): 89–94. http://dx.doi.org/10.14745/ccdr.v48i23a06.
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Background: Infectious syphilis rates have been increasing in Winnipeg, Manitoba among individuals during their childbearing years. Untreated or inadequately treated prenatal infection often results in congenital syphilis, with devastating consequences to fetal health and survival. The objective of this study was to review public health surveillance data regarding congenital syphilis incidence and birthing parent risk factors in Winnipeg from 2018 to 2020. Methods: Data extracted from a population-based surveillance database maintained by the Winnipeg Regional Health Authority Public Health investigations for all 2018–2020 probable or confirmed cases of early congenital syphilis or syphilitic stillbirth were reviewed. Rates of congenital syphilis were calculated per 1,000 live births. Descriptive analyses were performed to describe birthing parent age, neighbourhood of residence, intravenous substance use, Child and Family Services involvement, access to prenatal care and obtainment of adequate prenatal treatment. Results: There were eight cases of confirmed/probable congenital syphilis in 2018, 22 cases in 2019 and 30 cases in 2020. Average birthing parent age was 26.5–27.0 years. The majority (66.7%) of birthing parents lived in inner city neighbourhoods with known infectious syphilis outbreaks. Over 50% of birthing parents did not receive any prenatal care, or the care received consisted of inadequate treatment or follow-up. Reinfection among birthing parents who did receive prenatal care was suspected in an additional 23.3% of cases. Conclusion: Congenital syphilis rates in Winnipeg have increased dramatically. Public health and healthcare provider efforts to address the needs of the community are vital for promoting access to safe and effective prenatal care.
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Macie, C., K. Wooldrage, J. Manfreda, and NR Anthonisen. "Introduction of Leukotriene Receptor Antagonists in Manitoba." Canadian Respiratory Journal 13, no. 2 (2006): 94–98. http://dx.doi.org/10.1155/2006/724167.
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Patient characteristics and prescribing patterns during the introduction of leukotriene receptor antagonists (LTRA) in Manitoba are described using the provincial health database. Residents of Manitoba with asthma, chronic obstructive pulmonary disease, bronchitis or claims for respiratory medications were identified. Six thousand forty-one of 160,626 (3.8%) patients received LTRA; the likelihood of receiving LTRA increased if a patient was younger than 15 years, lived in a rural locale, had asthma, had frequent physician visits or used inhaled corticosteroids. Subsequent prescriptions (68%) were associated with the number of physician visits and inhaled corticosteroid use, which were thought to be indexes of severity. Patients, especially children, who received more than five prescriptions showed evidence of increased asthma control, but there was little evidence of benefit in less selected patient groups due, at least in part, to poor compliance with all respiratory drugs.
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Ricci, Maria Florencia, Marie Paterson, Andreah Anterola, Elizabeth Hammond, James McCammon, Jonathan Lau, Chelsea Day, and Mubeen Rafay. "44 Prevalence estimates of Cerebral Palsy among 4-year-old children living Manitoba, Births: 2013-2015." Paediatrics & Child Health 27, Supplement_3 (October 1, 2022): e21-e21. http://dx.doi.org/10.1093/pch/pxac100.043.
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Abstract Background Cerebral palsy (CP) is the most common physical disability in children with an estimated prevalence of 2.1 per 1000 live births. Understanding the provincial prevalence of CP and describing clinical sub-types within Manitoba assists with planning future funding and ensuring adequate resources. Objectives This study aimed to determine the prevalence estimate of CP among 4-year-old children in Manitoba, and further describe children’s clinical presentation. Design/Methods As the Rehabilitation Centre for Children (RCC) is a referral site for all Manitoba children requiring multidisciplinary evaluation/treatment for CP, this retrospective study used RCC’s electronic medical records to identify all 4-year-old children who had a confirmed CP diagnosis, were living in Manitoba and were born between Jan 2013 to Dec 2015. To ensure provincial data was complete, information was cross-referenced with the Pediatric Neurology Clinic’s medical records and the Neonatal Follow-up database. Prevalence rate was determined using Government of Manitoba denominators of same age children. The Gross Motor Function Classification system (GMFCS) determined the child’s level of functioning Results The prevalence of CP in Manitoba (birth years 2013-2015) for 108 4-year-old-children is 2.05 (95% CI1.7, 2.5) per 1000 4-year-old children. Of the 108 4-year-old children with CP, 6 (5.6%) had a post neonatal cause, while 102 (94.4%) had a perinatal cause; and 51/108 (47%) were born preterm. Motor subtypes for 108 children are: Spastic 99 (91.7%) including hemiplegia 41.4%, diplegia 21.2%, triplegia 8.1%, and quadriplegia 29.3%; Dyskinetic 4 (3.7%); Ataxic 3(2.8%) and Hypotonic 2 (1.8%). 58/108 (54%) were independent ambulators (GMFCS level II/II). Conclusion Our provincial rate of CP is consistent with the prevalence reported in developed countries. Understanding the clinical presentation assists in informing treatment and resources for children with CP in our province.
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Winchar, Kelcey, Pascal Lambert, Kirk J. McManus, Bernie Chodirker, Sarah Kean, Kim Serfas, Kathleen Decker, Mark W. Nachtigal, and Alon D. Altman. "Referral, Genetic Counselling, and BRCA Testing in the Manitoba High-Grade Serous Ovarian Cancer Population, 2004–2019." Current Oncology 29, no. 12 (November 30, 2022): 9365–76. http://dx.doi.org/10.3390/curroncol29120735.
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(1) Background: The primary objective of this study was to examine the rate of genetic referral, BRCA testing, and BRCA positivity amongst all patients with high-grade serous ovarian cancers (HGSOC) from 2004–2019. The secondary objective was to analyze secondary factors that may affect the rates of referral and testing. (2) Methods: This population-based cohort study included all women diagnosed with HGSOC using the Manitoba Cancer Registry, CervixCheck registry, Medical Claims database at Manitoba Health, the Hospital Discharge abstract, the Population Registry, and Winnipeg Regional Health Authority genetics data. Data were examined for three different time cohorts (2004–2013, 2014–2016; 2017–2019) correlating to practice pattern changes. (3) Results: A total of 944 patients were diagnosed with HGSOC. The rate of genetic referrals changed over the three timeframes (20.0% → 56.7% → 36.6%) and rate of genetic testing increased over the entire timeframe. Factors found to increase rates of referral and testing included age, histology, history of oral contraceptive use, and family history of ovarian cancer. Prior health care utilization indicators did not affect genetic referral or testing. (4) Conclusion: The rate of genetic referral (2004–2016) and BRCA1/2 testing (2004–2019) for patients with a diagnosis of HGSOC increased over time. A minority of patients received a consultation for genetics counselling, and even fewer received testing for a BRCA1/2. Without a genetic result, it is difficult for clinicians to inform treatment decisions. Additional efforts are needed to increase genetics consultation and testing for Manitoban patients with HGSOC. Effects of routine tumour testing on rates of genetic referral will have to be examined in future studies.
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Bilandzic, Anja, and Songul Bozat-Emre. "Initial evaluation of Manitoba’s cannabis surveillance system." Health Promotion and Chronic Disease Prevention in Canada 40, no. 7/8 (July 2020): 245–49. http://dx.doi.org/10.24095/hpcdp.40.7/8.04.
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The Government of Manitoba created a cannabis public health surveillance system in 2018 in preparation for nonmedical cannabis legalization on 17 October, 2018. An initial evaluation was conducted to assess the usefulness, flexibility and simplicity attributes of the system, using an online stakeholder survey, website metrics, system analysis and interviews. Resulting recommendations included creating a detailed communication plan for surveillance products, changing the format and frequency of reporting, maintaining strong relationships with partners and building towards a centralized provincial substance use surveillance database and surveillance system.
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Huzel, Lisa, Leslie L. Roos, Nick R. Anthonisen, and Jure Manfreda. "Diagnosing Asthma: The Fit between Survey and Administrative Database." Canadian Respiratory Journal 9, no. 6 (2002): 407–12. http://dx.doi.org/10.1155/2002/921497.
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BACKGROUND:Standard methods for population studies of asthma include surveying population samples using questionnaires and examining people in laboratories. These procedures are extremely expensive. It would be helpful if, at least for some purposes, they could be replaced by cheaper techniques with adequate validity. OBJECTIVES: To determine agreement between survey and database in regard to the prevalence of asthma.METHODS: Responses to survey questions about asthma symptoms in the past 12 months were linked to physician claims in the Manitoba Population Health Repository.RESULTS: The overall agreement was moderate (κ=0.45 to 0.50) and increased if two years of physician claims were studied (κ=0.55 to 0.59); studying additional years had no further effect on agreement. Sex and smoking did not significantly affect the kappa scores.CONCLUSIONS: There were several plausible reasons for discrepancies. Symptoms recorded on the survey were intrinsically different from those recorded for physician visits. Physicians also used other respiratory codes instead of asthma, and survey participants did not see a physician every year for asthma. The estimates of prevalence derived from the survey and the administrative database included two overlapping groups of people. In each, the diagnosis of asthma seems justifiable, although the agreement between the two groups was only moderate to substantial. Both methods are useful, although they are useful for different purposes. Health care utilization estimates may be particularly useful for studying trends over time.
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Roos, N. P., C. Black, L. L. Roos, N. Frohlich, C. DeCoster, C. Mustard, M. Brownell, et al. "Managing Health Services: How Administrative Data and Population-Based Analyses Can Focus the Agenda." Health Services Management Research 11, no. 1 (February 1998): 49–67. http://dx.doi.org/10.1177/095148489801100110.
