Lisa M Lix

McGill University, Montréal, Quebec, Canada

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Publications (232)1007.59 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Prescription medication use, which is common among long-term care facility (LTCF) residents, is routinely used to describe quality of care and predict health outcomes. Data sources that capture medication information, which include surveys, medical charts, administrative health databases, and clinical assessment records, may not collect concordant information, which can result in comparable prevalence and effect size estimates. The purpose of this research was to estimate agreement between two population-based electronic data sources for measuring use of several medication classes among LTCF residents: outpatient prescription drug administrative data and the Resident Assessment Instrument Minimum Data Set (RAI-MDS) Version 2.0. Methods Prescription drug and RAI-MDS data from the province of Saskatchewan, Canada (population 1.1 million) were linked for 2010/11 in this cross-sectional study. Agreement for anti-psychotic, anti-depressant, and anti-anxiety/hypnotic medication classes was examined using prevalence estimates, Cohen’s κ, and positive and negative agreement. Mixed-effects logistic regression models tested resident and facility characteristics associated with disagreement. Results The cohort was comprised of 8,866 LTCF residents. In the RAI-MDS data, prevalence of anti-psychotics was 35.7%, while for anti-depressants it was 37.9% and for hypnotics it was 27.1%. Prevalence was similar in prescription drug data for anti-psychotics and anti-depressants, but lower for hypnotics (18.0%). Cohen’s κ ranged from 0.39 to 0.85 and was highest for the first two medication classes. Diagnosis of a mood disorder and facility affiliation was associated with disagreement for hypnotics. Conclusions Agreement between prescription drug administrative data and RAI-MDS assessment data was influenced by the type of medication class, as well as selected patient and facility characteristics. Researchers should carefully consider the purpose of their study, whether it is to capture medication that are dispensed or medications that are currently used by residents, when selecting a data source for research on LTCF populations. Electronic supplementary material The online version of this article (doi:10.1186/s12877-015-0023-2) contains supplementary material, which is available to authorized users.
    BMC Geriatrics 12/2015; 15(1). DOI:10.1186/s12877-015-0023-2 · 2.00 Impact Factor
  • W. Kouokam, L.M. Lix
    Revue d Épidémiologie et de Santé Publique 05/2015; 63. DOI:10.1016/j.respe.2015.03.037 · 0.66 Impact Factor
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    ABSTRACT: Conclusion Across all analyses—estimated population based, matched, and propensity score—we found that smoking was associated with an increased burden on the healthcare system. The dichotomous ever-versus-never-smoked analyses consistently showed that individuals who reported having ever smoked used more health services than those who reported having never smoked. When we separated individuals into more refined categories we found that much of the healthcare burden was concentrated among individuals in three categories: current daily smokers, former daily smokers who quit daily smoking five years or less before survey date, and former daily smokers who quit daily smoking over five years before survey date. A common perception is that while smokers may use more healthcare services, they die younger. It is believed that these individuals’ burden is truncated resulting in few or no additional costs in the long run. However, our results show that if smokers live to the age of 50, they typically live well into their late 70s and early 80s. Thus, not only did we find that smoking was associated with increased healthcare use; we also found that this increase was not curtailed by smokers dying young. Those in Manitoba who ever smoked use significantly more healthcare services and they do so over a considerably long period—into their late 70s and early 80s. When we estimated the costs of those healthcare services used by those who ever smoked compared with those who never smoked we found that those who ever smoked cost the healthcare system more, even after adjusting for several confounding characteristics. Our estimates suggest that, on average, smoking costs the Manitoba healthcare system an additional $226,034,777 per year, plus another $18,342,017 for cancer-related costs.
    First 05/2015; Winnipeg MB: Manitoba Centre for Health Policy., ISBN: ISBN 978-1-896489-77-3
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    ABSTRACT: As individuals experience changes in their health, they may alter the way they evaluate health and quality of life. The purpose of this study is to estimate the extent to which individuals with IBD change their rating of health over time because of response shift (RS). This is a reanalysis of a population-based longitudinal study of IBD in Manitoba, Canada (n = 388). RS was examined using trajectories of the difference between observed and predicted health. Logistic regression and dual trajectories were used to identify predictors of RS. Disease activity, vitality, pain, somatization, and physical and social function explained 51% of the variation in general health over two years with no evidence of RS in 82% of the sample. Negative RS was found for 8%, who initially rated health better than predicted; positive RS was found for 6%. The positive RS group was younger and had better baseline scores on measures of general health, hostility, pain, mental health and social and role function; less pain and better social function scores at baseline were predictors of negative RS. In conclusion, the majority of people with IBD did not demonstrate a RS indicating that the health rating over time was stable in relation to that predicted by known time varying clinical variables. This adds to the evidence that the single question on self-rated health is useful for monitoring individuals over time.
