Background:Previous research has shown that Black adults in Canada experience higher cause-specific mortality and differential rates of diagnosis and hospitalization compared with White adults. These disparities may reflect underlying differences in access to health care. This study assesses whether inequalities in access to primary and pharmaceutical health care exist between Black and White adults in Canada. Data and methods:This study used pooled data from the annual Canadian Community Health Survey from 2015 to 2019. Access to care was measured through indicators of primary care access and insurance for prescription medicine. Inequalities were assessed through crude and adjusted differences between Black and White adults, and counterfactual decomposition methods were applied to identify the contributions of specific factors to observed inequalities. Results:Primary care access and insurance for prescription medicine were significantly lower for Black adults aged 25 years and older, compared with White adults in the same age group, from 2015 to 2019. About three-quarters of the differences in having a regular health care provider and insurance for prescription medicine were explained by population differences in the levels of measured covariates, including demographic, immigrant, and socioeconomic factors. By contrast, less than one-third of the difference in going to a doctor's office for care of a minor problem was explained by model covariates. Interpretation:Much of the measured inequality between Black and White adults in having a regular health care provider and insurance for prescription medicine was attributable to differences in demographic factors, immigrant status, and socioeconomic variables. However, these factors explained less of the inequality in visiting a doctor's office for care of a minor problem. Notably, socioeconomic factors - including educational attainment, occupational skill level, and household income - represent modifiable determinants that may be amenable in reducing the observed disparity.
Background:Canada's population is aging rapidly, with implications for the health care system, including increasing demand for specialist care. However, few studies have examined factors associated with specialist care use, difficulty accessing such care, and the relationship between access difficulties and unmet health care needs among middle-aged (45 to 64 years) and older (65 years or older) adults. Data and methods:Data from the 2024 Survey on Health Care Access and Experiences - Primary and Specialist Care were used to identify factors associated with specialist care use, difficulty accessing specialist care, and to examine the relationship between access difficulties and unmet health care needs. Drawing on a nationally representative sample of 23,473 Canadians aged 45 or older, multivariable logistic regression analyses were conducted separately for middle-aged and older adults. Results:In 2024, 38.5% of Canadians aged 45 or older used specialist care, 27.8% experienced access difficulties, and 18.0% reported unmet health care needs. Older adults (65 years or older) were more likely than middle-aged adults (45 to 64 years) to use specialist care (42.9% versus 35.1%) but less likely to report difficulty accessing it (24.6% versus 30.2%). Having a greater number of chronic conditions or a disability was associated with both specialist care use and greater difficulty accessing specialist care among middle-aged and older adults. Experiencing difficulties accessing specialist care was strongly associated with a higher likelihood of having unmet health care needs among middle-aged (6.2 times) and older (14.0 times) adults. Interpretation:The study underscores the importance of accounting for multiple factors, such as age, gender, immigrant status, multimorbidity, disability, and access to a primary health care provider, when examining access to care.
Background:Breast cancer is the most commonly diagnosed cancer among women in Canada. Breast density substantially influences breast cancer risk and mammography performance. However, OncoSim-Breast, a Canadian microsimulation model representing breast cancer control, including cancer onset, screening, and survival, has not previously explicitly accounted for breast density. This study describes the incorporation of density-specific parameters into the OncoSim-Breast model. Data and methods:Breast density-specific inputs were integrated into OncoSim-Breast using data from five Canadian provinces. Three key parameters - prevalence, relative risk of breast cancer, and digital mammography performance (sensitivity and specificity) - were estimated by age group and breast density category, following the American College of Radiology's Breast Imaging Reporting and Data System (BI-RADS) classification (categories A to D). Calibration experiments and internal validations were conducted to ensure the updated OncoSim-Breast model aligned with observed data from the Canadian Cancer Registry. Results:The prevalence of dense breasts declined with age: BI-RADS categories C and D accounted for 58% of women younger than 50 years and 26% of those aged 70 and older. Digital mammography sensitivity also decreased with increasing density: among women younger than 50 years, sensitivity was 88% for Category A and 69% for Category D. The updated OncoSim-Breast model accurately replicated age-specific incidence, age-adjusted incidence, and stage distribution based on historical data from the Canadian Cancer Registry (2010 to 2019). Interpretation:Incorporating breast density-specific parameters substantially improved the accuracy and policy relevance of OncoSim-Breast. The updated model provides a validated tool to inform screening policy decisions for Canadian women, allowing consideration for the effect of the variability of breast density among women.
