Evidence and Risk Assessment Division, Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, Ottawa, Ontario, Canada. Sai_Yi_Pan@phac-aspc.gc.ca
To understand the magnitude and the national trends of mortality and hospitalization due to injuries among Canadian adolescents aged 15-19 years in 1979-2003.
Data on injury deaths and hospitalizations were obtained from the national Vital Statistical System and the Hospital Morbidity Database. Injuries were classified by intent and by mechanism.
In 15-19-year-olds, 75.6% of all deaths and 16.6% of all hospitalizations were attributed to injuries. Unintentional and self-inflicted injuries accounted for 70.2% and 24.1%, respectively, of total injury deaths as well as 72.6% and 17.4%, respectively, of total injury hospitalizations. The main causes for injury were motor vehicle traffic-related injury (MVT), suffocation, firearm, poisoning, and drowning for injury deaths; and MVT, poisoning, fall, struck by/against, and cut/pierce for injury hospitalizations. Mortality and hospitalization rates of total and unintentional injuries decreased substantially, whereas those of self-inflicted injuries decreased only slightly, with a small increase in females. Rates also decreased for all causes except suffocation, which showed an increasing trend. Males had higher rates for all intents and causes than females, except for self-inflicted injury hospitalization (higher in females). The territories and Prairie Provinces also had higher ones of total injuries and self-inflicted injuries than in other provinces.
Injury is the leading cause of deaths and a major source of hospitalizations in Canadian adolescents. However, prevention programs in Canada have made significant progress in reducing injury mortality and hospitalization. The graduated driver licensing, enforcement of seat-belt use, speed limit and alcohol control, and Canadian tough gun control may have contributed to the decline.
Evidence and Risk Assessment Division, Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, 120 Colonnade Road, AL 6701A, Ottawa, Ontario, Canada. Jinfu_Hu@phac-aspc.gc.ca
Epidemiologic studies have reported that moderate alcohol consumption is inversely associated with the risk of renal cell carcinoma (RCC), but sex-specific results are inconsistent. The present study examines the association between alcohol intake and the risk of RCC among men and women.
Mailed questionnaires were completed by 1138 newly diagnosed, histologically confirmed RCC cases and 5039 population controls between 1994 and 1997 in eight Canadian provinces. A food frequency questionnaire provided data on eating habits and alcohol consumption 2 years before data collection. Other information included socio-economic status, lifestyle habits, alcohol use, and diet. Odds ratios (ORs) and 95% confidence intervals (CIs) were derived through unconditional logistic regression.
Total alcohol intake was inversely associated with RCC in men and in women; the OR for the highest intake group (> or =22.3 g/day among men and > or =7.9 g/day among women) versus the non-drinkers was 0.7 (95% CI, 0.5-0.9) for both sexes. Analysis of menopausal status produced ORs for the highest intake group versus the non-drinkers of 1.2 (95% CI, 0.7-2.1) among premenopausal women and 0.6 (95% CI, 0.4-0.9) among postmenopausal women. Smoking and obesity were not important effect modifiers.
Moderate alcohol consumption may be associated with a decreased risk of RCC in men and in women (mainly postmenopausal women).
To provide information on poorly described Canadian hepatocellular cancer epidemiology, we analyzed incident cases abstracted from the Canadian Cancer Registration Database (1969-1997) and Canadian annual death data (1969-1998). Age, sex, geographic distribution, and secular trends were described. Projection models were developed for the next decade.
Results indicated much higher incidence and mortality rates in males than females, with substantial increases for both with age. Age-standardized incidence rates increased an average of 3.4% per year in males, 1.2% per year in females (1969-1997). Age-standardized mortality rates increased an average of 1.48% in males, but decreased an average of 0.46% per year in females (1969-1998). Join-point analysis of the linear trends in the age-standardized incidence and mortality rates suggested that a new trend started to emerge about 1991. The fitted non-linear multiplicative model predicted the occurrence of 1,565 new cases and 802 deaths in the year 2010. HCC incidence was the highest in British Colombia, followed by Quebec, and the lowest in the Atlantic region.
