-
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: This study describes the association between unemployment and cause-specific mortality for a cohort of working-age Canadians. METHODS: We conducted a cohort study over an 11-year period among a broadly representative 15% sample of the non-institutionalized population of Canada aged 30--69 at cohort inception in 1991 (888,000 men and 711,600 women who were occupationally active). We used cox proportional hazard models, for six cause of death categories, two consecutive multi-year periods and four age groups, to estimate mortality hazard ratios comparing unemployed to employed men and women. RESULTS: For persons unemployed at cohort inception, the age-adjusted hazard ratio for all-cause mortality was 1.37 for men (95% confidence interval (CI): 1.32-1.41) and 1.27 for women (95% CI: 1.20-1.35). The age-adjusted hazard ratio for unemployed men and women was elevated for all six causes of death: malignant neoplasms, circulatory diseases, respiratory diseases, alcohol-related diseases, accidents and violence, and all other causes. For unemployed men and women, hazard ratios for all-cause mortality were equivalently elevated in 1991--1996 and 1997--2001. For both men and women, the mortality hazard ratio associated with unemployment attenuated with age. CONCLUSIONS: Consistent with results reported from other long-duration cohort studies, unemployed men and women in this cohort had an elevated risk of mortality for accidents and violence, as well as for chronic diseases. The persistence of elevated mortality risks over two consecutive multi-year periods suggests that exposure to unemployment in 1991 may have marked persons at risk of cumulative socioeconomic hardship.
BMC Public Health 05/2013; 13(1):441. · 2.00 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This study sought to examine provincial variation in work injuries and to assess whether contextual factors are associated with geographic variation in work injuries.
Individual-level data from the 2003 and 2005 Canadian Community Health Survey was obtained for a representative sample of 89,541 Canadians aged 15 to 75 years old who reported working in the past 12 months. A multilevel regression model was conducted to identify geographic variation and contextual factors associated with the likelihood of reporting a medically attended work injury, while adjusting for demographic and work variables.
Provincial differences in work injuries were observed, even after controlling for other risk factors. Workers in western provinces such as Saskatchewan (adjusted odds ratio [AOR], 1.30; 95% confidence interval [CI], 1.09-1.55), Alberta (AOR, 1.31; 95% CI, 1.13-1.51), and British Columbia (AOR, 1.46; 95% CI, 1.26-1.71) had a higher risk of work injuries compared with Ontario workers. Indicators of area-level material and social deprivation were not associated with work injury risk.
Provincial differences in work injuries suggest that broader factors acting as determinants of work injuries are operating across workplaces at a provincial level. Future research needs to identify the provincial determinants and whether similar large area-level factors are driving work injuries in other countries.
Annals of epidemiology 05/2013; 23(5):260-6. · 2.95 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To estimate the direct and indirect pathways between education and diabetes.
We examined the relative contribution of eight different pathways between education and diabetes incidence over a 9-year period in Ontario, Canada. Our data source was respondents (35-60 years of age) to the 2000-2001 Canadian Community Health Survey individually linked with physician and hospital administrative data. Our sample contained 11,899 participants with no previous diagnosis of diabetes. The direct and indirect effects of education level on incident diabetes were estimated using Aalen additive hazard models.
Not having completed secondary education was associated with 120 extra diabetes cases per 10,000 men per year and 43 additional diabetes cases per 10,000 women per year, compared with having Bachelors education or higher. Body mass index accounted for 13 of the 120 extra diabetes cases among men, and 24 of the 43 additional diabetes cases for women.
Of the mediating pathways examined in this paper, body mass index was the pathway through which the largest number of diabetes cases was mediated among men and women. A substantial number of excess diabetes cases among respondents with lower education levels, in particular among men, were not mediated through any of the eight pathways examined.