Background:Previous work has noted variability in cancer incidence and cancer-related outcomes according to place of residence. This study examined geographic variability in the incidence and mortality of breast cancer among females in Canada. Data and methods:Data from the 2021 Canadian Cancer Registry (breast cancer incidence) and the Canadian Vital Statistics - Death database (breast cancer mortality) were examined across provinces and territories, community sizes, and peer groups (i.e., clusters of health regions with similar socioeconomic and demographic characteristics). Age-standardized incidence rates (ASIRs) and age-standardized mortality rates (ASMRs) per 100,000 females per year and their rate ratios were calculated, as well as age group-specific and age-standardized stage-specific incidence rates. Results:From 2010 to 2020, the invasive breast cancer ASIR was 140.1 per 100,000 females annually, with marked geographic and community variation. Mean age at diagnosis was 62.7 years, and it was lowest in northern and remote regions. Three-quarters of cases were stages I and II, though stage-specific ASIRs varied. Overall ASIRs were highest in peer groups B (urban centres with large immigrant and racialized populations) and D (rural regions in Quebec, Ontario and the Prairies). They were lowest in peer groups F (Northern and remote regions with young populations), G (Montréal, Toronto, and Vancouver), and H (urban centres in Ontario and British Columbia). From 2010 to 2022, the ASMR was 28.3 per 100,000, highest in rural Eastern Peer Group E and lowest in large urban centres. Interpretation:The study found significant variability in female breast cancer incidence and mortality across the geographical classifications considered, highlighting the need for a closer look at regional- and individual-level factors and their respective associations with cancer incidence and outcomes.
Background Body mass index (BMI) is commonly used to estimate obesity prevalence; however, reliance on BMI alone can lead to an incomplete understanding of obesity's impact on health. In line with the 2025 recommendations of the Lancet Diabetes & Endocrinology Commission, this study combines population-level measures of excess adiposity with indicators of physiological dysfunction and activity limitation across eight body system domains to characterize clinical and preclinical obesity among Canadian adults. Data and methods Measured and self-reported data from the 2016 to 2019 Canadian Health Measures Survey were used to define excess adiposity as measured BMI in the obese range plus elevated waist circumference. A three-tier system was used to capture progressive obesity-related impairment. At each tier, clinical obesity was defined by excess adiposity and indicators of impairment in one or more domains (Tier 1), two or more domains (Tier 2), or three or more domains (Tier 3). Preclinical obesity at each tier was characterized by excess adiposity with fewer indicators of impairment than the corresponding clinical thresholds. Prevalence estimates for these indicators and characterizations of obesity were calculated by sex and age group. Results Just over one in four Canadian adults had excess adiposity. Prevalence of physiological dysfunction and activity limitation indicators varied across domains and sex and age groups. Clinical and preclinical obesity prevalences were 19% and 8% at Tier 1, 12% and 15% at Tier 2, and 7% and 20% at Tier 3, respectively. Preclinical obesity-especially at tiers 1 and 2-was more common in younger adults and females. Interpretation Younger adults and females with excess adiposity were less likely to present with obesity-related physiological dysfunction or activity limitation, indicating early-stage impairment and highlighting opportunities for targeted prevention. Integrating measures of impairment when assessing obesity can refine population surveillance efforts.
Background The accurate monitoring of population mental health requires repeated assessments using valid and reliable measures. The Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) and its short form (SWEMWBS) are widely used positive mental health (PMH) measures ([S]WEMWBS is used hereafter to refer to both). This study tested their validity among Canadian adults using representative health survey data. Data and methods Cross-sectional data from the 2024 Canadian Community Health Survey-Rapid Response on Sleep Quality and Positive Mental Health of adults (18 years and older) living in the provinces were used. The distributions of (S)WEMWBS responses and scores were examined. Confirmatory factor analysis (CFA) and bifactor exploratory structural equation modelling (ESEM) were conducted to assess factorial validity. Measurement invariance was tested across gender and age. Differences in (S)WEMWBS scores by gender, age, and other mental health indicators were examined. Cronbach's alphas were used to investigate internal consistency. Results (S)WEMWBS scores had relatively normal distributions, with no floor and minimal ceiling effects. A bifactor ESEM and bifactor CFA model for the WEMWBS and SWEMWBS, respectively, fit the data best, with indices suggesting that they were essentially unidimensional. Evidence was found for measurement invariance across gender and age. Older adults had higher (S)WEMWBS scores on average, as did men on the WEMWBS. The (S)WEMWBS had acceptable internal consistency and were associated with other mental health indicators. Interpretation The (S)WEMWBS appear to be valid and reliable PMH measures for Canadian adults. The (S)WEMWBS could be regularly included in health surveys to support the surveillance of population-level changes in PMH.