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University-based researchers in Manitoba, Canada, have used administrative data routinely collected as part of the national health insurance plan to design an integrated database and population-based health information system. This information system is proving useful to policymakers for providing answers to such questions as: which populations need more physician services? Which need fewer? Are high-risk populations poorly served or do they have poor health outcomes despite being well served? Does high utilization represent overuse or utilization related to high need? More specifically, this system provides decision-makers with the capability to make critical comparisons across regions and subregions of residents' health status, socioeconomic risk characteristics, and use of hospitals, nursing homes, and physicians. The system permits analyses of demographic changes, expenditure patterns, and hospital performance in relation to the population served. The integrated database has also facilitated outcomes research across hospitals and counties, utilization review within a single hospital, and longitudinal research on health reform. A particularly interesting application to planning physician supply and distribution is discussed. The discussion highlights the strengths of integrated population-based information in analyzing the health care system and raising important questions about the relationship between health care and health.
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Fortier, Janique, Mariette Chartier, Sarah Turner, Nora Murdock, Frank Turner, Jitender Sareen, Tracie O. Afifi, et al. "Adapting and enhancing PAX Good Behavior Game for First Nations communities: a mixed-methods study protocol developed with Swampy Cree Tribal Council communities in Manitoba." BMJ Open 8, no. 2 (February 2018): e018454. http://dx.doi.org/10.1136/bmjopen-2017-018454.
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IntroductionHigh rates of mental health problems, such as suicidal behaviours, among First Nations youth in Canada are a major public health concern. The Good Behavior Game (GBG) is a school-based intervention that provides a nurturing environment for children and has been shown to promote positive outcomes. PAX Good Behavior Game (PAX GBG) is an adaptation and enhancement of the GBG. While PAX GBG has been implemented in Indigenous communities, little research exists examining the cultural and contextual appropriateness and effectiveness of the intervention in First Nations communities.Methods and analysisThe present paper describes a protocol of the mixed-methods approach guided by an Indigenous ethical engagement model adopted to implement, adapt and evaluate PAX GBG in First Nations communities in Manitoba, Canada. First, implementation outcomes (eg, acceptability, adoption) of PAX GBG will be evaluated using qualitative interviews with teachers, principals and community members from Swampy Cree Tribal Council (SCTC) communities. Second, by linking administrative databases to programme data from schools in 38 First Nations communities, we will compare PAX GBG and control groups to evaluate whether PAX GBG is associated with improved mental health and academic outcomes. Third, the qualitative results will help inform a cultural and contextual adaptation of PAX GBG called First Nations PAX (FN PAX). Fourth, FN PAX will be implemented in a few SCTC communities and evaluated using surveys and qualitative interviews followed by the remaining communities the subsequent year.Ethics and disseminationEthical approval was obtained from the University of Manitoba Health Research Ethics Board and will be obtained from the Health Information Privacy Committee and respective data providers for the administrative database linkages. Dissemination and knowledge translation will include community and stakeholder engagement throughout the research process, reports and presentations for policymakers and community members, presentations at scientific conferences and journal publications.
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Cohen, Marsha M., Noralou P. Roos, Carolyn DeCoster, Charlyn Black, and Kathleen M. Decker. "Manitoba's Population-Based Databases and Long-Term Planning: Beyond the Hospital Databases." Healthcare Management Forum 8, no. 3 (October 1995): 5–13. http://dx.doi.org/10.1016/s0840-4704(10)60914-3.
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The Manitoba Centre for Health Policy and Evaluation (MCHPE) conducts health services research focusing on Manitoba's administrative databases. Administrative databases contain information which is routinely and systematically collected for administrative purposes such as hospital and physician claims and funding requirements. This article describes the MCHPE's five major databases, their strengths and limitations, and the development of the Population Health Information System (PHIS). Four modules from PHIS illustrate how the data are used to provide useful information for health care planners, administrators and policy analysts. Finally, future projects and directions for using administrative databases are explored.
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Bernstein, Charles N., Zoann Nugent, Laura E. Targownik, Harminder Singh, Carolyn Snider, and Julia Witt. "The Cost of Use of the Emergency Department by Persons With Inflammatory Bowel Disease Living in a Canadian Health Region: A Retrospective Population-Based Study." Journal of the Canadian Association of Gastroenterology 3, no. 3 (February 19, 2019): 135–40. http://dx.doi.org/10.1093/jcag/gwz001.
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Abstract Background We aimed to determine the costs of emergency department (ED) attendance by persons with inflammatory bowel disease (IBD) not admitted to hospital from the ED. Methods This was a population-based administrative database study linking the University of Manitoba IBD Epidemiology Database with the Winnipeg Regional Health Authority (WRHA) ED Information Service database. We identified persons with IBD who presented to the ED and were not admitted between January 1, 2009 and March 31, 2012. We then applied costs in Canadian dollars for these visits including an average ED visit cost plus 26% for overhead (total = $508), an average estimated cost of laboratory investigations ($50), and costs for each of radiographic imaging, lower endoscopy and consultation with an internist/gastroenterologist or a surgeon. We tallied the costs of each unique ED presentation. We determined average costs for visits associated with specific consultations or investigations. Results One thousand six hundred and eighty-two persons with IBD (4,853 individual visits) attended the ED and did not get hospitalized. The average cost per ED visit by a person with IBD who did not get hospitalized was $650. This resulted in a total expenditure of $3,152,227 on these persons for their ED attendance or $969,916 per year. The visits with the highest mean costs were those associated with an abdominal computerized tomography scan ($979), those associated with surgical consultation ($1019), and those associated with an internist/gastroenterologist consultation ($942). Conclusion Better strategies for management of acute issues for persons with IBD that can reduce the use of an ED are needed and can be considerably cost saving.
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Singh, Harminder, Robert B. Penfold, Carolyn De Coster, Wendy Au, Charles N. Bernstein, and Michael Moffatt. "Predictors of Serious Complications Associated with Lower Gastrointestinal Endoscopy in a Major City-Wide Health Region." Canadian Journal of Gastroenterology 24, no. 7 (2010): 425–30. http://dx.doi.org/10.1155/2010/714591.
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BACKGROUND: There are limited data regarding complications associated with colonoscopy and flexible sigmoidoscopy in usual clinical practice in Canada.OBJECTIVE: To determine the risk factors for lower gastrointestinal (GI) endoscopy-associated complications in usual clinical practice.METHODS: All outpatient lower GI endoscopies performed in Winnipeg (Manitoba) between April 1, 2004 and March 31, 2006, were identified from the provincial physicians’ claims database. All subsequent hospital admissions within 30 days that documented potential complications associated with lower GI endoscopies were identified from the electronic hospital discharges database and reviewed. Multivariate generalized estimating equation regression analysis was performed to determine independent factors (patient, endoscopist and procedure) associated with the risk of developing complications.RESULTS: There were 29,990 outpatient lower GI endoscopies performed in Winnipeg during the years studied. Seventy-seven (0.26%) procedures were associated with complications requiring hospitalization within 30 days of the index procedure. Stricture dilation (rate ratio [RR] 23.14; 95% CI 6.70 to 76.51), polypectomy (RR 5.93; 95% CI 3.66 to 9.62), increasing patient age (for each year increase in age, RR 1.03; 95% CI 1.01 to 1.05) and performance of endoscopy by low-volume endoscopists (fewer than 200 procedures per year, RR 2.28; 95% CI 1.18 to 4.42) and family physicians (RR 2.23; 95% CI 1.39 to 3.58) were independently associated with complications.CONCLUSIONS: The results of the present study suggest that increasing patient age, complex procedures and performance of the index procedure by low-volume endoscopists are independent risk factors for lower GI endoscopy-associated complications in usual clinical practice. This suggests that it may be time to consider implementing minimum volume requirements for endoscopists performing non-screening lower GI endoscopies.
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Finlayson, Marcia, and Joseph Kaufert. "Older Women's Community Mobility: A Qualitative Exploration." Canadian Journal on Aging / La Revue canadienne du vieillissement 21, no. 1 (2002): 75–84. http://dx.doi.org/10.1017/s0714980800000659.
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ABSTRACTMany of the limitations experienced by community-dwelling older women are related to mobility within their communities. This qualitative study explored community mobility from the perspective of older, community-dwelling women in Winnipeg, Manitoba. Semi-structured interviews were completed with 23 older women (mean age 75.9 years) identified through an existing database. In addition to travels to conduct instrumental activities of daily living and participate in social and recreational activities, the women in the study described trips to fulfil social obligations (e.g., attending funerals, visiting sick friends) and emphasized the importance of these trips. The women's travels through the city were influenced by their perception of risk and the strategies they employed to minimize or avoid risk during the day, in the evening, and during bad weather. Autonomous community mobility provided the women with a sense of independence and control. The findings have potential implications for health care providers and community programmers who work to maintain older women in the community.
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Somji, Mohamed, and Anthony M. Kaufmann. "Geographic Disparities in the Surgical Management of Hemifacial Spasm in Canada." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 46, no. 1 (November 12, 2018): 83–86. http://dx.doi.org/10.1017/cjn.2018.350.
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AbstractBackgroundWe aimed to interrogate the Canadian Institute for Health Information (CIHI) database in order to determine the geographic distribution and outcomes of microvascular decompression (MVD) for the treatment of hemifacial spasm (HFS).MethodsThe CIHI database was searched from 2004 to 2017 for relevant diagnostic and procedure codes. A new database was populated with the following categories: year, institution, province, number of interventions per year, and mean length of stay. Descriptive statistics were generated. Provincial utilization rates of MVD for HFS were calculated.ResultsDuring the period 2004-17, we identified 671 MVDs performed for HFS at 20 centers across Canada. During the study period, 286 MVDs (42.6%) were performed at one center in Manitoba. Another 131 (19.5%) and 72 (10.7%) were performed at one center in British Columbia and Ontario, respectively. The remaining 182 (27.1%) MVDs for HFS were performed at 17 centers across the rest of Canada where the mean number of cases performed per year was 1.1 (SD=0.9, range 0.2-2.9). When out-of-province cases were re-allocated to place of residence, the adjusted provincial utilization of MVD for HFS ranged between 0.5 and 6.1 patients per million per year.ConclusionsMicrovascular decompression for HFS is performed relatively rarely and there is a tremendous geographic variation in utilization across Canada. Although most of these surgeries are performed by a few surgeons, more than half of Canadian centers perform an average of less than 1 case per year. Further examination of the impact of these discrepancies appears warranted.
