Chronic Diseases in Canada

Volume 29, No. 3, 2009

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Table of Contents

 

Feature articles

1. Validation of perinatal data in the Discharge Abstract Database of the Canadian Institute for Health Information View Abstract K. S. Joseph, J. Fahey for the Canadian Perinatal Surveillance System	PDF version 98 KB
2. Validity of autism diagnoses using administrative health data View Abstract L. Dodds, A. Spencer, S. Shea, D. Fell, B. A. Armson, A. C. Allen, S. Bryson	PDF version 100 KB
3. Associations between chronic disease, age and physical and mental health status View Abstract W. M. Hopman, M. B. Harrison, H. Coo, E. Friedberg, M. Buchanan, E. G. VanDenKerkhof	PDF version 235 KB
4. Statistical modelling of mental distress among rural and urban seniors View Abstract C. P. Karunanayake, P. Pahwa	PDF version 214 KB
5. Factors associated with the adoption of a smoking ban in Quebec households View Abstract É. Ouedraogo, F. Turcotte, M. J. Ashley, J. M. Brewster, R. Ferrence	PDF version 127 KB
Workshop/conference report
6. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome program E. Stein, M. MacQuarrie	PDF version 121 KB
Book review
7. Dissonant disabilities: women with chronic illnesses explore their lives M. Rezai	PDF version 121 KB

 

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 29, No 3, 2009

Article 1: Validation of perinatal data in the Discharge Abstract Database of the Canadian Institute for Health Information

Authors: K. S. Joseph, J. Fahey for the Canadian Perinatal Surveillance System

Abstract: We compared perinatal information submitted to the Canadian Institute for Health Information (CIHI) hospitalization database with information submitted to the Nova Scotia Atlee Perinatal Database (NSAPD) in order to assess the accuracy of the CIHI data. Procedures such as Caesarean delivery were coded accurately (i.e. sensitivity of 99.8%; specificity of 98.7%). Postpartum hemorrhage, induction of labour and severe intraventricular hemorrhage also had sensitivity and specificity rates above 85% and 95%, respectively. Some diagnoses, defined differently in the two databases, were less accurately coded, e.g. respiratory distress syndrome (RDS) had a sensitivity of 50.9% and a specificity of 99.8%. Restriction to more severe forms of the disease improved accuracy, e.g. restriction of RDS to severe RDS in the NSAPD and identification of severe RDS in the CIHI database, using codes for RDS and intubation, resulted in a sensitivity of 100% and a specificity of 99.6%. Our study supports the use of CIHI data for national surveillance of perinatal morbidity, with the caveat that an understanding of clinical practice and sensitivity analyses to identify robust findings be used to facilitate inference.

Article 2: Validity of autism diagnoses using administrative health data

Authors: L. Dodds, A. Spencer, S. Shea, D. Fell, B. A. Armson, A. C. Allen, S. Bryson

Abstract: It is necessary to monitor autism prevalence in order to plan education support and health services for affected children. This study was conducted to assess the accuracy of administrative health databases for autism diagnoses. Three administrative health databases from the province of Nova Scotia were used to identify diagnoses of autism spectrum disorders (ASD): the Hospital Discharge Abstract Database, the Medical Services Insurance Physician Billings Database and the Mental Health Outpatient Information System database. Seven algorithms were derived from combinations of requirements for single or multiple ASD claims from one or more of the three administrative databases. Diagnoses made by the Autism Team of the IWK Health Centre, using state-of-the-art autism diagnostic schedules, were compared with each algorithm, and the sensitivity, specificity and C-statistic (i.e. a measure of the discrimination ability of the model) were calculated. The algorithm with the best test characteristics was based on one ASD code in any of the three databases (sensitivity=69.3%). Sensitivity based on an ASD code in either the hospital or the physician billing databases was 62.5%. Administrative health databases are potentially a cost efficient source for conducting autism surveillance, especially when compared to methods involving the collection of new data. However, additional data sources are needed to improve the sensitivity and accuracy of identifying autism in Canada.