Incidence rates of hepatocellular carcinoma have increased substantially, consistent with the reported increase in the prevalence of Hepatitis C Virus (HCV) and Hepatitis B Virus (HBV) infections in recent decades.
The Public Health Agency of Canada adapted a Finnish diabetes screening tool (FINDRISC) to create a tool (CANRISK) tailored to Canada's multi-ethnic population. CANRISK was developed using data collected in seven Canadian provinces. In an effort to extend the applicability of CANRISK to northern territorial populations, we completed a study with the mainly Inuit population in the Kitikmeot region of Nunavut.
We obtained CANRISK questionnaires, physical measures and blood samples from participants in five Nunavut communities in Kitikmeot. We used logistic regression to test model fit using the original CANRISK risk factors for dysglycemia (prediabetes and diabetes). Dysglycemia was assessed using fasting plasma glucose (FPG) alone and/or oral glucose tolerance test. We generated participants' CANRISK scores to test the functioning of this tool in the Inuit population.
A total of 303 individuals participated in the study. Half were aged less than 45 years, two-thirds were female and 84% were Inuit. A total of 18% had prediabetes, and an additional 4% had undiagnosed diabetes. The odds of having dysglycemia rose exponentially with age, while the relationship with BMI was U-shaped. Compared with lab test results, using a cut-off point of 32 the CANRISK tool achieved a sensitivity of 61%, a specificity of 66%, a positive predictive value of 34% and an accuracy rate of 65%.
The CANRISK tool achieved a similar accuracy in detecting dysglycemia in this mainly Inuit population as it did in a multi-ethnic sample of Canadians. We found the CANRISK tool to be adaptable to the Kitikmeot region, and more generally to Nunavut.
Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada K1H 8M5. Electronic address: ychen@uottawa.ca.
The study was to determine the association between mental health and the incidence of injury among Canadian immigrants and non-immigrants. We used data from 15,405 individuals aged 12 years or more, who were living in British Columbia, Canada, and participated in the 2007-2008 Canadian Community Health Survey (CCHS). We calculated a 12-month cumulative incidence of fall injury based on self-reporting. Logistic regression model was used to examine the association of the 12-month cumulative incidence of fall injury with immigration status and mental health before and after adjustment for covariates. The results show that self-reported mood and anxiety disorders were significantly associated with an increased incidence of fall injury. The adjusted odds ratios were 1.81 (95% CI: 1.37, 2.38) for mood disorder and 1.55 (95% CI: 1.12, 2.13) for anxiety disorder. Immigrant status was a significant effect modifier for the association between mental health and fall injury, with stronger associations in immigrants than in non-immigrants especially in elderly people. People with poor self perceived health were more likely to have a fall injury. Both mental health and general health were related to fall injury. There was a stronger association between mental health and fall injury in immigrants compared with non-immigrants in the elderly. More attention should be paid to mental health in immigrants associated with fall injury.
To determine the age and sex variations in the associations between obesity and depression.
This analysis was based on data from 59,652 adults >or=18 years of age in the provinces of Nova Scotia, Quebec, Saskatchewan, Alberta, and British Columbia, who participated in the Canadian Community Health Survey conducted in 2005. The survey included a set of 27 questions about symptoms of depression, which were taken from the Composite International Diagnostic Interview. Based on these questions, depression scores were calculated and used to define depression, which corresponds to a 90% likelihood of a positive diagnosis of major depressive episode. Body weight and height were based on self-report.
The prevalence of depression was 5.3% in adults living in the five provinces and was higher in women than in men. People with abnormal body weight tended to have an increased risk of depression. On average, obesity and being underweight were associated with approximately 30% and 40% increases in depression, respectively. Particularly in women, depression was more markedly associated with obesity in the 18-39 year age group (OR 1.67, 95% CI 1.29-2.15) and with being underweight in the 40-59 year age group (OR 2.23, 95% CI 1.45-3.42) than other age groups.
