Suchergebnisse

BackgroundThe impacts of the built environment on health is a widely studied international area of research. One area of research is how urban morphology (e.g. active living environments, also known as neighbourhood walkability) may promote healthy behaviour within a population. However urban morphology and data relating to the built environment varies across different countries.
ObjectivesOne of the challenges in international studies is producing consistent, comparable measures of the built environment, in this case active living environments. As part of a study which compares the impact of neighbourhood environments on health outcomes for patients with type 2 diabetes (T2D), neighbourhood-level measures for walkable environments were derived for Canada and Wales using Geographic Information Systems (GIS).
MethodsUsing method based upon the Canadian Active Living Environments Database (Can-ALE) we created walkability indicators for Wales, UK. We created GIS models using OpenStreetMap and Office for National Statistics (ONS) Open Data to produce walkability metrics for each Lower Layer Super Output Area (LSOA) in Wales for linkage into the SAIL databank. We compared the GIS generated walkability metrics for Wales with those produced for Canada to evaluate whether the GIS methods are internationally transferable in the context of generating walkability indictors and associations with T2D.
FindingsThis work highlights the challenges in creating internationally comparable environmental exposure metrics. The differences in urban morphology and scale in Canada and Wales are significant, however this work demonstrates how with considered methodological choices these differences can be overcome to generate comparable built environment indicators.
ConclusionsThe generation of comparable walkability indicators for the built environment has allowed subsequent analysis into hospital admissions for people living with T2D in Caranda and Wales. This study has wider implications for international research into the impacts of the built environment on population health and are reproducible on future studies.

IntroductionWhile some comparative work has provided evidence for a universally positive impact of built environment features that promote physical activity, less is known about chronic diseases and hospitalization among different social contexts and health care systems. Parallel international linkage efforts present an opportunity to study health impacts of the built environment.
Objectives and ApproachThis study compares the impact of neighbourhood environments on health outcomes for patients with type 2 diabetes (T2D) in two countries. Neighborhood-level measures for walkable environments were derived for Canada and Wales using Geographic Information Systems. Hospitalization admissions from routine data sources and linked survey data responses (from the Welsh Health Survey and Canadian Community Health Survey) allow for the generation of population-based descriptive statistics on socio-demographic information, self-reported health, diagnostic patterns, and health care use. We examine the feasibility of investigating contextual differences in walkable environments, T2D, and hospitalization between Wales and Canada.
ResultsData linkage in respective privacy protecting safe havens in the Canada Research Data Centre Network (CRDCN) and the Wales Secure Anonymised Information Linkage (SAIL) Databank show promise for a comparative study, enabling parallel modelling of environmental and socio-demographic factors with hospitalization data. Both the Canadian and Welsh surveys ask respondents about their current diabetes status, allowing us to compare hospitalization rates and neighborhood effects of those who report having diabetes with the those who do not. Moreover, the linking of survey responses and similarity in geographic scale permitted consistent measurement of walkable environments across countries. Key administrative variables have been identified relating to health and behaviors, such as socio-demographic information, smoking status, and body mass index, and hospitalization metrics in both countries are commensurable.
Conclusion/ImplicationsThe generation of comparable linked datasets, built environment indicators and comparative research for T2D patients will have wider implications for international assessment of the impacts of environment on chronic diseases, and the hospital burden associated with these conditions.

IntroductionHospital utilization varies across socioeconomic and demographic strata in Canada, which has a universal health care system that grants essential services to everyone. Rates of adverse birth outcomes are known to differ among high and low SES women, but less is known of the excess burden attached to those outcomes across Canadian provinces.
ObjectiveTo examine length of stay for childbirth relative to women's socio-demographic characteristics, in the context of the Canadian universal health care system.
MethodsA population-based record linkage between the Canadian Community Health Survey (CCHS) cycles 3.1 (2005) and 4.1 (2007/8), and the Discharge Abstract Database (DAD) allowed the tracking of hospital utilization for linked survey respondents between 2005 and 2009. Hourly length of stay for delivery was modeled by socio-demographic factors, controlling for other clinical and individual-level characteristics.
ResultsThere were 7,166 complete delivery records from 5,570 female CCHS respondents who agreed to link and share their information. Women with the lowest income had on average, four-hour longer stays for vaginal delivery as compared to high-income women (IRR 1.07, 95% CI 1.02-1.13, p=0.01), and eight-hour longer stays for Caesarian delivery (IRR 1.08, 95% CI 0.95-1.22, p=0.23). A greater proportion of teenage pregnancy was seen for Aboriginal girls. Aboriginal status and rural area of residence were co-determinants of elevated length of stay.
ConclusionThe absence of egregious socio-demographic differences regarding childbirth is reassuring for the Canadian health care system. However, the persistence of marginally longer, and in turn, costlier visits for low-income and rural Aboriginal women is suggestive that policies of cash transfers during the prenatal period might be highly cost-effective if they achieve population-wide reductions in length of stay.