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Johnston, James Blain, Joss N. Reimer, John L. Wylie, and Jared Bullard. "Observational study of the populations accessing rapid point-of-care HIV testing in Winnipeg, Manitoba, Canada, through a retrospective chart review of site records." Sexually Transmitted Infections 94, no. 3 (October 7, 2017): 194–99. http://dx.doi.org/10.1136/sextrans-2017-053195.
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ObjectivesHIV point-of-care testing (POCT) has been available in Manitoba since 2008. This study evaluated the effectiveness of POCT at identifying individuals with previously unknown HIV status, its effects on clinical outcomes and the characteristics of the populations reached.MethodsA retrospective database review was conducted for individuals who received HIV POCT from 2011 to 2014. Time to linkage to care and viral load suppression were compared between individuals who tested positive for HIV using POCT and controls identified as positive through standard screening. Testing outcomes for labouring women with undocumented HIV status accessing POCT during labour were also assessed.Results3204 individuals received POCT (1055 females (32.9%) and 2149 males (67.1%)), being the first recorded HIV test for 2205 (68.8%). Males were more likely to be targeted with POCT as their first recorded HIV test (adjusted OR (AOR) 1.40). Between the two main test sites (Main Street Project (MSP) and Nine Circles Community Health Centre), MSP tested relatively fewer males (AOR 0.79) but a higher proportion of members of all age groups over 30 years old (AOR 1.83, 2.51 and 3.64 for age groups 30–39, 40–49 and >50, respectively). There was no difference in time to linkage to care (p=0.345) or viral load suppression (p=0.405) between the POCT and standard screening cohorts. Of 215 women presenting in labour with unknown HIV status, one was identified as HIV positive.ConclusionsPOCT in Manitoba has been successful at identifying individuals with previously unknown HIV-positive status. Demographic differences between the two main testing sites support that this intervention is reaching unique populations. Given that we observed no significant difference in time to clinical outcomes, it is reasonable to continue using POCT as a targeted intervention.MeSH termsHIV infection; rapid HIV testing; vertical infectious disease transmission; community outreach; service delivery; marginalised populations.
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Szwajcer, David, William D. Leslie, A. Majid Shojania, Marina Yogendran, and Colleen Metge. "An Operational Definition of Cobalamin Replacement Based upon Administrative Health Data." Blood 104, no. 11 (November 16, 2004): 3147. http://dx.doi.org/10.1182/blood.v104.11.3147.3147.
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Abstract Background: A large clinical dataset of vitamin B12 measurements (over 12,000 patients) and Schilling tests (over 700 patients) has been assembled from participating Manitoba laboratories (1995–2000) in order to assess clinical outcomes (as defined from administrative health data) in relation to tests of cobalamin [Cbl] deficiency. In order to control for Cbl replacement, it is necessary to confirm that Cbl replacement can be accurately determined from administrative data sources such as the Drug Program Information Network (DPIN) and/or medical claims for therapeutic injections. DPIN is known to be reliable for oral prescription drugs, but parenteral Cbl may be more difficult to identify and non-prescription oral Cbl would not be recorded. We believe that the preferred route of Cbl administration in Manitoba was parenteral during 1995–2000, but this needs to be confirmed. Methods: Cases (expected to have a high likelihood for Cbl replacement) consisted of all adult hospital discharges between 1995 and 2000 with a diagnosis of pernicious anemia or other Cbl deficiency anemia (ICD-9-CM 281.0, 281.1) who survived for at least one year post-discharge without personal care home admission (n=388). Matched controls (3 controls for each case) with a low likelihood for Cbl replacement were similarly defined from hospital discharges without any ICD-9-CM neurologic or haematologic diagnosis (n=1,164). Controls were matched with cases for gender, birth year and hospitalization year. For each case and control the number of Cbl dispensations (ATC code B03BA01) and therapeutic injections (tariff code #8954) were tabulated during the first three years post-discharge. Sensitivities (fraction of cases receiving Cbl replacement) and specificities (fraction of controls not receiving Cbl replacement) were calculated for different cutoffs of Cbl dispensations, therapeutic injections and combinations according to year of diagnosis (YOD) and overall. Weighted linear regression between YOD and sensitivity was performed to look for an effect of recent oral Cbl replacement. Results: Sensitivity for the a priori operational definition (≥2 Cbl dispensations) was 0.59±0.02 with specificity 0.96±0.01. Using one or more Cbl dispensations improved sensitivity to 0.71±0.02 with similar specificity of 0.95±0.01. Therapeutic injections alone were less useful (≥1 injection sensitivity of 0.65±0.02 with specificity of 0.92±0.01, ≥2 injections sensitivity of 0.61±0.02 with specificity of 0.95±0.01). The combination that maximized sensitivity + specificity was ≥1 dispensation or ≥2 therapeutic injections (sensitivity 0.80±0.02, specificity 0.93±0.01). Sensitivity measurements did not show any significant relationship with YOD. Conclusions: The optimal definition for Cbl therapy based upon administrative health data appears to be at least one Cbl dispensation identified in the DPIN database or at least two therapeutic injections identified from medical claims. In assessing clinical outcomes in relation to Cbl testing and replacement, we propose to validate findings derived with the primary combined definition through secondary analyses using independent definitions of Cbl replacement (≥1 dispensation alone or ≥2 therapeutic injections alone). Overall sensitivity was lower than expected but may reflect that some cases are not prescribed Cbl replacement post-discharge. Sensitivity was unrelated to YOD arguing against oral Cbl replacement as the explanation.
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Crowson, Matthew G., Joseph M. Chen, and Debara Tucci. "Provincial Variation of Cochlear Implantation Surgical Volumes and Cost in Canada." Otolaryngology–Head and Neck Surgery 156, no. 1 (October 3, 2016): 137–43. http://dx.doi.org/10.1177/0194599816668325.
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Objectives To investigate provincial cochlear implantation (CI) annual volume and cost trends. Study Design Database analysis. Setting National surgical volume and cost database. Subjects and Methods Aggregate-level provincial CI volumes and cost data for adult and pediatric CI surgery from 2005 to 2014 were obtained from the Canadian Institute for Health Information. Population-level aging forecast estimates were obtained from the Ontario Ministry of Finance and Statistics Canada. Linear fit, analysis of variance, and Tukey’s analyses were utilized to compare variances and means. Results The national volume of annual CI procedures is forecasted to increase by <30 per year ( R2 = 0.88). Ontario has the highest mean annual CI volume (282; 95% confidence interval, 258-308), followed by Alberta (92.0; 95% confidence interval, 66.3-118), which are significantly higher than all other provinces ( P < .05 for each). Ontario’s annual CI procedure volume is forecasted to increase by <11 per year ( R2 = 0.62). Newfoundland and Nova Scotia have the highest CI procedures per 100,000 residents as compared with all other provinces ( P < .05). Alberta, Newfoundland, and Manitoba have the highest estimated implantation cost of all provinces ( P < .05). Conclusions Historical trends of CI forecast modest national volume growth. Potential bottlenecks include provincial funding and access to surgical expertise. The proportion of older adult patients who may benefit from a CI will rise, and there may be insufficient capacity to meet this need. Delayed access to CI for pediatric patients is also a concern, given recent reports of long wait times for CI surgery.
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Targownik, Laura E., Eric I. Benchimol, Julia Witt, Charles N. Bernstein, Harminder Singh, Lisa Lix, Aruni Tennakoon, et al. "The Effect of Initiation of Anti-TNF Therapy on the Subsequent Direct Health Care Costs of Inflammatory Bowel Disease." Inflammatory Bowel Diseases 25, no. 10 (June 18, 2019): 1718–28. http://dx.doi.org/10.1093/ibd/izz063.
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Abstract Background Anti–tumor necrosis factor (anti-TNF) drugs are highly effective in the treatment of moderate-to-severe Crohn’s disease (CD) and ulcerative colitis (UC), but they are very costly. Due to their effectiveness, they could potentially reduce future health care spending on other medical therapies, hospitalization, and surgery. The impact of downstream costs has not previously been quantified in a real-world population-based setting. Methods We used the University of Manitoba IBD Database to identify all persons in a Canadian province with CD or UC who received anti-TNF therapy between 2004 and 2016. All inpatient, outpatient, and drug costs were enumerated both in the year before anti-TNF initiation and for up to 5 years after anti-TNF initiation. Costs before and after anti-TNF initiation were compared, and multivariate linear regression analyses were performed to look for predictors of higher costs after anti-TNF initiation. Results A total of 928 people with IBD (676 CD, 252 UC) were included for analyses. The median cost of health care in the year before anti-TNF therapy was $4698 for CD vs $6364 for UC. The median cost rose to $39,749 and $49,327, respectively, in the year after anti-TNF initiation, and to $210,956 and $245,260 in the 5 years after initiation for continuous anti-TNF users. Inpatient and outpatient costs decreased in the year after anti-TNF initiation by 12% and 7%, respectively, when excluding the cost of anti-TNFs. Conclusions Direct health care expenditures markedly increase after anti-TNF initiation and continue to stay elevated over pre-initiation costs for up to 5 years, with only small reductions in the direct costs of non-drug-related health care.
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Moore, D. F., L. M. Lix, M. S. Yogendran, P. Martens, and A. Tamayo. "Stroke surveillance in Manitoba, Canada: Estimates from administrative databases." Chronic Diseases in Canada 29, no. 1 (2008): 22–30. http://dx.doi.org/10.24095/hpcdp.29.1.03.
