Proportion of Life Spent in Canada and the Incidence of Multiple Sclerosis in Permanent Immigrants.

BACKGROUND AND OBJECTIVES: While immigrants to high-income countries have a lower risk of multiple sclerosis (MS) compared with host populations, it is unknown whether this lower risk among immigrants increases over time. Our objective was to evaluate the association between proportion of life spent in Canada and the hazard of incident MS in Canadian immigrants. METHODS: We conducted a population-based retrospective cohort study in Ontario, using linked health administrative databases. We followed immigrants, who arrived in Ontario between 1985 and 2003, from January 1, 2003, to December 31, 2016, to record incident MS using a validated algorithm based on hospital admission or outpatient visits. We derived proportion of life spent in Canada based on age at arrival and time since immigration obtained from linked immigration records. We used multivariable proportional hazard models, adjusting for demographics and comorbidities, to evaluate the association between proportion of life in Canada and the incidence of MS, where proportion of life was modelled using restricted cubic spline terms. We further evaluated the role of age at migration (15 or younger vs older than 15 years), sex, and immigration class in sensitivity analyses. RESULTS: We included 1.5 million immigrants (49.9% female, mean age 35.9 [SD 14.2] years) who had spent a median of 20% (Q1-Q3 10%-30%) of their life in Canada. During a mean follow-up of 13.9 years (SD 1.0), 934 (0.44/100,000 person-years) were diagnosed with MS. Compared with the median, a higher risk of MS was observed at higher values of proportion of life spent (e.g., hazard ratio [70% vs 20% proportion of life] 1.38; 1.07-1.78). This association did not vary by sex (p(sex × proportion of life) = 0.70) or immigration class (p(immigration class × proportion of life) = 0.13). The results did not vary by age at migration but were statistically significant only at higher values of proportion of life for immigrants aged 15 years or younger at arrival. DISCUSSION: The risk of incident MS in immigrants varied with the proportion of life spent in Canada, suggesting an acculturation effect on MS risk. Further work is required to understand environmental and sociocultural factors driving the observed association.

Who sleeps well in Canada? The social determinants of sleep health among middle-aged and older adults in the Canadian Longitudinal Study on Aging.

OBJECTIVES: Sleep health inequities likely contribute to disparities in health outcomes. Our objective was to identify social determinants of sleep health among middle-aged/older adults in Canada, where prior evidence is limited. METHODS: We analyzed cross-sectional data from the Canadian Longitudinal Study on Aging, a survey of over 30,000 community-dwelling adults aged 45-85years. Self-reported measures included sleep duration, sleep satisfaction, and sleep efficiency. We explored associations between sleep measures and social determinants of health. We used modified Poisson regression to estimate prevalence ratios for sleep satisfaction and sleep efficiency, and linear regression for sleep duration. Estimates were adjusted for all social, lifestyle, and clinical covariates. We explored effect modification by sex. RESULTS: Of the 11 social determinants explored, all were significantly associated with at least one domain of sleep health. These associations were reduced to 9 variables with adjustment for all social variables, and 7 with further adjustment for lifestyle and clinical covariates, including differences by sex, age, education, marital status, employment, race/ethnicity, and sexual orientation. Better sleep health in >1 domain was observed among males, older age groups (65 and older), higher income groups, the retired group, and homeowners with adjustment for social variables, and only in males and older age groups with additional adjustment for lifestyle and clinical variables. Only sleep duration associations were modified by sex. CONCLUSIONS: Sleep health disparities among Canadian adults exist across socioeconomic gradients and racial/ethnic minority groups. Poor sleep health among disadvantaged groups warrants increased attention as a public health problem in Canada.

Association of neighbourhood-level material deprivation with adverse outcomes and processes of care among patients with heart failure in a single-payer healthcare system: A population-based cohort study.