Annals of epidemiology 03/2013; 23(3):143-9. · 2.95 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: Implementation effectiveness models have identified important factors that can promote the successful implementation of an innovation; however, these models have been examined within contexts where innovations are adopted voluntarily and often ignore the socio-political and environmental context. In the field of occupational health and safety, there are circumstances where organizations must adopt innovations to comply with a regulatory standard. Examining how the external environment can facilitate or challenge an organization's change process may add to our understanding of implementation effectiveness. The objective of this study is to describe implementation facilitators and barriers in the context of a regulation designed to promote the uptake of safer engineered needles in healthcare. METHODS: The proposed study will focus on Ontario's safer needle regulation (2007) which requires healthcare organizations to transition to the use of safer engineered needles for the prevention of needlestick injuries. A collective case study design will be used to learn from the experiences of three acute care hospitals in the province of Ontario, Canada. Interviews with management and front-line healthcare workers and analysis of supporting documents will be used to describe the implementation experience and examine issues associated with the integration of these devices. The data collection and analysis process will be influenced by a conceptual framework that draws from implementation science and the occupational health and safety literature. DISCUSSION: The focus of this study in addition to the methodology creates a unique opportunity to contribute to the field of implementation science. First, the study will explore implementation experiences under circumstances where regulatory pressures are influencing the organization's change process. Second, the timing of this study provides an opportunity to focus on issues that arise during later stages of implementation, a phase during the implementation cycle that has been understudied. This study also provides the opportunity to examine the relevance and utility of current implementation science models in the field of occupational health where the adoption of an innovation is meant to enhance the health and safety of workers. Previous work has tended to focus almost exclusively on innovations that are designed to enhance an organization's productivity or competitive advantage.
Implementation Science 01/2013; 8(1):9. · 3.10 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVE: To estimate the rate of work injury over the 24 h clock in Ontario workers over 5 years (2004-2008). METHODS: A cross-sectional, observational study of work-related injury and illness was conducted for a population of occupationally active adults using two independent data sources (lost-time compensation claims and emergency department encounter records). Hours worked annually by the Ontario labour force by time of day, age, gender and occupation were estimated from population-based surveys. RESULTS: There was an approximately 40% higher incidence of emergency department visits for work-related conditions than of lost-time workers' compensation claims (707 933 emergency department records and 457 141 lost-time claims). For men and women and across all age groups, there was an elevated risk of work-related injury or illness in the evening, night and early morning periods in both administrative data sources. This elevated risk was consistently observed across manual, mixed and non-manual occupational groups. The fraction of lost-time compensation claims that can be attributed to elevated risk of work injury in evening or night work schedules is 12.5% for women and 5.8% for men. CONCLUSIONS: Despite the high prevalence of employment in non-daytime work schedules in developed economies, the work injury hazards associated with evening and night schedules remain relatively invisible. This study has demonstrated the feasibility of using administrative data sources to enhance capacity to conduct surveillance of work injury risk by time of day. More sophisticated aetiological research is needed to understand the specific mechanisms of hazards associated with non-regular work hours.
Occupational and environmental medicine 09/2012; · 3.64 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The objective of this study was to compare the incidence of work-related injury and illness presenting to Ontario emergency departments to the incidence of worker's compensation claims reported to the Ontario Workplace Safety & Insurance Board over the period 2004-2008.
Records of work-related injury were obtained from two administrative data sources in Ontario for the period 2004-2008: workers' compensation lost-time claims (N=435,336) and records of non-scheduled emergency department visits where the main problem was attributed to a work-related exposure (N=707,963). Denominator information required to compute the risk of work injury per 2,000,000 work hours, stratified by age and gender was estimated from labour force surveys conducted by Statistics Canada.
The frequency of emergency department visits for all work-related conditions was approximately 60% greater than the incidence of accepted lost-time compensation claims. When restricted to injuries resulting in fracture or concussion, gender-specific age differences in injury incidence were similar in the two data sources. Between 2004 and 2008, there was a 14.5% reduction in emergency department visits attributed to work-related causes and a 17.8% reduction in lost-time compensation claims. There was evidence that younger workers were more likely than older workers to seek treatment in an emergency department for work-related injury.
In this setting, emergency department records available for the complete population of Ontario residents are a valid source of surveillance information on the incidence of work-related disorders. Occupational health and safety authorities should give priority to incorporating emergency department records in the routine surveillance of the health of workers.
Occupational and environmental medicine 01/2012; 69(5):317-24. · 3.64 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Adolescents and young adults who are out of school are at elevated risk for a work injury.
To obtain more information on this "high risk" group of young workers, young people at youth employment centers across Ontario were asked through an online survey about training, unsafe work conditions, work injuries and safety knowledge.
The 1,886 youth who completed the survey reported a medically attended work injury rate of 14.45 per 100 FTEs. Also, the most common unsafe work conditions were dust/particles, trip hazards and heavy lifting. In addition, many young workers reported using much of their income for living essentials (e.g., rent).
Though not a representative sample, it appears that youth using employment centers experience many unsafe work conditions and work injuries. While many report safety training, the nature and effectiveness of this training remains to be determined. The large portion of young workers out of school and working for living essentials included in this sample suggest that youth employment centers should be considered in future prevention efforts targeting this vulnerable subgroup of workers.
