Chronic kidney disease is an important risk factor for death and cardiovascular-related morbidity, but estimates to date of its prevalence in Canada have generally been extrapolated from the ...prevalence of end-stage renal disease. We used direct measures of kidney function collected from a nationally representative survey population to estimate the prevalence of chronic kidney disease among Canadian adults.
We examined data for 3689 adult participants of cycle 1 of the Canadian Health Measures Survey (2007-2009) for the presence of chronic kidney disease. We also calculated the age-standardized prevalence of cardiovascular risk factors by chronic kidney disease group. We cross-tabulated the estimated glomerular filtration rate (eGFR) with albuminuria status.
The prevalence of chronic kidney disease during the period 2007-2009 was 12.5%, representing about 3 million Canadian adults. The estimated prevalence of stage 3-5 disease was 3.1% (0.73 million adults) and albuminuria 10.3% (2.4 million adults). The prevalence of diabetes, hypertension and hypertriglyceridemia were all significantly higher among adults with chronic kidney disease than among those without it. The prevalence of albuminuria was high, even among those whose eGFR was 90 mL/min per 1.73 m(2) or greater (10.1%) and those without diabetes or hypertension (9.3%). Awareness of kidney dysfunction among adults with stage 3-5 chronic kidney disease was low (12.0%).
The prevalence of kidney dysfunction was substantial in the survey population, including individuals without hypertension or diabetes, conditions most likely to prompt screening for kidney dysfunction. These findings highlight the potential for missed opportunities for early intervention and secondary prevention of chronic kidney disease.
Objectives
Exposure to ionizing radiation may increase the risk of circulatory diseases, including heart disease. A limited number of cohort studies of underground miners have investigated these ...associations. We previously reported a positive but non-statistically significant association between radon progeny and heart disease in a cohort of Newfoundland fluorspar miners. In this study, we report updated findings that incorporate 15 additional years of follow-up.
Methods
The cohort included 2050 miners who worked in the fluorspar mines from 1933 to 1978. Statistics Canada linked the personal identifying data of the miners to Canadian mortality data to identify deaths from 1950 to 2016. We used previously derived individual-level estimates of annual radon progeny exposure in working-level months. Cumulative exposure was categorized into quantiles. We estimated relative risks and their 95% confidence intervals using Poisson regression for deaths from circulatory, ischemic heart disease and acute myocardial infarction. Relative risks were adjusted for attained age, calendar year, and the average number of cigarettes smoked daily.
Results
Relative to the Newfoundland male population, the standardized mortality ratio for circulatory disease in this cohort was 0.82 (95% CI 0.74–0.91). Those in the highest quantile of cumulative radon progeny exposure had a relative risk of circulatory disease mortality of 1.03 (95% CI 0.76–1.40) compared to those in the lowest quantile. The corresponding estimates for ischemic disease and acute myocardial infarction were 0.99 (95% CI 0.66–1.48), and 1.39 (95% CI 0.84–2.30), respectively.
Conclusions
Our findings do not support the hypothesis that occupational exposure to radon progeny increases the risk of circulatory disease.
Cancer of the small intestine is very uncommon.There are 4 main histological subtypes:adenocarcinomas,carcinoid tumors,lymphoma and sarcoma.The incidence of small intestine cancer has increased over ...the past several decades with a four-fold increase for carcinoid tumors,less dramatic rises for adenocarcinoma and lymphoma and stable sarcoma rates.Very little is known about its etiology.An increased risk has been noted for individuals with Crohn’s disease,celiac disease,adenoma,familial adenomatous polyposis and Peutz-Jeghers syndrome.Several behavioral risk factors including consumption of red or smoked meat,saturated fat,obesity and smoking have been suggested.The prognosis for carcinomas of the small intestine cancer is poor(5 years relative survival < 30%),better for lymphomas and sarcomas,and best for carcinoid tumors.There has been no signif icant change in longterm survival rates for any of the 4 histological subtypes.Currently,with the possible exceptions of obesity and cigarette smoking,there are no established modifiable risk factors which might provide the foundation for a prevention program aimed at reducing the incidence and mortality of cancers of the small intestine.More research with better quality and sufficient statistical power is needed to get better understanding of the etiology and biology of this cancer.In addition,more studies should be done to assess not only exposures of interest,but also host susceptibility.