    Health and Quality of Life Outcomes 05/2015; 13(1):52. DOI:10.1186/s12955-015-0232-6 · 2.10 Impact Factor
  • Value in Health 05/2015; 18(3):A16. DOI:10.1016/j.jval.2015.03.101 · 2.89 Impact Factor
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    ABSTRACT: Social Anxiety Disorder (SAD) models implicate social threat cue vigilance (i.e., attentional biases) in symptom development and maintenance. A modified dot-probe protocol has been shown to reduce SAD symptoms, in some but not all studies, presumably by modifying an attentional bias. The current randomized controlled trial was designed to replicate and extend such research. Participants included treatment-seeking adults (n=108; 58% women) who met diagnostic criteria for SAD. Participants were randomly assigned to a standard (i.e., control) or modified (i.e., active) dot-probe protocol condition and to participate in-lab or at home. The protocol involved twice-weekly 15-min sessions, for 4 weeks, with questionnaires completed at baseline, post-treatment, 4-month follow-up, and 8-month follow-up. Symptom reports were assessed with repeated measures mixed hierarchical modeling. There was a main effect of time from baseline to post-treatment wherein social anxiety symptoms declined significantly (p<.05) but depression and trait anxiety did not (p>.05). There were no significant interactions based on condition or participation location (ps>.05). Reductions were maintained at 8-month follow-up. Symptom reductions were not correlated with threat biases as indexed by the dot-probe task. The modified and standard protocol both produced significant sustained symptom reductions, whether administered in-lab or at home. There were no robust differences based on protocol type. As such, the mechanisms for benefits associated with modified dot-probe protocols warrant additional research. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Journal of Anxiety Disorders 04/2015; 33. DOI:10.1016/j.janxdis.2015.03.011 · 2.96 Impact Factor
  • Gastroenterology 04/2015; 148(4):S-159. DOI:10.1016/S0016-5085(15)30535-7 · 13.93 Impact Factor
  • Gastroenterology 04/2015; 148(4):S-176. DOI:10.1016/S0016-5085(15)30588-6 · 13.93 Impact Factor
  • Gastroenterology 04/2015; 148(4):S-464-S-465. DOI:10.1016/S0016-5085(15)31566-3 · 13.93 Impact Factor
  • Gastroenterology 04/2015; 148(4):S-24. DOI:10.1016/S0016-5085(15)30082-2 · 13.93 Impact Factor
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    ABSTRACT: Background: With aging and obesity trends, the incidence and prevalence of osteoarthritis (OA) are expected to rise in Canada, increasing the demand for health resources. Resource planning to meet this increasing need requires estimates of the anticipated number of OA patients. Using administrative data from Alberta, we estimated OA incidence and prevalence rates and examined their sensitivity to alternative case definitions.Methods: We identified cases in a linked dataset spanning 1993 to 2010 (Population Registry, Discharge Abstract Database, Physician Claims, Ambulatory Care Classification System and prescription drug data) using diagnostic codes and drug identification numbers. In the base case, incident cases were captured for patients with an OA diagnostic code for at least two physician visits within two years or any hospital admission. Seven alternative case definitions were applied and compared.Results: Age-sex standardized incidence and prevalence rates were estimated to be 8.6 and 80.3 cases/1000 population, respectively, in the base case. Physician Claims data alone captured 88% of OA cases. Prevalence rate estimates required 15 years of longitudinal data to plateau. Compared to base case, estimates are sensitive to alternative case definitions.Conclusion: Administrative databases are a key source for estimating the burden and epidemiological trends of chronic diseases such as OA in Canada. Despite their limitations, these data provide valuable information for estimating disease burden and planning health services. Estimates of OA are mostly defined through Physician Claims data and require a long period of longitudinal data. This article is protected by copyright. All rights reserved.
