Little is known about residential satisfaction in individuals who wait for subsidized housing and its relationship to health. This paper measures residential satisfaction in applicants for subsidized housing in New Brunswick, Canada and investigates its contributions to mental and physical health. The findings indicate that residential dissatisfaction is significantly associated with depression and distress; however, it is not significantly associated with physical health. The authors conclude that individuals may experience better mental health with the introduction of targeted interventions (e.g. programs to improve social interactions in lower income neighbourhoods) to improve residential dissatisfaction.

Use of fluoroquinolones (FQs), broad-spectrum antibiotics, has been linked to adverse health outcomes and resulted in safety warnings by regulatory agencies worldwide. We tested the effect of Canadian risk mitigation measures (RMMs) introduced in January 2017 on FQ prescription rates. We conducted a retrospective multi-site cohort study using administrative data from six Canadian provinces. The cohort included adults (18 + years) with outpatient prescriptions for four oral systemic FQs (ciprofloxacin, levofloxacin, moxifloxacin, norfloxacin) between 2008 and 2022. Overall FQ prescription rates and percentage of FQ prescriptions for three antibiotic indications (acute bacterial sinusitis [ABS], acute exacerbation of chronic obstructive pulmonary disease [AECOPD], urinary tract infection [UTI]) were assessed before and after RMMs were introduced. Segmented generalized linear models were applied to monthly prescription rates and percentages for: (1) pre-RMM (January 2008-December 2016; reference), (2) post-RMM pre-COVID (January 2017-Feburary 2020), and (3) post-RMM within-COVID (March 2020-December 2022) segments. We estimated province-specific relative rates (RR) for the post-RMM segments and slope coefficients for pre- and post-RMM segments and their 95

INTRODUCTION:To describe opioid prescribing patterns for opioid-naive patients who filled prescriptions after surgical or emergency care. METHODS:We conducted a population-based, cross-sectional study of opioid-naive adults who filled opioid prescriptions within 14 days of receiving surgical or emergency care in Nova Scotia, Canada. Using linked administrative databases, we estimated the prevalence of opioid prescriptions with >7 days' supply, ≥90 morphine milligram equivalents (MME)/day or long-acting opioids. We assessed the association of care setting and specialty with these outcomes. RESULTS:Among 124,515 patients, 36,716 (29.5%) were opioid-naive. The median opioid supply duration was 3 days (IQR 2-5), the median dose was 50 MME/day (IQR 30-75). Prescriptions for >7 days, ≥90 MME/day or involving long-acting opioids were filled by 10.9%, 20.2% and 0.7% of the patients, respectively. Hydromorphone (50%) and codeine (26.4%) were the most filled opioids. The emergency care setting had double the odds of filling >7 days' supply (OR 2.13, 95% CI 1.99-2.28), and 69% lower chance of filling ≥90 MME/day (OR 0.31, 95% CI 0.29-0.33) than surgical care. In the surgical care setting, there was significant variation across medical specialties. Otolaryngology was associated with a higher chance of prescribing >7 days' opioid supply than general surgery (OR 4.89, 95% CI 3.86-6.20). Orthopaedic surgery had a higher likelihood of ≥90 MME/day prescriptions (OR 2.92, 95% CI 2.58-3.30) than general surgery. DISCUSSION AND CONCLUSIONS:Opioid prescribing patterns vary significantly by setting and specialty in Nova Scotia, Canada. Our results emphasise the need for tailored guidelines that consider clinical context and specialty to enhance patient safety and reduce opioid misuse risk.

