Publications

Publication

Survey Results on Mental Health Impacts of COVID-19 in New Brunswick

Sandra Magalhaes, Madeleine Gorman-Asal, Chandy Somayaji

Summary...


This research seeks to describe the impacts that specific physical, social, or economic factors are having on the mental health of New Brunswickers overall, as well as for specific subgroups in our communities. 

In August 2020, Pollara Strategic Insights and Mental Health Research Canada carried out an online survey asking New Brunswickers to indicate the impact a particular factor had on their mental health. Our research analyzes responses to questions regarding social and economic factors and recreational activities.

We also examine survey questions on changes in the frequency of respondents’ negative behaviours, such as cannabis use, alcohol use, and household conflict, as well as on perceptions of confidence in their ability to recover from the challenges of the pandemic.

Rapport - Résultats du sondage sur les effets de la COVID-19 sur la santé mentale au Nouveau-Brunswick (2021)
Report: Survey Results on Mental Health Impacts of COVID-19 in New Brunswick (2021)

NB-IRDT Chronic Obstructive Pulmonary Disease research program – Report one: investigation of Statistics Canada Public Use Microdata Files

Ted McDonald, Kyle Rogers, Bethany Daigle, Anat Ziv

Summary...



This report examines the utility of existing and easy-to-access data in the form of Statistics Canada’s Canadian Community Health Survey public use microdata files (CCHS PUMF). 
 
These data sources allow for easy presentation of Chronic Obstructive Pulmonary Disease (COPD) at the New Brunswick level, as well as partial presentation at the health zone level. Because the CCHS is an annual national product, we will be able to continually update the data presented herein following the trends over time and can compare NB values against other Canadian jurisdictions for benchmarking. Further, the CCHS PUMF data include a variety of items for examination rarely available in administrative data sources—items like: 
 
·         Blood Pressure
·         Body Mass Index
·         Difficulty with Activities
·         Education
·         Life Stress 
·         Needed Help with Instrumental Activities of Daily Living 
·         Physical Inactivity
·         Self-Perceived Health
·         Type of Smoker
·         Working Status 



Report - NB-IRDT Chronic Obstructive Pulmonary Disease research program – Report one: investigation of Statistics Canada Public Use Microdata Files (2021)

College & university graduate retention in New Brunswick: 2010 - 2018

Ted McDonald, Erfan Bhuiyan, Bethany Daigle, Pablo Miah

Summary...




New Brunswick (NB) invests substantially in educating post-secondary students. When qualified graduates leave the province, much of that investment is lost, as they take their human capital (and potential earnings) with them when they relocate. Understanding what kinds of graduates are leaving and what kinds of graduates are staying can help inform targeted policies that encourage graduates to stay and contribute to the local economy, and estimating graduate retention rates can help determine if NB is seeing a high or low return on its investments. 
 
The objective of this report is to present a statistical description of individuals who have graduated from the following publicly funded colleges and universities in NB*:

  • The University of New Brunswick (UNB)
  • Université de Moncton (UdeM)
  • Mount Allison University (MTA) 
  • St. Thomas University (STU)
  • New Brunswick Community College (NBCC)
  • Collège communautaire du Nouveau-Brunswick (CCNB)
  • The New Brunswick College of Craft and Design (NBCCD)

*The Maritime College of Forest Technology is excluded from this study. 






Report - College & university graduate retention in New Brunswick: 2010 - 2018 (2021)
Rapport - Rétention des diplômés collégiaux et universitaires au Nouveau-Brunswick : 2010-2018

Evaluating the Sensitivity of PM2.5–Mortality Associations to the Spatial and Temporal Scale of Exposure Assessment

Dan L. Crouse, Anders C. Erickson, Tanya Christidis, Lauren Pinault, Aaron van Donkelaar, Chi Li, Jun Meng, Randall V. Martin, Michael Tjepkema, Perry Hystad, Rick Burnett, Amanda Pappin, Michael Brauer, Scott Weichenthal

Summary...

Background:
The temporal and spatial scales of exposure assessment may influence observed associations between fine particulate air pollution (PM2.5) and mortality, but few studies have systematically examined this question.

Methods:
We followed 2.4 million adults in the 2001 Canadian Census Health and Environment Cohort for nonaccidental and cause-specific mortality between 2001 and 2011. We assigned PM2.5 exposures to residential locations using satellite-based estimates and compared three different temporal moving averages (1, 3, and 8 years) and three spatial scales (1, 5, and 10 km) of exposure assignment. In addition, we examined different spatial scales based on age, employment status, and urban/rural location, and adjustment for O3, NO2, or their combined oxidant capacity (Ox).

Results:
In general, longer moving averages resulted in stronger associations between PM2.5 and mortality. For nonaccidental mortality, we observed a hazard ratio of 1.11 (95% CI = 1.08, 1.13) for the 1-year moving average compared with 1.23 (95% CI = 1.20, 1.27) for the 8-year moving average. Respiratory and lung cancer mortality were most sensitive to the spatial scale of exposure assessment with stronger associations observed at smaller spatial scales. Adjustment for oxidant gases attenuated associations between PM2.5 and cardiovascular mortality and strengthened associations with lung cancer. Despite these variations, PM2.5 was associated with increased mortality in nearly all of the models examined.

Conclusions:
These findings support a relationship between outdoor PM2.5 and mortality at low concentrations and highlight the importance of longer-exposure windows, more spatially resolved exposure metrics, and adjustment for oxidant gases in characterizing this relationship.

Journal - Evaluating the Sensitivity of PM2.5–Mortality Associations to the Spatial and Temporal Scale of Exposure Assessment (2020)

Individual and community-level income and the risk of diabetes rehospitalization among women and men: a Canadian population-based cohort study

Neeru Gupta, Dan L. Crouse, Adele Balram

Summary...

Background
Marked disparities by socioeconomic status in the risk of potentially avoidable hospitalization for chronic illnesses have been observed in many contexts, including those with universal health coverage. Less well known is how gender mediates such differences. We conducted a population-based cohort study to describe associations between household and community-level income and rehospitalizations for types 1 and 2 diabetes mellitus among Canadian women and men.

Methods
Our cohorts were drawn from respondents to the 2006 mandatory long-form census linked longitudinally to 3 years of nationally standardized hospital records. We included adults 30–69 years hospitalized with diabetes at least once during the study period. We used logistic regressions to estimate odds ratios for 12-month diabetes rehospitalization associated with indicators of household and community-level income, with separate models by gender, and controlling for a range of other sociodemographic characteristics. Since diabetes may not always be recognized as the main reason for hospitalization, we accounted for disease progression through consideration of admissions where diabetes was previously identified as a secondary diagnosis.

