The Ontario Agency for Health Protection and Promotion (more commonly known as Public Health Ontario) is the Ontario Government agency responsible for providing scientific and technical advice to those working to promote and protect the health of people in Ontario, Canada.
Importance:Extreme heat poses a serious health risk to older adults because they are generally more susceptible to heat-related mortality. Many nursing homes in the US and elsewhere lack air conditioning (AC). Ecological studies have evaluated the protective role of AC against mortality on extreme heat days in prisons and large urban settings; however, the nursing home setting remains understudied. Objective:To assess mortality rates during extreme heat days in nursing homes with AC compared to those without AC. Design, Setting, and Participants:This was a case-crossover study conducted in Ontario, Canada, to determine the odds of mortality associated with extreme days separated for nursing homes with and without AC using conditional logistic regression. Nursing home residents who died during the warm months (June to September) from 2010 to 2023 were included. Data were analyzed from June 2024 to April 2025. Exposures:An extreme heat day was defined as any day in the ≥90th percentile of the heat index (ambient temperature and relative humidity) for any given nursing home location during the study period. Main Outcomes and Measures:All-cause mortality during extreme heat days, by AC status of nursing homes. Results:Of the 73 578 deaths of nursing home residents from 2010 to 2023, 40 255 residents (mean [SD] age, 86.8 [8.8] years; 65.6% women) died at 276 homes with AC and 33 323 residents (mean [SD] age, 87.2 [8.7] years; 64.8% women) at 339 homes without AC. Before the AC mandate was announced in July 2020, nursing homes without AC (55.1%) were predominantly investor owned (ie, for profit; standardized mean difference [SMD], 0.47), were built to older design standards (SMD, 0.57), and had more residents per room (SMD, 0.58) compared with nursing homes with AC. Overall, 4889 deaths (13.8%) in nursing homes without AC occurred on extreme heat days compared with 4611 deaths (12.1%) in those with AC. Extreme heat was associated with significantly increased odds of mortality in nursing homes without AC (odds ratio [OR], 1.11; 95% CI, 1.06-1.16) but not in those with AC (OR, 1.03; 95% CI, 0.98-1.07). Compared to nursing homes with AC, those without AC were associated with significantly higher relative odds of mortality on extreme heat days (relative OR, 1.08; 95% CI, 1.01-1.15). Lagged analyses suggest that the associated effects of extreme heat persisted for 3 days beyond the initial exposure. Conclusion and Relevance:In this case-crossover study, mortality was lower during extreme heat days in nursing homes with AC compared to those without AC. These findings suggest that AC provision in nursing homes and other congregate care settings may be important for preventing mortality among older adults during extreme heat days.
Air quality regulations and programs are vital for protecting the public from harms caused by air pollution. To support these actions, numerous epidemiological studies have sought to identify the pollutants most responsible for adverse outcomes. These studies often used statistical adjustments for copollutants in outcome regression models, a practice also commonly applied to assess interactions between copollutants. Here, we highlight possible pitfalls of multipollutant analyses. Indiscriminate copollutant adjustment can induce noncausal associations through collider adjustment, distorting effect estimates for individual air pollutants. We describe the underlying mechanisms and provide empirical evidence on how such bias may realistically influence the relationships between air pollution and health outcomes from a well-characterized Canadian national cohort alongside a simulation study. Additionally, we discuss strategies to mitigate the impact of this bias. Given the widespread interest in multipollutant approaches among the scientific and policy communities, greater caution is needed when conducting and interpreting research on multiple pollutants.
BACKGROUND:Alcohol is a leading cause of global death and disability yet labelling requirements for alcohol products remain inconsistent across WHO Member States and comparatively weak in Canada, where Bill S-202 to mandate warnings is currently under review. In contrast, tobacco and cannabis are subject to more rigorous government mandated labelling requirements. This study compares federally-mandated labelling requirements for alcohol, tobacco, and cannabis across WHO regions to contextualize Canada's position within the global landscape and assess whether Canadian alcohol labelling requirements align with the documented health burden. METHODS:A systematic secondary data synthesis and document review of labelling regulations across all 194 WHO Member States was conducted in February 2023. Sources included WHO reports and regulatory databases on alcohol, tobacco, and cannabis labelling. Comparative analyses were undertaken across WHO regions. Labelling requirements were categorized by the presence and content of health warnings, including labelling design elements, and ingredient information, including allergens, calories, and additives, and content displays. RESULTS:While 32.5% of WHO Member States mandate alcohol health warnings, 84.5% WHO Member States mandate tobacco health warnings. Further, all jurisdictions with legal recreational cannabis require multiple labelling measures, including health warnings and ingredient information. In Canada, alcohol remains the only controlled substance without federally mandated warning labels. INTERPRETATION:Strengthening alcohol labelling requirements represents a policy strategy with high population reach to support informed decision-making and reduce substance-related harms. Establishing evidence-based minimum international standards for alcohol labelling could strengthen global regulatory coherence, while leadership from countries such as Canada may help catalyse progress internationally.
BACKGROUND AND AIMS:Canada's drug toxicity crisis has been largely attributed to a volatile fentanyl-dominated unregulated drug supply with increasing reports of fentanyl detected in combination with benzodiazepines, stimulants and xylazine. Although rates of opioid-related harms vary significantly by region, it remains unknown how the composition of the unregulated drug supply differs across Canada. Therefore, we sought to describe trends in Canadian fentanyl-containing drug seizures nationally and compare trends by province/territory. DESIGN:Repeated cross-sectional analysis between February 2020 and December 2024. SETTING AND CASES:Fentanyl-containing drug samples seized by law enforcement agencies across Canada were analyzed by Health Canada's Drug Analysis Service, with test results made publicly available. MEASUREMENTS:Counts and crude rates of fentanyl-containing drug seizures, with the population of each province/territory used to calculate rates per 100 000. We described the number of notable drug classes (e.g. benzodiazepines, stimulants, non-fentanyl opioids, etc.) and chemical substances identified within each drug seizure and used the Cochrane Armitage Test for Trend to look for significant changes over time. All analyses were conducted overall and stratified by province/territory. FINDINGS:We identified 71 996 fentanyl-containing drug seizures over the study period, with the quarterly number of seizures increasing by 24.4% (from 2640 in 2020 to 3284 in 2024) across Canada. This varied by province/territory, with the highest annual rates of fentanyl-containing seizures in 2024 reported in British Columbia (60.4 per 100 000) and Alberta (52.3 per 100 000). Among fentanyl types, we observed statistically significant increases (P < 0.001) in the detection of para-flurofentanyl (0.0% to 46.3%) and methylfentanyl (0.0% to 28.6%). Additionally, there was a notable rise in the annual proportion of seizures in which benzodiazepines (13.4% to 40.2%) or xylazine (1.5% to 18.9%) were detected. Approximately half of all seizures contained fentanyl in combination with at least one other drug class and over 95% contained fentanyl in combination with at least one other chemical substance. CONCLUSIONS:Across Canada from 2020 to 2024, there has been a 24% increase in fentanyl-containing drug seizures in which multiple substances are detected, most notably benzodiazepines, xylazine and potent fentanyl analogues within a single sample.
