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

Four unhealthy habits land Ontarians in hospital more than 900,000 days a year

Manuel DG, Perez R, Bennett C, Rosella L, Choi B. 900,000 Days in Hospital: The Annual Impact of Smoking, Alcohol, Diet and Physical Activity on Hospital Use in Ontario. Toronto, ON: ICES; 2014.

ISSUE

Previous studies in Ontario have shown that unhealthy behaviours result in a substantial reduction in life expectancy and quality of life. What is the impact of these unhealthy behaviours on hospital use and hospital costs?

STUDY

Examined 79,447 community-dwelling Ontarians aged 20 to 79 who were surveyed between 2001 and 2005 regarding their health status. Their subsequent hospital use was tracked to determine how much of it could be attributed to smoking, alcohol consumption, diet and physical activity, and the impact of these four behaviours on hospital costs was estimated.

KEY FINDINGS

The investigators found that:
  • Thirty-two percent of hospital bed use between 2001 and 2012 could be attributed to the four unhealthy behaviours.
  • In 2011, these behaviours accounted for the use of 942,000 hospital bed days at a cost of $1.8 billion for insured residents of Ontario.
  • Nearly all Ontarians reported at least one of the four behaviour risks; only 7.2% reported none.
  • Smoking had the greatest impact on hospital use, followed by physical inactivity and poor diet (17%, 12% and 6% of hospital use, respectively).
  • People between the ages of 20 and 79 with the unhealthiest behaviours for all four categories used 280% more bed days (42 more days) than people with the healthiest behaviours.

IMPLICATIONS

In addition to increasing life expectancy and overall quality of life, healthier living would significantly reduce demands on Ontario’s health care system. Improving health behaviours should be considered an imperative for government and society.
 
 

Higher strength statins linked to moderately increased risk of diabetes

Dormuth CR, Filion KB, Paterson JM, James MT, Teare GF, Raymond CB, Rahme E, Tamim H, Lipscombe L. Higher potency statins and the risk of new diabetes: multicentre, observational study of administrative databases. BMJ. 2014; 348:g3244.

ISSUE

Statins are among the most widely used prescription drugs and are proven to be life-saving for patients with cardiovascular disease. Is there an association between statin potency and new diabetes in patients treated for secondary prevention of cardiovascular disease?

STUDY

Identified 136,966 patients aged 40 and older who were newly prescribed a statin between January 1997 and March 2011 after hospitalization for a major cardiovascular event in Canada, the US or the UK. Compared diabetes incidence among users of higher potency statins (Crestor, Lipitor and Zocor) with users of all other statins by identifying a first hospitalization for diabetes or a prescription for insulin or an oral antidiabetic drug.

KEY FINDINGS

Approximately two-thirds of patients were prescribed a higher potency statin. In the first two years of statin use, there was a 15% increase in the risk of new onset diabetes with higher  potency statins compared with lower potency statins. 

IMPLICATIONS

Clinicians should consider the risk of diabetes when prescribing higher potency statins in patients treated for secondary prevention of cardiovascular diseases.
 
 

Prompt follow-up care after ICD procedure associated with significant reduction in death

Laksman ZW, Krahn AD, Dorian P, Simpson CS, Crystal E, Healey JS, Khaykin Y, Wang X, Lee DS. Greater mortality risk among patients with delayed follow-up after implantable cardioverter defibrillator procedures. Can J Cardiol. 2014; 30(6):598–605.

ISSUE

Substantial numbers of deaths occur among implantable cardioverter defibrillator (ICD) recipients. Are patients who receive delayed follow-up care at increased risk of death compared to those who receive early follow-up?

STUDY

Identified patients who underwent a first ICD implant or a replacement procedure between February 2007 and March 2011 and compared outcomes of those with delayed (more than 12 weeks) to early ICD clinic follow-up.