Results
Among persons hospitalized at least once with diabetes (n = 41,290), 1.5% were readmitted within 12 months where the initial admission had diabetes as the primary diagnosis, and 1.8% were readmitted where the initial admission had diabetes as a secondary diagnosis. For men, being in the lowest household income quintile was associated with higher odds of rehospitalization in cases where the initial admission listed diabetes as either the primary diagnosis (OR = 2.21; 95% CI = 1.38–3.51) or a secondary diagnosis (OR = 1.51; 95% CI = 1.02–2.24). For women, we found no association with income and rehospitalization, but having less than university education was associated with higher odds of rehospitalization where diabetes was a secondary diagnosis of the initial admission (OR = 1.88; 95% CI = 1.21–2.92). We also found positive, but insignificant associations between community-level poverty and odds of rehospitalization.

Conclusions
Universal health coverage remains insufficient to eliminate socioeconomic inequalities in preventable diabetes-related hospitalizations, as illustrated in this Canadian context. Decision-makers should tread cautiously with gender-blind poverty reduction actions aiming to enhance population health that may inadequately respond to the different needs of disadvantaged women and men with chronic illness.

Journal - Individual and community-level income and the risk of diabetes rehospitalization among women and men: a Canadian population-based cohort study (2020)

Global estimates of mortality associated with long-term exposure to outdoor fine particulate matter

Richard Burnett, Hong Chen, View ORCID ProfileMieczysław Szyszkowicz, Neal Fann, Bryan Hubbell, C. Arden Pope III, Joshua S. Apte, View ORCID ProfileMichael Brauer, Aaron Cohen, Scott Weichenthal, Jay Coggins, Qian Di, Bert Brunekreef, Joseph Frostad, Stephen S. Lim, Haidong Kan, Katherine D. Walker, George D. Thurston, View ORCID ProfileRichard B. Hayes, Chris C. Lim, Michelle C. Turner, Michael Jerrett, Daniel Krewski, Susan M. Gapstur, View ORCID ProfileW. Ryan Diver, Bart Ostro, Debbie Goldberg, Daniel L. Crouse, Randall V. Martin, Paul Peters, Lauren Pinault, Michael Tjepkema, Aaron van Donkelaar, Paul J. Villeneuve, Anthony B. Miller, Peng Yin, Maigeng Zhou, Lijun Wang, Nicole A. H. Janssen, Marten Marra, Richard W. Atkinson, Hilda Tsang, Thuan Quoc Thach, John B. Cannon, Ryan T. Allen, Jaime E. Hart, Francine Laden, Giulia Cesaroni, Francesco Forastiere, Gudrun Weinmayr, Andrea Jaensch, Gabriele Nagel, Hans Concin, Joseph V. Spadaro

Summary...

Exposure to ambient fine particulate matter (PM2.5) is a major global health concern. Quantitative estimates of attributable mortality are based on disease-specific hazard ratio models that incorporate risk information from multiple PM2.5 sources (outdoor and indoor air pollution from use of solid fuels and secondhand and active smoking), requiring assumptions about equivalent exposure and toxicity. We relax these contentious assumptions by constructing a PM2.5-mortality hazard ratio function based only on cohort studies of outdoor air pollution that covers the global exposure range. We modeled the shape of the association between PM2.5 and nonaccidental mortality using data from 41 cohorts from 16 countries—the Global Exposure Mortality Model (GEMM). We then constructed GEMMs for five specific causes of death examined by the global burden of disease (GBD). The GEMM predicts 8.9 million [95% confidence interval (CI): 7.5–10.3] deaths in 2015, a figure 30% larger than that predicted by the sum of deaths among the five specific causes (6.9; 95% CI: 4.9–8.5) and 120% larger than the risk function used in the GBD (4.0; 95% CI: 3.3–4.8). Differences between the GEMM and GBD risk functions are larger for a 20% reduction in concentrations, with the GEMM predicting 220% higher excess deaths. These results suggest that PM2.5 exposure may be related to additional causes of death than the five considered by the GBD and that incorporation of risk information from other, nonoutdoor, particle sources leads to underestimation of disease burden, especially at higher concentrations.

Journal - Global estimates of mortality associated with long-term exposure to outdoor fine particulate matter (2018)

Neighbourhood environments and the risk of hospital admission for cardiometabolic and mental health comorbidities in multiple sclerosis: A population cohort analysis using linked administrative data

Dan Lawson Crouse, Ismael Foroughi, Neeru Gupta

Summary...

This study exploits administrative data for neuroepidemiological research and examines associations between neighbourhood environments and risk of hospitalization among multiple sclerosis (MS) patients in New Brunswick, Canada. We created a provincial database of MS patients by linking administrative health records with geographic-based characteristics of local communities. Using Cox models, we found the risk of admission for cardiometabolic complications was lower among residents of ethnically homogeneous neighbourhoods (hazards ratio [HR]: 0.75 [95% confidence interval (CI): 0.60–0.95]); that for mental health disorders was higher in socioeconomically deprived (HR: 1.80 [95% CI: 1.06–3.05]) and residentially unstable (HR: 1.61 [95% CI: 1.05–2.46]) neighbourhoods. Results suggest that selected neighbourhood environments may be associated with differential hospital burden among MS patients.

Journal - Neighbourhood environments and the risk of hospital admission for cardiometabolic and mental health comorbidities in multiple sclerosis: A population cohort analysis using linked administrative data (2021)

New administrative data for research on immigrants to Canada

Ted McDonald, Michael Haan

Summary...

 

Chapter - New Administrative Data for Research on Immigrants to Canada (2019)

Complex relationships between greenness, air pollution, and mortality in a population-based Canadian cohort

Dan L. Crouse, Lauren Pinault, Adele Balram, Michael Brauer, Richard T. Burnett, Randall V. Martin, Aaron van Donkelaar, Paul J. Villeneuve, Scott Weichenthal

Summary...

Background
Epidemiological studies have consistently demonstrated that exposure to fine particulate matter (PM2.5) is associated with increased risks of mortality. To a lesser extent, a series of studies suggest that living in greener areas is associated with reduced risks of mortality. Only a handful of studies have examined the interplay between PM2.5, greenness, and mortality.

Methods
We investigated the role of residential greenness in modifying associations between long-term exposures to PM2.5 and non-accidental and cardiovascular mortality in a national cohort of non-immigrant Canadian adults (i.e., the 2001 Canadian Census Health and Environment Cohort). Specifically, we examined associations between satellite-derived estimates of PM2.5 exposure and mortality across quintiles of greenness measured within 500 m of individual's place of residence during 11 years of follow-up. We adjusted our survival models for many personal and contextual measures of socioeconomic position, and residential mobility data allowed us to characterize annual changes in exposures.

