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  INSTITUTE FOR CLINICAL EVALUATIVE SCIENCES
MAY 2014
 
At a Glance
  MONTHLY HIGHLIGHTS OF ICES RESEARCH FINDINGS FOR STAKEHOLDERS  
 

Pregnant drivers at greater risk of a serious motor vehicle crash in second trimester

Redelmeier DA, May SC, Thiruchelvam D, Barrett JF. Pregnancy and the risk of a traffic crash. CMAJ. 2014 May 12 [Epub ahead of print].

ISSUE

Pregnancy causes physiologic and lifestyle changes that may contribute to increased driving and driving error. Does pregnancy increase the risk of a serious motor vehicle crash?

STUDY

Identified 507,262 women aged 18 and older who gave birth in Ontario between April 2006 and March 2011. Compared their risk of a serious motor vehicle crash (defined as a crash resulting in an emergency department visit) in each trimester to their baseline risk in the three-year interval before pregnancy. 

KEY FINDINGS

Women in their second trimester of pregnancy were 42% more likely to be involved in a crash compared to before pregnancy. The increased risk extended to diverse populations and different crash characteristics but not to crashes where the pregnant woman was a passenger or a pedestrian. The absolute risk was similar in magnitude to the risk associated with sleep apnea.

IMPLICATIONS

Prenatal care guidelines for pregnant women should address the increased risk of a motor vehicle crash and include specific safe driving techniques.
 
 

Ontario Métis have higher prevalence of asthma and COPD than general population

Gershon AS, Khan S, Klein-Geltink J, Wilton D, To T, Crighton EJ, Pigeau L, MacQuarrie J, Allard Y, Russell SJ, Henry DA.  Asthma and chronic obstructive pulmonary disease (COPD) prevalence and health services use in Ontario Métis: a population-based cohort study. PLoS One. 2014; 9(4):e95899.

ISSUE

Aboriginal populations in Canada are at increased risk of asthma and chronic obstructive pulmonary disease (COPD). What is the risk of these diseases in Canada’s Métis population, who have mixed Aboriginal and European ancestry?

STUDY

Linked the Métis Nation of Ontario Citizenship Registry with health administrative databases to compare the burden of asthma and COPD between Métis and non-Métis populations in Ontario from 2009 to 2012.

KEY FINDINGS

Prevalence of asthma and COPD were 30% and 70% higher, respectively, in the Métis compared to the general population. General physician and specialist ambulatory care visits were significantly lower in Métis with asthma; specialist visits for COPD were also lower. Emergency department visits and hospitalizations were generally higher for Métis with either disease. All-cause mortality in Métis with COPD was 1.3 times higher compared to non-Métis with COPD.

IMPLICATIONS

These findings suggest deficiencies in primary care access for these diseases for the Métis, which may in turn make this population more reliant on emergency services. Future research should focus on identifying specific factors that contribute to higher rates of asthma and COPD among the Métis and determining strategies to minimize the disease burden for this at-risk population.
 
 

Immigrants from Sub-Saharan Africa at greatest risk for pregnancy complications

Urquia ML, Glazier RH, Gagnon AJ, Mortensen LH, Nybo Andersen AM, Janevic T. Guendelman S, Thornton D, Bolumar F, Rio Sanchez I, Small R, Davey MA, Hjern A. Disparities in preeclampsia and eclampsia among immigrant women giving birth in six industrialised countries. BJOG. 2014 Apr 24 [Epub ahead of print].

ISSUE

Preeclampsia is a disorder of pregnancy characterized by hypertension and excess protein in the urine. Preeclampsia may proceed to eclampsia, which is marked by life-threatening seizures. What disparities in preeclampsia and eclampsia exist among immigrant women from various world regions giving birth in industrialized countries?

STUDY

Used national or regional heath data from Australia, Canada (Ontario), Denmark, Spain, Sweden and the United States to identify obstetrical deliveries by immigrants and non-immigrants within a 10-year period. Maternal country of birth was determined and assigned to a world region of origin.

