Association of alcohol use disorder on alcohol-related cancers, diabetes, ischemic heart disease and death: a population-based, matched cohort study.

BACKGROUND AND AIMS: High-risk alcohol consumption is associated with compromised health. This study aimed to compare the incidence of alcohol-related cancers, diabetes, ischemic heart disease (IHD) and mortality between those with and without an indication of alcohol use disorder (AUD). DESIGN: Retrospective, population-based, matched cohort study using data from the Manitoba Population Research Data Repository. Rates were modeled using generalized linear models with either negative binomial distribution or Poisson distribution and a log offset of person-years to account for each person's time to follow-up. SETTING: Manitoba, Canada. PARTICIPANTS: Individuals aged ≥ 12 years with a first indication of AUD (index date) between 1 April 1990 and 31 March 2015 were matched to five controls based on age, sex and geographical region at index. This study included 53 410 individuals with AUD and 264 857 matched controls. MEASUREMENTS: Adjusted rate ratios (aRR) and 95% confidence intervals (CI) were determined for each outcome from 5 years prior to and 20 years after AUD detection. FINDINGS: Alcohol-related cancers (aRR = 4.85, 95% CI = 3.88-6.07 and aRR = 1.85, 95% CI = 1.35-2.53 for men and women, respectively), diabetes (aRR = 1.74, 95% CI = 1.50-2.02 and aRR = 2.43, 95% CI = 2.20-2.68) and IHD (aRR = 3.59, 95% CI = 3.31-3.90 and aRR = 2.92, 95% CI = 2.50-3.41) peaked in the 1 year prior to index for those with AUD compared with matched controls. All-cause mortality (aRR = 3.31, 95% CI = 3.09-3.55 and aRR =3.61, 95% CI = 3.21-4.04) was highest in the year of index and remained higher among cases compared with controls throughout the 20-year follow-up. CONCLUSION: People with alcohol use disorder appear to have higher rates of adverse health outcomes in the year before alcohol use disorder recognition, and death at the time of alcohol use disorder recognition, compared with matched controls.

What is Being Taught to Canadian Undergraduate Dental Students About the Oral Health of Long-Term Care Residents?

INTRODUCTION: Residents of long-term care (LTC) facilities face many oral health challenges, which are often complicated by their underlying medical conditions, use of medications and limited access to oral health care. OBJECTIVE: To determine to what extent accredited university-based dental and dental hygiene programs in Canada prepare students in the areas of geriatric oral health and oral health of LTC residents. METHODS: Accredited dental and dental hygiene programs across Canada were assessed for the degree of education and training that is presented to students on the oral health of LTC residents. A survey questionnaire, emailed to programs, was used to gather descriptive statistics (frequencies, means and standard deviations), and bivariate analysis (χ2 and t tests) was completed. A p value ≤ 0.05 was considered significant. RESULTS: Representatives of all 4 dental hygiene and 9 out of 10 dental schools responded. All four dental hygiene and seven dental programs (77.8%, 7/9) stated that geriatric oral health is an integral part of their curriculum. The majority (91.6% [11/12], 4 dental hygiene and 7 of 9 dental schools) reported that their program educates students about medically, physically and cognitively compromised geriatric patients. Eight programs (3 dental hygiene and 5 dental schools), stated that they provide clinical training opportunities with LTC residents. However, some programs reported certain barriers preventing them from providing such clinical training opportunities. CONCLUSION: Oral health educational institutions must ensure that curricula are current and evidence-based to reflect the overall oral health needs of today's aging population.

Health service use among Manitobans with alcohol use disorder: a population-based matched cohort study.