Results
Our cohort included approximately 2.4 million individuals at baseline, 194,270 of whom died from non-accidental causes during follow-up. Adjustment for greenness attenuated the association between PM2.5 and mortality (e.g., hazard ratios (HRs) and 95% confidence intervals (CIs) per interquartile range increase in PM2.5 in models for non-accidental mortality decreased from 1.065 (95% CI: 1.056–1.075) to 1.041 (95% CI: 1.031–1.050)). The strength of observed associations between PM2.5 and mortality decreased as greenness increased. This pattern persisted in models restricted to urban residents, in models that considered the combined oxidant capacity of ozone and nitrogen dioxide, and within neighbourhoods characterised by high or low deprivation. We found no increased risk of mortality associated with PM2.5 among those living in the greenest areas. For example, the HR for cardiovascular mortality among individuals in the least green areas was 1.17 (95% CI: 1.12–1.23) compared to 1.01 (95% CI: 0.97–1.06) among those in the greenest areas.

Conclusions
Studies that do not account for greenness may overstate the air pollution impacts on mortality. Residents in deprived neighbourhoods with high greenness benefitted by having more attenuated associations between PM2.5 and mortality than those living in deprived areas with less greenness. The findings from this study extend our understanding of how living in greener areas may lead to improved health outcomes.

Journal - Complex relationships between greenness, air pollution, and mortality in a population-based Canadian cohort (2019)

Provider volume and maternal complications after Caesarean section: results from a population-based study

Philip S. J. Leonard, Dan L. Crouse, Jonathan G. Boudreau, Neeru Gupta, James T. McDonald

Summary...

Background
A large literature search suggests a relationship between hospital/surgeon caseload volume and surgical complications. In this study, we describe associations between post-operative maternal complications following Caesarean section and provider caseload volume, provider years since graduation, and provider specialization, while adjusting for hospital volumes and patient characteristics.

Methods
Our analysis is based on population-based discharge abstract data for the period of April 2004 to March 2014, linked to patient and physician universal coverage registry data. We consider all hospital admissions (N = 20,914) in New Brunswick, Canada, where a Caesarean Section surgery was recorded, as identified by a Canadian Classification of Health Intervention code of 5.MD.60.XX. We ran logistic regression models to identify the odds of occurrence of post-surgical complications during the hospital stay.

Results
Roughly 2.6% of admissions had at least one of the following groups of complications: disseminated intravascular coagulation, postpartum sepsis, postpartum hemorrhage, and postpartum infection. The likelihood of complication was negatively associated with provider volume and provider years of experience, and positively associated with having a specialization other than maternal-fetal medicine or obstetrics and gynecology.

Conclusions
Our results suggest that measures of physician training and experience are associated with the likelihood of Caesarean Section complications. In the context of a rural province deciding on the number of rural hospitals to keep open, this suggests a trade off between the benefits of increased volume versus the increased travel time for patients.

Journal - Provider volume and maternal complications after Caesarean section: results from a population-based study (2020)

Residential exposure to fine particulate matter air pollution and incident breast cancer in a cohort of Canadian women

Paul J. Villeneuve, Mark S. Goldberg, Dan L. Crouse, Teresa To, Scott A. Weichenthal, Claus Wall, Anthony B. Miller

Summary...

Background:
Air pollution has been classified as a human carcinogen based largely on epidemiological studies of lung cancer. Recent research suggests that exposure to ambient air pollution increases the risk of breast cancer.

Methods: 
Our aim was to characterize associations between residential exposure to ambient fine particulate matter (PM2.5) and the incidence of breast cancer in a cohort of 89,247 women enrolled in the Canadian National Breast Screening Study between 1980 and 1985. Vital status and incident cancers were determined through record linkage to the national registry data through 2005. Individual-level estimates of exposures to PM2.5 at baseline were derived from satellite observations. Six thousand five hundred three incident breast cancers were identified during follow-up. We classified menopausal status using self-reported information collected at baseline and by attained age (50, 52, and 54 years) as women were followed-up. We computed hazard ratios (HRs) and their 95% confidence intervals (CI) using age as the time axis. Models were adjusted for several individual risk factors, including reproductive history, as well as census-based neighborhood-level characteristics.

Results: 
The median residential concentration of PM2.5 was 9.1 μg/m3. In models adjusted for personal and contextual risk factors, a 10-μg/m3 increase in PM2.5 was associated with an elevated risk of premenopausal (HR = 1.26; 95% CI = 0.99, 1.61) but not postmenopausal breast cancer (HR = 1.01; 95% CI = 0.94, 1.10). The elevated risk of premenopausal breast cancer from PM2.5 was only evident among those randomized to the screening arm of the study.

Conclusions: 
Our findings support the hypothesis that exposure to low concentrations of PM2.5 increase the risk of premenopausal breast cancer.

Journal - Residential exposure to fine particulate matter air pollution and incident breast cancer in a cohort of Canadian women (2018)

Shedding light on the link between early life sun exposure and risk of multiple sclerosis: results from the EnvIMS Study

Sandra Magalhaes, Maura Pugliatti, Trond Riise, Kjell-Morten Myhr, Antonio Ciampi, Kjetil Bjornevik, Christina Wolfson

Summary...

Background
Lower levels of sun exposure in childhood have been suggested to be associated with increased risk of multiple sclerosis (MS). In this paper we extend previous work, using two novel analytical strategies.

Results
The analyses included 2251 cases and 4028 controls. The accumulation model was found to be the best model, which demonstrated a nearly 50% increased risk of MS comparing lowest reported summer sun exposure with highest [risk ratio (RR) = 1.47 (1.24, 1.74)]. The latent sun exposure behaviour group, characterized by low sun exposure during summer and winter and high sun protection use, had the highest risk of MS; a 76% increased risk as compared with the group with high sun exposure and low sun protection use [RR = 1.76 (1.27, 2.46)].

Conclusions
Our analyses provide novel insights into the link between sun exposure and MS. We demonstrate that more time indoors during childhood and early adolescence is linked with MS risk, and that sun protection behaviours in those who spend most time indoors may play a key role in increasing risk.

Journal - Shedding light on the link between early life sun exposure and risk of multiple sclerosis: results from the EnvIMS Study (2018)

The cost of occupational cancer in New Brunswick

Margaret Holland, Adele Balram, Jonathan Boudreau, Ted McDonald

Summary...


 

Report - The cost of occupational cancer in New Brunswick (2018) (Colour)
Report - The cost of occupational cancer in New Brunswick (2018) (Greyscale)

Deep poverty in New Brunswick: A description and national comparisons

Daniel J Dutton

Summary...