Homelessness is an important risk factor for premature death, with individuals experiencing homelessness having substantially higher mortality rates than the general population. To assess the association of housing and support interventions with mortality among individuals experiencing homelessness and mental illnesses. This secondary analysis of a randomized clinical trial included 2255 homeless adults with mental illnesses. The study was conducted in 5 Canadian cities (Vancouver, Winnipeg, Toronto, Montreal, and Moncton). Recruitment took place from October 2009 to July 2011; mortality data were collected until March 30, 2019. Due to the complexity of accessing health administrative data, analyses were conducted and completed between February 2021 and December 2023. Participants were randomized to receive either the Housing First (HF) intervention, which provided immediate permanent, scattered-site housing and support through intensive case management or assertive community treatment to chronically homeless individuals, or treatment as usual (TAU). Mortality rate ratios were ascertained at each site using health administrative databases. Adjusted hazard ratios were computed using Cox proportional hazard survival models. Random-effects meta-analysis was used to calculate pooled effect sizes across sites. Of the 2255 total participants, 2108 (93.5%) were successfully linked with health administrative data; among them, 1434 (68.0%) were male, with a mean (SD) age of 40.6 (11.5) years. Mortality rates were not different in the HF compared with TAU groups (pooled log mortality rate ratio, −0.07; 95% CI, −0.36 to 0.22). The pooled adjusted hazard ratio comparing mortality in the HF and TAU groups was 0.83 (95% CI, 0.43-1.22). In this secondary analysis of a randomized clinical trial, the HF intervention was not directly associated with mortality risk. Research is needed to determine whether adjunctive interventions could reduce mortality among homeless individuals with mental illnesses. isrctn.org Identifier: ISRCTN42520374

BACKGROUND:A better understanding of calcitonin gene-related peptide (CGRP) inhibitor use is in migraine treatment needed. METHODS:A retrospective, observational, population-based cohort study was conducted using administrative data. Adults (≥18 years) who received ≥1 prophylactic CGRP inhibitor in Canada (six provinces) between 2018 (first approved) and 2023 were identified. CGRP inhibitor use was described; migraine-related acute medication and healthcare use were compared pre-post CGRP inhibitor initiation (independent and paired t-tests). RESULTS:12,851 adults were identified. CGRP inhibitor use increased from 11.8 (incident/prevalent) to 22.4 (incident) and 57.3 (prevalent) per 100,000 adults. Erenumab use decreased over time, as use of newer agents increased. During the 1-year period after CGRP inhibitor initiation, 57.4% had concomitant use with a different prophylactic migraine medication class (onabotulinumtoxinA injection: 23.2%; oral non-CGRP inhibitor: 34.2%), and 30.4% stopped use (21.3% switched to a different prophylactic migraine medication class; 9.1% discontinued all prophylactic migraine medication). During the 1-year period after CGRP inhibitor initiation (versus before), days of supply for migraine-related acute medication was lower (mean [standard deviation]: 129 [191] versus 145 [197] days; mean difference [95% confidence interval]: -16: [-22, -11] days), as were the number of healthcare visits (7.36 [8.70] versus 9.18 [10.10]; -1.82 [-2.06, -1.58]). CONCLUSION:CGRP inhibitor use increased from 2018 to 2023. After CGRP inhibitor initiation, most patients had concomitant use with a different prophylactic migraine medication class, and some stopped use; migraine-related acute medication and healthcare use were lower (versus before). Findings provide a real-world description of the evolving landscape of CGRP inhibitor use in Canada.

Building on Canadian data at the provincial, regional, community, and personal levels, the Canadian Social Determinants Urban Laboratory (CSDUL) will enable multilevel and longitudinal investigation of how social determinants of health (SDOH) impact population health (both mental and physical) and health inequities in Canada. Utilizing administrative data linkage, CSDUL will be developed by combining social, economic, and political mechanisms at multiple levels, from national to individual, following the World Health Organization (WHO) SDOH framework. Organized using a hub-and-node model, CSDUL will be created by validating unit and area-level indicators and merging survey and administrative data to provide a comprehensive understanding of SDOH at micro, meso, and macro levels. The project will replicate WHO/Europe's decomposition analysis of income-related inequalities in self-reported health, assessing the relative impact of social determinants on health outcomes. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This research was funded in part by the Urban Public Health Network and the College of Medicine of the University of Saskatchewan. This research was funded by the Canadian Institutes of Health Research (CIHR). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Not applicable

IntroductionGreenness is considered to be a health-promoting feature of both natural and built environments and has the potential to influence mental health outcomes. However, most studies to date have neglected to address whether greenness differentially affects mental health outcomes for individuals across the socioeconomic spectrum. Our study explored if greenness is a moderating factor in the relationship between socioeconomic status (SES) and mental health using data from the Canadian Longitudinal Study on Aging (CLSA).MethodsA cross-sectional design was used to compare mental health outcomes between individuals with different levels of SES and residential greenness. We used self-rated social standing as a measure of SES and depression score measured using the Centre for Epidemiologic Studies 10-Item Depression Scale (CESD-10) as a measure of mental health. Greenness was measured using the annual maximum Normalized Difference Vegetation Index (NDVI) within a 1,000 m buffer area of participants' residential postal code locations.ResultsThere was a statistically significant moderating effect of greenness for the relationship between self-rated social standing and depression score. As greenness increased, individuals with lower self-rated social standing had the greatest decreases in depression score.DiscussionThe results of our study suggests that targeting greening interventions at individuals and communities with low SES may reduce depressive symptoms overall, as well as decrease socioeconomic inequalities in depression.

