Diabetes prevalence is associated with low socioeconomic status (SES), but less is known about the relationship between SES and diabetes incidence.
Data from eight cycles of the National Population Health Survey (1994/1995 through 2008/2009) are used. A sample of 5,547 women and 6,786 men aged 18 or older who did not have diabetes in 1994/1995 was followed to determine if household income and educational attainment were associated with increased risk of diagnosis of or death from diabetes by 2008/2009. Three proportional hazards models were applied for income and for education--for men, for women and for both sexes combined. Independent variables were measured at baseline (1994/1995). Diabetes diagnosis was assessed by self-report of diagnosis by a health professional. Diabetes death was based on ICD-10 codes E10-E14.
Among people aged 18 or older in 1994/1995 who were free of diabetes, 7.2% of men and 6.3% of women had developed or died from the disease by 2008/2009. Lower-income women were more likely to develop type 2 diabetes than were those in high-income households. This association was attenuated, but not eliminated, by ethno-cultural background and obesity/overweight. Associations with lower educational attainment in unadjusted models were almost completely mediated by demographic and behavioural variables.
Social gradients in diabetes incidence cannot be explained entirely by demographic and behavioural variables.
According to epidemiologic studies that use recall of lifetime episodes, the prevalence of depression is increasing. This report from the Stirling County Study compares rates of current depression among representative samples of adults from a population in Atlantic Canada.
Sample sizes were 1003, 1201, and 1396 in 1952, 1970, and 1992, respectively. The depression component of the study's method, the DPAX (DP for depression and AX for anxiety), was employed. The original procedure (DPAX-1) was applied in all years. A revision (DPAX-2) was used in 1970 and 1992. The Diagnostic Interview Schedule (DIS) was also used in 1992.
With the DPAX-1, the overall prevalence of current depression was steady at 5% over the 2 early samples but declined in 1992 because of vernacular changes referring to dysphoria. The DPAX-2 gave a stable overall prevalence of 5% in the 2 recent samples, but indicated that women and younger people were at greater risk in 1992 than in 1970. The DIS, like the DPAX-2, found a current 1992 rate of 5% for major depressive episodes combined with dysthymia. Recalled lifetime rates using the DIS showed the same profile interpreted in other studies as suggesting an increase in depression over time.
Three samples over a 40-year period showed a stable current prevalence of depression using the DPAX methods that was comparable in 1992 with the current rates using the DIS. This casts doubt on the interpretation that depression is generally increasing. Within the overall steady rate observed in this study, historical change was a matter of redistribution by sex and age, with a higher rate among younger women being of recent origin.
Comment In: Arch Gen Psychiatry. 2000 Mar;57(3):223-410711907
Comment In: Arch Gen Psychiatry. 2000 Mar;57(3):227-810711908
Rates and correlates of alcohol use are reported from the 1993 General Social Survey, a household telephone survey of 10,385 Canadians carried out by Statistics Canada. Continuing a recent trend, alcohol use has declined. The portrait of the Canadian who is most likely to drink and drink heavily is that of a young adult male who is not married, relatively well-off, and rarely or never attends religious services. In a multivariate analysis of the combined impact of sociodemographic factors on drinking and drinking levels, it was found that the frequency of religious attendance and age were the strongest predictors of current drinking. Gender was the strongest predictor of volume of alcohol consumption, while religious attendance, age, marital status and employment status were also significant predictors.
Rates and correlates of problems associated with the use of alcohol are reported from the 1993 General Social Survey in Canada. Approximately 1 in 11 drinkers (9.2%) reported that drinking has had an adverse effect on his or her social life, physical health, happiness, home life or marriage, work, or finances in the past year. The most commonly reported problems concerned physical health (5.1%), and financial position (4.7%). Approximately one in eight drinkers (12.9%) had driven a car within an hour after consuming two or more drinks in the previous year. Furthermore, more than two of every five respondents reported that they had experienced some problem due to other people's drinking. In a multivariate analysis, age, marital status, gender, religious attendance and employment status were the strongest predictors of problem drinking. The number of heavy drinking occasions is a stronger predictor of drinking problems than is overall level of consumption.
Most epidemiologic studies concerned with Major Depressive Disorder have employed cross-sectional study designs. Assessment of lifetime prevalence in such studies depends on recall of past depressive episodes. Such studies may underestimate lifetime prevalence because of incomplete recall of past episodes (recall bias). An opportunity to evaluate this issue arises with a prospective Canadian study called the National Population Health Survey (NPHS).