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This study investigated the use of population-based administrative databases for stroke surveillance. First, a meta-analysis was conducted of four studies, identified via a PubMed search, which estimated the sensitivity and specificity of hospital data for ascertaining cases of stroke when clinical registries or medical charts were the gold standard. Subsequently, case-ascertainment algorithms based on hospital, physician and prescription drug records were developed and applied to Manitoba's administrative data, and prevalence estimates were obtained for fiscal years 1995/96 to 2003/04 by age group, sex, region of residence and income quintile. The meta-analysis results revealed some over-ascertainment of stroke cases from hospital data when the algorithm was based on diagnosis codes for any type of cerebrovascular disease (Mantel-Haenszel Odds-Ratio [OR] – 1.70 [95% confidence interval (CI): 1.53 – 1.88]). Analyses of Manitoba administrative data revealed that while the total number of stroke cases varied substantially across the algorithms, the trend in prevalence was stable regardless of the algorithm adopted.
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Anthonisen, NR, K. Woodlrage, and J. Manfreda. "Use of Spirometry and Respiratory Drugs in Manitobans Over 35 Years of Age with Obstructive Lung Diseases." Canadian Respiratory Journal 12, no. 2 (2005): 69–74. http://dx.doi.org/10.1155/2005/974678.
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BACKGROUND: Previous data indicated that spirometry was underused in people with obstructive disease, especially those with chronic obstructive pulmonary disease (COPD).OBJECTIVE: To examine the use of respiratory drugs in patients with COPD and asthma, and to relate drug use to spirometry.METHODS: Manitoba Health maintains a database of physician services remunerated by fees that includes spirometry. The database contains the diagnosis and patient identifiers, as well as sex, date of birth and residential postal code. Similar identifiers are used in the provincial pharmacare program that records prescriptions dispensed at retail pharmacies. These databases were examined for the time period between 1996 to 2000, and people over 35 years of age diagnosed with asthma, COPD or both were identified. The frequency of spirometry in these patients and their use of respiratory drugs was determined.RESULTS: Spirometry and drug prescription frequencies increased with the number of physician visits (including those for bronchitis), but their patterns differed. Patients with asthma or asthma plus COPD had considerably higher rates of drug prescription and slightly higher spirometry rates than did those with COPD. Patients with asthma and asthma plus COPD who underwent spirometry were slightly more likely to receive drugs than those who did not undergo spirometry; this trend was more striking in patients with COPD. However, approximately 30% of patients with COPD who had five physician visits and who underwent spirometry did not receive drugs; this was true for approximately 10% of similar patients with asthma. Patients with asthma generally received beta-agonists and inhaled steroids; these agents were less commonly given to patients with COPD, who instead were given anticholinergics much more often than were asthmatics. Patients who were diagnosed with asthma plus COPD had beta-agonist and inhaled corticosteroid prescription rates similar to asthmatics, and anticholinergic prescription rates similar to patients with COPD. Theophylline and antileukotriene drugs were used less often than were inhaled agents. In patients with asthma, drugs were frequently discontinued, and during drug use, prescription refills were consistent with an intake of 30.9% of the prescribed doses. In patients with COPD, discontinuing drugs early was uncommon, and refills were consistent with the use of 54% of the prescribed amounts. The same was true of patients with both COPD and asthma.DISCUSSION: Drug prescription was considerably more common in patients labelled with asthma or COPD plus asthma than in patients with COPD. Spirometry was also less common in patients with COPD but had a distinct influence on the frequency of drug prescription. Patterns of drug prescription were predictable, and patterns of drug use indicated poor compliance, in agreement with other data. The results suggest that COPD symptoms may be discounted and patients systematically undertreated or the diagnosis could frequently be applied to people with trivial disease or both.
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Wilk, Piotr, Shehzad Ali, Kelly K. Anderson, Andrew F. Clark, Martin Cooke, Stephanie J. Frisbee, Jason Gilliland, et al. "Geographic variation in preventable hospitalisations across Canada: a cross-sectional study." BMJ Open 10, no. 5 (May 2020): e037195. http://dx.doi.org/10.1136/bmjopen-2020-037195.
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ObjectiveThe objective of this study is to examine the magnitude and pattern of small-area geographic variation in rates of preventable hospitalisations for ambulatory care-sensitive conditions (ACSC) across Canada (excluding Québec).Design and settingA cross-sectional study conducted in Canada (excluding Québec) using data from the 2006 Canadian Census Health and Environment Cohort (CanCHEC) linked prospectively to hospitalisation records from the Discharge Abstract Database (DAD) for the three fiscal years: 2006–2007, 2007–2008 and 2008–2009.Primary outcome measurePreventable hospitalisations (ACSC).ParticipantsThe 2006 CanCHEC represents a population of 22 562 120 individuals in Canada (excluding Québec). Of this number, 2 940 150 (13.03%) individuals were estimated to be hospitalised at least once during the 2006–2009 fiscal years.MethodsAge-standardised annualised ACSC hospitalisation rates per 100 000 population were computed for each of the 190 Census Divisions. To assess the magnitude of Census Division-level geographic variation in rates of preventable hospitalisations, the global Moran’s I statistic was computed. ‘Hot spot’ analysis was used to identify the pattern of geographic variation.ResultsOf all the hospitalisation events reported in Canada during the 2006–2009 fiscal years, 337 995 (7.10%) events were ACSC-related hospitalisations. The Moran’s I statistic (Moran’s I=0.355) suggests non-randomness in the spatial distribution of preventable hospitalisations. The findings from the ‘hot spot’ analysis indicate a cluster of Census Divisions located in predominantly rural and remote parts of Ontario, Manitoba and Saskatchewan and in eastern and northern parts of Nunavut with significantly higher than average rates of preventable hospitalisation.ConclusionThe knowledge generated on the small-area geographic variation in preventable hospitalisations can inform regional, provincial and national decision makers on planning, allocation of resources and monitoring performance of health service providers.
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Peschken, Christine A., Carol A. Hitchon, Allan Garland, Charles N. Bernstein, Hui Chen, Randy Fransoo, and Ruth Ann Marrie. "A Population-based Study of Intensive Care Unit Admissions in Rheumatoid Arthritis." Journal of Rheumatology 43, no. 1 (December 1, 2015): 26–33. http://dx.doi.org/10.3899/jrheum.150312.
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Objective.We aimed to determine the incidence of and mortality after critical illness in rheumatoid arthritis (RA) compared with the general population, and to describe the risks for and characteristics of critical illness in patients with RA.Methods.We used population-based administrative data from the Data Repository at the Manitoba Centre for Health Policy from 1984 to 2010, and linked clinical data from an intensive care unit (ICU) database to identify all persons with RA in the province requiring ICU admission. We identified a population-based control group, matched by age, sex, socioeconomic status, and region of residence. The incidence of ICU admission, reasons for, and mortality after ICU admission were compared between populations using age- and sex-standardized rates, rate ratios, Cox proportional hazards models, and logistic regression models.Results.We identified 10,078 prevalent and 5560 incident cases of RA. After adjustment, the risk for ICU admission was higher for RA (HR 1.65, 95% CI 1.50–1.83) versus the matched general population. From 2000–2010, the annual incidence of ICU admission among prevalent patients was about 1% in RA, with a crude 10-year incidence of 8%. Compared with the general population admitted to ICU, 1 year after ICU admission, mortality was increased by 40% in RA. Cardiovascular disorders were the most common reason for ICU admission in RA.Conclusion.Patients with RA have a higher risk for admission to the ICU than the general population and increased mortality 1 year after admission. Even with advances in management, RA remains a serious disease with significant morbidity.
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Skrabek, Pamela, Rajat Kumar, James B. Johnston, Joseph Baptiste, Bernie Lozar, Scott Streilein, Venetia Bourrier, and Sri Navaratnam. "Effectiveness and Cost of Rituximab for CLL in the Province of Manitoba Prior to Its Approval As Part of First Line Treatment." Blood 120, no. 21 (November 16, 2012): 4701. http://dx.doi.org/10.1182/blood.v120.21.4701.4701.
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Abstract Abstract 4701 Introduction: In Manitoba (MB), population 1.25 million, utilization of parenteral oncology drugs is captured through a provincial oncology drug program (PODP) database. The MB Oncology Drug Utility and Clinical Outcomes Program (MODUCO) evaluates drug/regimen utilization with correlation to clinical outcomes. Rituximab (R) accounts for a significant proportion of PODP expenditures, as such monitoring effectiveness at the population level is essential. First line treatment of CLL with FR or FCR was approved in MB in 2009. Prior to this, approval for R based regimens required a non-formulary request. This was a MODUCO initiative to determine effectiveness and cost of R based therapy for CLL in MB, prior to formulary approval of R as part of first line treatment. Methods: Using the PODP database all patients in MB with CLL (and SLL) who received any form of R based therapy between January 14, 2003 and December 14, 2007 were identified. Using this cohort, treatment with R based regimens up until March 14, 2011 was analyzed with follow up until August 1, 2012. Treatment with R for transformed lymphoma was excluded. The primary outcome measure of Treatment Free Survival (TFS) was defined as the interval from initiation of R to next treatment or death. Patients were censored if alive without further treatment at the date of last follow up. The following factors were analyzed for impact on TFS: age, gender, treatment line (greater than or equal to 1), R treatment line (greater than or equal to 1), regimen, treatment indication (symptomatic disease, lymphocyte doubling time (DT), autoimmune cytopenias, or stage 3/4 disease) and response (No /Yes). Response was defined as improvement in peripheral blood counts or reduction in lymphadenopathy and/or organomegaly. Exact dose of R received during each treatment was recorded for cost analysis. Results: Between 2003–2007 R based therapy was administered for the first time to 86 patients (57 males) with mean age 65.1 years. Median number of prior treatments was 3 (range 1–9). Second time treatment with R was given to 40 patients (46.5%) while 12 (14%) received R on three or more occasions during the follow up period. Overall response was seen in 72.4%. The median time to next treatment or death (TFS) was 1.28 years (95% CI 1.01–1.64) with 50 deaths. Factors contributing to shorter TFS based on univariate analysis were (a) lack of response (p<0.0001), (b) 2nd or 3rd time R administration (p 0.04 and 0.0002), and (c) use of RCVP or RCHOP (p <0.02) or other regimens (p <0.001) compared to the reference (FR/FCR). Multivariate analysis revealed that treatment initiation due to DT, compared to all other indications, was associated with decreased rate of retreatment or death (HR 0.36, 95% CI 0.17–0.73). As seen in Figure 1, patients receiving R for the third time (or greater) had shorter median TFS (HR 2.54, 95% CI 1.48–4.36). Regimens other than FR, FCR, RCVP, RCHOP and RCD had increased risk of needing alternative treatment or dying (HR 1.82, 95% CI 1.08–3.06). Mean cost of R per regimen was $12,999.91. The total cost of R for this cohort was $1.87 million. Cost of R when used for the third time or greater was $410,698. Conclusion: This population-based retrospective analysis of cost and effectiveness of R, prior to formulary inclusion for CLL, reveals that patients derive maximum benefit with 1st and 2nd administration of R. These patients had refractory or relapsed disease with multiple prior treatments, yet a high proportion responded to treatment confirming the utility of R for salvage therapy. Duration of response is an important consideration in cost-effectiveness, with the MODUCO experience suggesting that effectiveness diminishes with non-standard regimens and greater than 2 previous R containing regimens. Improving patient access to treatments in health care systems that are publically funded means balancing cost with effectiveness in the population. Disclosures: Kumar: Celgene: Membership on an entity's Board of Directors or advisory committees. Johnston:Roche: Membership on an entity's Board of Directors or advisory committees, Research Funding. Bourrier:Roche: Grant Funding for Educational Initiatives Other.