Background:Canada's drug toxicity crisis has burdened some populations disproportionately. This study identifies populations facing higher (or lower) rates of acute toxicity death (ATD) relative to a comparison group, using integrated Canadian Census Health and Environment Cohort data. Methods:This national prospective cohort study linked census long-form questionnaire respondents to Canadian Vital Statistics Deaths to identify ATDs occurring within five years of the 2016 Census (from May 10, 2016, to May 9, 2021). Age-standardized mortality rates (ASMRs) and ratios relative to a reference population group were compiled for Canada overall, by sex, and by select socioeconomic characteristics. Results:Approximately 0.05% of Canada's household population experienced an ATD during the follow-up period. The national ASMR of 10.7 per 100,000 person-years varied by population group. The highest ASMRs related to lowest educational attainment, household income quintile, and unemployment. Among employed people, highest ASMRs occurred for workers in trades, transport, equipment operators, and related occupations (19.0 per 100,000 person-years) or in occupations in manufacturing and utilities (15.3 per 100,000 person-years). People who spent between 50% to under 100% of their household total income on housing had the highest ASMR (27.9) compared with people spending less than 15% of their total household income on housing. Lower ASMRs also occurred for racialized people and immigrants. Interpretation:This study's results generally align with previous studies, while also identifying new details about which disaggregated population groups experienced higher ATD rates. These findings can support intervention programs and policies tailored for populations facing greater ATD risk and enable future monitoring of progress towards equitable outcomes.
Background:Accurate and ongoing assessments of physical activity (PA) and sedentary time (SED) are needed to support public health surveillance, evaluate interventions, and advance the understanding of how movement behaviours relate to health. After six cycles of data collection (2007 to 2019) using the Actical (AC) accelerometer, the Canadian Health Measures Survey (CHMS) transitioned to the ActiGraph wGT3X-BT (AG). To understand how estimates from the AC accelerometer may compare with those from the AG in the context of the CHMS, this study compares AC and AG accelerometer estimates of PA, step counts, and SED using CHMS protocols. Methods:A convenience sample of 47 adults (aged 18 to 79 years) and 36 children and youth (aged 3 to 17 years) wore both AC and AG accelerometers on their waist for seven consecutive days. Estimates of PA and SED, step counts, and the percentage of those meeting PA recommendations were compared between the devices using descriptive, correlation, and agreement statistics. Results:Agreement ranged from poor to excellent, with variability across PA intensities and age groups. Significant absolute differences in SED and light PA (LPA) were observed across all age groups, and in step counts among children and youth. Agreement was good to excellent across most age groups for moderate-to-vigorous PA (MVPA), and among adults for step counts. While the percentage of those meeting PA recommendations was higher with the AG, results were not statistically different. Similar comparisons could be made with the AG device when using the normal and low frequency extension filters. Interpretation:The results of the present study provide data users and researchers with an indication of the expected differences between the devices across various movement behaviour outcomes in the context of the CHMS. Results suggest that comparisons between cycles 1 to 6 and Cycle 7 onward of the CHMS for MVPA are acceptable, but they should be carried out with caution. Comparisons of SED, LPA, vigorous PA, and step counts are not recommended.