American Journal of Industrial Medicine 02/2011; 54(4):325-37. · 1.63 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To describe the association between occupation and risk of suicide among working-age men and women in Canada.
This study of suicide mortality over an 11-year period is based on a broadly representative 15% sample of the noninstitutionalized population of Canada aged 30 to 69 years at cohort inception. Age-standardized mortality rates (ASMRs) and rate ratios were calculated for men and women in 5 categories of skill level and 80 specific occupational groups, as well as for people not occupationally active.
The suicide mortality rate was 20.1/100 000 person years for occupationally active men (during 9 600 000 person years of follow-up) and 5.3/100 000 person years for occupationally active women (during 8 100 000 person years of follow-up). Among occupationally active men, elevated rates of suicide mortality were observed for 9 occupational groups and protective effects were observed for 6 occupational groups. Among women, elevated rates of suicide were observed in 4 occupational groups and no protective effects were observed. For men and women, ASMRs for suicide were inversely related to skill level.
The limited number of associations between occupational groups and suicide risk observed in this study suggests that, with few exceptions, the characteristics of specific occupations do not substantially influence the risk for suicide. There was a moderate gradient in suicide mortality risk relative to occupational skill level. Suicide prevention strategies in occupational settings should continue to emphasize efforts to restrict and limit access to lethal means, one of the few suicide prevention policies with proven effectiveness.
Canadian journal of psychiatry. Revue canadienne de psychiatrie 06/2010; 55(6):369-76. · 2.42 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This study was designed to test the hypothesis that fetal exposure to corticosteroids in the antenatal period is an independent risk factor for the development of asthma in early childhood with little or no effect in later childhood. A population-based cohort study of all pregnant women who resided in Nova Scotia, Canada, and gave birth to a singleton fetus between 1989 and 1998 was undertaken. After a priori specified exclusions, 80,448 infants were available for analysis. Using linked health care utilization records, incident asthma cases developed after 36 months of age were identified. Extended Cox proportional hazards models were used to estimate hazard ratios while controlling for confounders. Exposure to corticosteroids during pregnancy was associated with a risk of asthma in childhood between 3-5 years of age: adjusted hazard ratio of 1.19 (95% confidence interval: 1.03, 1.39), with no association noted after 5 years of age: adjusted hazard ratio for 5-7 years was 1.06 (95% confidence interval: 0.86, 1.30) and for 8 or greater years was 0.74 (95% confidence interval: 0.54, 1.03). Antenatal steroid therapy appears to be an independent risk factor for the development of asthma between 3 and 5 years of age.
Journal of pregnancy 01/2010; 2010:789748.
-
[show abstract]
[hide abstract]
ABSTRACT: This study was designed to test the hypothesis that fetal exposure to corticosteroids in the antenatal period is an independent risk factor for the development of asthma in childhood.
A population-based cohort study was conducted of all pregnant women who resided in Nova Scotia, Canada, and gave birth to a singleton fetus between January 1989 and December 1998 and lived to discharge. After exclusions, 79,395 infants were available for analysis. Using linked health care utilization records, incident asthma cases between 36 to 72 months of age were identified. Generalized Estimating Equations were used to estimate the odds ratio of the association between exposure to corticosteroids and asthma while controlling for confounders.
Over the 10 years of the study corticosteroid therapy increased by threefold. Exposure to corticosteroids during pregnancy was associated with a risk of asthma in childhood: adjusted odds ratio of 1.23 (95% confidence interval: 1.06, 1.44).
Antenatal steroid therapy appears to be an independent risk factor for the development of asthma between 36 and 72 months of age. Further research into the smallest possible steroid dose required to achieve the desired post-natal effect is needed to reduce the risk of developing childhood asthma.
Journal of Asthma 03/2009; 46(1):47-52. · 1.52 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The objective of this article is to examine the factors associated with differences in access to income replacement benefits for workers experiencing a work-related injury or illness of 1-week or longer in the Canadian labor force.
This study utilized data from the Survey of Labour and Income Dynamics, a representative longitudinal survey conducted by Statistics Canada. A total of 3,352 work-related absences were identified. Logistic regression models examined factors at the individual, occupational, and geographic level that were associated with the probability of receiving compensation.
The probability of not receiving employer or workers' compensation benefits was higher among women, immigrants in their first 10 years in Canada, younger workers, respondents who were in their first year of a job, those who were not members of a union or collective bargaining agreement, and part-time workers.