The NPHS is a longitudinal study that has followed a community sample representative of household residents since 1994. Follow-up interviews have been completed every two years and have incorporated the Composite International Diagnostic Interview short form for major depression. Data are currently available for seven such interview cycles spanning the time frame 1994 to 2006. In this study, cumulative prevalence was calculated by determining the proportion of respondents who had one or more major depressive episodes during this follow-up interval.
The annual prevalence of MDD ranged between 4% and 5% of the population during each assessment, consistent with existing literature. However, 19.7% of the population had at least one major depressive episode during follow-up. This included 24.2% of women and 14.2% of men. These estimates are nearly twice as high as the lifetime prevalence of major depressive episodes reported by cross-sectional studies during same time interval.
In this study, prospectively observed cumulative prevalence over a relatively brief interval of time exceeded lifetime prevalence estimates by a considerable extent. This supports the idea that lifetime prevalence estimates are vulnerable to recall bias and that existing estimates are too low for this reason.
To compare mortality rates across indicators of adiposity and relative adipose tissue distribution in the Canadian population.
The sample included 10,323 adult participants 20-69 y of age from the Canada Fitness Survey who were monitored for all-cause mortality over 13 y.
BMI, waist circumference (WC) and the sum of five skinfolds (SF5) were indicators of adiposity, and the first principal component of skinfold residuals (PC1) represented subcutaneous adipose tissue distribution. Proportional hazards regression was used to estimate relative mortality risk from mortality rates across levels of adiposity and adipose tissue distribution, controlling for the confounding effects of age, smoking status and alcohol consumption.
:Significant curvilinear (J-shaped) relationships in men and linear relationships in women were observed between BMI, WC and SF5 and all-cause mortality rates. PC1 was not related to mortality rates in either men or women. In women, the inclusion of the other indicators of adiposity and adipose tissue distribution did not significantly add to the prediction of mortality rates beyond BMI; however, combinations of BMI and both WC and SF5 produced significant models in men.
The results support the hypothesis that overall level of adiposity is an important predictor of all-cause mortality, more so than the relative distribution of subcutaneous body fat, once overall level of body fatness has been accounted for.
The Health Utilities Index Mark 3 (HUI3) is a multi-dimensional, preference-based measure of health status and health-related quality of life (HRQoL). HUI3 scores correlate strongly with self-ratings of health status and functional disability and vary according to age, gender and occupation. In comparative studies relating to HRQoL, it is necessary to carry out adjusted comparison of the health status of the different groups. taking into account unbalanced distribution of confounding variables. This paper describes a stratification method to adjust the distributions of HUI3 scores. This method provides a graphical representation of adjusted distribution of HUI3, which can also be used to adjust other HRQoL scores. Cross-sectional data from the 1998/1999 National Population Health Survey (NPHS) in Canada were used to verify the proposed method. Male agriculture workers and male construction workers in Canada had quite different age distributions but similar HUI3 distributions. After adjusting the age distribution of the construction group to match the distribution of agriculture group, the mean HUI3 score of the former significantly decreased.
To develop algorithm equations that could be used to adjust self-reported height and weight to elicit better estimates of actual BMI.
Linear regression analyses were performed to generate equations that could predict actual height and weight from self-reported data collected through telephone interviews on a representative sample of Canadians aged 18 years or older.
There were systematic biases in self-reported height and weight, leading to an underestimation of BMI. The application of our calibration equations to self-reported data produced closer estimates to actual rates of overweight and obesity.
We advocate the use of our correction equation whenever dealing with self-reported height and weight from telephone surveys to avoid potential distortions in estimating obesity prevalence.
This article presents a description of injuries among 24312 Canadian adolescents, aged 12-24 years, based on the Canadian Community Health Survey, 2000-2001. A total of 3214 (25.6%) males and 2227 (16.5%) females reported having at least one serious injury in the past year. The leading causes of injury in adolescents were: falls; overexertion or strenuous movement; accidentally bumped, pushed or bitten; and accidentally struck or crushed by objects. The parts of the body most often affected were the ankles/feet, wrists/ hands and knees/lower legs. The most frequent locations of injuries were: sports or athletic areas; home; school, college or university areas; and the street, highway or pavement. Injuries were more often reported to have occurred during the summer months. Low socio-economic status was inversely associated with the occurrence of injury in the past year whereas risk-taking behaviour in the form of cigarette smoking and drinking alcohol was positively associated with injury occurrence.