Prevalence and Incidence of Rheumatoid Arthritis in Canadian First Nations and Non-First Nations People: A Population-Based Study.

BACKGROUND: The aim of this study was to determine the prevalence, incidence, and onset age at rheumatoid arthritis (RA) diagnosis in First Nations (FN) and non-FN populations in Manitoba, Canada. METHODS: Population-based administrative health records from April 1, 1995, to March 31, 2010, were accessed for all Manitobans. The FN population was identified using the Federal Indian Registry File. Crude and adjusted RA prevalence and incidence rates (adjusted for age, sex, health region of residence) were compared using Poisson regression and reported as relative rates (RRs) with 95% confidence intervals (CIs). Mean (CI) diagnosis age and physician visits were compared with Student t tests. RESULTS: Rheumatoid arthritis crude prevalence increased between 2000 and 2010 to 0.65%; adjusted RA prevalence in females was 1.0% and in males was 0.53%. The 2009/2010 adjusted RA prevalence was higher in FN than non-FN (RR, 2.55; CI, 2.08-3.12) particularly for ages 29 to 48 years (RR, 4.52; CI, 2.71-7.56). Between 2000 and 2010, crude RA incidence decreased from 46.7/100,000 to 13.4/100,000. Adjusted RA incidence remained higher in FN than non-FN (2000-2010 RR, 2.1; CI, 1.7-2.6; p < 0.0001) particularly for ages 29 to 48 years (RR, 4.6; CI, 2.8-7.4; p < 0.0001). The FN population was younger at diagnosis than the non-FN population (mean age, 39.6 years [CI, 38.3-40.8 years] vs. 53.3 years [CI, 52.7-53.9 years]; p < 0.0001). The FN population had more physician visits but fewer rheumatology visits than the non-FN population. CONCLUSIONS: Rheumatoid arthritis prevalence is increasing, and RA incidence is decreasing in Manitoba. The FN population has a greater prevalence and incidence of RA and is younger at diagnosis than the non-FN population. When combined with fewer rheumatology visits, this significant care gap highlights the need to optimize rheumatology care delivery to the FN population.

Mental health outcomes of burn: A longitudinal population-based study of adults hospitalized for burns.

PURPOSE: This study investigates the increased risk of mental health outcomes and health care utilization associated with burn with two year of follow-up using a longitudinal population-based matched cohort design. METHODS: Adult burn survivors (n=157) were identified from a provincial burn registry and matched 1:5 with non-burn control subjects from the general population (matching variables age and gender). The prevalence of mental health outcomes and the rates of health care utilization between the groups were compared for the 2years pre and post index date using anonymously linked population-based administrative health care data. Rates were adjusted for age, gender and sociodemographic characteristics. RESULTS: While the burn cohort had an increased prevalence of mental health problems after burn compared to the control cohort, the burn group also had an increased prevalence of pre-burn depression (16.6% vs 7.8%; p=0.0005) and substance use disorders (8.9% vs 3.2%; p=0.001) when compared to controls. Once the pre-existing prevalence of mental illness was taken into account there was no significant change in the prevalence of mental health problems when comparing the burn group to controls over time. CONCLUSIONS: Although burns may not increase rates of mental health issues and health care utilization, burn survivors are a vulnerable group who already demonstrate increased rates of psychopathology and need for care. The present study highlights the importance of assessment and treatment of mental health outcomes in this population.

Mental and Physical Health Outcomes in Parents of Children with Burn Injuries as Compared with Matched Controls.

