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IntroductionAt the Manitoba Centre for Health Policy (MCHP), we have been performing data linkage for over 25 years. Over time, the Manitoba Population Research Data Repository (MPRDR) has expanded to over 80 datasets. Data linkage methods are key to bringing all this data together for population-based research.
Objectives and ApproachThe presentation will include a detailed description of the individual steps involved in the data linkage process and provide information about the methods developed and knowledge gained over time at MCHP. We will present different scenarios linking health, education, social and justice data and the choices that are made prior to and during data linkage. The data linkage process and linkage methods, including data validation techniques, will be illustrated with examples from our work.
ResultsThe presentation will describe the different types of data we have in the MPRDR and illustrate how the data are processed in a de-identified manner so that privacy and confidentiality are maintained.
The presentation will provide details on the data linkage methods used, dependent on the type of data sources being linked. This involves identifying and describing a 5-step data linkage process, including:

pre-processing (gaining knowledge about the data and cleaning/standardization techniques);
searching for and selecting the appropriate linkage variables;
applying different linkage techniques (e.g.: deterministic, probabilistic, "fuzzy matching" and manual review) to the data,
"rules" for deciding when data linkage should occur, and
reporting and Interpreting linkage outcome metrics and quality.

Conclusion/ImplicationsOur ability to link different data sources provides the capacity to study questions and complex issues related to health, social, education and justice from a population perspective. The techniques and methods described in this presentation should be applicable to other organizations linking administrative data.

Abstract Background Well-organized administrative data with large numbers of cases (building on linked files from several government departments) and a population registry facilitate new studies of population health and child development. Analyses of family relationships and a number of outcomes--educational achievement, health, teen pregnancy, and receipt of income assistance--are relatively easy to conduct using several birth cohorts. Looking both at means/proportions and at sibling correlations enriches our study of opportunity and well-being in late adolescence. With observational research possibly exaggerating the causal effects of risk factors, sibling comparisons involving individuals sharing both many family characteristics and many genes help deal with such criticisms. Methods This paper uses a rich dataset from one Canadian province (Manitoba) covering a wide range of geographical areas (cities to rural regions). Influences on opportunity and well-being are analyzed looking at both means/proportions and sibling correlations. We measure a variety of outcomes that may reflect different causal influences. A creative application of linear programming advances the use of data on residential location. Results Predicting educational achievement using available variables was much easier than predicting adolescent health status (R-square of .200 versus R-square of .043). Low levels of educational achievement, high levels of teenage pregnancy, and high sibling correlations outside Winnipeg and within Winnipeg's lower income areas highlight inequalities across socioeconomic and geographic backgrounds. Stratifying our analyses by different variables, such as income quintiles, reveals differences in means and correlations within outcomes and across groups. Particular events--changes in mother's marital status and in place of residence--were associated with less favorable outcomes in late adolescence. Conclusion Our findings suggest a paradox: Canadian developmental outcomes through late adolescence appear quite similar to those in the United States, even though intergenerational mobility in Canada is closer to mobility in the Nordic countries than to that in the United States.

Abstract Background Well-organized administrative data with large numbers of cases (building on linked files from several government departments) and a population registry facilitate new studies of population health and child development. Analyses of family relationships and a number of outcomes--educational achievement, health, teen pregnancy, and receipt of income assistance--are relatively easy to conduct using several birth cohorts. Looking both at means/proportions and at sibling correlations enriches our study of opportunity and well-being in late adolescence. With observational research possibly exaggerating the causal effects of risk factors, sibling comparisons involving individuals sharing both many family characteristics and many genes help deal with such criticisms. Methods This paper uses a rich dataset from one Canadian province (Manitoba) covering a wide range of geographical areas (cities to rural regions). Influences on opportunity and well-being are analyzed looking at both means/proportions and sibling correlations. We measure a variety of outcomes that may reflect different causal influences. A creative application of linear programming advances the use of data on residential location. Results Predicting educational achievement using available variables was much easier than predicting adolescent health status (R-square of .200 versus R-square of .043). Low levels of educational achievement, high levels of teenage pregnancy, and high sibling correlations outside Winnipeg and within Winnipeg's lower income areas highlight inequalities across socioeconomic and geographic backgrounds. Stratifying our analyses by different variables, such as income quintiles, reveals differences in means and correlations within outcomes and across groups. Particular events--changes in mother's marital status and in place of residence--were associated with less favorable outcomes in late adolescence. Conclusion Our findings suggest a paradox: Canadian developmental outcomes through late adolescence appear quite similar to those in the United States, even though intergenerational mobility in Canada is closer to mobility in the Nordic countries than to that in the United States. ; Peer Reviewed

Objectives. This study examined preventive care delivered in Manitoba during the 1990s by 3 different methods —childhood immunizations (by physicians and public health nurses under a government program), screening mammography (through a government program introduced in 1995), and cervical cancer screening (no program).