More research is required to understand why almost 50% of respondents with 1-week or longer work-related absences did not report receiving workers' compensation payments following their absence. More importantly, research is required to understand why particular groups of workers are more likely to be excluded from any type of compensation for lost earnings after a work-related injury and illness in Canada.
American Journal of Industrial Medicine 02/2009; 52(4):341-9. · 1.63 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In Canada levels of smoking have decreased and levels of physical activity have increased over the last 20 years. However, little research has examined if educational inequalities in either of these important health determinants have changed.
A secondary analysis of Canadian population-based surveys from 1974 through to 2005 was conducted. The prevalence of both smoking and physical activity across educational groups for both men and women, as well as relative and absolute measures of inequality was estimated.
Differences in both smoking and physical activity across educational groups in all surveys examined between 1974 and 2005 were found, with lower educational groups more likely to be heavy smokers and inactive in each survey. Both relative and absolute educational inequalities in smoking widened between 1974 and 2005 (relative concentration index (RCI) for smoking 10 plus cigarettes per day changed from -7.9 to -26.9 among men; and from -4.8 to -27.4 among women), with inequalities in physical activity narrowing between 1981 and 1996, then widening between 1996 and 2005 (RCI for inactivity -4.34 to -6.75 among men; -3.57 to -5.54 among women). In general, results among men and women did not differ substantially.
It is unlikely that the widening educational inequalities in smoking and physical activity documented here reflect lower knowledge of the consequences of smoking and physical inactivity among lower educated groups. The results suggest more work needs to be done in both designing population health approaches that focus on equity and the creation of supportive environments that provide equal opportunities for behaviour change for all educational groups in Canada.
Journal of epidemiology and community health 02/2009; 63(4):317-23. · 3.04 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This paper presents a hypothesis that fetal exposure to corticosteroids is an independent risk factor for the development of asthma in childhood. The prevalence of childhood asthma saw a dramatic rise from the 1980s up until the early 2000s. Among the explanations for the increase in asthma prevalence included interest in exposures arising in the gestational period. Overlapping the time period of the increasing prevalence of childhood asthma is the increased use of antenatal corticosteroid therapy for fetal lung maturation. Through an examination of the published literature, a time dependent association between year of birth (and hence exposure to the antenatal corticosteroids) and the relationship between preterm birth and childhood asthma is noted. A brief review of the trends in the prevalence of asthma, the use of antenatal corticosteroids including their established latent effects and the time dependant association between preterm birth and the risk of childhood asthma are provided.
Medical Hypotheses 02/2008; 70(5):981-9. · 1.39 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Existing research suggests that workplace injuries can have significant economic and social consequences for workers; but there are no quantitative studies on complete populations.
The British Columbia Linked Health Database (BCLHD) was used to examine 1994 injured workers who lost work time due to the injury (LT) and a group of injured individuals who did not lose time after their injuries (NLT). Three outcomes were explored: (1) residential change, (2) marital instability, and (3) social assistance use. Logistic regression adjusted for several individual and injury characteristics.
LTs were more likely to move and collect income assistance benefits, and less likely to experience a relationship break-up than the NLTs. LTs off work for 12 or more weeks were more likely to receive income assistance than LTs off for less time.
The increased risk suggests that the long-term economic consequences of disabling work injury may not be fully mitigated by workers compensation benefits.
American Journal of Industrial Medicine 10/2007; 50(9):633-45. · 1.63 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To describe the provision of safety training to Canadian employees, specifically those in their first year of employment with a new employer.
Three repeated national Canadian cross-sectional surveys.
59 159 respondents from Statistics Canada's Workplace and Employee Surveys (1999, 2001 and 2003), 5671 who were in their first year of employment.
Receiving occupational health and safety training, orientation training or office or non-office equipment training in either a classroom or on-the-job in the previous 12 months.
Only 12% of women and 16% of men reported receiving safety training in the previous 12 months. Employees in their first 12 months of employment were more likely to receive safety training than employees with >5 years of job tenure. However, still only one in five new employees had received any safety training while with their current employer. In a fully adjusted regression model, employees who had access to family and support programs, women in medium-sized workplaces and in manufacturing, and men in large workplaces and in part-time employment all had an increased probability of receiving safety training. No increased likelihood of safety training was found in younger workers or those in jobs with higher physical demands, both of which are associated with increased injury risk.
From our results, it would appear that only one in five Canadian employees in their first year of a new job received safety training. Further, the provision of safety training does not appear to be more prevalent among workers or in occupations with increased risk of injuries.