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    ABSTRACT: Administrative health data have been used in hypertension surveillance using the 1H2P method: the International Classification of Disease (ICD) hypertension diagnosis codes were recorded in at least 1 hospitalization or 2 physician claims within 2 year-period. Accumulation of false positive cases over time using the 1H2P method could result in the overestimation of hypertension prevalence. In this study, we developed and validated a new reclassification method to define hypertension cases using regularized logistic regression with the age, sex, hypertension and comorbidities in physician claims, and diagnosis of hypertension in hospital discharge data as independent variables. A Bayesian method was then used to adjust the prevalence estimated from the reclassification method. We evaluated the hypertension prevalence in data from Alberta, Canada using the currently accepted 1H2P method and these newly developed methods. The reclassification method with Bayesian adjustment produced similar prevalence estimates as the 1H2P method. This supports the continued use of the 1H2P method as a simple and practical way to conduct hypertension surveillance using administrative health data
    PLoS ONE 03/2015; 10(3). DOI:10.1371/journal.pone.0119186 · 3.53 Impact Factor
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    ABSTRACT: Context: Bone mineral density (BMD) measurement from dual-energy X-ray absorptiometry (DXA) is widely used to assess skeletal strength in clinical practice, but DXA instruments can also measure biomechanical parameters related to skeletal shape. Objective: To determine whether DXA-derived hip geometry measures provide information on fracture prediction that is independent of hip fracture probability determined from the FRAX® algorithm. Design and Setting: Retrospective registry study using BMD results for Manitoba, Canada. Patients: Women age 40 years and older with baseline hip DXA, derived hip geometry measures and FRAX scores (N=50,420). Main Outcome Measures: Hospitalized hip fracture (N=1,020) diagnosed during 319,137 person-years of follow-up (median 6.4 years). Results: Among the hip geometry measures, hip axis length (HAL) showed a consistent association with hip fracture risk when adjusted for age (hazard ratio [HR] 1.30 per standard deviation [SD] increase, 95% confidence interval [CI] 1.22-1.38) and this was unaffected by further adjustment for BMD or FRAX score. Adjusted for FRAX score with BMD, there was a significant effect of increasing HAL quintile on hip fracture risk (linear trend P<0.001); relative to quintile 1 (referent), the HR (95% CI) increased from 1.43 (1.12-1.82) for quintile 2, 1.61 (1.27-2.04) for quintile 3, 1.85 (1.47-2.32) for quintile 4, and 2.45 (1.96-3.05) for quintile 5. There was a modest but significant improvement in net reclassification improvement (1.5%) and integrated discrimination improvement (0.7%) indices. The effect of HAL was particularly strong among younger, non-osteoporotic women (FRAX-adjusted HR 1.70 per SD increase, 95% CI 1.48-1.94). Conclusions: DXA-derived hip geometry measurements are associated with incident hip fracture risk, but many do not confer significant independent predictive information. HAL was found to predict hip fractures when adjusted for BMD or FRAX score, and may be of clinical value in refining hip fracture risk.
    Journal of Clinical Endocrinology &amp Metabolism 03/2015; 100(5):jc20144390. DOI:10.1210/jc.2014-4390 · 6.31 Impact Factor
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    ABSTRACT: Context: Intuitively, rapid bone mineral density (BMD) loss should predict fracture risk independently of current BMD, but studies have not confirmed this. We hypothesized that measurement error when characterizing rates of BMD loss might explain this paradox. Objective: To examine the importance of measurement error in predicting BMD loss. Design and Setting: Retrospective registry study using BMD results for Manitoba, Canada. Patients: Untreated women age 50 years and older with three femoral neck BMD tests. Main Outcome Measures: Correlation in annualized rates of BMD change for interval 1 (first to second scan) versus interval 2 (second to third scan) with confirmatory model-based simulations that varied measurement error and testing intervals. Results: Five hundred forty two women with a mean age of 62 years had BMD measurements separated by a mean of 3.5 years for interval 1 and 3.4 years for interval 2. Mean femoral neck BMD loss was stable (-0.5% per year for interval 1, -0.6% per year for interval 2) with a weak negative correlation between intervals (r = -0.11, P = .01). There were no significant correlations for BMD change at the total hip (r = 0.01, P = .74) or total spine (r = -0.01, P = .77). Simulations showed low explained variation for BMD change between intervals 1 and 2 (<20%). To explain 50% of the variation of BMD change between intervals 1 and 2 required a BMD measurement error ≤0.008 g/cm(2) or a BMD testing interval ≥5 years. Conclusions: The low correlation between past and future BMD loss helps explain why the rate of BMD loss is unlikely to be helpful for refining fracture risk.