AIM: We studied the association between neighbourhood material deprivation, a metric estimating inability to attain basic material needs, with outcomes and processes of care among incident heart failure patients in a universal healthcare system. METHODS AND RESULTS: In a population-based retrospective study (2007-2019), we examined the association of material deprivation with 1-year all-cause mortality, cause-specific hospitalization, and 90-day processes of care. Using cause-specific hazards regression, we quantified the relative rate of events after multiple covariate adjustment, stratifying by age ≤65 or ≥66 years. Among 395 763 patients (median age 76 [interquartile range 66-84] years, 47% women), there was significant interaction between age and deprivation quintile for mortality/hospitalization outcomes (p ≤ 0.001). Younger residents (age ≤65 years) of the most versus least deprived neighbourhoods had higher hazards of all-cause death (hazard ratio [HR] 1.19, 95% confidence interval [CI] 1.10-1.29]) and cardiovascular hospitalization (HR 1.29 [95% CI 1.19-1.39]). Older individuals (≥66 years) in the most deprived neighbourhoods had significantly higher hazard of death (HR 1.11 [95% CI 1.08-1.14]) and cardiovascular hospitalization (HR 1.13 [95% CI 1.09-1.18]) compared to the least deprived. The magnitude of the association between deprivation and outcomes was amplified in the younger compared to the older age group. More deprived individuals in both age groups had a lower hazard of cardiology visits and advanced cardiac imaging (all p < 0.001), while the most deprived of younger ages were less likely to undergo implantable cardioverter-defibrillator/cardiac resynchronization therapy-pacemaker implantation (p = 0.023), compared to the least deprived. CONCLUSION: Patients with newly-diagnosed heart failure residing in the most deprived neighbourhoods had worse outcomes and reduced access to care than those less deprived.

Does Shiftwork Impact Cognitive Performance? Findings from the Canadian Longitudinal Study on Aging (CLSA).

Few large nationwide studies have investigated the relationship between shiftwork and cognitive performance, and little is known about whether and how psychological distress may impact this relationship. This study aimed to examine: (1) the cross-sectional relationship between shiftwork (yes/no) and some aspects of cognitive performance (declarative memory and executive functioning) and (2) the potential moderating effect of psychological distress among 20,610 community-dwelling adults from the comprehensive cohort of the Canadian Longitudinal Study on Aging (CLSA). Differences by sex and retirement status were also explored. Shiftwork was significantly associated with poorer performance for executive functioning (interference condition: ß = 0.47, 95% CI: 0.31 to 0.63; MAT: ß = -0.85, 95% CI: -1.21 to -0.50) but not for declarative memory. Completely and not/partly retired males showed poorer cognitive performance on executive functioning. However, no evidence of a moderating effect by psychological distress was found. Our findings confirm the association between shiftwork and cognitive performance and highlight important health correlates of shiftwork.

Associations between sleep patterns, smoking, and alcohol use among older adults in Canada: Insights from the Canadian Longitudinal Study on Aging (CLSA).

Poor sleep is associated with chronic health conditions among older adults. As substance use rates increase in this population, age-related physiological and cognitive declines may exacerbate its detrimental consequences, including sleep problems. We analyzed cross-sectional associations between sleep patterns, smoking, and alcohol use using baseline data from 30,097 community-dwelling Canadian adults aged 45-85 years from the Canadian Longitudinal Study on Aging. Insomnia symptoms (difficulties falling/staying asleep), sleep duration (short:<6h; long:>8h), and sleep satisfaction(dissatisfied/neutral/satisfied) were measured. Smoking and alcohol-use frequency (past 12 months), average daily amount (past 30 days), and binge drinking (past 12 months) were self-reported, and associations were examined using modified Poisson regression. Approximately 23% of participants had insomnia symptoms, and 26% reported sleep dissatisfaction. 91% of participants were current non-smokers, whereas 7% reported smoking daily. Over 50% drank ≤ 2 drinks daily, and 3% reported binge drinking. There was a higher adjusted prevalence of insomnia among daily smokers (PR = 1.10, 95% CI = 1.00-1.21) and binge drinkers (PR = 1.21, 95% CI = 1.02-1.43). Odds of short sleep duration were lower among regular drinkers (COR = 0.71, 95% CI = 0.56-0.90) and higher among daily smokers (COR = 1.19, 95% CI = 1.01-1.40). Heavy and frequent smoking and alcohol use are associated with both insomnia symptoms and sleep dissatisfaction, but not consistently with sleep duration. Further longitudinal investigation of this relationship in aging populations is needed in clinical and public health settings to infer the extent of causality and design effective public health interventions in this vulnerable population.

Association between physical activity and life satisfaction among adults with multimorbidity in Canada.