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Report - Deep poverty in New Brunswick: A description and national comparisons
Summary - Deep poverty (2020)

Analysis of unmatched immigrants in the BizNet Database

Philip Leonard, Ted McDonald, Pablo Miah

Summary...


 New Brunswick has been facing the problem of an aging and shrinking population for some time now, and both factors are likely to affect the economy and workforce of the province. To implement measures for proactive population growth and for increasing the size of the labour force, the Government of New Brunswick (GNB) has identified immigration as a key strategy – and while NB has seen a growing number of immigrant arrivals, the retention of landed immigrants must be a primary objective. Identifying trends in immigrant retention, and factors influencing retention, can help decision makers understand how well current policies work and – if required – make necessary changes. 

Report - Analysis of unmatched immigrants in the BizNet Database (2020) (Colour)
Report - Analysis of unmatched immigrants in the BizNet Database (2020) (Greyscale)

School locations and road transportation nuisances in Montreal: An environmental equity diagnosis

Mathieu Carrier, Philippe Apparicio, Anne-Marie Séguin, Dan Crouse

Summary...

The analysis of the concentration of the traffic-related pollutants in the environments around elementary schools constitutes an important issue, as children are at school for a large part of the day and are physiologically vulnerable to these nuisances. The study has three main objectives. These are, respectively, to compare the levels of NO2 concentrations and road traffic noise in parcels of land that include a school with the levels for the rest of the Island of Montreal, to determine whether there are significant differences in the values obtained for the air and noise pollution indicators according to the schools' socioeconomic deprivation levels, and to identify, among these schools, those showing the highest levels of pollutants. The methodology was carried out in two stages. The parcels of land that include the 234 elementary schools and the 7,765 inhabited city blocks in the study area were first geocoded, and two air and road traffic noise pollution indicators were then calculated in all of the city blocks in the study area and in all of the parcels that include an elementary school. Our results show that elementary schools, regardless of their level of socioeconomic deprivation, are located in parcels where there is a lower level of road traffic noise but a similar level of NO2 concentration compared with city blocks without schools. However, the NO2 concentration in the parcels that include elementary schools is significantly and positively associated with the schools' socioeconomic deprivation level.

Journal - School locations and road transportation nuisances in Montreal: An environmental equity diagnosis (2019)

Using maps to communicate environmental exposures and health risks: Review and best-practice recommendations

David M. Stieb, Anne Huang, Robyn Hocking, Daniel L. Crouse, Alvaro R. Osornio-Vargas, Paul J. Villeneuve

Summary...

Background
Graphical materials can be effective communication tools, and maps in particular are a potentially powerful means of conveying spatial information. Previous reviews have provided insights on the application of cartographic best practices, pitfalls to avoid, and considerations related to risk perception and communication, but none has reviewed primary studies of the effectiveness or utility of maps to users, nor have they addressed the issue from the perspective of health literacy, environmental health literacy, or public health ethics.

Objectives
To systematically identify and review the literature pertaining to evaluation of maps in general, or specific map features, as environmental exposure and health risk communication tools; to formulate best-practice recommendations; and to identify future research priorities.

Results and Discussion 
While there are significant gaps in the evidence, we formulated best practice recommendations highlighting the perspectives of health literacy and environmental health literacy. Key recommendations include: understanding the map developer's societal role and mental model underlying map design; defining, understanding and iteratively engaging with map users; informing map design using key theoretical constructs; accounting for factors affecting risk perception; adhering to risk communication principles and cartographic best practices; and considering environmental justice and public health ethics implications. Recommendations for future research are also provided.

Journal - Using maps to communicate environmental exposures and health risks: Review and best-practice recommendations (2019)

Provider caseload-volume and short-term outcomes following colorectal surgeries in New Brunswick: results from a provincial-level cohort study

Dan L. Crouse, Jonathan Boudreau, Philip S.J. Leonard, Keith Pawluk, James T. McDonald

Summary...

Background: American studies have shown that higher provider and hospital volumes are associated with reduced risk of mortality following colorectal surgical interventions. Evidence from Canada is limited, and to our knowledge only a single study has considered outcomes other than death. We describe associations between provider surgical volume and all-cause mortality and postoperative complications following colorectal surgical interventions in New Brunswick.

Results: Overall, 9170 interventions were performed by 125 providers across 18 hospitals. We found decreased odds of experiencing a complication following colorectal surgery per increment of 10 interventions performed per year (odds ratio 0.94, 95% confidence interval 0.91–0.96). We found no associations with mortality. Associations remained consistent across models restricted to cancer patients or to interventions performed by general surgeons and across models that also considered overall hospital volumes.

Conclusion: Our results suggest that increased caseloads are associated with reduced odds of complications, but not with all-cause mortality, following colorectal surgery in New Brunswick. We also found no evidence of volume having differential effects on outcomes from colon and rectal procedures.

Journal - Provider caseload-volume and short-term outcomes following colorectal surgeries in New Brunswick: results from a provincial-level cohort study (2020)

Influence of Socioeconomic Status on Stage at Presentation of Laryngeal Cancer in the United States

Nicole L. Lebo, Diana Khalil, Adele Balram, Margaret Holland, Martin Corsten, James Ted McDonald, Stephanie Johnson-Obaseki

Summary...

Objective
Identify socioeconomic predictors of stage at diagnosis of laryngeal cancer in the United States.

Study Design
Retrospective analysis of the North American Association of Central Cancer Registries’ Incidence Data–Cancers in North America Deluxe Analytic File for expanded races.

Setting
All centers reporting to the US Centers for Disease Control and Prevention’s National Program of Cancer Registries.

Results
A total of 72,472 patients were identified and included. Analysis revealed significant correlation between advanced stage at diagnosis and: Medicaid insurance, lack of insurance, female sex, older age, black race, and certain states of residence. The strongest predictor of advanced stage was lack of insurance (OR, 2.212; P < .001; 95% CI, 2.035-2.406). The strongest protective factor was residing in the state of Utah (OR, 0.571; P < .001; 95% CI, 0.536-0.609). Once adjusted for regional price and wage disparities, relative income was not a significant predictor of stage at presentation across multiple analyses.

Conclusion
Multiple socioeconomic factors were predictive of severity of disease at presentation of laryngeal cancer in the United States. This study demonstrated that insurance type was strongly predictive, whereas relative income had surprisingly little influence.

Journal - Influence of Socioeconomic Status on Stage at Presentation of Laryngeal Cancer in the United States (2019)

An examination of the association between lifetime history of prostate and pancreatic cancer diagnosis and occupation in a population sample of Canadians

Smriti Singh, James Ted McDonald, Gabriela Ilie, Anil Adisesh

Summary...