Background The prevalence of mood and anxiety disorders has risen in Canada over the past decade, and a large proportion of affected individuals do not receive professional help. This study aimed to understand how sociodemographic factors, including age, gender, immigrant status, population group, and household income, were associated with mental health care service use among people with mood or anxiety disorders. Data and methods Data from the 2022 Mental Health and Access to Care Survey were used to assess how many of the people who met the criteria for selected mood and anxiety disorders had (1) talked to a health professional about their mental health and (2) received counselling or therapy services in the 12 months before completing the survey. Chi-squared tests and logistic regression models were used to examine demographic differences in mental health service use among those with mood or anxiety disorders. Results Mental health service use among those with a mood or anxiety disorder was lower for youth aged 15 to 24, adults aged 45 and older, men, recent immigrants, and those with household income from $40,000 to $79,999, when controlling for other sociodemographic factors. The most frequently cited reasons for not having received counselling or therapy services included both attitudinal and structural barriers. Interpretation Disparities in the use of mental health care services exist beyond differences in the underlying prevalence of mental disorders. Different sociodemographic groups may face attitudinal and structural barriers that can contribute to difficulties in accessing care.
Background Canadians' positive mental health (PMH) decreased during the early and mid stages of the COVID-19 pandemic. Less is known about whether PMH recovered as the pandemic transitioned away from being a global health emergency. The aim of the current study was to compare PMH estimates during the late stage of the pandemic with earlier stages. Data and methods Population-based, cross-sectional data from adults in the 10 Canadian provinces from all three cycles of the Survey on COVID-19 and Mental Health were analyzed. Data were collected in the early (September to December 2020; N=11,324), mid (February to May 2021; N=5,742), and late (February to May 2023; N=11,526) stages of the pandemic. Estimates for three PMH outcomes (high self-rated mental health [SRMH], high community belonging, and mean life satisfaction) in the late stage of the pandemic were compared with estimates from the early and mid stages, overall and for various subgroups. Results Overall, mean life satisfaction and the prevalence of high SRMH and community belonging were higher in 2023 compared with 2021. Compared with 2020, mean life satisfaction was higher in 2023. However, the prevalence of high SRMH and community belonging remained lower in 2023. Similar patterns were observed among many subgroups; however, the specific groups to which they applied varied by PMH outcome. Younger adults displayed relatively low estimates at all timepoints. Interpretation Despite some indication of recovery in the well-being of adults in Canada in the late stage of the pandemic, there remains room for improvement, especially among certain sociodemographic groups (e.g., younger adults).
Background An increasing number of Canadians are living with mental health problems, including mood disorders. However, few studies have examined the prevalence of, and factors associated with, mood disorders among older Canadians (65 years or older). Data and methods A pooled sample of 172,524 community-dwelling older Canadians from nine cycles of the annual Canadian Community Health Survey-2015 to 2023-was used to examine mood disorders and associated correlates. Multivariable logistic regression, stratified by sex, was implemented to identify factors associated with mood disorders. Results From 2015 to 2023, on average, 7.0% of older Canadians reported a diagnosis of a mood disorder, with females (8.3%) more likely than males (5.5%) to do so. In a multivariable analysis that adjusted for demographic, socioeconomic, geographic, and health-related factors, Indigenous people (males and females) had higher odds of having a mood disorder than non-Indigenous, non-racialized populations. South Asian and Chinese males, as well as females belonging to Black and Other racialized groups, had significantly lower odds compared with their non-Indigenous, non-racialized counterparts. Living alone, being a male immigrant, and having lower household income were associated with a higher likelihood of experiencing mood disorders among older Canadians. Interpretation The results of this study highlight the importance of considering racialized population groups, as well as socioeconomic, geographic, and health-related factors-separately for males and females-when examining mood disorders among older Canadians to inform screening and intervention programs.
Background The prevalence of household food insecurity in the 10 provinces rose from 16.8% in 2019 to 18.4% in 2022 and 22.9% in 2023. This study examines whether and how the sociodemographic and economic patterning of households' vulnerability to food insecurity changed across these years. Data and methods Using data from the master files for households in the 10 provinces from the 2018, 2021, and 2022 cycles of the Canadian Income Survey, year-specific logistic regression models were conducted to estimate the predicted probability of household food insecurity by sociodemographic and economic characteristics. The predicted probability of food insecurity was also charted in relation to household income from the prior tax year, expressed in 2022 constant dollars and adjusted for household size, for each survey year. Results The probability of food insecurity increased significantly for most households, irrespective of the sociodemographic or economic characteristics considered. In 2019 and 2022, households receiving 50% or more of their income from employment or self-employment had a lower probability of food insecurity than those with a smaller proportion of their income from employment, but there was no difference between these groups in 2023. The probability of food insecurity was significantly higher in 2022 than 2019 at all household income levels above $20,000 and higher along the entire household income continuum in 2023 than 2022. Interpretation The probability of food insecurity is highest for low-income households, but food insecurity is becoming more prevalent among moderate-and higher-income households, and reliance on employment income is no longer protective against food insecurity.