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Peterson, Sandra, Evelyn Shapiro, and Noralou P. Roos. "Regional Variation in Home Care Use in Manitoba." Canadian Journal on Aging / La Revue canadienne du vieillissement 24, S1 (2005): 69–80. http://dx.doi.org/10.1353/cja.2005.0054.
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ABSTRACTPrevious studies report geographic variation in the use of home care services. In the province of Manitoba, home care is a core service that Manitoba' twelve regional health authorities (RHAs) are obligated to deliver. Manitoba' RHAs range from remote northern and rural southern regions to a major city, resulting in different challenges for delivering home care. Given this potential for inconsistent delivery and the previous findings of regional variation in other settings, the objective of this study was to measure and assess variation in the use of home care across Manitoba' RHAs. We used data from the Provincial Home Care Program' client registry, other health care administrative databases, and Vital Statistics. Home care use was measured using multiple indicators, including rates of population use, use after hospitalization, before entry to a long-term care facility, and before death. While some important differences emerged, overall we found comparable use of home care across Manitoba.
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Singh, H., C. De Coster, E. Shu, K. Fradette, S. Latosinksy, M. Pitz, M. Cheang, and D. Turner. "Wait Times from Presentation to Treatment for Colorectal Cancer: A Population-Based Study." Canadian Journal of Gastroenterology 24, no. 1 (2010): 33–39. http://dx.doi.org/10.1155/2010/692151.
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BACKGROUND: The wait time from cancer diagnosis to treatment has been a recent focus of cancer care in Canada.OBJECTIVE: To examine the trends in wait times from patient presentation to treatment (overall health system wait time [OWT]) for colorectal cancer (CRC).METHODS: Patients with colorectal adenocarcinomas, diagnosed between 2001 and 2005, and their first definitive treatments were identified from the population-based Manitoba Cancer Registry (Winnipeg, Manitoba). By linkage to Manitoba Health and Healthy Living’s administrative databases, a patient’s first gastrointestinal investigation (abdominal radiological imaging, lower gastrointestinal endoscopy or fecal occult blood test) before CRC diagnosis was identified. The index contact with the health care system was estimated from the date of the visit with the physician who ordered the first gastroenterological investigation. The OWT was defined as the time from the index contact to the first treatment, while diagnostic delay was defined as the time from the index contact to the diagnosis of CRC. Multivariate Cox regression analysis was performed to determine independent predictors of OWT.RESULTS: The OWT was estimated for 2552 cases of CRC over the five years that were examined. The median OWT increased from 61 days in 2001 to 95 days in 2005 (P<0.001). Most of the increase was in diagnostic wait times (median of 44 days in 2001 versus 64 days in 2005 [P<0.001]). Year of diagnosis, older age, urban residence and diagnosis at a teaching facility were independent predictors of OWT.CONCLUSIONS: The OWT from presentation to treatment of CRC in Manitoba steadily increased between 2001 and 2005, mostly due to diagnostic delays.
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Singh, Harminder, Emma Shu, Alain Demers, Charles N. Bernstein, Jane Griffith, and Katherine Fradette. "Trends in Time to Diagnosis of Colon Cancer and Impact on Clinical Outcomes." Canadian Journal of Gastroenterology 26, no. 12 (2012): 877–80. http://dx.doi.org/10.1155/2012/363242.
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BACKGROUND: There has been a rapid increase in screening for colorectal cancer (CRC) over the past several years in North America. This could paradoxically lead to worsening outcomes if the system is not adapted to deal with the increased demand. For example, this could create increased wait times for endoscopy and delayed time to CRC diagnosis, which could worsen clinical outcomes such as stage at diagnosis and/or survival. No previous Canadian study has evaluated the association between time to CRC diagnosis and clinical outcomes.METHODS: The present historical cohort study used Manitoba’s population-based cancer registry and Manitoba Health administrative databases. The effect of time to diagnosis on patient survival was evaluated using Cox regression analysis with adjustment for stage at diagnosis, grade of CRC, age, sex, socioeconomic status, comorbidity index score and year of CRC diagnosis. The association between time to diagnosis and CRC stage at diagnosis was evaluated using multivariate logistic regression analysis.RESULTS: The median time to CRC diagnosis increased significantly from 72 days (95% CI 61 days to 83 days) in 2004 to 105 days (95% CI 64 days to 129 days) in the first three months of 2009 (P=0.04). There was no significant association between time to diagnosis and survival. Individuals with the longest time to diagnosis were less likely to have stage III/IV CRC at diagnosis (quartile 4 versus quartile 1: OR 0.50 [95% CI 0.33 to 0.75).CONCLUSION: Time to CRC diagnosis is continuing to increase in Manitoba. Although the present study did not detect a significant negative clinical effect of increasing time to diagnosis, additional studies are required.
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Tricco, Andrea C., Ba' Pham, and Nigel S. B. Rawson. "Manitoba and Saskatchewan administrative health care utilization databases are used differently to answer epidemiologic research questions." Journal of Clinical Epidemiology 61, no. 2 (February 2008): 192–97. http://dx.doi.org/10.1016/j.jclinepi.2007.03.009.
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Tanner, Julie-Anne, Jennifer Hensel, Paige E. Davies, Lisa C. Brown, Bryan M. Dechairo, and Benoit H. Mulsant. "Economic Burden of Depression and Associated Resource Use in Manitoba, Canada." Canadian Journal of Psychiatry 65, no. 5 (December 13, 2019): 338–46. http://dx.doi.org/10.1177/0706743719895342.
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Objectives To characterize the health-care utilization and economic burden associated with depression in Manitoba, Canada. Methods Patient-level data were retrieved from the Manitoba Centre for Health Policy administrative, clinical, and laboratory databases for the study period of January 1, 1996, through December 31, 2016. Patients were assigned to the depression cohort based on diagnoses recorded in hospitalizations and outpatient physician claims, as well as antidepressant prescription drug claims. A comparison cohort of nondepressed subjects, matched with replacement for age, gender, place of residence (urban vs. rural), and index date, was created. Demographics, comorbidities, intentional self-harm, mortality, health-care utilization, prescription drug utilization, and costs of health-care utilization and social services were compared between depressed patients and matched nondepressed patients, and incidence rate ratios and hazard ratios were reported. Results There were 190,065 patients in the depression cohort and 378,177 patients in the nondepression cohort. Comorbidities were 43% more prevalent among depressed patients. Intentional self-harm, all-cause mortality, and suicide mortality were higher among patients with depression than the nondepression cohort. Health-care utilization—including hospitalizations, physician visits, physician-provided psychotherapy, and prescription drugs—was higher in the depression than the nondepression cohort. Mean health-care utilization costs were 3.5 times higher among depressed patients than nondepressed patients ($10,064 and $2,832, respectively). Similarly, mean social services costs were 3 times higher ($1,522 and $510, respectively). Overall, depression adds a total average cost of $8,244 ( SD = $40,542) per person per year. Conclusions Depression contributes significantly to health burden and per patient costs in Manitoba, Canada. Extrapolation of the results to the entire Canadian health-care system projects an excess of $12 billion annually in health system spending.
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Cheung, W. Y., J. Butler, E. Kliewer, A. Demers, G. Musto, and S. Navaratnam. "Use of health administrative databases in the analysis of waiting times and costs for the diagnosis of non-small cell lung cancer (NSCLC)." Journal of Clinical Oncology 24, no. 18_suppl (June 20, 2006): 6042. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.6042.