Background
Occupation was assessed as possible risk factors for prostate (PCa) and pancreatic cancer in a large Canadian worker cohort.

Results
In Canadian men aged 24–64 years, the highest elevated risks of PCa were observed for library clerks (HR = 2.36, 95% CI:1.12–4.97), medical radiation technologists (HR = 1.66, 95% CI:1.04–2.65), telecommunications and line cable workers (HR = 1.62, 95% CI: 1.22–3.16) and commissioned police officers (HR = 1.54, 95% CI: 1.10–2.16. The highest elevated risk for pancreatic cancer were observed for commissioned police officers (HR = 4.34, 95% CI: 1.85–10.21), photographic and film processors (HR = 3.97, 95% CI:1.69–9.34), railway and motor transport labourers (HR = 3.94, 95% CI: 1.67–9.29), and computer engineers (HR = 3.82, 95%CI: 1.52–9.61).

Conclusion
These findings emphasize the need for further study of job-related exposures and the potential influence of non-occupational factors such as screening practices.

Journal - An examination of the association between lifetime history of prostate and pancreatic cancer diagnosis and occupation in a population sample of Canadians (2020)

A profile of employment across industries in New Brunswick

Eton Boco, Philip Leonard, Ted McDonald

Summary...


This report examines employment and industry changes in New Brunswick (NB) over a 20-year period (1996 to 2016) using data from the Canadian Census. It also examines changes over a ten-year period (2009 to 2019) using data from the Labour Force Survey. Results are stratified by CMA/CA1 and by industry using the North American Industry Classification System (NAICS).


Report - A profile of employment across industries in New Brunswick: 1996-2019 (2020)

A framework for measurement and harmonization of pediatric multiple sclerosis etiologic research studies: The Pediatric MS Tool-Kit

Sandra Magalhaes, Brenda Banwell, Amit Bar-Or, Isabel Fortier, Heather E Hanwell, Ming Lim, Georg E Matt, Rinze F Neuteboom, David L O’Riordan, Paul K Schneider, Maura Pugliatti, Bryna Shatenstein, Catherine M Tansey, Evangeline Wassmer, Christina Wolfson

Summary...

Background:
While studying the etiology of multiple sclerosis (MS) in children has several methodological advantages over studying etiology in adults, studies are limited by small sample sizes.

Objective:
Using a rigorous methodological process, we developed the Pediatric MS Tool-Kit, a measurement framework that includes a minimal set of core variables to assess etiological risk factors.

Results:
The Tool-Kit includes six core variables to measure ETS, six to measure sun exposure, and six to measure vitamin D intake. The Tool-Kit can be accessed online (www.maelstrom-research.org/mica/network/tool-kit).

Conclusion:
The goals of the Tool-Kit are to enhance exposure measurement in newly designed pediatric MS studies and comparability of results across studies, and in the longer term to facilitate harmonization of studies, a methodological approach that can be used to circumvent issues of small sample sizes. We believe the Tool-Kit will prove to be a valuable resource to guide pediatric MS researchers in developing study-specific questionnaire

A framework for measurement and harmonization of pediatric multiple sclerosis etiologic research studies: The Pediatric MS Tool-Kit

Does socioeconomic status affect stage at presentation for larynx cancer in Canada’s universal health care system?

Diana Khalil, Martin J. Corsten, Margaret Holland, Adele Balram, James Ted McDonald, Stephanie Johnson-Obaseki

Summary...

Objective
Diagnosis of laryngeal cancer is dependent on awareness that persistent hoarseness needs to be investigated as well as access to an otolaryngologist. This study aimed to better classify and understand 3 factors that may lead to variability in stage at presentation of laryngeal cancer: (1) socioeconomic status (SES), (2) differences in access to health care by location of residence (rural vs urban or by province), and (3) access to an otolaryngologist (by otolaryngologists per capita).

Results
A total of 1550 cases were included (1280 males and 265 females). The stage at presentation was earlier in the highest income quintile (quintile 5) compared to the lower income quintiles (quintiles 1-4) (odds ratio [OR], 0.68; P < .05). There was a statistically significant difference in stage at presentation based on rural or urban residence within the highest income quintile (OR, 1.73; P < .005).

Conclusion
There is a relationship between SES and stage at presentation for laryngeal cancer even in the Canadian universal health care system.

Journal - Does socioeconomic status affect stage at presentation for larynx cancer in Canada’s universal health care system? (2018)

Increased distance from the tertiary cardiac care centre prolongs wait times but does not affect long-term outcomes in patients undergoing cardiac catheterization in New Brunswick

A. Yip, J. MacLeod, P. Leonard, S. Lutchmedial, J. Legare, A. Hassan

Summary...

Background
Previous studies have demonstrated the harmful effect of remote geographic place of residence on access to cardiac catheterization across Canada. However, little is known regarding the impact of these disparities in access to cardiac catheterization on long-term clinical outcomes. The purpose of this study was to examine the effect of geographic factors on access to and long-term outcomes following cardiac catheterization in New Brunswick.

Results
17,397 patients formed the final study population (inpatient: n=10,530; outpatient: n=6,867). The median length of follow-up was 1156 days for inpatients and 1203 days for outpatients. Following risk adjustment, patients who lived farthest from the NBHC were most likely to experience the longest wait times for cardiac catheterization, whether it was as an inpatient or as an outpatient (Table 1). However, distance did not emerge as an independent predictor of the composite long-term outcome of interest for either group (Table 1).

Conclusion
While increased distance from the tertiary care facility was found to be independently associated with longer wait times for cardiac catheterization in New Brunswick, it had no effect on long-term adverse outcomes. This suggests that geographic place of residence, and by extension prolonged wait times, are of minimal long-term clinical consequence in patients undergoing cardiac catheterization.

Journal - Increased distance from the tertiary cardiac care centre prolongs wait times but does not affect long-term outcomes in patients undergoing cardiac catheterization in New Brunswick (2018)

Migration and immigration: recent advances using linked administrative data

Michael Haan, James Ted McDonald

Summary...

.

Editorial - Migration and immigration: recent advances using linked administrative data (2018)

Diabetes status and susceptibility to the effects of PM2.5 exposure on cardiovascular mortality in a National Canadian Cohort

Lauren Pinault, Michael Brauer, Daniel L. Crouse, Scott Weichenthal, Anders Erickson, Aaron van Donkelaar, Randall V. Martin, Shannon Charbonneau, Perry Hystad, Jeffrey R. Brook, Michael Tjepkema et al.

Summary...

Background: 
Diabetes is infrequently coded as the primary cause of death but may contribute to cardiovascular disease (CVD) mortality in response to fine particulate matter (PM2.5) exposure. We analyzed all contributing causes of death to examine susceptibility of diabetics to CVD mortality from long-term exposure.