Background The COVID-19 pandemic changed how Canadians accessed health care, increasing their use of virtual services. While virtual care use decreased after the pandemic lockdowns, it continues to play an important role in health care delivery. More information is needed about variations in virtual care use by sociodemographic and health characteristics. Data and methods Data from the 2023 Canadian Social Survey-Quality of Life, Virtual Health Care and Trust were used. Descriptive statistics estimated the types of health care appointments individuals had in the past 12 months, access to virtual care, the types of health care providers consulted virtually, and the reasons individuals declined virtual appointments. Multivariate analyses examined whether sociodemographic and health characteristics were associated with patients' virtual care use. Results Over half of patients (57.5%) had in-person appointments only, 5.3% had virtual appointments only, and over one-third (37.2%) had both types of appointments. Of individuals who sought or were offered virtual care, 78.5% had a virtual appointment. Most virtual care users consulted a family doctor, general practitioner, or nurse practitioner only (62.1%). Higher education, not having a regular health care provider, and multimorbidity were positively associated with virtual care use. Greater comfort with in-person appointments was the most common reason for declining virtual care. Interpretation While many individuals in Canada accessed virtual care, only a small proportion had virtual appointments only. Virtual care use varied by some sociodemographic and health factors, such as education and multimorbidity. Technological barriers were not a common reason for declining virtual appointments.
Background:There is mounting evidence about the negative dietary, health, and environmental impacts associated with high consumption of ultra-processed food and drink products (UPF) and low consumption of unprocessed or minimally processed foods and drinks (MPF). Eating context, including eating location and occasion, can influence food intake. This cross-sectional study used the most recent available national-level data for Canada to describe how consumption of UPF and MPF varied according to eating location and occasion. Data and methods:The 2015 Canadian Community Health Survey - Nutrition provided 24-hour dietary recall data for Canadians aged 2 and older residing in the 10 Canadian provinces (n=20,080). Food and drink items were categorized using the NOVA classification. Descriptive statistics were used to characterize UPF and MPF consumption, as a percentage of energy intake, across four common eating locations (home, institution, restaurant, and other) and eating occasions (breakfast, lunch, dinner, and snack), overall and by age group. Results:In 2015, overall, Canadians consumed most of their total daily energy at home (70.1%), and dinner accounted for 33.1% of energy intake. Meals consumed at home and in institutions (e.g., school, work) generally provided lower proportions of energy from UPF and higher proportions of energy from MPF compared with restaurants and "other" locations, with some variation by eating occasion and age group. Dinner consumed at home had the most favourable profile in terms of type of processing (overall, 30.6% of energy from UPF and 53.9% from MPF relative to total at-home dinner energy content). UPF intake in restaurants, as a proportion of energy consumed in restaurants, was high for all age groups (over 50% of energy), particularly for children and adolescents (over 65% of energy). Interpretation:Eating location and occasion matter in terms of UPF and MPF energy intakes. These findings can inform the design of policies and programs aiming to encourage and support healthy eating environments.
Background The association between oral health and general health is not yet fully understood. This study examines the association between missing teeth, mortality, and hospitalization outcomes. Data and methods This cohort study utilized time-to-event data from the Canadian Health Measures Survey Cycle 1 (2007 to 2009) linked to death and hospital discharge records. Participants with clinically assessed tooth counts were followed up to 2019. Cox proportional hazards models were used, treating missing teeth as either categorical or continuous exposures, adjusting for socioeconomic and health-related factors. Results In participants aged 20 to 79 years, 3,450 records were linked to mortality data (n=300 deaths) and 2,250 to hospitalization data (n=650 with at least one hospital stay). Missing teeth were associated with elevated all-cause and cancer mortality in unadjusted models, but not after covariate adjustment. After adjusting for key risk factors, including age and sex, participants with five or more missing teeth had a 76% higher risk of all-cause hospitalization (hazard ratio [HR] 1.76, 95% confidence interval [CI]: 1.41 to 2.20) and a 120% higher risk of circulatory-related hospitalization (HR 2.20, 95%CI: 1.09 to 4.45). Respiratory hospitalizations were also linked to missing teeth. No significant links were found with hospitalizations for digestive diseases or cancer. Interpretation Missing teeth is associated with hospitalization in Canadian adults. These findings highlight that oral health may play a role or serve as an indicator of overall health and health service use among Canadian adults.