Neighbourhood greenness has been frequently associated with improved mental health in adulthood, yet its impact among youth is less clear. Additionally, though youth spend large portions of time at ...school, no study has investigated associations between school-based measures of greenness and students' mental health in Canada. We addressed this gap by linking participant responses from the 2016-2017 Ontario Student Drug Use and Health Survey to school-based features of the built environment. Our analyses included 6313 students, ages 11-20. Measures of greenness were the mean and max of the annual mean Normalized Difference Vegetation Index within 500 m and 1000 m from the centroid of the school postal code. Measures of mental health included: serious psychological distress (Kessler 6-item Psychological Distress Scale), self-rated mental health (using a five-point Likert scale), suicide ideation, and suicide attempt. In our study population, the prevalence of serious psychological distress and low self-rated mental health was 16.7% and 20.3%, respectively. Suicide ideation was reported by 13.5% of participants, while 3.7% reported a suicide attempt. Quantity of greenness was similar between schools in the lower and upper quartiles. In logistic regressions, we found no association between objective school-based greenness and mental health, as assessed by multiple measures, both before and after adjustment. Null findings held true after stratification by season, as well. Whether other characteristics of school greenness (such as type, quality, or access and use) are more impactful to students' mental health should be a focus of future analyses.
Dysglycemia, including prediabetes and type 2 diabetes, is dangerous and widespread. Yet, the condition is transiently reversible and sequelae preventable, prompting the use of prediction algorithms ...to quickly assess dysglycemia status through self-reported data. However, as current algorithms have largely been developed in older populations, their application to younger adults is uncertain considering associations between risk factors and dysglycemia vary by age. We sought to identify sex-specific predictors of current dysglycemia among young adults and evaluate their ability to screen for prediabetes and undiagnosed diabetes. We analyzed 2005–2014 data from the National Health and Nutrition Examination Survey for 3251 participants aged 20–39, who completed an oral glucose tolerance test (OGTT), had not been diagnosed with diabetes, and, for females, were not pregnant. Sex-specific stepwise logistic models were fit with predictors identified from univariate analyses. Risk scores were developed using adjusted odds ratios and model performance was assessed using area under the curve (AUC) measures. The OGTT identified 906 (27.9%) and 78 (2.4%) participants with prediabetes or undiagnosed diabetes, respectively. Predictors of dysglycemia status for males were BMI, age, race, and first-degree family history of diabetes, and, in addition to those, education, delivered baby weight, waist circumference, and vigorous physical activity for females. Our male- and female-specific models demonstrated improved validity to assess dysglycemia presence among young adults relative to the widely-used American Diabetes Association test (AUC = 0.69 vs. 0.61; 0.92 vs. 0.71, respectively). Thus, age-specific scoring algorithms employing questionnaire data show promise and are effective in identifying dysglycemia among young adults.
•1 in 3 young adults had objectively-assessed dysglycemia (prediabetes or diabetes).•Adiposity was the strongest predictor of dysglycemia for both sexes.•Fewer factors strongly predicted dysglycemia status in young adult males vs. females.•The popular American Diabetes Association test performed modestly in this age group.•Sex-specific scores for young adults improved model discrimination and calibration.
Surveillance of childhood cancer incidence trends can inform etiologic research, policy and programs. This study presents the first population-based report on demographic and geographic variations in ...incidence trends of detailed pediatric diagnostic groups in Canada.
The Canadian Cancer Registry data were used to calculate annual age-standardized incidence rates (ASIRs) from 1992 to 2010 among children less than 15 years of age by sex, age and region for the 12 main diagnostic groups and selected subgroups of the International Classification of Childhood Cancer (ICCC), 3rd edition. Temporal trends were examined by annual percent changes (APCs) using Joinpoint regression.
The ASIRs of childhood cancer among males increased by 0.5% (95% confidence interval (CI) = 0.2-0.9) annually from 1992 to 2010, whereas incidence among females increased by 3.2% (CI = 0.4-6.2) annually since 2004 after an initial stabilization. The largest overall increase was observed in children aged 1-4 years (APC = 0.9%, CI = 0.4-1.3). By region, the overall rates increased the most in Ontario from 2006 to 2010 (APC = 5.9%, CI = 1.9-10.1), and increased non-significantly in the other regions from 1992 to 2010. Average annual ASIRs for all cancers combined from 2006 to 2010 were lower in the Prairies (149.4 per million) and higher in Ontario (170.1 per million). The ASIRs increased for leukemias, melanoma, carcinoma, thyroid cancer, ependymomas and hepatoblastoma for all ages, and neuroblastoma in 1-4 year olds. Astrocytoma decreased in 10-14 year olds (APC = -2.1%, CI = -3.7 to -0.5), and among males (APC = -2.4%, CI = -4.6 to -0.2) and females (APC = -3.7%, CI = -5.8 to -1.6) in Ontario over the study period.
Increasing incidence trends for all cancers and selected malignancies are consistent with those reported in other developed countries, and may reflect the changes in demographics and etiological exposures, and artefacts of changes in cancer coding, diagnosis and reporting. Significant decreasing trend for astrocytoma in late childhood was observed for the first time.