BACKGROUND: Alcohol is the drug most commonly used by Canadians, with multiple impacts on health and health service use. We examined patterns of short- and long-term health service use among people with a diagnosis of alcohol use disorder. METHODS: In this retrospective matched cohort study, we used population-based administrative data from the province of Manitoba, Canada, to identify individuals aged 12 years or older with a first indication of alcohol use disorder (index date) in the period 1990 to 2015. We matched cases (those with diagnosis of alcohol use disorder) to controls (those without this diagnosis), at a 1:5 ratio, on the basis of age, sex, geographic region and income quintile at the index date. The outcome measures were inpatient hospital admission, outpatient physician visits, emergency department visits and use of prescription medications. We modelled crude rates using generalized estimating equations with either a negative binomial or a Poisson distribution RESULTS: We identified 53 410 people with alcohol use disorder and 264 857 matched controls. All outcomes occurred at a higher rate among people with the disorder than among controls. For example, during the year of diagnosis, the rate ratio for hospital admission was 4.0 (95% confidence interval [CI] 3.9-4.2) for women and 4.5 (95% CI 4.4-4.7) for men. All rates of health service use peaked close to the index date, but remained significantly higher among people with alcohol use disorder than among controls for 20 years. Among people with alcohol use disorder, the most commonly filled prescriptions were for psycholeptics, whereas among controls, the most commonly filled prescriptions were for sex hormones (women) and antihypertensives (men). INTERPRETATION: Compared with controls, people with alcohol use disorder used significantly more health services from the time of diagnosis and over the next 20 years. This finding highlights the need for better detection and early intervention to reduce the need for acute and emergency care, as well as the need for improved management of alcohol use disorder over the longer term.

Ten-year trajectories of health care utilization by Manitobans with MS predict nursing home entry.

BACKGROUND: Nursing home (NH) care is expensive and restrictive. Understanding trajectories to NH entry among people with multiple sclerosis (MS) could facilitate monitoring and early risk identification. We investigated 10-year trajectories of health care use in matched cohorts of people with MS who did and did not enter NH, the characteristics associated with trajectory group membership, and whether group membership predicted NH entry. METHODS: We used population-based administrative (health claims) data from Manitoba, Canada, to identify 226 NH entrants with MS between January 2005 and December 2012 and 896 age-, sex- and geographically matched non-NH entrants with MS. Using semiparametric group-based trajectory approaches, we described trajectories for 5 measures of health care utilization: physician visits, medications, hospital days and their intensity, and home care days. Using multivariable logistic models, we determined whether membership in a trajectory group predicted NH entry. RESULTS: Mean (SD) age at MS diagnosis was 48.35 (13.25) years for NH entrants and 44.91 (11.58) for nonentrants. Most patients were female (NH entrant, 64%; nonentrant, 61%). Over the study period, trajectories for physician visits and medication use were relatively stable, while trajectories for hospital days and home care increased. High use trajectories for hospital days and medication use were associated with NH entry, while higher use of ambulatory physician visits was associated with a 40%-60% lower risk of NH entry. CONCLUSION: Complex patterns of service use and underlying need contribute to NH entry among people with MS. An increasing number of hospital days is strongly associated with NH entry.

Dentists' Views on Providing Care for Residents of Long-Term Care Facilities.

INTRODUCTION: People living in long-term care (LTC) facilities face many oral health challenges, often complicated by their medical conditions, use of medications and limited access to oral health care. OBJECTIVE: To determine Manitoba dentists' perspectives on the oral health of LTC residents and to identify the types of barriers and factors that prevent and enable them to provide care to these residents. METHODS: Manitoba general dentists were surveyed about their history of providing care and their views on the provision of care to LTC residents. Descriptive statistics, bivariate analysis and logistic regression analysis were carried out. RESULTS: Surveys were emailed to 575 dentists, with a response rate of 52.5%. Most respondents were male (62.8%), graduates of the University of Manitoba (85.0%), working in private practice (89.8%) and located in Winnipeg (72.4%). Overall, only 26.2% currently treat LTC residents. A predominant number of respondents identified having a busy private practice (60.0%), lack of an invitation to provide dental care (53.0%) and lack of proper dental equipment (42.6%) as barriers preventing them from seeing LTC residents. Receiving an invitation to provide treatment, professional obligation and past or current family or patients residing in LTC were the most common reasons why dentists began treating LTC residents. CONCLUSION: Most responding dentists believe that daily mouth care for LTC residents is not a priority for staff, and only a minority of dentists currently provide care to this population.

Acute risk of suicide and suicide attempts associated with recent diagnosis of mental disorders: a population-based, propensity score-matched analysis.