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6042 Background: Knowledge of waiting times and costs involved in diagnosis will help to define more effective diagnostic services. The use of administrative databases for such health services research provides a large, population-based cohort and permits an accurate calculation of costs. Methods: Patients diagnosed with NSCLC in Manitoba, Canada from 1996 to 2000 were identified by the cancer registry. Information on diagnostic and staging tests, timeline of investigations, physician visits, hospital admissions, and outcomes were obtained from detailed chart review for 472 patients and from the Manitoba Health Administrative Databases for 2,862 patients. Tariff codes for physician services were used to calculate costs. Results: An excellent correlation was observed (range 83.3 to 99.2%) between the chart review and the administrative databases with regards to timelines of imaging studies, physician services, and procedures. However, charts considerably underreported certain services. For instance, only 58% of chest x-rays performed were captured by chart review. Therefore, costs were analyzed using the administrative databases. Waiting times from chest x-ray to chest CT scan and from CT scan to definitive histologic diagnosis were a median of 8 (range 1–25) and 18 (range 3–42) days respectively by administrative databases, and 10 (range 1–31) and 18 (range 6–36) days respectively by chart review. At least 25% of 2862 patients waited more than 55 days from initial suspicion on chest x-ray to arrive at a final diagnosis. The mean cost to reach a lung cancer diagnosis was $7,578 but analysis indicates that there were large variations in costs among patients. The majority of expenses was accounted by hospital admissions and repeated primary care physician visits, while shorter waiting times to diagnosis corresponded with relatively less costs. Conclusions: Since there is an excellent correlation between chart review and administrative databases, the latter can be used in the future for large cohort studies instead of expensive, laborious chart reviews. Despite clinical suspicion, 25% of patients wait more than 8 weeks for a final diagnosis. A centralized diagnostic service may reduce waiting times and costs for diagnosis. No significant financial relationships to disclose.
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Pitz, Marshall W., Grace Musto, and Srisala Navaratnam. "Sex as an Independent Prognostic Factor in a Population-Based, Non-Small Cell Lung Cancer Cohort." Canadian Respiratory Journal 20, no. 1 (2013): 30–34. http://dx.doi.org/10.1155/2013/618691.
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BACKGROUND: Males with non-small cell lung cancer (NSCLC) tend to experience worse outcomes, as do those with nonadenocarcinoma histology; however, the independent effects of these factors remain unclear.OBJECTIVE: To evaluate the independent effect of sex and histology on mortality in a population of patients with NSCLC.METHODS: All patients with NSCLC in Manitoba from 1985 to 2004 were identified from the Manitoba Cancer Registry. Treatment data were extracted from the Manitoba Health administrative databases and linked to the registry. Cox regression analysis was used to determine the independent effect of sex on survival.RESULTS: A total of 10,908 patients (6665 male, 4243 female) with NSCLC were identified. Females had a median overall survival of 9.4 months versus 6.8 months for males (P<0.001). The adjusted HR for death for males compared with females was 1.13 (95% CI 1.04 to 1.23; P=0.004). Sex modified the effect of surgical treatment on survival (HR 1.26 [95% CI 1.13 to 1.40]; P<0.001). Adenocarcinoma histology modified the effect of sex on survival (HR 1.36 [95% CI 1.24 to 1.50]; P<0.001) when treatment was accounted for.CONCLUSION: Females experienced a significantly better survival rate than males independent of treatment, age, year of diagnosis and histology. This was greatest in surgically treated patients and in those with adenocarcinoma.
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Righolt, Christiaan H., Karla Willows, Erich V. Kliewer, and Salaheddin M. Mahmud. "Incidence of anogenital warts after the introduction of the quadrivalent HPV vaccine program in Manitoba, Canada." PLOS ONE 17, no. 4 (April 26, 2022): e0267646. http://dx.doi.org/10.1371/journal.pone.0267646.
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Background The incidence of anogenital warts (AGW) decreased after the introduction of the quadrivalent human papillomavirus (qHPV) vaccine in multiple jurisdictions. We studied how comparing AGW incidence rates with different outcomes affects the interpretation of the qHPV vaccination program. To do this, we replicated multiple study designs within a single jurisdiction (Manitoba). Methods We measured the incidence rates of AGW, AGW-related prescriptions, chlamydia, and gonorrhea (the latter two as sham outcomes) between 2001 and 2017 using several clinical and administrative health databases from Manitoba. We then used incidence rate ratios (IRRs) to compare, for each outcome, the rate for the 1997–1998 birth cohort (the first cohorts eligible for the publicly funded qHPV vaccination program) and the older 1995–1996 birth cohort. Results AGW incidence in Manitoba dropped 72% (95% confidence interval 54–83%) among 16–18 year-old girls and 51% (14–72%) among boys after the introduction of the female-only qHPV vaccination program. Trends in AGW-related prescriptions were different from trends in AGW diagnoses as these prescriptions peaked shortly after the introduction of the publicly funded qHPV vaccine program. Chlamydia and gonorrhea incidence rates also decreased 12% (5–18%) and 16% (-1-30%), respectively, for 16–18 year-old girls. Conclusions The publicly funded school-based qHPV vaccine program reduced AGW incidence in Manitoba by three-quarters in young females. AGW-related prescriptions are a poor proxy for medically attended AGW after the introduction of the publicly funded qHPV vaccination program. Different sexual habits in adolescents are, at most, responsible for a small portion of the reduction in AGW incidence.
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Righolt, Christiaan H., Karla Willows, Erich V. Kliewer, and Salaheddin M. Mahmud. "Incidence of anogenital warts after the introduction of the quadrivalent HPV vaccine program in Manitoba, Canada." PLOS ONE 17, no. 4 (April 26, 2022): e0267646. http://dx.doi.org/10.1371/journal.pone.0267646.
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Background The incidence of anogenital warts (AGW) decreased after the introduction of the quadrivalent human papillomavirus (qHPV) vaccine in multiple jurisdictions. We studied how comparing AGW incidence rates with different outcomes affects the interpretation of the qHPV vaccination program. To do this, we replicated multiple study designs within a single jurisdiction (Manitoba). Methods We measured the incidence rates of AGW, AGW-related prescriptions, chlamydia, and gonorrhea (the latter two as sham outcomes) between 2001 and 2017 using several clinical and administrative health databases from Manitoba. We then used incidence rate ratios (IRRs) to compare, for each outcome, the rate for the 1997–1998 birth cohort (the first cohorts eligible for the publicly funded qHPV vaccination program) and the older 1995–1996 birth cohort. Results AGW incidence in Manitoba dropped 72% (95% confidence interval 54–83%) among 16–18 year-old girls and 51% (14–72%) among boys after the introduction of the female-only qHPV vaccination program. Trends in AGW-related prescriptions were different from trends in AGW diagnoses as these prescriptions peaked shortly after the introduction of the publicly funded qHPV vaccine program. Chlamydia and gonorrhea incidence rates also decreased 12% (5–18%) and 16% (-1-30%), respectively, for 16–18 year-old girls. Conclusions The publicly funded school-based qHPV vaccine program reduced AGW incidence in Manitoba by three-quarters in young females. AGW-related prescriptions are a poor proxy for medically attended AGW after the introduction of the publicly funded qHPV vaccination program. Different sexual habits in adolescents are, at most, responsible for a small portion of the reduction in AGW incidence.
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Wall-Wieler, Elizabeth, Leslie L. Roos, and Nathan C. Nickel. "Adolescent Pregnancy Outcomes Among Sisters and Mothers: A Population-Based Retrospective Cohort Study Using Linkable Administrative Data." Public Health Reports 133, no. 1 (December 20, 2017): 100–108. http://dx.doi.org/10.1177/0033354917739583.
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Objectives: Female family members affect both the likelihood of adolescent pregnancy and the outcome of that pregnancy. We examined the degree to which an older sister’s adolescent reproductive outcomes affect her younger sister’s reproductive behavior, and whether relationships in adolescent pregnancy among sisters born to adolescent mothers differ from those born to nonadolescent mothers. Methods: We followed a birth cohort in Manitoba, Ontario, Canada, to age 20 using linkable administrative databases housed at the Manitoba Centre for Health Policy. The cohort consisted of 12 391 girls born in Manitoba between April 1, 1984, and March 31, 1996, who had 1 older sister. We used logistic regression models to examine the relationships among familial adolescent pregnancy outcomes. Results: Compared with adolescent girls whose older sister did not have an adolescent pregnancy, adolescent girls whose older sister had an adolescent pregnancy were more likely to have a pregnancy (adjusted odds ratio [aOR] = 2.57), regardless of whether that pregnancy was completed (aOR = 2.56) or terminated (aOR = 2.59). Relationships in adolescent pregnancy among sisters were much stronger for those born to nonadolescent mothers (aOR = 3.16 [older sister completed adolescent pregnancy] and 3.18 [older sister terminated adolescent pregnancy]) than to adolescent mothers (aOR = 1.65 [older sister completed adolescent pregnancy] and 1.77 [older sister terminated adolescent pregnancy]). For younger sisters having an adolescent pregnancy, the odds of her completing the pregnancy were reduced if her older sister had terminated an adolescent pregnancy and her mother had not been an adolescent mother (aOR = 0.38). Conclusions: Younger sisters of adolescents who had a pregnancy may benefit from targeted interventions to reduce their likelihood of adolescent pregnancies.
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Aboulatta, Laila, Payam Peymani, Christine Vaccaro, Christine Leong, Kaarina Kowalec, Joseph Delaney, Jamie Falk, Silvia Alessi-Severini, Basma Aloud, and Sherif Eltonsy. "Drug utilization patterns before and during COVID-19 pandemic in Manitoba, Canada: A population-based study." PLOS ONE 17, no. 11 (November 28, 2022): e0278072. http://dx.doi.org/10.1371/journal.pone.0278072.
