Chronic Diseases in Canada

Volume 28, No. 4, 2008

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Chronic Diseases in Canada (CDIC) is a quarterly scientific journal focussing on current evidence relevant to the control and prevention of chronic (i.e. non-communicable) diseases and injuries in Canada. Since 1980 the journal has published a unique blend of peer-reviewed feature articles by authors from the public and private sectors and which may include research from such fields as epidemiology, public/community health, biostatistics, the behavioural sciences, and health services or economics. Only feature articles are peer reviewed. Authors retain responsibility for the content of their articles; the opinions expressed are not necessarily those of the CDIC editorial committee nor of the Public Health Agency of Canada.

Abstracts from Feature Articles in Chronic Diseases in Canada Volume 28, No 4, 2008

Article 1: Risk factors for falling among community-dwelling seniors using home-care services: An extended hazards model with time-dependent covariates and multiple events

Authors: BS Leclerc, MSc; C Bégin, MSc; É Cadieux, MSc; L Goulet, MD, PhD; N Leduc, PhD; M-J Kergoat, MD; P Lebel, MD

Abstract:

The identification of risk factors for falls in longitudinal studies becomes difficult because of exposures that change during the follow-up and also because individual subjects may experience an event more than once. These issues have been neglected and improper statistical techniques have been used. The typical approaches have been to report the proportion of fallers or the time to first fall. Both avoid the underlying assumption of independence between events and discard pertinent data. We review the existing methods and propose a Cox hazards extension. We exemplify it in the study of potential risk factors associated with all falls in 959 seniors. Finally, we compare the results of the proposed Wei, Lin, & Weissfeld (WLW) method with those of several other techniques. Stable exposure variables measured at baseline and updated time-varying exposures include socio-demographic characteristics, BMI, nutritional risk, alcohol consumption, home hazards, gait and balance, and medications. Results demonstrate that the usual methods of analyzing risk factors for falling are inappropriate, as they produce considerable biases relative to the WLW model using time-dependent covariates. Results also show that modeling for first events may be inefficient, given that the risk of occurrence varies between falls.

Article 2: Gender and the smoking behaviour of Ethiopian immigrants in Toronto

Authors: I Hyman, PhD; H Fenta, PhD; S Noh, PhD

Abstract:

The objective of this paper is to present descriptive data on gender and smoking among Ethiopian immigrants in Toronto, Canada. The study used a cross-sectional epidemiological survey design (N = 342). The main outcome measures identified subjects as current (regular or occasional) smokers, daily smokers and former smokers. Overall, 20.8% of the individuals in the sample were current smokers and 15.7% were daily smokers. Although smoking rates (current and daily) were significantly higher among males compared to females, nearly twice as many female as male daily smokers reported that they began smoking post-migration (60.0% vs. 30.2%). Furthermore, 80.0% of female compared to nearly 56% of male daily smokers reported that they were smoking more post-migration. A significantly higher proportion of males compared to females were former daily smokers (17.8% vs. 4.4%). These findings present a challenge for public health professionals in terms of preventing the adoption of smoking among Ethiopian females and facilitating smoking cessation among Ethiopian males. Correlates with current smoking suggested that smoking prevention and cessation programs in newcomer immigrant communities may benefit from incorporating social, economic and religious contexts of these newcomers' lives from a gender-specific perspective.

Article 3: Ethnicity and mental health: Conceptualization, definition and operationalization of ethnicity from a Canadian context

Authors: DE Clarke, PhD; A Colantonio, PhD; AE Rhodes, PhD; M Escobar, PhD

Abstract:

The current study provides a critical review of Canadian studies on ethnicity and mental health with respect to the definition, conceptualization and operationalization of ethnicity. It provides a discussion on the methodological issues related to these factors and their implications to guide future research and enable comparability of results across studies. Sociological Abstracts, PsycINFO, MEDLINE and CINAHL were used to identify relevant Canadian articles published between January 1980 and December 2004. The review highlights a number of key issues for future researchers to consider such as the need for: 1) clear rationales as to why ethnicity is important to their outcome of interest; 2) clarity on the definition of ethnicity, which affects its conceptualization and operationalization; 3) a theoretically driven conceptualization of ethnicity, which should be related to the research question of interest; and 4) clear rationales for the decisions made regarding the data source used, the operationalization of ethnicity, and the ethnic categories included in their studies.

Article 4: Association of comorbid mood disorders and chronic illness with disability and quality of life in Ontario, Canada

Authors: T Gadalla, PhD

Abstract:

Mood disorders are more prevalent in individuals with chronic physical illness compared to individuals with no such illness. These disorders amplify the disability associated with the physical condition and adversely affect its course, thus contributing to occupational impairment, disruption in interpersonal and family relationships, poor health and suicide. This study used data collected in the Canadian Community Health Survey, cycle 3.1 (2005) to examine factors associated with comorbid mood disorders and to assess their association with the quality of life of individuals living in Ontario. Results indicate that individuals with chronic fatigue syndrome, fibromyalgia, bowel disorder or stomach or intestinal ulcers had the highest rates of mood disorders. The odds of having a comorbid mood disorder were higher among women, the single, those living in poverty, the Canadian born and those between 30 and 69 years of age. The presence of comorbid mood disorders was significantly associated with short-term disability, requiring help with instrumental daily activities and suicidal ideation. Health care providers are urged to proactively screen chronically ill patients for mood disorders, particularly among the subgroups found to have elevated risk for these disorders.

Article 5: Costs associated with mood and anxiety disorders, as evaluated by telephone survey

Authors: SB Patten, MD, PhD; JVA Williams, MSc; C Mitton, MSc

Abstract:

Costing studies are central to health policy decisions. Available costing estimates for mood and anxiety disorders in Canada may, however, be out of date. In this study, we estimated a set of direct health care costs using data collected in a provincial telephone survey of mood and anxiety disorders in Alberta. The survey used random digit dialing to reach a sample of 3394 household residents aged 18 to 64. A telephone interview included items assessing costs without reference to whether these were incurred by the respondent, government or a health plan. The survey interview also included the Mini Neuropsychiatric Diagnostic Interview (MINI). Costs for antidepressant medications appear to have increased since the last available estimates were published. Surprisingly, most medication costs for antidepressants were incurred by respondents without an identified disorder. Also, an unexpectedly large proportion of medication costs were for psychotropic medications other than antidepressants and anxiolytic-sedative-hypnotics. These results suggest that major changes have occurred in the costs associated with antidepressant treatment. Available cost-of-illness data may be outdated, and some assumptions made by previous studies may now be invalid.