BackgroundCanadian health data repositories link datasets at the provincial level, based on their residents' registrations to provincial health insurance plans. Linking national datasets with provincial health care registries poses several challenges that may result in misclassification and impact the estimation of linkage rates. A recent linkage of a federal immigration database in the province of Manitoba illustrates these challenges.
Objectivesa) To describe the linkage of the federal Immigration, Refugees and Citizenship Canada Permanent Resident (IRCC-PR) database with the Manitoba healthcare registry and b) compare data linkage methods and rates between four Canadian provinces accounting for interprovincial mobility of immigrants.
MethodsWe compared linkage rates by immigrant's province of intended destination (province vs. rest of Canada). We used external nationwide immigrant tax filing records to approximate actual settlement and obtain linkage rates corrected for interprovincial mobility.
ResultsThe immigrant linkage rates in Manitoba before and after accounting for interprovincial mobility were 84.8% and 96.1, respectively. Linkage rates did not substantially differ according to immigrants' characteristics, with a few exceptions. Observed linkage rates across the four provinces ranged from 74.0% to 86.7%. After correction for interprovincial mobility, the estimated linkage rates increased >10 percentage points for the provinces that stratified by intended destination (British Columbia and Manitoba) and decreased up to 18 percentage points for provinces that could not use immigration records of those who did not intend to settle in the province (New Brunswick and Ontario).
ConclusionsDespite variations in methodology, provincial linkage rates were relatively high. The use of a national immigration dataset for linkage to provincial repositories allows a more comprehensive linkage than that of province-specific subsets. Observed linkage rates can be biased downwards by interprovincial migration, and methods that use external data sources can contribute to assessing potential selection bias and misclassification.

IntroductionRoutine health care information systems only capture a portion of violence against women because some victimized women may not seek health care and some events may not require medical attention. Population-based estimates of the risk of violent injury (VI) among women with a history of intimate partner victimization (IPV) are lacking.
Objectives and ApproachTo determine the risk of violent injury following IPV among women living in Manitoba, Canada, 2004-2016. Linked administrative justice, healthcare, and social databases were used. Exposure began after a woman was first involved with the Manitoba Justice system as a victim of IPV, assessed through provincial prosecution and disposition records. IPV victims (n= 20,469) were matched to three non-victims (n= 61,407) on age, relationship status and place of residence at the date of the IPV incident. The main outcomes were first health care use for violent injury and violent death. Outcomes were assessed through emergency department, hospital and vital statistics records. Conditional Cox Regression was used to obtain Hazard Ratios with 95% confidence intervals (CI).
ResultsThe crude risk of VI was 8.5 per 1000 women among non-victims and 55.8 among victims of IPV. Compared to non-victims, IPV victims were 3.8 [95% confidence interval (CI): 3.4, 4.3] times more likely to suffer IIIO and 4.5 [95% CI: 2.3, 9.0] times to have a violent death, after adjustment. Victims had approximately half the risk of VI if the accused is on probation.
Conclusion / ImplicationsJustice System-identified victims of IPV are at higher risk of assault and violent death than women not exposed to IPV. Justice involvement represents an opportunity for prevention of violent injury and homicide among IPV victims.

IntroductionMajor osteoporotic fractures (MOF) are associated with significant morbidity and healthcare system burden.
Objectives and ApproachWe aimed to determine whether sibling fracture history is associated with MOF risk amongst individuals from a population-based cohort using objectively-ascertained measures of fracture history. This retrospective cohort study used administrative databases from the province of Manitoba, Canada, which has a universal healthcare system. The cohort included individuals aged 40 years and older between 1997 and 2015 with linkage to at least one sibling. The exposure was MOF diagnosis occurring at age 40 years or older in a randomly selected sibling. The outcome was incident clinically-diagnosed MOF (hip, wrist, humerus or spine) identified in hospital and physician records using established case definitions. A multivariable Cox proportional hazards regression was used to test the association of sibling fracture history with the risk of MOF in individuals after adjustment for known fracture risk factors.
ResultsThe cohort included 217,519 individuals; 92% were linked to full siblings (i.e., same mother/father) and 49% were females. During a median follow-up of 11 years (IQR 5 -15), 7274 (3.3%) incident MOF cases were identified. Sibling MOF history was associated with increased risk of MOF (HR 1.71, 95% CI 1.48–1.97). The risk was elevated in both men (HR 1.63, 95% CI 1.29-2.06) and women (HR 1.78, 95% CI 1.48-2.13) but was higher among sisters (HR 2.08, 95% CI 1.65-2.61) compared to brothers (HR 1.67, 95% CI 1.20-2.32). In a secondary analysis of sibling fracture site, the highest risk was observed with diagnosis of wrist followed by spine fractures (HR 1.86, 95% CI 1.57-2.21 and HR 1.46, 95% CI 1.08-1.98, respectively).
ConclusionSibling fracture history is associated with increased MOF risk in individuals and should be considered as a candidate risk factor for improving fracture risk prediction.