Using linked data from emergency shelters and a dental program in Canada, we sought to determine whether dental care is associated with fewer emergency shelter stays in this retrospective cohort study. We can observe when an individual accessed free dental care and how emergency shelter use changed over four years of follow-up, matching participants to comparable controls. We estimate difference-in-differences effects for each year since receipt of dental care. We estimate models for the typical user (M-estimation) and the average user (OLS regression). We found that in years 2, 3, and 4 after care, the typical user experienced a net result of fewer shelter stays than controls. The estimated average user stayed more nights in shelter than controls over the four years after dental care, likely driven by outliers that used substantially more shelter stays than the typical user. These results are consistent with the idea that participants benefit in the long-term from dental care received while at an emergency shelter after an initial stabilization period. That is likely due to both the permanent nature of the intervention and the lack of access to publicly-funded dental care in Canada.

Objective and ApproachCanada’s federated health data system along with access pathways geared toward academic research, pose challenges for knowledge Users (KUs) requiring timely, pan-Canadian evidence to inform decisions. To understand challenges and explore solutions, we conducted two use cases for a pan-Canadian health technology assessment organization and a federal agency, using health administrative data at one federal and six provincial data centres. The population-based cohort studies described socio-demographics, comorbidities, treatment patterns, service utilization and costs. One focused on spinal muscular atrophy, a rare disease and the other on dementia, a complex chronic disease. ResultsAdministrative challenges included aligning varied ethical review and data access policies/procedures including requiring local and/or academic principal investigators and differing definitions of “research” vs. planning, evaluation, and monitoring. Data-related challenges included differences in structure, timeliness, and completeness across regions resulting in difficulty aligning constructs such as incident cases and episodes of care. Privacy requirements prohibited pooling jurisdictional estimates resulting in “small cells” that couldn’t be shared with KUs. ConclusionsWe provided analytic outputs from multiple regions, albeit with some differences and gaps, increasing knowledge around both diseases while developing capacity for combined analyses and gaining insight into national possibilities for data access. ImplicationsAs decision makers must rely on best available information, some data is better than none. However, to improve data-analytic services for Pan-Canadian KUs, next steps will include improving data harmonization, expanding data assets and filling data gaps, implementing common data models, and exploring options for federated and/or pooled analyses.

Household food insecurity is associated with both low income and high cost of living, it is a potentially better measure for consumption compared to income. We use data on food insecurity and income from 10 years of the Canadian Community Health Survey (2007–2017) of single-person households (n = 145,044) to estimate the probability of being food insecure at the Canadian poverty thresholds (Market Basket Measure thresholds, or MBMs), and determine the income required to reach that probability in each MBM region, aggregated by province and rural/urban status. A regression model shows the probability of being food insecure at the MBM is approximately 30

Background:Hip fractures in older adults often lead to adverse health outcomes, which may be related to time to surgery and longer hospital stays. The experience of older adults with hip fractures in New Brunswick is not known. Methods:This was a retrospective observational study. All hip fracture patients 65 years of age and older admitted to one hospital designated as a Level One Trauma Centre between April 1, 2015 and March 31, 2019 comprised the sample. Results:The majority (86.5%) received surgery within 48 hours and those who had surgery beyond this time frame had a significantly longer stay in acute care (OR: 3.79, 95% CI: 2.05-7.15). The mean total length of stay (Total-LOS) for patients discharged after their acute care needs were met was 9.8 days (SD=8.1) compared to patients experiencing delays in discharge for nonmedical reasons which was 26.3 days (SD=33.7). An extended stay in acute care (OR: 1.93, 95% CI: 1.09-3.43) and increasing age (OR: 1.03, 95% CI: 1.001-1.06) were associated with a higher likelihood of death at one year post-discharge. Time to surgery beyond 24 hours (OR: 2.80, 95% CI: 1.13-7.38) was associated with a higher likelihood of death 30 days post-discharge. Conclusions:Most patients had surgery within the national benchmark of less than 48 hours. The Total-LOS increased 2.5-fold in patients who remained in hospital after their acute care needs were met. A better understanding of patient characteristics, such as frailty, may better predict patients at risk for longer hospital stays and adverse health outcomes.