ObjectivesLocal neighbourhoods have great potential to foster community belonging which can improve health and well-being. In partnership with the City of Toronto, we prioritize and assess the importance of physical and social environmental attributes to community belonging. Using new data linkages, we contribute to Toronto's community safety and well-being plan, SafeTO.
ApproachWe leverage an individual-level record linkage of respondents from multiple cycles of the Canadian Community Health Survey (CCHS, 2000 to 2017), the Canadian Vital Statistics Death Database (CVSD), and the Discharge Abstract Database (DAD) from the Centre for Population Health Data at Statistics Canada. Environmental data sources include the Census, administrative data, and open-source data. Using postal code information from the CCHS, we connected each respondent with their neighbourhood's attributes, which include but are not limited to proximity to amenities (such as childcare, libraries and public transit), the Canadian Active Living Environment measure, green space, and air quality.
ResultsOf the 74,000 CCHS respondents from the Toronto census metropolitan area (representing a population of 4 to 5 million annually), an overall rate of 86% agreed to link and share their data, which renders an estimated linked sample of approximately 63,600 respondents. Across the entire linkage, 54% of respondents are linked to a record in the DAD between 1999/00 and 2017/18, and 10% are linked to a death record in the CVSD between 2000 and 2017. In consultation with municipal agencies and community stakeholders, we will prioritize the environmental attributes that are most relevant to community belonging and well-being, and comprehensively model the relationship between these attributes, community belonging and downstream health outcomes using multivariable regression and time-to-event models.
ConclusionThis on-going work contributes to the development of innovative approaches for using multi-sector data to inform decision making, as per the goals of SafeTO. Results from the analyses will be used to identify environmental attributes potentially important for community belonging and will support municipal city planning and resource allocation.

Shock events uncover deficits in social cohesion and exacerbate existing social inequalities at the household, community, local, regional, and national levels. National and regional government recovery planning requires careful stakeholder engagement that centers on marginalized people, particularly women and marginalized community leaders. The aim of this rapid scoping review was to inform the United Nations Research Roadmap for the COVID-19 Recovery, based on Pillar 5 of the United Nations Framework for the Immediate Socioeconomic Response to COVID-19: Social Cohesion and Community Resilience. We present a summary of key concepts across the literature that helped situate this review. The results include a description of the state of the science and a review of themes identified as being crucial to sustainable and equitable recovery planning by the United Nations. The role of social cohesion during a disaster, particularly its importance for upstream planning and relationship building before a disaster occurs, is not well understood and is a promising area of future research. Understanding the applicability of social cohesion measurement methodologies and outcomes across different communities and geographies, as well as the development of new and relevant instruments and techniques, is urgently needed in the context of the global COVID-19 pandemic.

IntroductionNeighbourhoods have the potential to influence population-wide modifiable risk factors such as physical inactivity and obesity. Built environments that encourage active living hold promise as a policy lever for reducing health care burden, particularly that related to cardiometabolic disease.
Objectives and ApproachWe examined the role of active living environments on hospitalization risk, frequency, and cumulative length of stay for all-causes and cardiometabolic diseases. The linked dataset is a combination of survey data from Canadian respondents aged 45+, records from a national census of acute hospitalizations, and the Canadian Active Living Environment (Can-ALE) - a 5-class measure of how conducive one's neighbourhood is to active living based on street connectivity, points of interest, and population density. We modelled the risk of all-cause and cardiometabolic hospitalizations for respondents living in more and less favourable environments using logistic regression. Frequency and cumulative length of stay were modelled using truncated negative binomial regression. Models were adjusted for individual-level factors and proximity to a hospital. An offset variable was included to account for different follow-up times.
Results232,000 respondents were included with a mean follow-up time of 5.37 years. Those living in progressively more favourable active living environments (classes 2, 3, 4, and 5) exhibited incrementally lower risk of hospitalization compared to those living in the least favourable (class 1). Relative to respondents living in the least favourable environments (class 1), odds ratios were 0.84 (95% CI 0.76-0.93) for all-cause hospitalization and 0.80 (95% CI 0.68-0.93) for cardiometabolic hospitalization for respondents living in the most favourable environments (class 5). There was little evidence of similar associations for hospitalization frequency and cumulative length of stay.
Conclusion / ImplicationsLiving in neighbourhoods that are more conducive to active living are associated with lower risk of all-cause and cardiometabolic hospitalization.