Article 3: Associations between chronic disease, age and physical and mental health status

Authors: W. M. Hopman, M. B. Harrison, H. Coo, E. Friedberg, M. Buchanan, E. G. VanDenKerkhof

Abstract: This paper examines the associations between chronic disease, age, and physical and mental health-related quality of life (HRQOL), using data collected in 10 studies representing five chronic conditions. HRQOL was measured using the SF-36 or the shorter subset, SF-12. Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were graphed by condition in age increments of 10 years, and compared to age- and sex-adjusted normative data. Linear regression models for the PCS and MCS were controlled for available confounders. The sample size of 2418 participants included 129 with renal failure, 366 with osteoarthritis (OA), 487 with heart failure, 1160 with chronic wound (leg ulcer) and 276 with multiple sclerosis (MS). For the PCS, there were large differences between the normative data and the mean scores of those with chronic diseases, but small differences for the MCS. Female gender and comorbid conditions were associated with poorer HRQOL; increased age was associated with poorer PCS and better MCS. This study provided additional evidence that, while physical function could be severely and negatively affected by both chronic disease and advanced age, mental health remained relatively high and stable.

Article 4: Statistical modelling of mental distress among rural and urban seniors

Authors: C. P. Karunanayake, P. Pahwa

Abstract: The senior population is growing rapidly in Canada. Consequently, there will be an increased demand for health care services for seniors who have mental illness. Seniors are more likely to live in rural areas than younger people; therefore, it is important to identify the differences between rural and urban seniors in order to design and deliver mental health services. The main objective of this paper was to use the National Population Health Survey (NPHS) to examine the differences with regard to mental distress between rural and urban seniors (i.e. 55 years and older). The other objectives were to investigate the long-term association between smoking and mental health and the long-term association between unmet health care needs and the mental health of seniors in rural and urban areas. The mental distress measure was examined as a binary outcome. The analysis was conducted using a generalized estimating equation approach that accounted for the complexity of a multi-stage survey design. Rural seniors reported a higher proportion of mental distress [OR=1.16; 95% CI: 0.98, 1.37] with a borderline statistical significance than urban seniors. This finding was based on a final multivariate model to study the relationship between mental distress and location of residence (i.e. rural or urban) as well as between smoking and self-perceived unmet health care needs, adjusting for other important covariates and missing outcome values. A significant correlation was noted between smoking and mental health problems among seniors after adjusting for other covariates [OR = 1.26; 95% CI: 1.00, 1.60]. Participants who reported self-perceived unmet health care needs reported a higher proportion of mental distress [OR = 1.72; 95% CI: 1.38, 2.13] compared to those who were satisfied with their health care.

Article 5: Factors associated with the adoption of a smoking ban in Quebec households

Authors: É. Ouedraogo, F. Turcotte, M. J. Ashley, J. M. Brewster, R. Ferrence

Abstract: The home represents an important source of exposure to environmental tobacco smoke for non-smokers, including children, who live with smokers. Our goal is to identify the sociodemographic factors associated with the adoption of smoking bans in “smoker households” in Quebec. Selected associations are compared with three other Canadian provinces (Ontario, British Columbia and Nova Scotia). This is a cross-sectional study involving 2648 respondents. Logistic regression analysis is employed. Few smoker households in Quebec (21%) have a ban on smoking; the presence of a non-smoker is strongly linked to the existence of such a ban; the presence of a child under the age of 6 is less strongly associated with the adoption of a ban in Quebec than in the other provinces, and the presence of an adolescent shows no association whatsoever. In addition to the child health benefits of household smoking bans, greater emphasis should be placed on the impact that such bans can have on children’s future smoking behaviour. One option from a health promotion standpoint might be to organize a campaign aimed at non-smokers who live with smokers, in order to urge them to be less tolerant of environmental tobacco smoke.