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Background The COVID-19 pandemic has led the Canadian provincial governments to take unprecedented measures, including restrictions to healthcare services and pharmacists. Limited evidence exists on changes in prescription trends in Canada during the pandemic period. Objectives To examine the trend of prescription medications’ utilization before and during COVID-19, among incident and prevalent users in the general population. We examined 18 major classes of medications. Methods We used the administrative health databases from the province of Manitoba, Canada, to conduct a province-wide cross-sectional study. Incident and prevalent use was compared between two time periods; pre-COVID-19: July 2016-March 2020 and during COVID-19: April 2020-March 2021. Interrupted time series analysis using autoregressive models was used to quantify the change in level and slope in quarterly medication use among incident and prevalent users. Results The quarterly study population ranged from 1,353,485 to 1,411,630 Manitobans. The most common comorbidities were asthma (26.67%), hypertension (20.64%), and diabetes (8.31%). On average, the pandemic restrictions resulted in a 45.55% and 12.17% relative decline in the aggregated utilization of all drugs among both incident and prevalent users, respectively. Subclass analysis showed a 46.83%, 23.05%, and 30.98% relative drop among incident users of antibiotics, cardiovascular drugs and opioids use, respectively. We observed a significant slope increase during COVID-19 among the quarterly cardiovascular, antidiabetics, alpha-1 blockers, and statins incident users compared to the pre-COVID-19 period. We noted a significant decrease in level among NSAIDs, opioids, and antibiotic prevalent users, however, no significant changes in slope were observed. Conclusion Our findings show a significant impact of COVID-19 measures on prescription trends in the general population. The observed decline among several medication classes was temporary. Further research is needed to monitor prescription trends and better understand if those changes were associated with increased health services and worsened outcomes.
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Witges, Kelcie M., Charles N. Bernstein, Kathryn A. Sexton, Tracie Afifi, John R. Walker, Zoann Nugent, and Lisa M. Lix. "The Relationship Between Adverse Childhood Experiences and Health Care Use in the Manitoba IBD Cohort Study." Inflammatory Bowel Diseases 25, no. 10 (March 28, 2019): 1700–1710. http://dx.doi.org/10.1093/ibd/izz054.
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Abstract Background We aimed to determine the prevalence of adverse childhood experiences (ACEs) in persons with inflammatory bowel disease (IBD) and whether having ACEs was associated with health care utilization post-IBD diagnosis. Method Three hundred forty-five participants from the population-based Manitoba IBD Cohort Study self-reported ACEs (ie, physical abuse, sexual abuse, death of a very close friend or family member, severe illness or injury, upheaval between parents, and any other experience thought to significantly impacts one’s life or personality) at a median of 5.3 years following IBD diagnosis. Cohort study data were linked to administrative health databases that captured use of hospitals, physician visits, and prescription drugs; use was classified as IBD-related and non-IBD-related. Mean annual estimates of health care use were produced for the 60-month period following the ACE report. Generalized linear models (GLMs) with generalized estimating equations (GEEs) with and without covariate adjustment were fit to the data. Results The prevalence of at least 1 ACE was 74.2%. There was no statistically significant association between having experienced an ACE and health care use. However, unadjusted mean annual non-IBD-related general practitioner visits were significantly higher for participants exposed to physical and sexual abuse than those not exposed. Selected adjusted rates of IBD-related health care use were lower for participants who reported exposure to an upheaval between parents and high perceived trauma from ACEs. Conclusion The estimated prevalence of at least 1 self-reported ACE in persons with diagnosed IBD was high. Health care use among those who experienced ACEs may reflect the impacts of ACE on health care anxiety.
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Shooshtari, Shahin, Patricia Joan Martens, Charles A. Burchill, Natalia Dik, and Saba Naghipur. "Prevalence of Depression and Dementia among Adults with Developmental Disabilities in Manitoba, Canada." International Journal of Family Medicine 2011 (August 8, 2011): 1–9. http://dx.doi.org/10.1155/2011/319574.
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Study Objective. To estimate and compare the prevalence of dementia and depression among adults with and without developmental disabilities (DDs). Methods. We linked data from several provincial administrative databases to identify persons with DDs. We matched cases with DD with persons without DD as to sex, age, and place of residence. We estimated the prevalence of dementia and depression and compared the two groups using the Generalized Estimating Equations (GEEs) technique. Results. The estimated prevalence of depression and dementia among younger adults (20–54) and older adults (50+) with DD was significantly higher than the estimated rates for the matched non-DD group (Depression: younger adults: RR = 2.96 (95% CI 2.59–3.39); older adults: RR = 2.65 (95% CI 1.84–3.81)), (Dementia: younger adults: RR = 4.01 (95% CI 2.72–5.92); older adults: RR = 4.80 (95% CI 2.48–9.31)). Conclusion. Significant disparities exist in mental health between persons with and without DDs.
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Marshall, John K. "Talk Is Cheap: The Impact of Consultation. Commentary on the Article." Canadian Journal of Gastroenterology 18, no. 3 (2004): 181–82. http://dx.doi.org/10.1155/2004/931930.
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Most recommendations for managing irritable bowel syndrome emphasize the positive roles of patient education and reassurance (1), but the impact and value of these approaches are difficult to assess. Therefore, a recent paper by Ilnyckyj et al (2) is both relevant and reassuring. This well designed study used Manitoba Health administrative databases to track health resource utilization, before and after a standardized gastroenterology consultation, by a consecutive cohort of patients with Rome I irritable bowel syndrome (IBS) attending an academic tertiary care clinic. Subjects also completed standardized survey instruments at the time of the consultation, one year and two years later to assess physical morbidity, psychological function and pain severity. During the two years of follow-up, the authors observed a reduction from baseline in the use of health resources for gastrointestinal diagnoses, but no change in consumption of resources for other indications. While pain was improved at follow-up, other measures of physical and psychological health were unchanged.
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Bérard, Anick, Padma Kaul, Sherif Eltonsy, Brandace Winquist, Dan Chateau, Steven Hawken, Ann Sprague, et al. "The Canadian Mother-Child Cohort Active Surveillance Initiative (CAMCCO): Comparisons between Quebec, Manitoba, Saskatchewan, and Alberta." PLOS ONE 17, no. 9 (September 20, 2022): e0274355. http://dx.doi.org/10.1371/journal.pone.0274355.
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Background Given that pregnant women taking medications are excluded from clinical trials, real-world evidence is essential. We aimed to build a Canadian Mother-Child Cohort Active Surveillance Initiative (CAMCCO) and compare frequency of prematurity, low-birth-weight (LBW), major malformations, multiplicity, and gestational medication use across four provinces. Methods CAMCCO is a collaborative research infrastructure that uses real-world data from large provincial health care databases in Canada; developed with standardized methods to similarly construct population-based pregnancy/child cohorts with longitudinal follow-up by linking administrative/hospital/birth databases. CAMCCO also includes a common repository to i) share algorithms and case definitions based on diagnostic and procedural codes for research/training purpose, and ii) download aggregate data relevant to primary care providers, researchers, and decision makers. For this study, data from Quebec (1998–2015), Manitoba (1995–2019), Saskatchewan (1996–2020), and Alberta (2005–2018) are compared (Chi-square tests, p-values), and trends are calculated using Cochran-Armitage trend tests. Results Almost two-thirds (61%) of women took medications during pregnancy, mostly antibiotics (26%), asthma drugs (8%), and antidepressants (4%). Differences in the prevalence of prematurity (5.9–6.8%), LBW (4.0–5.2%), and multiplicity (1.0–2.5%) were statistically significant between provinces (p<0.001). Frequency of major malformations increased over time in Quebec (7–11%; p<0.001), Saskatchewan (5–11%; p<0.001), and Alberta (from 7–8%; p<0.001), and decreased in Manitoba (5–3%; p<0.001). Cardiovascular and musculoskeletal malformations were the most prevalent. Interpretation Medications are often used among Canadian pregnancies but adverse pregnancy outcomes vary across provinces. Digitized health data may help researchers and care providers understand the risk-benefit ratios related to gestational medication use, as well as province-specific trends.
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Harlos, C. H., H. Singh, Z. Nugent, A. Demers, S. M. Mahmud, and P. M. Czaykowski. "The risk of colorectal cancer is not increased after a diagnosis of urothelial cancer: a population-based study." Current Oncology 23, no. 6 (December 22, 2016): 391. http://dx.doi.org/10.3747/co.23.3304.
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Background The data about whether patients with a prior urothelial cancer (uca) are at increased risk of colorectal cancer (crc) are conflicting. We used a competing risks analysis to determine the risk of crc after uca.Methods Historical cohorts were assembled by record linkage of Manitoba Cancer Registry and Manitoba Health databases. The incidence of crc for individuals with uca as their first cancer between 1987 and 2009 was compared with the incidence for randomly selected age- and sex-matched individuals without a cancer diagnosis at the index date (uca diagnosis date). Three competing outcomes (crc, another primary cancer, and death) were evaluated by competing risks proportional hazards models with adjustment for relevant confounders.Results The cohorts of 4591 patients with uca and 22,312 without uca were followed for a total of 179,287 person– years (py). After uca, the rate of subsequent colon cancer in uca patients was 4.5 per 1000 py compared with 3.6 per 1000 py in the non-cancer cohort. In the multivariable analysis, no overall increase in crc risk was observed for patients first diagnosed with uca (hazard ratio: 0.88; 95% confidence interval: 0.70 to 1.1; p = 0.26).Conclusions Because of similar crc risk, a similar crc screening strategy should be applied for individuals with and without uca.
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Oake, Justin, Oksana Harasemiw, Navdeep Tangri, Thomas Ferguson, Jeff W. Saranchuk, Rahul K. Bansal, Darrel Drachenberg, and Jasmir G. Nayak. "The relationship between socioeconomic status and treatment for prostate cancer in a universal healthcare system: A population-based analysis." Journal of Clinical Oncology 38, no. 6_suppl (February 20, 2020): 361. http://dx.doi.org/10.1200/jco.2020.38.6_suppl.361.