IntroductionThe built environment can shape modifiable risk factors such as obesity, poor diet, and physical inactivity, and could be a policy lever for the reduction of chronic disease. In Canada, the health care costs related to chronic disease continue to rise and there have been few policy options offered.
Objectives and ApproachWe examine the role of the built environment in hospital burden and premature mortality, with an emphasis on one of the highest burden diseases, Type 2 Diabetes (T2D). Neighbourhood built environment measures for active living were derived using geographic information systems for respondents of the Canadian Community Health Survey, for whom we have linked hospitalization and mortality records. A combination of ICD codes, self-reported diabetes status, as well as a population-based algorithm identifying those at higher risk of developing diabetes were used to identify cases. Differences in hospitalization frequency, cumulative length of stay, and mortality are investigated.
ResultsOver half a million hospitalization records were identified in our cohort of roughly 450,000 survey respondents. Key factors such as age, gender, race, and socioeconomic status are accounted for in modelling the association between neighborhood environment and hospitalization. Hospital burden and mortality in T2D patients are much higher than that of patients who do not report having the condition, and those at elevated risk of T2D display intermediate levels of hospitalization. Two-part hurdle models show evidence of an association between more walkable neighborhoods and lower hospitalization risk in non-T2D patients as well as those at elevated risk of developing T2D. The relationship between neighborhoods and the volume of chronic-disease related episodes as well as mortality is unclear, and under further investigation.
Conclusion/ImplicationsElucidating the role of neighbourhood built environments on hospital burden and premature mortality for individuals with diabetes will provide insight as to the full range of clinical and non-clinical interventions that could feasibly address the needs of some the highest health care system users.

ABSTRACTObjectivesTo demonstrate the methodology and results for linking measures of neighbourhood walking-friendliness or "walkability" to Canadian health surveys and Canadian health surveys linked to administrative health care records.
ApproachWe linked multiple measures of neighbourhood walkability to hundreds of thousands of 6-digit postal codes of respondents to three large Canadian surveys using geographic information systems and anonymized banks of postal codes.
ResultsLong term exposure to walkable neighbourhoods was associated with increased reporting of walking for utilitarian purposes. Moving to a high walkable neighbourhood from a low walkable neighbourhood was associated with a full unit decrease in the body mass index of Canadian men over a 12-year follow-up. In a linkage of walkability measures to respondents who wore biosensors for a one-week period in several Canadian cities, we found that neighbourhood walkability was associated with increased reporting of utilitarian walking but not overall physical activity and step counts as measured by biosensors.
ConclusionThere is potential for walkable neighbourhoods to influence physical activity and body weight of Canadians which is more evident when individuals are followed for long periods of time.

ABSTRACTObjectivesBirth and delivery in hospital is one of the most common medical procedures in Canadian hospitals, and can be used to assess equity in the delivery of health care. This study investigates the association between socioeconomic status and hospital burden for childbirth using linked Canadian survey and administrative databases, accounting for a wide array of other individual and health-care related characteristics.
ApproachA population-based record linkage between national health survey data and the Canadian Discharge Abstract Database (a census of all Canadian hospital separations) allowed the tracking of hospital utilization between 2005 and 2009 for which individual-level socioeconomic and demographic factors were also available. Length of stay for delivery, risk of pre-delivery hospitalization within 30 days of admission for delivery, and risk of maternal readmission within 30 days of discharge for delivery were the three measures of hospital utilization modeled.
ResultsComplete information for 7,163 deliveries of 5,568 women was available and used in the models of length of stay and risk of maternal admission pre- and post-delivery. In fully adjusted models, predicted length of stay was graded by household income with longest stays for lowest income women (2.79 days, 95% CI 2.61-2.92), followed by middle income women (2.63 days, 95% CI 2.50-2.76) and high income women (2.56 days, 95% CI 2.49-2.63). Factors intrinsic to routine hospital care and protocol such as province and vaginal versus Cesarean section delivery were stronger predictors of length of stay than income. Additionally, Aboriginal status, compounded with residing in a rural setting was associated with higher predicted probability of maternal readmission.
ConclusionsLow income women have marginally longer stays in hospital following birth events than do middle and high-income women in Canada that persist after adjustment for strong drivers of length of stay (parity and birth mode). While this may suggest that more complicated cases are benefiting from longer stays in hospital, it provokes the question as to whether there may be additional reductions in length of stay that could be achieved through resource redistribution to the prenatal period. Overall, the results suggest that equity goals of the Canadian health care system are being achieved for birth-related hospitalizations, and the availability of these linked data will be key for further comprehensive evaluation of population health status.