Obesity is associated with an increased risk of depression in younger women.
Surveillance and Risk Assessment Division, Centre for Chronic Disease Prevention and Control, Population and Public Health Branch, Health Canada, Ottawa, Ontario, Canada. Saiyi_Pan@hc-sc.gc.ca
The authors conducted a population-based, case-control study of 21,022 incident cases of 19 types of cancer and 5,039 controls aged 20-76 years during 1994-1997 to examine the association between obesity and the risks of various cancers. Compared with people with a body mass index of less than 25 kg/m(2), obese (body mass index of > or = 30 kg/m(2)) men and women had an increased risk of overall cancer (multivariable adjusted odds ratio = 1.34, 95% confidence interval (CI): 1.22, 1.48), non-Hodgkin's lymphoma (odds ratio = 1.46, 95% CI: 1.24, 1.72), leukemia (odds ratio = 1.61, 95% CI: 1.32, 1.96), multiple myeloma (odds ratio = 2.06, 95% CI: 1.46, 2.89), and cancers of the kidney (odds ratio = 2.74, 95% CI: 2.30, 3.25), colon (odds ratio = 1.93, 95% CI: 1.61, 2.31), rectum (odds ratio = 1.65, 95% CI: 1.36, 2.00), pancreas (odds ratio = 1.51, 95% CI: 1.19, 1.92), breast (in postmenopausal women) (odds ratio = 1.66, 95% CI: 1.33, 2.06), ovary (odds ratio = 1.95, 95% CI: 1.44, 2.64), and prostate (odds ratio = 1.27, 95% CI: 1.09, 1.47). Overall, excess body mass accounted for 7.7% of all cancers in Canada-9.7% in men and 5.9% in women. This study provides further evidence that obesity increases the risk of overall cancer, non-Hodgkin's lymphoma, leukemia, multiple myeloma, and cancers of the kidney, colon, rectum, breast (in postmenopausal women), pancreas, ovary, and prostate.
The concept of 'avoidable' mortality (AM) has been proposed as a performance measure of health care systems. In this study we examined mortality in five geographic regions of Canada from 1975 to 1999 for previously defined avoidable disease groups that are amenable to medical care and public health. These trends were compared to mortality from other causes.
National and regional age-standardized mortality rates for ages less than 65 years were estimated for avoidable and other causes of death for consecutive periods (1975-1979, 1980-1985, 1985-1989, 1990-1994, and 1995-1999). The proportion of all-cause mortality attributable to avoidable causes was also determined.
From 1975-1979 to 1995-1999, the AM decrease (46.9%) was more pronounced compared to mortality from other causes (24.9%). There were persistent regional AM differences, with consistently lower AM in Ontario and British Columbia compared to the Atlantic, Quebec, and Prairies regions. This trend was not apparent when mortality from other causes was examined. Injuries, ischaemic heart disease, and lung cancer strongly influenced the overall AM trends.
The regional differences in mortality for ages less than 65 years was attributable to causes of death amenable to medical care and public health, especially from causes responsive to public health.
Environmental Risk Assessment and Case Surveillance Division, Laboratory Centre for Disease Control, Health Canada, Ottawa, Ontario, Canada K1A 0L2. pvillene@uottawa.ca
The relationship between occupational exposure to magnetic fields and brain cancer in men was investigated using population-based case-control data collected in eight Canadian provinces. Emphasis was placed on examining the variations in risk across different histological types.
A list of occupations was compiled for 543 cases and 543 controls that were individually matched by age. Occupations were categorized according to their average magnetic field exposure through blinded expert review ( or = 0.6 microT). In total, 133 cases (14%) and 123 controls (12%) were estimated to have at least one occupation whereby magnetic field exposures exceeded 0.3 microT. Odds ratios (OR) were generated using conditional logistic regression, and were adjusted for suspected occupational risk factors for brain cancer.
A non-significantly increased risk of brain cancer was observed among men who had ever held a job with an average magnetic field exposure >0.6 microT relative to those with exposures