Introduction Cancer is the leading cause of death in Canada, and cases are expected to rise by 83% between 2012 and 2042. Jurisdictions with higher ratios of social-to-medical spending exhibit better population health outcomes; however, the connection between the ratio and both cancer incidence and mortality is not well established. We aim to determine the association between the ratio and both age-standardised cancer incidence and mortality.Methods Using linear regressions with provincial and yearly fixed effects, we measured associations between the ratio and incidence of the four most common cancers in Canada (ie, lung and bronchus, colorectal, breast and prostate cancer), and mortality from any cancer, from 1992 to 2017 (incidence) and 2000 to 2019 (mortality).Results A one-cent increase in social spending for each dollar spent on medical services was significantly associated with a decrease in colorectal (−0.2%), breast (−0.1%), and prostate cancer (−0.6%). The relationship is statistically insignificant and negligible for lung cancer incidence and cancer mortality.Conclusion The ratio was significantly associated with a decrease in three out of four cancer incidence categories, but not mortality. This implies that, consistent with the social determinants of health, preventing cancer incidence might be a function of social spending, whereas medical spending is more relevant for individuals already diagnosed with cancer. This analysis points to the importance of a health-in-all-policies perspective, as social spending might be more important for population health than spending on the medical care system. We provide evidence that morbidity measures are responsive to the ratio, building on a literature focused on mortality.

BackgroundOld Age Security (OAS) represents an public policy through which income-related inequalities in health may be improved. The goal of this cross-sectional study was to investigate the health benefits of receiving OAS in financially insecure older Canadians.MethodsUsing data from the Canadian Longitudinal Study on Aging (CLSA) (n=15,691), ordered logistic regression was used to measure associations between financial insecurity and allostatic load.ResultsReceiving OAS as highest personal income source appeared to remove the health penalty of being financially insecure. While financial insecurity was associated with worse allostatic load in both males and females not receiving OAS, those receiving OAS as highest personal income source had better allostatic load compared to other financially insecure older adults (ORM: 0.398, 95% CI: 0.227, 0.696; ORF: 0.677, 95% CI: 0.483, 0.949).DiscussionWhile longitudinal data would be needed to draw causal inferences, these results suggest OAS may play a role improving health outcomes and narrowing income-related health inequalities. Such findings may have important implications on older adults, other vulnerable populations, and future directions of Canadian health and public policy.

Statistically model the likelihood of changes in the activities of daily living (ADLs) over time for three groups of older adults: those on a pension at all time periods, those never on a pension, and those who transition onto a public pension. Our study used data from the Canadian Longitudinal Study on Aging (CLSA), a large national survey. We used data from baseline (2010–2015) and the first follow-up wave (2015–2018). We used logistic regression to model the likelihood of ADL changes in males and females by pension receipt status, controlling for several potential confounders and allowing for the impact of public pensions to be modified by baseline income. The magnitudes of the estimates indicated that those who transition to a public pension are less likely to report ADL degradation and more likely to report ADL improvement compared to those with no public pension. In the lowest baseline income group, those who transitioned onto a pension at follow-up had a 15

Background Public health policies designed to influence individuals' infection-control behaviour are a tool for governments to help prevent the spread of disease. Findings on the impacts of policies are mixed and there is limited information on the effects of removing restrictions and how policies impact behavioural trends. Methods We use low-acuity emergency department visits from 12 hospitals in New Brunswick, Canada, (January 2017-October 2021) as a proxy for infection-control behaviour and provide insight into the effects of the COVID-19 virus on a population with a low prevalence of cases. Quasi-experimental techniques (event studies) are applied to estimate the magnitude and persistence of effects of specific events (e.g., policy changes), to control for COVID-19 cases and vaccines, and to explore how the effectiveness of policy changes during the pandemic as more policies are introduced. Results Initial tightening of restrictions on March 11, 2020 reduced low-acuity emergency department visits by around 60% and reached a minimum after 30 days. Relaxing policies on social gatherings and personal services gradually increased low-acuity emergency department visits by approximately 50% after 44 days. No effects were found from policies lifting all restrictions, and reinstating a state of emergency on July 31, 2021, and September 24, 2021. Conclusion These results suggest that policy interventions are less likely to be effective at influencing infection control behaviour with time and more policies introduced, and that tracking and publicly reporting case numbers can influence infection control behaviour.