Results: 
Among CanCHEC subjects, comention of diabetes on the death certificate increased the magnitude of association between CVD mortality and PM2.5 (HR = 1.51 [1.39–1.65] per 10 μg/m3) versus all CVD deaths (HR = 1.25 [1.21–1.29]) or CVD deaths without diabetes (HR = 1.20 [1.16–1.25]). Among CCHS subjects, diabetics who used insulin or medication (included as proxies for severity) had higher HR estimates for CVD deaths from PM2.5 (HR = 1.51 [1.08–2.12]) relative to the CVD death estimate for all respondents (HR = 1.31 [1.16–1.47]).

Conclusions:
Mention of diabetes on the death certificate resulted in higher magnitude associations between PM2.5 and CVD mortality, specifically among those who manage their diabetes with insulin or medication. Analyses restricted to the primary cause of death likely underestimate the role of diabetes in air pollution–related mortality. See video abstract at, http://links.lww.com/EDE/B408.

Journal - Diabetes status and susceptibility to the effects of PM2.5 exposure on cardiovascular mortality in a National Canadian Cohort (2018)

Effect modification of perinatal exposure to air pollution and childhood asthma incidence

Éric Lavigne, Marc-André Bélair, Daniel Rodriguez Duque, Minh T. Do, David M. Stieb, Perry Hystad, Aaron van Donkelaar, Randall V. Martin, Daniel L. Crouse, Eric Crighton, Hong Chen, Richard T. Burnett et al.

Summary...

Perinatal exposure to ambient air pollution has been associated with childhood asthma incidence; however, less is known regarding the potential effect modifiers in this association. We examined whether maternal and infant characteristics modified the association between perinatal exposure to air pollution and development of childhood asthma.

761 172 births occurring between 2006 and 2012 were identified in the province of Ontario, Canada. Associations between exposure to ambient air pollutants and childhood asthma incidence (up to age 6 years) were estimated using Cox regression models.

110 981 children with asthma were identified. In models adjusted for postnatal exposures, second-trimester exposures to particulate matter with a 50% cut-off aerodynamic diameter ≤2.5 μm (hazard ratio (HR) per interquartile range (IQR) increase 1.07, 95% CI 1.06–1.09) and nitrogen dioxide (HR per IQR increase 1.06, 95% CI 1.03–1.08) were associated with childhood asthma development. Enhanced impacts were found among children born to mothers with asthma, who smoked during pregnancy or lived in urban areas during pregnancy, males and children born preterm or of low birthweight.

Prenatal exposure to air pollution may have a differential impact on the risk of asthma development, according to maternal and infant characteristics.

Journal - Effect modification of perinatal exposure to air pollution and childhood asthma incidence (2018)

Associations between living near water and risk of mortality among urban Canadians

Dan L. Crouse, Adele Balram, Perry Hystad, Lauren Pinault, Matilda van den Bosch, Hong Chen, Daniel Rainham, Errol M. Thomson, Christopher H. Close, Aaron van Donkelaar, Randall V. Martin, Richard Ménard, Alain Robichaud, Paul J. Villeneuve

Summary...

Background:
Increasing evidence suggests that residential exposures to natural environments, such as green spaces, are associated with many health benefits. Only a single study has examined the potential link between living near water and mortality.

Objective:
We sought to examine whether residential proximity to large, natural water features (e.g., lakes, rivers, coasts, “blue space”) was associated with cause-specific mortality.

Results:
Our cohort included approximately 1.3 million subjects at baseline, 106,180 of whom died from nonaccidental causes during follow-up. We found significant, reduced risks of mortality in the range of 12–17% associated with living within 250m250m of water in comparison with living farther away, among all causes of death examined, except with external/accidental causes. Protective effects were found to be higher among women and all older adults than among other subjects, and protective effects were found to be highest against deaths from stroke and respiratory-related causes.

Conclusions:
Our findings suggest that living near blue spaces in urban areas has important benefits to health, but further work is needed to better understand the drivers of this association.

Journal - Associations between living near water and risk of mortality among urban Canadians (2018)

Associations between provider and hospital volumes and postoperative mortality following total hip arthroplasty in New Brunswick: results from a provincial-level cohort study

Dan L. Crouse, Philip S.J. Leonard, Jonathan Boudreau, James T. McDonald

Summary...

Background: Several international studies have reported negative associations between hospital and/or provider volume and risk of postoperative death following total hip arthroplasty (THA). The only Canadian studies to report on this have been based in Ontario and have found no such association. We describe associations between postoperative deaths following THA and provider caseload volume, also adjusted for hospital volume, in a population based cohort in New Brunswick.

Results: About 7095 patients were admitted for THA in New Brunswick over the 7-year study period and 170 died within 30 days. We found no associations with provider volume and postoperative mortality in any of our models. Adjustment for contextual characteristics or hospital volume had no effects on this association.

Conclusion: Our results suggest that patients admitted for hip replacements in New Brunswick can expect to have similar risk of death regardless of whether they are admitted to see a provider with high or low THA volumes and of whether they are admitted to the province’s larger or smaller hospitals.

Journal - Associations between provider and hospital volumes and postoperative mortality following total hip arthroplasty in New Brunswick: results from a provincial-level cohort study (2018)

Associations between long-term PM2.5 and ozone exposure and mortality in the Canadian Census Health and Environment Cohort (CANCHEC), by spatial synoptic classification zone

Sabit Cakmak, Chris Hebbern, Lauren Pinault, Eric Lavigne, Jennifer Vanos, Dan Lawson Crouse, Michael Tjepkema

Summary...

Studies suggest that long-term chronic exposure to fine particulate matter air pollution can increase lung cancer mortality. We analyzed the association between long term PM2.5 and ozone exposure and mortality due to lung cancer, ischemic heart disease, and chronic obstructive pulmonary disease, accounting for geographic location, socioeconomic status, and residential mobility. Subjects in the 1991 Canadian Census Health and Environment Cohort (CanCHEC) were followed for 20 years, and assigned to regions across Canada based on spatial synoptic classification weather types. Hazard ratios (HR) for mortality, were related to PM2.5 and ozone using Cox proportional hazards survival models, adjusting for socioeconomic characteristics and individual confounders. An increase of 10 μg/m3 in long term PM2.5 exposure resulted in an HR for lung cancer mortality of 1.26 (95% CI 1.04, 1.53); the inclusion in the model of SSC zone as a stratum increased the risk estimate to HR 1.29 (95% CI 1.06, 1.57). After adjusting for ozone, HRs increased to 1.49 (95% CI 1.23, 1.88), and HR 1.54 (95% CI 1.27, 1.87), with and without zone as a model stratum. HRs for ischemic heart disease fell from 1.25 (95% CI 1.21, 1.29) for exposure to PM2.5, to 1.13 (95% CI 1.08, 1.19) when PM2.5 was adjusted for ozone. For COPD, the 95% confidence limits included 1.0 when climate zone was included in the model. HRs for all causes of death showed spatial differences when compared to zone 3, the most populated climate zone. Exposure to PM2.5 was related to an increased risk of mortality from lung cancer, and both ozone and PM2.5 exposure were related to risk of mortality from ischemic heart disease, and the risk varied spatially by climate zone.