    Journal of Clinical Endocrinology &amp Metabolism 01/2015; 100(2):jc20143777. DOI:10.1210/jc.2014-3777 · 6.31 Impact Factor
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    ABSTRACT: We aimed to describe trends in the prevalence and incidence of diabetes mellitus and also report the overall use of diabetes medications among patients newly admitted to a long-term care facility (LTCF). A retrospective cohort study was done using health administrative databases in Saskatchewan. Eligible patients were newly admitted to LTCF in Saskatchewan between 2003 and 2011 and maintained LTCF residency for at least 6 months. Prevalence of diabetes was defined with physician or hospital claims in the 2 years preceding admission. Antihyperglycemic medication use was estimated from prescription claims data during the first 6 months after LTCF admission. All data were descriptively analyzed. The validated case definition for diabetes (≥2 diagnostic claims) in the 2 years before or 6 months after admission was met by 16.9% of patients (2471 of 14,624). An additional 965 patients (6.6%) had a single diabetes diagnostic claim or antihyperglycemic prescriptions only. Among patients receiving antihyperglycemic therapies, 64.9% (1518 of 2338) were exclusively managed with oral medications, and metformin was the most commonly used medication. Glyburide was commonly withdrawn after LTCF admission. Insulin use was observed in 23.9% of diabetes patients, with a mean daily average consumption of 54.7 units per day. Use of diabetes medications appear to generally align with Canadian practice recommendations as evidenced by declining use of glyburide and frequent use of metformin. Future studies should examine clinical benefits and safety of hypoglycemic agent use in LTCFs. Copyright © 2015 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.
    Canadian Journal of Diabetes 01/2015; 39(2). DOI:10.1016/j.jcjd.2014.10.002 · 0.46 Impact Factor
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    ABSTRACT: Aboriginal populations in northern Canada are experiencing rapid changes in their environments, which may negatively impact on health status. The purpose of our study was to compare chronic conditions and risk factors in northern Aboriginal populations, including First Nations (FN), Inuit and Métis populations, and northern non-Aboriginal populations. Data were from the Canadian Community Health Survey for the period from 2005 to 2008. Weighted multiple logistic regression models tested the association between ethnic groups and health outcomes. Model covariates were age, sex, territory of residence, education and income. Odds ratios (ORs) are reported and a bootstrap method calculated 95% confidence intervals (CIs) and p values. Odds of having at least one chronic condition was significantly lower for the Inuit (OR = 0.59; 95% CI: 0.43-0.81) than for non-Aboriginal population, but similar among FN, Métis and non-Aboriginal populations. Prevalence of many risk factors was significantly different for Inuit, FN and Métis populations. Aboriginal populations in Canada's north have heterogeneous health status. Continued chronic disease and risk factor surveillance will be important to monitor changes over time and to evaluate the impact of public health interventions.
    Chronic Diseases and Injuries in Canada 11/2014; 34(4):210-7. · 1.22 Impact Factor
  • Lisa M Lix, William D Leslie
    Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research 11/2014; 29(11):2323-2326. DOI:10.1002/jbmr.2369 · 6.59 Impact Factor
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    ABSTRACT: Patterns of multimorbidity, the co-occurrence of two or more chronic diseases, may not be constant across populations. Our study objectives were to compare prevalence estimates of multimorbidity in the Aboriginal population in Canada and a matched non-Aboriginal Caucasian population and identify the chronic diseases that cluster in these groups. We used data from the 2005 Canadian Community Health Survey (CCHS) to identify adult (≥ 18 years) respondents who self-identified as Aboriginal or non-Aboriginal Caucasian origin and reported having 2 or more of the 15 most prevalent chronic conditions measured in the CCHS. Aboriginal respondents who met these criteria were matched on sex and age to non-Aboriginal Caucasian respondents. Analyses were stratified by age (18-54 years and ≥ 55 years). Prevalence was estimated using survey weights. Latent class analysis (LCA) was used to identify disease clusters. A total of 1642 Aboriginal respondents were matched to the same number of non-Aboriginal Caucasian respondents. Overall, 38.9% (95% CI: 36.5%-41.3%) of Aboriginal respondents had two or more chronic conditions compared to 30.7% (95% CI: 28.9%-32.6%) of non-Aboriginal respondents. Comparisons of LCA results revealed that three or four clusters provided the best fit to the data. There were similarities in the diseases that tended to co-occur amongst older groups in both populations, but differences existed between the populations amongst the younger groups. We found a small group of younger Aboriginal respondents who had complex co-occurring chronic diseases; these individuals may especially benefit from disease management programs.