Housing First (HF) is an approach that emphasizes providing housing as a precondition for assisting people experiencing homelessness. To the extent that housing reduces contacts with police, HF may reduce criminal behaviour and so reduce costs borne by the justice system. This may be particularly true for youth whose homelessness often forces them to adopt survival behaviour that exposes them to police and bylaw enforcement officers. Using regression analysis, we employ linked administrative data sets from police and from HF programs to examine how interactions of youth with police change following admission to a HF program. An important contribution of our study is the use of administrative police records rather than self-reported data on the number of criminal incidents and their severity. Unconditional quantile regression is used to observe HF’s effect on changes in both the number and severity of criminal incidents. Controlling for demographic characteristics of youth and for type of housing program and using administrative police records as opposed to self-reported police interactions, we find only weak evidence to suggest that the number of criminal incidents falls following admission to a HF program and only weak evidence of a fall in the seriousness of crimes.

Housing First (HF) addresses chronic homelessness by admitting individuals into permanent shelter regardless of their situation. Studies using self-reported data suggest that HF can potentially decrease justice system use, but they are limited by inaccurate measurement of police contacts. This study uses administrative data from police to measure the change in number of police interactions, change in average crime weight (or importance of crime), and change in the distribution of crime weight, before and after HF. Six hundred and two chronically homeless individuals with a history of criminal involvement and who were accommodated by an HF shelter between three months to a year were eligible for this study. We use unconditional quantile regression to observe HF's effect on changes in the distribution of crime weights over time. While the average crime weight increased during the study period (57-79.1), the average number of police interactions decreased. Statistically significant decreases of approximately 5 crime weight units were observed between percentiles 0.54 and 0.65 and decreases of approximately 15 crime weight units occurred at percentiles 0.73 and 0.81. HF is effective at reducing minor crimes at the highest end of the distribution and helping those experiencing homelessness to avoid the warrant cycle.

Background Accurately determining the fluid status of a patient during resuscitation in the emergency department (ED) helps guide appropriate fluid administration in the setting of undifferentiated hypotension. Our goal was to determine the diagnostic utility of point-of-care ultrasound (PoCUS) for inferior vena cava (IVC) size and collapsibility in predicting a volume overload fluid status in spontaneously breathing hypotensive ED patients. Methods This was a post hoc secondary analysis of the SHOC-ED data, a prospective randomized controlled trial investigating PoCUS in patients with undifferentiated hypotension. We prospectively collected data on IVC size and collapsibility for 138 patients in the PoCUS group using a standard data collection form, and independently assigned a fluid status (volume overloaded, normal, volume deplete) from a composite clinical chart review blinded to PoCUS findings. The primary outcome was the diagnostic performance of IVC characteristics on PoCUS in the detection of a volume overloaded fluid status. Results One hundred twenty-nine patients had completed determinant IVC assessment by PoCUS, with one hundred twenty-five receiving successful final fluid status determination, of which one hundred and seven were classified as volume deplete, thirteen normal, and seven volume overloaded. A receiver operating characteristic (ROC) curve was plotted using several IVC size and collapsibility categories. The best overall performance utilized the combined parameters of a dilated IVC (> 2.5 cm) with minimal collapsibility (less than 50%) which had a sensitivity of 85.7% and specificity of 86.4% with an area under the curve (AOC) of 0.92 for predicting an volume overloaded fluid status. Conclusion IVC PoCUS is feasible in spontaneously breathing hypotensive adult ED patients, and demonstrates potential value as a predictor of a volume overloaded fluid status in patients with undifferentiated hypotension. IVC size may be the preferred measure.

Multiple studies have reported decreased emergency department（ED） patient volumes during the coronavirus disease（COVID-19） pandemic, [1-6] including areas most affected by the virus. [7] Most existing studies have investigated general trends in ED presentations and have not examined the impact of COVID-19 on different types of EDs, specific ED patient groups, or illness presentations.