Journal - Associations between long-term PM2.5 and ozone exposure and mortality in the Canadian Census Health and Environment Cohort (CANCHEC), by spatial synoptic classification zone (2018)

Socioeconomic status and anterior epistaxis in adult population

Pourya Masoudiana, J. Ted McDonald, Andrea Lasso, Shaun J. Kilty

Summary...

Objective
Little was known about the role of socioeconomic status as a risk factor for epistaxis in adult population. The objective of this study was to determine whether socioeconomic status influences the presentation to emergency department for anterior epistaxis in an adult population.

Results
A total of 351 cases of anterior epistaxis were included. The mean age was 70 years and 51% of patients were male. The patients were stratified into two groups based on whether their age was equal to and above, or below 75 years. Our analysis indicated that those 75 years or older in higher income quintiles have an increased risk of anterior epistaxis compared to the subjects in the lower income quintiles (P < 0.05). This association did not hold true for those younger than 75 years or for all age groups combined.

Conclusion
There is an association between higher socioeconomic status and the presentation to the emergency department with anterior epistaxis in the population older than 75 years but not in younger patients.

Journal - Socioeconomic status and anterior epistaxis in adult population (2018)

Investigating the effects of multiple exposure measures to traffic-related air pollution on the risk of breast and prostate cancer

Maryam Shekarrizfard, Marie-France Valois, Scott Weichenthal, Mark S. Goldberg, Masoud Fallah-Shorshani, Laure Deville Cavellin, Dan Crouse, Marie-Elise Parent, Marianne Hatzopoulou

Summary...

Traffic-related nitrogen dioxide (NO2) has been traditionally estimated using surfaces generated through land-use regression (LUR). Recently, air pollution dispersion has been used to derive NO2 exposures in urban areas. There is evidence that data collection protocols and modelling assumptions can have a large effect on the resulting NO2 spatial distribution. This study investigates the effects of various NO2 surfaces on the risk estimates of postmenopausal breast cancer (BC) and prostate cancer (PC), both of which have already been associated with traffic-related air pollution. We derived exposures for individuals in two case control studies in Montreal, Canada using four different surfaces for NO2. Two of the surfaces were developed using LUR but employed different data collection protocols (LUR-1 and LUR-2), and the other two surfaces were generated using dispersion modelling; one with a regional model (dispersion-1) and another with a street canyon model (dispersion-2). Also, we estimated separate odds ratios (ORs) using concentrations of NO2 as measures of exposure for both cancers. While the range of NO2 concentrations from dispersion (4–26 ppb) was lower than the range from LUR (4–36 ppb), the four surfaces were found to be moderately correlated, with Spearman correlation coefficients ranging from 0.76 to 0.88. The ORs for BC were estimated to be 1.26, 1.10, 1.07, and 1.05 based on LUR-1, LUR-2, dispersion-1, and dispersion-2. In contrast, the ORs for PC were estimated to be 1.39, 1.30, 1.13, and 1.04 based on LUR-1, LUR-2, dispersion-1, and dispersion-2. The four exposure measures indicated positive associations but we observed higher mean ORs based on the LUR surfaces albeit with overlapping CIs. Since LUR models capture all sources of NO2 and dispersion models only capture traffic emissions, it is possible that this difference is due to the fact that non-road sources also contribute to the spatial distribution in NO2 concentrations.

Journal - Investigating the effects of multiple exposure measures to traffic-related air pollution on the risk of breast and prostate cancer (2018)

Immigrant retention in NB: an analysis using administrative Medicare Registry data

James Ted McDonald, Brent Cruickshank, Zikuan Liu

Summary...

This paper examines immigrant retention using a novel approach based on data contained in New Brunswick’s Medicare Registry database. To date, researchers studying immigrant retention in Canada have had only a few options with regard to suitable data, and each data source is characterized by limitations intrinsic to the nature of the data collection. These in turn raise caveats about the conclusions that can be drawn from analysis of those datasets. By demonstrating the utility and feasibility of another data source that to our knowledge has not previously been used for such a purpose, we are able to add new results to the existing literature, thereby improving our understanding of the extent of and characteristics underpinning immigrant retention in the host region as well as assess the robustness of published results based on data from other sources. The main objective of the paper is to improve the current understanding of secondary migration patterns of New Brunswick residents with the objective of increasing retention rates among vulnerable populations such as immigrants and refugees.

Journal - Immigrant retention in NB: an analysis using administrative Medicare Registry data (2018)

Associations between ambient air pollution and daily mortality in a cohort of congestive heart failure: Case-crossover and nested case-control analyses using a distributed lag nonlinear model

Stephane Buteau, Mark S.Goldberg, Richard T. Burnett, Antonio Gasparrini, Marie-France Valois, James M. Brophy, Dan L. Crouse, Marianne Hatzopoulou

Summary...

Background
Persons with congestive heart failure may be at higher risk of the acute effects related to daily fluctuations in ambient air pollution. To meet some of the limitations of previous studies using grouped-analysis, we developed a cohort study of persons with congestive heart failure to estimate whether daily non-accidental mortality were associated with spatially-resolved, daily exposures to ambient nitrogen dioxide (NO2) and ozone (O3), and whether these associations were modified according to a series of indicators potentially reflecting complications or worsening of health.

Results
The magnitude of the cumulative as well as the lag-specific estimates of association differed in many instances according to the metric of exposure. Using the back-extrapolation method, which is our preferred exposure model, we found for the case-crossover design a cumulative mean percentage changes (MPC) in daily mortality per interquartile increment in NO2 (8.8 ppb) of 3.0% (95% CI: −0.9, 6.9%) and for O3 (16.5 ppb) 3.5% (95% CI: −4.5, 12.1). For O3 there was strong confounding by weather (unadjusted MPC = 7.1%; 95% CI: 1.7, 12.7%). For the nested case-control approach the cumulative MPC for NO2 in daily mortality was 2.9% (95% CI: −0.9, 6.9%) and for O3 7.3% (95% CI: 3.0, 11.9%). We found evidence of effect modification between daily mortality and cumulative NO2 and O3 according to the prescribed dose of furosemide in the nested case-control analysis, but not in the case-crossover analysis.