Injury Prevention 03/2007; 13(1):37-41. · 1.39 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To examine the overall healthcare and mental healthcare services use of families of injured workers before and after a workplace injury.
We use an administrative database that links individual publicly funded healthcare data and Workers' Compensation Board (WCB) data for the entire population of British Columbia (BC), Canada. The spouses and children of all injured workers who filed a WCB claim in 1994 and missed one or more days of work due to the injury (lost time) were included. We compare their change in use of healthcare services relative to a year before the injury to families of workers who did not require time off for their injuries (no lost time) and families of individuals who were not injured (non-injured comparisons).
Differences in healthcare services use among the three groups of spouses were marginal, and differences for increases in mental healthcare services use were non-significant. As well, all three groups of children decreased their use of physician and hospital services and increased their use of mental healthcare services, with very little difference among groups.
This was a descriptive study looking at a broad group of injured workers and their families. Even modest increases in healthcare use following a workplace injury have some basis for further study.
Healthcare policy = Politiques de sante 03/2007; 2(3):e121-39.
-
[show abstract]
[hide abstract]
ABSTRACT: To examine the potential effectiveness and efficiency of different guidelines for statin treatment to reduce deaths from coronary heart disease in the Canadian population.
Modelled outcomes of screening and treatment recommendations of six national or international guidelines--from Canada, Australia, New Zealand, the United States, joint British societies, and European societies.
Canada.
Details for 6760 men and women aged 20-74 years from the Canadian Heart Health Survey (weighted sample of 12,300,000 people) that included physical measurements including a lipid profile.
The number of people recommended for treatment with statins, the potential number of deaths from coronary heart disease avoided, and the number needed to treat to avoid one coronary heart disease death with five years of statin treatment if the recommendations from each guideline were fully implemented.
When applied to the Canadian population, the Australian and British guidelines were the most effective, potentially avoiding the most deaths over five years (> 15,000 deaths). The New Zealand guideline was the most efficient, potentially avoiding almost as many deaths (14,700) while recommending treatment to the fewest number of people (12.9% of people v 17.3% with the Australian and British guidelines). If their "optional" recommendations are included, the US guidelines recommended treating about twice as many people as the New Zealand guidelines (24.5% of the population, an additional 1.4 million people) with almost no increase in the number of deaths avoided.
By focusing recommendations on people with the highest risk of coronary heart disease, the Canadian, US, and European societies guidelines could improve either their effectiveness (in terms of hundreds of avoided deaths) or efficiency (in terms of thousands of fewer people recommended treatment) in the Canadian population.
BMJ (Clinical research ed.). 06/2006; 332(7555):1419.
-
BMJ (Clinical research ed.). 04/2006; 332(7542):659-62.
-
[show abstract]
[hide abstract]
ABSTRACT: The present study examined the relationship between work-family spillover, job characteristics, and sleep quality in a sample of health care workers (N = 168) recruited from 3 Canadian hospitals. A multiple regression analysis revealed that positive family-to-work spillover is associated with better sleep quality, after controlling for age, physical health, depressive symptomatology, work situation, and number of children. These findings are discussed within a theoretical framework drawing on the concepts of effort and recovery.
Journal of Occupational Health Psychology 02/2006; 11(1):27-37. · 2.07 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Major social policy changes were implemented in Canada in the last decade with few efforts to examine their potential health effects.
We sought to determine the impact of a large reduction in welfare benefits on use of ambulatory physician mental health services in areas with high levels of welfare dependency relative to areas with low levels of welfare dependency.
The setting was Toronto, Canada. Data sources included census, provincial health insurance, and municipal welfare data. We used generalized estimating equations to compare ambulatory mental health service rates by neighborhood level of welfare dependency before and after a 21.6% reduction in welfare payments.
There were no long-term relative differences by welfare dependency in mental health service use before compared with after the policy change. There was a very small short-term increase in mental health visits to generalists in the 6 months after the policy change. We demonstrated a marked gradient in psychiatric service use with low welfare dependency areas having significantly higher rates of use than high welfare dependency areas.
We demonstrated a mismatch between known levels of need for care and levels of psychiatric use. We conclude that where use of services is not tightly linked to need for services, utilization data may be unsuitable for evaluating programs or policies. Social policy changes with potential health effects should have integrated evaluations planned at the time of policy implementation.
Medical Care 10/2005; 43(9):885-91. · 3.41 Impact Factor