Pediatric burn injuries are common, and the stress of caring for them can affect caregivers' health. This study's objective was to examine the rates of common mental and physical disorders of parents of burn-injured children (cases) compared with matched controls (controls). This is a population-based study linking the Regional Pediatric burn registry with administrative health information. Pediatric burn cases were matched 1:5 with control children from the general population based on age, sex, and geographical location then parents identified. One thousand and twenty-six parental cases and 4858 controls were identified. International Classification of Disease codes were used to identify diagnoses of common mental and physical disorders. Using rates of disease 2 years before and 2 years after the date of burn, the changes in the relative rates of health outcomes were compared between the cases and the controls. The cases had higher rates of postinjury mental and physical illness compared with the matches. However, it was found that controls also had increased rates postindex date and additionally cases had increased rates of preinjury illnesses. There was no difference in the relative rates of illnesses between the groups from pre- to post-index date. The higher rate of illness in cases postinjury could be explained by preinjury illness, and similar rate increases in the control cohort. Evaluation of the effect of a child's burn injury on parents should take into context the preexisting health of the parent. Socioeconomic factors associated with increased risk of burns may also be associated with adverse health outcomes.

Outcomes in Adult Survivors of Childhood Burn Injuries as Compared with Matched Controls.

Limited research exists examining long-term mental and physical health outcomes in adult survivors of pediatric burns. The authors examine the postinjury lifetime prevalence of common mental and physical disorders in a large pediatric burn cohort and compare the results with matched controls. Seven hundred and forty five survivors of childhood burns identified in the Burn Registry (<18 years old and total BSA >1% between April 1, 1988 and March 31, 2010) were matched 1:5 to the general population based on age at time of injury (index date), sex, and geographic residence. Postinjury rate ratio (RR) was used to compare burn cases and control cohorts for common mental and physical illnesses through physician billings, and hospital claims. RR was adjusted for sex, rural residence, and income. Compared with matched controls, postburn cases had significantly higher RR of all mental disorders, which remained significant (P < .05) after adjustment (major depression RR = 1.5 [confidence limit {CL}: 1.2-1.8], anxiety disorder RR = 1.5 [CL: 1.3-1.8), substance abuse RR = 2.3 [CL: 1.7-3.2], suicide attempt RR = 4.3 [CL: 1.6-12.1], or any mental disorder RR = 1.5 [CL: 1.3-1.8]). The relative rate of some physical illnesses was also significantly increased in burn survivors: arthritis RR = 1.2 (CL: 1.1-1.4), fractures RR = 1.4 (CL: 1.2-1.6), total respiratory morbidity RR = 1.1 (CL: 1.02-1.3), and any physical illness RR = 1.2 (CL: 1.1-1.3). Adult survivors of childhood burn injury have significantly increased rates of postburn mental and physical illnesses. Screening and appropriate management of these illnesses is essential when caring for this population.

Increased suicidal activity following major trauma: a population-based study.

BACKGROUND: Nonfatal injuries are a leading cause of morbidity and mortality. In 2008, 14,065 patients with major trauma were hospitalized across Canada. With individuals surviving trauma, the psychosocial sequelae of severe physical injury have become an important area of research. No previous studies have used a population-based sample to estimate the incidence of suicidality (suicide or suicide attempt) following physical injury. This study aimed to assess the odds ratio (OR) of suicidality among adults with major trauma compared with a matched cohort. METHODS: This retrospective study included persons older than 18 years who experienced an unintentional major traumatic injury (Injury Severity Score [ISS] > 12) at a regional academic trauma center between April 1, 2001, and March 31, 2011. Individuals who had no suicide attempts in the previous 5 years were identified from the trauma registry. These individuals were matched with data from provincial administrative databases. A cohort matched in terms of age, sex, and date of indexed injury was created from the general population with five controls for each trauma case, and the rate of suicidality was compared between groups. RESULTS: A total of 2,198 adults with major were matched to 10,990 individuals. Suicidality was increased in the trauma cohort (OR, 4.31). This increase persisted even if adjusted for anxiety/mood disorders and substance abuse (adjusted OR1, 3.65) as well as residence, physical comorbidities, income quintile and those factors in adjusted OR1 (adjusted OR2, 3.30). All ORs were significant with p < 0.05 CONCLUSION: Individuals who experience major traumatic injuries are at a greater risk for postinjury suicidality compared with those in a matched cohort. LEVEL OF EVIDENCE: Epidemiologic study, level IV.