OBJECTIVE: Maintaining life satisfaction may aid in multimorbidity resilience. As the prevalence of multimorbidity continues to rise in Canada, understanding modifiable factors that can influence life satisfaction among people with multimorbidity is warranted. This study aimed to examine the relationship between physical activity and life satisfaction among adults affected by multimorbidity. METHODS: Cross-sectional data from the 2015-2018 cycles of the Canadian Community Health Survey were used; 22,851 respondents with multimorbidity aged 20 years and older were included. Multiple linear regression models were used to investigate the relationship between physical activity (sedentary, somewhat active, moderately active, active) and life satisfaction for the whole population and for those having specific types of chronic conditions, controlling for self-perceived health status and sociodemographic factors. RESULTS: Respondents affected by multimorbidity who were somewhat active (ß = 0.20, 95% CI: 0.08, 0.32), moderately active (ß = 0.28, 95% CI: 0.13, 0.44), and active (ß = 0.29, 95% CI: 0.17, 0.41) were more satisfied with life than respondents who had a sedentary lifestyle. The relationship between physical activity and life satisfaction was also found to be statistically significant in sub-populations of respondents affected by cancer, diabetes, chronic respiratory diseases, and mental health disorders but not cardiovascular diseases. CONCLUSION: Physical activity may contribute to better life satisfaction among adults with multimorbidity. As multimorbidity increases in Canada, further investigation on the relationship between physical activity and life satisfaction is warranted to help improve interventions to cope with the effects of multimorbidity.

RéSUMé: OBJECTIF: Le maintien de la satisfaction à l'égard de la vie peut aider la résistance à la multimorbidité. Alors que la prévalence de la multimorbidité continue de monter au Canada, il est justifié de comprendre les facteurs modifiables qui peuvent influencer la satisfaction à l'égard de la vie des personnes ayant une multimorbidité. Cette étude visait à examiner la relation entre l'activité physique et la satisfaction à l'égard de la vie chez les adultes ayant la multimorbidité. MéTHODES: Les informations transversales des cycles 2015-2018 de l'Enquête sur la santé dans les collectivités canadiennes (ESCC) ont été utilisées; 22 851 répondants multimorbides âgés de 20 ans et plus ont été inclus. Les modèles de régression linéaire multiple ont été utilisés pour examiner la relation entre le niveau d'activité physique (inactive, quelque peu actif, modérément actif, actif) et la satisfaction à l'égard de la vie pour l'entier de la population et pour ceux qui souffrent d'un type spécifique de maladies chroniques, contrôlant pour état de santé perçu et les facteurs sociodémographiques. RéSULTATS: Les répondants affectés par la multimorbidité qui étaient quelque peu actifs (ß = 0,20, IC à 95% : 0,08 à 0,32), modérément actifs (ß = 0,28, IC à 95% : 0,13 à 0,44), et actifs (ß = 0,29, IC à 95% : 0,17 à 0,41) étaient plus satisfaits à l'égard de la vie que les répondants avec un mode de vie plus sédentaire. La relation entre l'activité physique et la satisfaction à l'égard de la vie est statistiquement significative dans les sous-populations des répondants affectées par le cancer, le diabète, les maladies respiratoires chroniques et les troubles de santé mentale, mais pas les maladies cardiovasculaires. CONCLUSION: L'activité physique peut contribuer à une meilleure satisfaction à l'égard de la vie pour les adultes ayant une multimorbidité. À mesure que la multimorbidité augmente au Canada, une enquête plus approfondie sur la relation entre l'activité physique et la satisfaction à l'égard de la vie est justifiée pour aider à améliorer les interventions visant d'affronter les effets de la multimorbidité dans la population canadienne.

Interplay between social media use, sleep quality, and mental health in youth: A systematic review.

Social media applications are increasingly prominent among youth. This systematic review provides a comprehensive assessment of the literature on the relationship between active social media use, sleep quality, and common mental health outcomes (anxiety, depression, and psychological distress) among youth. MEDLINE, PsychINFO, EMBASE and Scopus were searched for observational studies investigating this relationship among youth (aged 16-25). Thirty-six cross-sectional studies and six prospective cohort studies met the inclusion criteria. Among cross-sectional studies, significant associations between excessive social media use with poor mental health outcomes (n = 33), poor sleep quality (n = 24), and significant associations between poor sleep quality and negative mental health (n = 16) were found. In longitudinal studies, frequent social media use was a risk factor for both poor mental health (n = 6) and poor sleep outcomes (n = 5). Some studies showed sleep quality mediating the relationship between social media use and negative mental health outcomes in youth. Overall, included evidence links excessive social media use to poor sleep quality and negative mental health in youth. Given the public health implications of sleep problems, excessive social media use warrants further investigation to clarify the directionality and strength of their associations with poor sleep quality and negative mental health outcomes.