Background Globally, cervical cancer is one of the most common cancers, yet it is largely preventable. Switching methods for primary screening from cytology testing, via Pap test, to human papillomavirus (HPV) testing is a component of that prevention. OncoSim-Cervix, a Canadian cervical cancer microsimulation model, assesses the long-term effects of HPV vaccination and screening interventions. This study projects the impact of differing roll-out strategies for HPV primary testing for cervical cancer screening in Canada. Data and methods OncoSim-Cervix simulates the progression from HPV infection to cervical cancer, incorporating Canadian data on incidence, mortality, HPV vaccination, screening, and costs. This analysis compared the effect of different roll-out strategies for switching from current practice to HPV primary screening every five years. Using OncoSim-Cervix, the study simulated one status quo scenario (cytology primary screening every three years) and three quinquennial HPV primary screening scenarios: (1) one-time roll-out, (2) population-based roll-out over two years, and (3) age-based roll-out over three years. Results All HPV screening roll-out strategies were found to improve clinical outcomes, with reductions of approximately 20% in cervical cancer cases and 18% in deaths, while screening less frequently, compared with cytology screening. The one-time roll-out scenario initially spiked colposcopy referrals by 60%, while phased implementation produced smaller peaks (35% to 40%) followed by declining referrals, compared with cytology screening. Interpretation Switching from three-year cytology to five-year HPV testing improves outcomes, with phased strategies mitigating the initial colposcopy surge. Modelling can help programs anticipate and manage colposcopy demand during the transition.
Background Metabolic syndrome (MetS) is a major cause of cardiovascular morbidity and mortality. This study provides an updated prevalence of MetS and its components among Canadian adults aged 18 to 79 years in the period from 2016 to 2019 by age group and sex. It also examines trends in the prevalence of MetS and its components over time in this population from 2007 to 2019. Data and methods This study used direct health measures data from cycles 1 to 6 (2007 to 2019) of the Canadian Health Measures Survey. MetS was defined as the presence of at least three of the following components: elevated waist circumference, elevated triglycerides, reduced high-density lipoprotein (HDL) cholesterol, high blood pressure, and elevated fasting blood glucose. Results In the period from 2016 to 2019, 26.1% of Canadian adults aged 18 to 79 years had MetS. The prevalence of MetS was similar among females (25.2%) and males (27.0%) and increased with age, from 11.1% for those aged 18 to 39 years to 44.3% for those aged 60 to 79 years. The prevalence of MetS remained stable from the 2007-to-2011 period to the 2016-to-2019 period. Among individuals with MetS in the period from 2016 to 2019, high waist circumference was the most common component (90.0%), followed by high fasting blood glucose (70.6%) and low HDL cholesterol (65.8%). The prevalence of all components of MetS increased with age, except for low HDL cholesterol, which significantly decreased with age. Interpretation The prevalence of MetS among adults has remained stable over time in Canada. Low HDL cholesterol seems to be the leading component of MetS among young adults.
Background To better understand the interplay between adiposity and metabolic health, joint phenotypes have been used to categorize people as being metabolically healthy (MH) or metabolically unhealthy (MU) while having a body mass index (BMI) indicative of obesity, overweight, or normal weight. This study examines the prevalence of these phenotypes in adults, the factors associated with them, and their relationship with adverse health outcomes. Data and methods Three cycles of the Canadian Health Measures Survey (from 2014 to 2019) were combined to characterize adults aged 20 to 79 years as MU if they had at least three out of five measures of elevated waist circumference, elevated triglycerides, reduced high-density lipoprotein cholesterol, elevated blood pressure, or elevated fasting glucose. Measured BMI, categorized as indicative of normal weight, overweight, or obesity, was combined with MH or MU to produce six joint phenotypes. Phenotype prevalence was examined across selected characteristics and separate multivariable logistic regression models estimated the association with self-reported health status and morbidity indicators. Results One in four Canadian adults was either MU with obesity or MU with overweight. These phenotypes were more prevalent at older ages. Among MH adults, higher BMI was associated with worse self-rated general health. MU adults with obesity were 1.8 times more likely to report worse general health than MH adults with obesity. MU adults with obesity or with overweight were 1.2 times more likely to have higher levels of systemic inflammation than MH adults with obesity or overweight. Higher BMI, regardless of metabolic health, was associated with higher levels of systemic inflammation. Interpretation Gaining insight into the population prevalence of metabolic health and BMI phenotypes and their association with health risks can help improve awareness and inform health promotion strategies.