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361 Background: A large body of research has shown that there are strong socioeconomic disparities in access to cancer treatment. However, whether these inequalities persist among men with prostate cancer has not been previously explored in the equal-access, universal Canadian health care system. The aim of this study is to compare whether socioeconomic status is associated with the type of treatment received (radical prostatectomy (RP) versus radiation therapy (RT)) for men diagnosed with nonmetastatic prostate cancer in Manitoba, Canada. Methods: Men who were diagnosed with non-metastatic prostate cancer between 2004 and 2016 and subsequently treated with RP or RT were identified using the CancerCare Manitoba Registry and linked to provincial databases. SES was defined as neighbourhood income by postal code and divided into income quintiles (Q1-Q5, with Q1 the lowest quintile and Q5 the highest). Multivariable logistic regression nested models were used to compare whether socioeconomic status was associated with treatment type received. Results: We identified 4,560 individuals between 2004-2016 who were diagnosed with non-metastatic prostate cancer. 2,554 men were treated with RP and 2,006 with RT.As income quintile increased, men were more likely to undergo RP than RT (Q3 vs Q1: aOR 1.45 (1.09-1.92); Q5 vs. Q1: aOR 2.17, 95% CI 1.52-2.86). Conclusions: Despite a universal health care system, socioeconomic inequities are present for men seeking primary treatment for prostate cancer. Further investigation into the decision making process among patients diagnosed with prostate cancer may inform decision making to ameliorate these disparities.
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Rosella, Laura C., Kathy Kornas, Joykrishna Sarkar, and Randy Fransoo. "External Validation of a Population-Based Prediction Model for High Healthcare Resource Use in Adults." Healthcare 8, no. 4 (December 4, 2020): 537. http://dx.doi.org/10.3390/healthcare8040537.
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Predicting high healthcare resource users is important for informing prevention strategies and healthcare decision-making. We aimed to cross-provincially validate the High Resource User Population Risk Tool (HRUPoRT), a predictive model that uses population survey data to estimate 5 year risk of becoming a high healthcare resource user. The model, originally derived and validated in Ontario, Canada, was applied to an external validation cohort. HRUPoRT model predictors included chronic conditions, socio-demographics, and health behavioural risk factors. The cohort consisted of 10,504 adults (≥18 years old) from the Canadian Community Health Survey in Manitoba, Canada (cycles 2007/08 and 2009/10). A person-centred costing algorithm was applied to linked health administrative databases to determine respondents’ healthcare utilization over 5 years. Model fit was assessed using the c-statistic for discrimination and calibration plots. In the external validation cohort, HRUPoRT demonstrated strong discrimination (c statistic = 0.83) and was well calibrated across the range of risk. HRUPoRT performed well in an external validation cohort, demonstrating transportability of the model in other jurisdictions. HRUPoRT’s use of population survey data enables a health equity focus to assist with decision-making on prevention of high healthcare resource use.
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Decker, K. M., E. V. Kliewer, A. A. Demers, K. Fradette, N. Biswanger, G. Musto, B. Elias, and D. Turner. "Cancer incidence, mortality, and stage at diagnosis in First Nations living in Manitoba." Current Oncology 23, no. 4 (August 8, 2016): 225. http://dx.doi.org/10.3747/co.23.2906.
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BackgroundIn the present study, we examined breast (bca) and colorectal cancer (crc) incidence and mortality and stage at diagnosis for First Nations (fn) individuals and all other Manitobans (aoms).Methods Several population-based databases were linked to determine ethnicity and to calculate age-standardized incidence and mortality rates. Logistic regression was used to compare bca and crc stage at diagnosis.Results From 1984–1988 to 2004–2008, the incidence of bca increased for fn and aom women. Breast cancer mortality increased for fn women and decreased for aom women. First Nations women were significantly more likely than aom women to be diagnosed at stages iii–iv than at stage i [odds ratio (or) for women ≤50 years of age: 3.11; 95% confidence limits (cl): 1.20, 8.06; or for women 50–69 years of age: 1.72; 95% cl: 1.03, 2.88). The incidence and mortality of crc increased for fn individuals, but decreased for aoms. First Nations status was not significantly associated with crc stage at diagnosis (or for stages i–ii compared with stages iii–iv: 0.98; 95% cl: 0.68, 1.41; or for stages i–iii compared with stage iv: 0.91; 95% cl: 0.59, 1.40).Conclusions Our results underscore the need for improved cancer screening participation and targeted initiatives that emphasis collaboration with fn communities to reduce barriers to screening and to promote healthy lifestyles.
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Harlos, Craig Henry, Marshall W. Pitz, and Grace Musto. "Androgen deprivation therapy and survival in patients with lung cancer." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): 1597. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.1597.
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1597 Background: The epidemiology of lung cancer differs between men and women. There exists significant evidence suggesting estrogens influence the pathophysiology of lung cancer, however the role of androgens remains unclear. This study was performed to determine if exposure to androgen deprivation therapy (ADT) has an effect on survival in male patients (pts) diagnosed with lung cancer. Methods: Using the population-based Manitoba Cancer Registry and Manitoba Health Administrative Databases, all pts diagnosed with lung cancer from January 1, 2004 to December 31, 2010 were identified. Information from the Drug Program Information Network (DPIN) and the Aria electronic record at CancerCare Manitoba were used to determine prescriptions filled for anti-androgens, 5-alpha reductase inhibitors and GnRH agonists as a measure of exposure (defined as having filled at least 2 prescriptions and/or bilateral orchiectomy). Multivariable analysis with Cox proportional hazards analysis was used to compare survival. Results: A total of 3018 men with lung cancer were identified between 2004 and 2010. Of these, 339 (10%) were identified as having used a form of ADT. The majority of pts received 5-alpha reductase inhibitors (85%), the most common being finasteride (80% of total). Multivariable analysis revealed that patients who received ADT prior to the diagnosis of lung cancer had no statistically significant difference in survival (HR: 0.97 p=0.69) compared to those who did not. Patients exposed to ADT after their diagnosis were found to have a significantly better survival than those not exposed (HR 0.36 p=0.0007). This effect was also seen in those who received ADT before and after diagnosis (HR 0.53 p<0.0001). Conclusions: In male pts diagnosed with lung cancer, exposure to ADT is associated with significantly better survival when compared with no exposure. This effect is only seen when some or all of the exposure has occurred after the diagnosis of lung cancer. This study supports the hypothesis that the androgen pathway plays a role in lung cancer pathophysiology, and that androgen deprivation may improve prognosis
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Razaz, Neda, Helen Tremlett, W. Thomas Boyce, Martin Guhn, KS Joseph, and Ruth Ann Marrie. "Impact of parental multiple sclerosis on early childhood development: A retrospective cohort study." Multiple Sclerosis Journal 21, no. 9 (January 12, 2015): 1172–83. http://dx.doi.org/10.1177/1352458514559298.
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Background: Exposure to parental chronic illness is associated with several adverse developmental outcomes. Objectives: We examined the association between parental multiple sclerosis (MS) and childhood developmental outcomes. Methods: We conducted a population-based retrospective cohort study in Manitoba, Canada, using linked databases. The outcome was childhood development at 5 years of age, expressed as vulnerability (absent vs. present) on the Early Development Instrument (EDI). Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI). Results: Children with an MS parent ( n=153) were similar to children of unaffected parents ( n=876) on all EDI domains. However, mental health morbidity was more common among MS parents compared with non-MS parents 49.5% vs. 35.3%. Among MS parents, mental health morbidity was associated with children’s vulnerability on the social competence (OR, 5.73 [95% CI:1.11–29.58]) and emotional maturity (OR, 3.03 [95% CI:1.03–8.94]) domains. The duration of child’s exposure to parental MS was associated with vulnerability on the physical health domain (OR, 1.49 [95%CI:1.03–2.15]). Conclusion: Parental MS was not associated with adverse early childhood developmental outcomes. However, children of parents with mental health morbidity, and those with longer duration of exposure to parental MS, were at higher risk for early childhood developmental vulnerability.
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Gingerich, Joel Roger, Pascal Lambert, Malcolm Doupe, Paul Joseph Daeninck, Marshall W. Pitz, Piotr Czaykowski, and Alison Bertram-Farough. "The risk of debilitating falls in Manitobans living with prostate cancer (pc)." Journal of Clinical Oncology 31, no. 6_suppl (February 20, 2013): 244. http://dx.doi.org/10.1200/jco.2013.31.6_suppl.244.
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244 Background: Falls and fall-related injuries are important patient safety problems. Some studies suggest that pc patients have higher fall rates, however the severity of these falls is unknown. We sought to measure if pc patients are at increased risk of a debilitating fall requiring hospitalization. Methods: This is a retrospective population-based study utilizing the Manitoba Cancer Registry and Manitoba Health administrative databases. Our cohort consists of all community-dwelling patients living in Manitoba Canada who were diagnosed with pc between 2004 and 2008. These individuals were matched by age, sex, and time of diagnosis with up to three cancer-free controls. Debilitating falls were defined as falls/fractures requiring hospitalization and were identified using ICD-9 and -10 billing codes. A competing risk model was used to compare debilitating falls between the pc and cancer-free cohorts and expressed as sub-hazard ratios. Follow-up ended December 31, 2009. Results: 2,903 pc patients were identified along with 8,686 matched controls. The mean age was 69.3 and 68.8 respectively. The median follow-up was 3.05 years. Debilitating falls were identified in 109 patients (3.8%) with pc and 345 (4%) matched controls. The cumulative incidence of debilitating falls for those with pc vs cancer-free controls were: 1.08% vs. 1.13% at 1-year and 5.25% vs. 5.96% at five years of follow-up (SHR = 0.95, 95% CI = 0.77 – 1.18, p = 0.65). On univariate analysis, patients with stage IV pc were at higher risk of falls compared to matched controls. This difference was not significant on multivariate analysis though (SHR = 1.19, 95% CI = 0.74 – 1.89, p = 0.48). On multivariate analysis, patients with a Gleason score of ≤6 experienced a reduced risk of debilitating falls compared to matched controls (SHR = 0.44, 95% CI = 0.27 – 0.72, p = 0.001), whereas patients with other Gleason scores did not. The analysis was similar when patients with fractures were excluded. Conclusions: In this large population-based study, the 1- and 5-year cumulative incidence of debilitating falls did not differ significantly for patients with vs without pc. In fact, compared to matched controls, low grade pc patients were less likely to experience a debilitating fall.