    Chronic Diseases and Injuries in Canada 11/2014; 34(4):218-25. · 1.22 Impact Factor
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    ABSTRACT: Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) are used to treat hypertension, however in vivo and clinical studies suggests that ARBs and ACE inhibitors may exert different effects on bone. The association between long-term use of ARBs and ACE inhibitors, and fracture requiring medical attention is limited. We conducted a population-based, retrospective cohort study with propensity score-matching using administrative databases in Ontario, Canada to examine the risk of osteoporosis-related fractures in hypertensive elderly treated with ARBs versus ACE inhibitors. We identified a cohort of newly treated hypertensive patients aged 66 years and older who initiated an ACE inhibitor from May 1, 2004 to March 31, 2012 and matched them to ARB users on propensity score, sex and age at drug initiation. The primary outcome was hip fracture and secondary outcomes were non-hip major osteoporotic fractures (other femoral, clinical vertebral, forearm, wrist, humerus) and other osteoporotic fractures (pelvis, clavicle, patella, shoulder, upper arm, tibia, fibula, ankle, scapula, ribs, sternum, trunk). We calculated hazard ratios (HRs) using Cox proportional hazards model with robust standard errors. Of the 87,635 patients who initiated treatment, 28,819 (32.9%) started ARBs and 58,816 (67.1%) started ACE inhibitors. Among new ARB users, 27,815 (96.5%) were successfully matched to ACE inhibitor users. Without dose adjustment, no significant association was observed for ARBs relative to ACE inhibitor users for hip fractures (HR = 0.88; 95% confidence interval [CI] 0.70–1.11), with a decreased risk of other major osteoporotic fractures (HR = 0.81; CI 0.70–0.93) and no significant association for other osteoporotic fractures (HR = 0.88; CI 0.74–1.05). When adjusted for dosage, there was no significant difference between the effects of ARBs and ACE inhibitors on hip (HR = 0.99; CI 0.78–1.25), other major osteoporotic (HR = 0.87; CI 0.75–1.01) and other osteoporotic fractures (HR = 0.90; CI 0.74–1.08). © 2014 American Society for Bone and Mineral Research
    Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research 11/2014; 29(11). DOI:10.1002/jbmr.2271 · 6.59 Impact Factor

Publication Stats

3k Citations
1,007.59 Total Impact Points


  • 2015
    • McGill University
      • Division of General Internal Medicine
      Montréal, Quebec, Canada
  • 1996–2015
    • University of Manitoba
      • • Department of Community Health Sciences
      • • Department of Internal Medicine
      • • Manitoba Centre for Health Policy
      • • Department of Psychology
      Winnipeg, Manitoba, Canada
  • 2014
    • Laval University
      Quebec City, Quebec, Canada
    • Canadian Academy of Dental Health and Community Sciences
      Mississauga, Ontario, Canada
    • Health Sciences Centre Winnipeg
      Winnipeg, Manitoba, Canada
  • 2013
    • University of British Columbia - Vancouver
      • Department of Obstetrics and Gynaecology
      Vancouver, British Columbia, Canada
    • The University of Sheffield
      • Medical School
      Sheffield, England, United Kingdom
  • 2008–2013
    • University of Saskatchewan
      • School of Public Health
      Saskatoon, Saskatchewan, Canada
    • University of Regina
      • Department of Psychology
      Regina, Saskatchewan, Canada
  • 2000
    • Health Canada
      Ottawa, Ontario, Canada