Background Cost and lack of dental insurance coverage are major obstacles to accessing dental care in Canada. This study estimates the prevalence and explores the characteristics of cost-related avoidance of oral health services among a nationally representative sample of people in Canada aged 12 years and older who may qualify for coverage under the Canadian Dental Care Plan (CDCP). Data and methods Data from the 2023 to 2024 Canadian Oral Health Survey were used to construct a population-based cohort of CDCP-eligible individuals based on income and insurance status. The responses from 11,189 CDCP-eligible individuals in Canada who answered questions about avoiding visits to an oral health professional or avoiding recommended dental care because of the cost were analyzed. Generalized linear models were used to examine the association between sociodemographic characteristics and the outcomes of cost-related avoidance of oral health services. Results During the period from November 2023 to March 2024-before the CDCP was available to help pay for care-47% of CDCP-eligible individuals avoided visits to an oral health professional and 38% avoided recommended dental care in the past year because of the cost. Young and middle-aged adults, uninsured individuals (compared with those with public insurance), and individuals with an adjusted family net income of less than $38,800 reported greater cost-related avoidance of oral health services. After adjustments, dental insurance status (odds ratio [OR]: 5.78; 95% confidence interval [CI]: 3.74 to 8.94) and self-reported mouth problems (OR: 4.80; 95% CI: 3.87 to 5.96) had the strongest association with cost-related avoidance of dental visits in the past year. The same was true for cost-related avoidance of recommended dental care (OR: 3.15; 95% CI: 2.07 to 4.78 and OR: 5.11; 95% CI: 4.17 to 6.27, respectively). Interpretation This study identified cost as a significant barrier to accessing oral health care for nearly half of CDCP-eligible individuals. The findings suggest that the use of oral health services by CDCP-eligible individuals in Canada is largely influenced by their income and ability to pay out of pocket for dental care expenses, rather than their need for treatment, leaving many vulnerable to unmet oral health care needs. Establishing baseline estimates of cost-related avoidance before the CDCP became available to help pay for care is essential for gauging the success of easing financial barriers and facilitating effective program monitoring.
Background Data measuring life expectancy (LE) and health-adjusted life expectancy (HALE) in Canada are available for large geographical areas, such as provinces, territories, and health regions. However, to date, no study has analyzed LE and HALE at the municipal level. Data and methods Death and population counts from January 1, 2019, to December 31, 2020, were retrieved for 1,227 census subdivisions (CSDs) in Canada. CSDs are municipalities or areas treated as municipal equivalents by provincial and territorial governments. Functional health status was operationalized via the Health Utilities Index Mark 3 (HUI3) and obtained from the 2019 and 2020 Canadian Community Health Survey. CSD mortality rates and HUI3 scores for sex and age groups were estimated via multilevel regression models and poststratification. LE and HALE were calculated using life table methods and compared with previously published data for a subset of CSDs. The variability of LE and HALE was described using population, income, and educational characteristics. Results The median CSD had estimates of LE at birth of 84.1 years for females and 79.6 years for males. The median CSD had estimates of HALE at birth of 70.8 years for females and 69.7 years for males. For both measures, the gaps between CSDs at the 95th and 5th percentiles of LE were approximately 13 years for females and 14 years for males. The differences between the model-based LE estimates and published data were typically less than one year. LE and HALE at birth were positively correlated with population size and the percentage of individuals aged 25 to 64 with a postsecondary education. Interpretation This study develops, validates, and describes the first set of LE and HALE estimates for municipalities in Canada. Municipal-level health indicators are important for research and policy focused on the health of local populations.