KEY FINDINGS

Among 8,096 ICD recipients, 1 in 7 (14%) did not undergo an ICD clinic visit within 12 weeks after their implant. Median times to first follow-up visit were 19 days for early follow-up and 133 days for delayed follow-up. Sixty-six patients (5.8%) who received delayed follow-up died compared with 202 patients (2.9%) who received early follow-up. Patients with early follow-up experienced a 31% reduced risk of all-cause mortality after adjusting for clinical factors, primary care visits after discharge and distance to a follow-up centre.

IMPLICATIONS

Implanting physicians should carefully counsel patients regarding the importance of a thorough post-ICD implant clinic evaluation, which cannot be substituted by primary care physician follow-up.
 
 

Cervical cancer screening may offer little benefit to women before age 30

Vicus D, Sutradhar R, Lu Y, Elit L, Kupets R, Paszat L. The association between cervical cancer screening and mortality from cervical cancer: a population based case–control study. Gynecol Oncol. 2014; 133(2):167–71.

ISSUE

Screening low-risk populations for cervical cancer, which is caused by human papillomavirus infection, may lead to treatments (removal of lesions) that have a very low likelihood of benefitting the patient and may cause more harm than good (rupture of cervical membranes, preterm delivery). What is the effect of cervical cancer screening on mortality from cervical cancer in women between the ages of 20 and 69?

STUDY

Identified women aged 20 to 69 who were diagnosed with cervical cancer in Ontario between January 1998 and December 2008 and died from cervical cancer by December 2008. They were age- and income-matched with up to 10 women without a diagnosis of cervical cancer.  Dates of Pap smears taken up to 120 months prior to diagnosis date were analyzed for the two groups.

KEY FINDINGS

Of the 1,052 women who died from cervical cancer over the 11-year span, 9 were aged 20–24 and 25 were aged 25–29. Cervical cancer screening performed 3 to 36 months prior to the date of diagnosis was found to be protective of mortality from cervical cancer in women aged 30 and older. It appeared to confer no such benefit to women younger than 30; this could be due to the fact that there was no actual protective effect, a small effect that was undetectable or as a result of the rarity of death from cervical cancer in women younger than 30.

IMPLICATIONS

Cervical screening is an important risk reduction strategy in preventing cervical cancer mortality in women over the age of 30 and should continue at a frequency of every 3 years, even among women who have been vaccinated for human papillomavirus.
 
 

One in six adults receiving care at Ontario diabetes education centres do not have diabetes

Hwee J, Cauch-Dudek K, Victor JC, Ng R, Shah BR. Utilization of diabetes education centres in Ontario by people without diabetes. Can J Diabetes. 2014; 38(3):186–90.

ISSUE

Although the main role of diabetes education centres (DECs) is to support and manage people living with diabetes, evidence suggests that many centres are increasingly serving people at risk for but not yet diagnosed with diabetes.  To what extent are DECs in Ontario seeing persons for diabetes prevention?

STUDY

Identified 117,660 adults aged 18 and older who attended a DEC in Ontario in 2006 and determined the proportion who were without diagnosed diabetes at the time of their visit. They were stratified by DEC and health region and followed until 2010 for incident diabetes.

KEY FINDINGS

More than 1 in 6 DEC attendees (19,920) did not have diagnosed diabetes. People without diagnosed diabetes made up a greater proportion of attendees at DECs in community health centres (47.5%) or First Nation communities (22.1%) than those based in hospitals (13.9%) or other community settings (13.0%). Only 13.8% of people without diabetes attended group classes; most attended individual counselling sessions. The incidence of diagnosed diabetes among these attendees was more than 10 times that of the overall Ontario population.

IMPLICATIONS

Almost 17% of attendees at DECs did not have a diagnosis of diabetes; however, these patients had 10 times the risk of diabetes as other Ontarians and were likely prediabetic. Whether the delivery of diabetes prevention care to such large numbers of patients is detracting from the DEC’s core function is uncertain. 
 
 
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