OBJECTIVE: To determine the degree of risk during the first year after diagnosis with a mental illness. METHODS: We used propensity scoring to create a matched sample for all identified suicide attempts and suicide deaths in the province of Manitoba from 1996 to 2009. This study identified 2100 suicide deaths and 8641 attempted suicides. Three control subjects were identified for every case and matched on age, sex, income decile, region of residence, and marital status. Five categories of physician-diagnosed mental disorders were tested: schizophrenia, anxiety, depression, dementia, and substance abuse. Logistic regression was used to determine the risk for suicide attempts and suicide deaths overall, and within 3 time periods since initial diagnosis: 1 to 90 days, 91 to 364 days, and 365 or more days. RESULTS: All disorders, except dementia, were independently related to death. All disorders were related to suicide attempts. The risk of dying by suicide was particularly high within the first 90 days after initial diagnosis for many disorders, including depression (adjusted odds ratio [AOR] 7.33; 95% CI 4.76 to 11.3), substance use disorders (AOR 4.07; 95% CI 2.43 to 6.82), and schizophrenia (AOR 20.91; 95% CI 2.55 to 172). Depression and anxiety disorders had elevated risk in the first year for suicide attempts. CONCLUSIONS: These data suggest that several mental disorders independently increase the risk of suicide attempts and death by suicide after controlling for all mental disorders and demographic risk factors. Clinicians should be aware of the heightened risk of suicide and suicidal behaviour within the first 3 months after initial diagnosis.

Direct medical cost of managing IBD patients: a Canadian population-based study.

BACKGROUND: This study aimed to quantify the direct medical cost of treating inflammatory bowel disease (IBD) in Manitoba in 2005/2006. METHODS: In all, 7375 individuals with IBD recorded in the University of Manitoba IBD Epidemiology Database were matched on age, gender, and geography to up to 10 non-IBD controls. Data for cases and controls were extracted from Manitoba Health databases in fiscal 2005/2006 for pharmaceutical, physician claims, and hospital abstracts. The mean and median expenditure were computed for the annual cost of pharmaceuticals, hospitalizations (day surgery and inpatient), and physician office visits. We assessed costs based on age, gender, type of IBD, disease duration, and level of care provided. RESULTS: In 2005/2006 the mean direct cost of an IBD case was $3896 (standard error [SE] = $90) which was twice that of controls (P < 0.05). Crohn's disease (CD; n = 3735) was significantly more costly on average than ulcerative colitis (UC; n = 3640) ($4232; SE = $137 and $3552; SE = $117, respectively, P < 0.001). The most costly cases included those within 1 year of diagnosis ($6611; SE = $593), those hospitalized overnight (15%) ($13,495, SE = $416; max = $130,332), those who had a surgical stay (2% of IBD cases) ($18,749, range = $13,413-$125,912), and those using infliximab (0.7%) ($31,440, SE = $2311; max = $96,328). For individuals using infliximab their direct annual average healthcare cost was $9683 (SE = $1745, Max = $55,208) prior to using infliximab. CONCLUSIONS: In Manitoba the direct average annual healthcare cost of CD is greater than UC and that of a patient using infliximab tends to be greater than one incurring a surgical stay.

Comparing apples to apples: the relative financial performance of Manitoba's acute care hospitals.

This paper presents comparative financial ratios that can be adopted by health system administrators and policy analysts to begin to evaluate the performance of acute care hospitals. We combined financial, statistical and clinical information for 73 acute care hospitals in Manitoba for fiscal 1997/98 to calculate 15 indicators of financial performance. Our findings suggest that there is variability between hospital types in their average costs per weighted case, cost structure and financial performance.

The relative cost of inpatient care in Manitoba's largest hospitals.

Comparative information from 1991/92 to 1997/98 regarding an indicator of the relative financial performance of teaching, urban community and major rural hospitals in Manitoba is presented. Results suggest that the acuity and complexity of patients in teaching and urban community hospitals was similar in 1997/98, and that teaching facilities had higher inpatient care costs in all time periods, even after accounting for differences in case-mix, physician remuneration, capital expenditures and the direct costs of teaching programs.