ObjectivesIndigenous children in Canada, including Metis children, are taken into care by the child welfare system at a disproportionately high rate. The objective of this study was to explore factors related to having a child taken into care from Metis families in Manitoba, and specifically from Metis mothers experiencing incarceration.
ApproachThe cohort comprised all mother-child dyads in Manitoba, Canada with live births between Jan 1, 2004-Dec 31, 2014. The factors we examined included the mother experiencing incarceration after the birth of a child, having prior interaction with the legal system, socioeconomic status, maternal age, and mother's mental health disorder diagnoses. Using the Cox proportional hazards model, unadjusted and adjusted hazard ratios describing the risk of a child being taken into care by five years of age were generated for three exposure groups: no incarceration, prenatal incarceration, and postnatal incarceration.
ResultsBefore adjustment, mothers experiencing incarceration after the birth of a child had greater risk of having a child taken into care (HR 9.3; 95% CI 7.7-11.3) compared with women who did not experience incarceration; after adjusting for measured confounders, their elevated risk dropped to aHR 6.1 (5.0-7.4). After further adjustment for prior custody in the prenatal period, mothers experiencing incarceration had 3.8 times the risk (3.0-5.0), and after adjusting for maternal mental health disorders, this dropped to 2.6 times the risk (2.0-3.4). In fully adjusted models, other factors associated with having a child taken into care included receiving diagnoses for a substance use disorder (aHR 2.6; 2.1-3.2) and for psychosis (aHR 2.4; 1.4-4.1) during the five years prior to the child's birth.
ConclusionDue to colonialism, Metis women experience high levels of social and mental health complexity, placing their children at increased risk of being taken into care. Responding to the Truth and Reconciliation Commission's Calls to Action to redress the harms of colonialism is necessary to support Metis children's health and well-being.

ObjectivesSPECTRUM is a unique multi-disciplinary, cross-sector collaborative research partnership between academics, government, and community organizations in Manitoba working together to address complex social problems. In our first research project, partners identified the need for quantitative evidence around outcomes of children involved with Child Protection Services (CPS), using linked administrative data.
ApproachFrom the SPECTRUM partnership, a research team with CPS expertise was established, including government policy-makers, community organizations representing First Nations families, and academics from multiple disciplines. The research is guided by an Advisory Circle of First Nations Knowledge Keepers. Linking health, education, CPS, and justice data we developed a matched cohort identifying children involved with CPS (2007-2018) for whom there was discretion in the decision to 1) place them in out-of-home care (n=19,718), or 2) keep them in their family home while providing services (n=28,154). Instrumental Variable analysis, with CPS agency as the instrument, will be used to compare outcomes.
ResultsFollowing the trajectories of these two groups of CPS-involved children over time, we will compare their mental and physical health, educational achievement, and justice system involvement while accounting for individual-level (e.g., age, sex, chronic health conditions) and family-level (e.g., family income, maternal mental health, number of siblings) factors that may contribute to these outcomes. Preliminary findings will be workshopped with the SPECTRUM partnership to facilitate discussions on framing the evidence for policy makers. The SPECTRUM policy team will then prepare policy recommendations for government to consider. The Advisory Circle and a youth advisory squad will facilitate contextualizing and mobilizing findings. Actions taken by government in response to material provided will be monitored and will inform the development of subsequent research projects conducted by SPECTRUM.
ConclusionGovernment and community stakeholder involvement throughout bolsters the likelihood of evidence translating into program and policy changes. This is not a situation where academics are telling government how to do their jobs – this is government, community organizations, and academics working together with the shared goal of better outcomes for children.