KEY FINDINGS

There were 9,028,802 deliveries across the six receiving countries, 33.6% of which were to immigrant women. The occurrence of preeclampsia per 1000 deliveries varied from 12.3 in Canada to 32.1 in Australia. The occurrence of eclampsia per 1000 deliveries varied from 0.4 in Denmark and Spain to 1.1 in the US. Compared with native-born women, European and East Asian immigrants were at lower risk of preeclampsia and eclampsia in most industrialized countries. Women from Sub-Saharan Africa had the highest risk, followed by women from Latin America and the Caribbean.

IMPLICATIONS

Clinicians are encouraged to consider enhanced surveillance of women from Sub-Saharan Africa, Latin America and the Caribbean for preeclampsia and eclampsia, and culturally sensitive peripartum care.
 
 

For women with diabetes, low mammogram rates independent of socioeconomic status 

Chan W, Yun L, Austin PC, Jaakkimainen RL, Booth GL, Hux J, Rochon PA, Lipscombe LL. Impact of socio-economic status on breast cancer screening in women with diabetes: a population-based study. Diabet Med. 2014 Mar 3 [Epub ahead of print].

ISSUE

Evidence suggests that the presence of diabetes is associated with a decrease in breast cancer screening. To what extent does socioeconomic status play a role in this disparity?

STUDY

Identified 188,759 screening-eligible Ontario women aged 50 to 69 with diabetes between January 1999 and December 2010 and age-matched them 1:2 to women without diabetes. Determined the likelihood of at least one screening mammogram within a 36-month period for both groups, adjusting for socioeconomic status (neighbourhood income) and other demographic and clinical variables.

KEY FINDINGS

Of 504,288 women studied, 321,564 (63.8%) had a screening mammogram, including 60.3% of those with diabetes and 65.8% of those without. Women with diabetes were 14% less likely to have a mammogram than women without diabetes. Diabetes was associated with lower mammogram use even among women from the highest socioeconomic status quintile: socioeconomic status did not explain differences in breast cancer screening between diabetic and non-diabetic patients. 

IMPLICATIONS

Both diabetes and low socioeconomic status are independently associated with less screening for breast cancer among eligible patients. Interventions that target patient, provider and health system factors are needed to improve breast cancer screening among women with diabetes.
 
 

Benzodiazepine use linked to adverse respiratory outcomes in seniors with COPD

Vozoris NT, Fischer HD, Wang X, Stephenson AL, Gershon AS, Gruneir A, Austin PC, Anderson GM, Bell CM, Gill SS, Rochon PA. Benzodiazepine drug use and adverse respiratory outcomes among older adults with COPD. Eur Respir J. 2014 Apr 17 [Epub ahead of print].

ISSUE

In Ontario, about one-third of older adults with chronic obstructive pulmonary disease (COPD) are new users of benzodiazepines. What is the association of new benzodiazepine use with the risk of adverse respiratory outcomes in this population?

STUDY

Identified 177,355 community-dwelling individuals aged 66 and older with COPD in Ontario between April 2003 and December 2009. Matched 48,915 new users of benzodiazepines to 48,915 non-users and compared differences in the risk of adverse respiratory outcomes within 30 days of the date a benzodiazepine was dispensed, or for non-users, the date of claim for a non-benzodiazepine medication.

KEY FINDINGS

Among the individuals identified with COPD, 28.4% were new benzodiazepine users. Compared to non-users, new users were at significantly higher relative risk for outpatient respiratory exacerbations (45%) and emergency department visits for COPD or pneumonia (92%). There was a trend toward an increased relative risk of hospitalization for COPD or pneumonia in new users (9%). 

IMPLICATIONS

While investigators found significantly increased relative risks for adverse respiratory outcomes among new benzodiazepine users, the absolute risks for these events were small. The potential for adverse respiratory outcomes needs to be considered when administering benzodiazepines to older patients with COPD.
 
 
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