In Canada, the prevalence of diabetes has seen the greatest relative increase in young adulthood, where the disorder is severely pathological compared to later-onset. Still, few prognostic models ...have been developed to screen young adults for dysglycemia risk and boost early identification and intervention. We sought to establish predictors of dysglycemia risk among young Canadian adults (aged 18-39) and evaluate their utility in identifying high-risk individuals. The Canadian Diabetes Risk Questionnaire (CANRISK) study collected questionnaire, anthropometric, and oral glucose tolerance test (OGTT) data from a large, multiethnic convenience sample of Canadians over two phases. Young adults with diagnosed diabetes, missing OGTT data, or pregnant were excluded. Potential factors that modestly predicted (p<0.20) dysglycemia status (FPG≥6.1mmol/L or 2h-PG≥7.8mmol/L) were entered into a lenient stepwise function, producing a young adult-specific model; risk scores were developed from adjusted odds ratios. Discriminatory ability was assessed by optimism-corrected area under the curve (AUC) via bootstrapping and goodness-of-fit by Hosmer-Lemeshow (H-L) test and calibration plot. More than half of the 3334 participants were female (62.4%), non-white (79.2%), less than 25kg/m2 (50.7%), and reported a family history of diabetes (55.4%); based on OGTT results, 7.3% were dysglycemic. The young adult-specific model displayed an adjusted AUC of 72.9%, and reasonable goodness-of-fit (H-L p=0.49). Model performance was similar when run sex-specifically (males: unadjusted AUC of 72.1%, H-L p=0.67; females: 73.6%, p=0.67). Employing a cut-point of 22, the tool displayed high sensitivity (78.8%) but low specificity (54.0%). Only 3% of those identified as low risk by the tool were misclassified.
This young adult-specific risk score shows promise to identify high-risk individuals in a multiethnic Canadian sample. Additional studies are needed to assess its generalizability to new datasets.
Disclosure
S.A. Srugo: None. Y. Jiang: None. H.I. Morrison: None. M.M. deGroh: None.
Canada is facing a childhood obesity epidemic. Elevated blood pressure (BP) is a major complication of obesity. Reports on the impact of excess adiposity on BP in children and adolescents have varied ...significantly across studies. We evaluated the independent effects of obesity, physical activity, family history of hypertension, and socioeconomic status on BP in a nationally representative sample of children and adolescents.
We analysed cross-sectional data for 1850 children aged 6 to 17 years who participated in the Canadian Health Measures Survey, Cycle 1, 2007-2009. Systolic BP (SBP) and diastolic BP (DBP) were age-, sex-, and height-adjusted to z-scores (SBPZ and DBPZ). Body mass index (BMI) z-scores were calculated based on World Health Organization growth standards. Multivariate linear regression was used to evaluate the independent effects of relevant variables on SBPZ and DBPZ.
For most age/sex groups, obesity was positively associated with SBP. Being obese was associated with higher DBP in adolescent boys only. The BP effect of obesity showed earlier in young girls than boys. Obese adolescents were estimated to have an average 7.6 mmHg higher SBP than normal weight adolescents. BMI had the strongest effect on BP among obese children and adolescents. Moderately active adolescent boys had higher SBP (3.9 mmHg) and DBP (4.9 mmHg) than physically active boys. Family history of hypertension showed effects on SBP and DBP in younger girls and adolescent boys. Both family income and parent education demonstrated independent associations with BP in young children.
Our findings demonstrate the early impact of excess adiposity, insufficient physical activity, family history of hypertension, and socioeconomic inequalities on BP. Early interventions to reduce childhood obesity can, among other things, reduce exposure to prolonged BP elevation and the future risk of cardiovascular disease.
The identification of various individual, social and physical environmental factors affecting physical activity (PA) behavior in Canada can help in the development of more tailored intervention ...strategies for promoting higher PA levels in Canada. This study examined the influences of various individual, social and physical environmental factors on PA participation by gender, age and socioeconomic status, using data from the 2002 nationwide survey of the Physical Activity Monitor.
In 2002, 5,167 Canadians aged 15-79 years, selected by random-digit dialling from household-based telephone exchanges, completed a telephone survey. The short version of the International Physical Activity Questionnaire was used to collect information on total physical activity. The effects of socio-economical status, self-rated health, self-efficacy, intention, perceived barriers to PA, health benefits of PA, social support, and facility availability on PA level were examined by multiple logistic regression analyses.
Self-efficacy and intention were the strongest correlates and had the greatest effect on PA. Family income, self-rated health and perceived barriers were also consistently associated with PA. The effects of the perceived health benefits, education and family income were more salient to older people, whereas the influence of education was more important to women and the influence of perceived barriers was more salient to women and younger people. Facility availability was more strongly associated with PA among people with a university degree than among people with a lower education level. However, social support was not significantly related to PA in any subgroup.
This study suggests that PA promotion strategies should be tailored to enhance people's confidence to engage in PA, motivate people to be more active, educate people on PA's health benefits and reduce barriers, as well as target different factors for men and women and for differing socio-economic and demographic groups.
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