Conclusions
Mortality in congestive heart failure was associated with exposure to daily ambient NO2 and O3 predicted from a back-extrapolation method using a land use regression model from dense sampling surveys. The methods used to assess exposure can have considerable influence on the estimated acute health effects of the two air pollutants.

Journal - Associations between ambient air pollution and daily mortality in a cohort of congestive heart failure: Case-crossover and nested case-control analyses using a distributed lag nonlinear model (2018)

Urban greenness and mortality in Canada's largest cities: A national cohort study

Dan L Crouse, Lauren Pinault, Adele Balram, Perry Hystad, Paul A Peters, Hong Chen, Aaron van Donkelaar, Randall V Martin, Richard Ménard, Alain Robichaud, Paul J Villeneuve

Summary...

Background

Findings from published studies suggest that exposure to and interactions with green spaces are associated with improved psychological wellbeing and have cognitive, physiological, and social benefits, but few studies have examined their potential effect on the risk of mortality. We therefore undertook a national study in Canada to examine associations between urban greenness and cause-specific mortality.


Findings
Our cohort consisted of approximately 1 265 000 individuals at baseline who contributed 11 523 770 person-years. We showed significant decreased risks of mortality in the range of 8–12% from all causes of death examined with increased greenness around participants' residence. In the fully adjusted analyses, the risk was significantly decreased for all causes of death (non-accidental HR 0·915, 95% CI 0·905–0·924; cardiovascular plus diabetes 0·911, 0·895–0·928; cardiovascular 0·911, 0·894–0·928; ischaemic heart disease 0·904, 0·882–0·927; cerebrovascular 0·942, 0·902–0·983; and respiratory 0·899, 0·869–0·930). Greenness associations were more protective among men than women (HR 0·880, 95% CI 0·868–0·893 vs 0·955, 0·941–0·969), and among individuals with higher incomes (highest quintile 0·812, 0·791–0·834 vs lowest quintile 0·991, 0·972–1·011) and more education (degree or more 0·816, 0·791–0·842 vs did not complete high school 0·964, 0·950–0·978).

Interpretation
Increased amounts of residential greenness were associated with reduced risks of dying from several common causes of death among urban Canadians. We identified evidence of inequalities, both in terms of exposures to greenness and mortality risks, by personal socioeconomic status among individuals living in generally similar environments, and with reasonably similar access to health care and other social services. The findings support the development of policies related to creating greener and healthier cities.

Journal - Urban greenness and mortality in Canada's largest cities: A national cohort study (2017)

The association between the incidence of postmenopausal breast cancer and concentrations at street-level of nitrogen dioxide and ultrafine particles

Mark S. Goldberg, France Labrèche, Scott Weichenthal, Eric Lavigne, Marie-France Valois, Marianne Hatzopoulou, Keith Van Ryswyk, Maryam Shekarrizfard, Paul J. Villeneuve, Daniel Crouse, Marie-Élise Parent

Summary...

Background
There is scant information as to whether traffic-related air pollution is associated with the incidence of breast cancer. Nitrogen dioxide (NO2) and ultrafine particles (UFPs, <0.1 µm), are two pollutants that capture intra-urban variations in traffic-related air pollution and may also be associated with incidence.

Results
We found that the functional form of the response functions between incident postmenopausal breast cancer and concentrations of NO2 and UFPs were consistent with linearity. For NO2, we found increasing risks of breast cancer for all subjects combined and stronger associations when analyses were restricted to those women who had lived at their current address for 10 years or more. Specifically, the OR, adjusted for personal covariates, per increase in the interquartile range (IQR=3.75 ppb) of NO2 was 1.08 (95%CI: 0.92–1.27). For women living in their homes for 10 years or more, the adjusted OR was 1.17 (95%CI: 0.93–1.46; IQR=3.84 ppb); for those not living at that home 10 years before the study, it was 0.93 (95%CI: 0.64, 1.36; IQR=3.65 ppb). For UFPs, the ORs were lower than for NO2, with little evidence of association in any of the models or sub-analyses and little variability in the ORs (about 1.02 for an IQR of ~3500 cm−3). On the other hand, we found higher ORs amongst cases with positive oestrogen and progesterone receptor status; namely for NO2, the OR was 1.13 (95%CI: 0.94–1.35) and for UFPs it was 1.05 (95%CI: 0.96–1.14).

Conclusions
Our findings suggest that exposure to ambient NO2 and UFPs may increase the risk of incident postmenopausal breast cancer especially amongst cases with positive oestrogen and progesterone receptor status.

Journal - The association between the incidence of postmenopausal breast cancer and concentrations at street-level of nitrogen dioxide and ultrafine particles (2017)

Do school junk food bans improve student health? Evidence from Canada

Philip S.J. Leonard

Summary...

Six Canadian provinces have banned the sale of junk food on school property to address child health issues such as obesity. Differences in the timing of the introduction of provincial policies provide variation in treatment across provinces, and variation within provinces comes from differences across students in the number of years of schooling during which junk food was banned. Using data from cycles of the Canadian Community Health Survey, I find that each year of a junk food ban is associated with a decline of about 0.05 body mass index. Students exposed to five or more years of a junk food ban had lower body mass index equivalent to a decrease of about two pounds for an individual who is five feet, six inches tall.

Journal - Do school junk food bans improve student health? Evidence from Canada (2017)

Maternal exposure to ambient air pollution and risk of early childhood cancers: A population-based study in Ontario, Canada

Éric Lavigne, Marc-André Bélair, Minh T. Do, David M. Stieb, Perry Hystad, Aaron van Donkelaar, Randall V. Martin, Daniel L. Crouse et al.

Summary...

Background
There are increasing concerns regarding the role of exposure to ambient air pollution during pregnancy in the development of early childhood cancers.

Objective
This population based study examined whether prenatal and early life (< 1 year of age) exposures to ambient air pollutants, including nitrogen dioxide (NO2) and particulate matter with aerodynamic diameters ≤ 2.5 μm (PM2.5), were associated with selected common early childhood cancers in Canada.

Results
A total of 2044 childhood cancers were identified. Exposure to PM2.5, per interquartile range increase, over the entire pregnancy, and during the first trimester was associated with an increased risk of astrocytoma (hazard ratio (HR) per 3.9 μg/m3 = 1.38 (95% CI: 1.01, 1.88) and, HR per 4.0 μg/m3 = 1.40 (95% CI: 1.05–1.86), respectively). We also found a positive association between first trimester NO2 and acute lymphoblastic leukemia (ALL) (HR = 1.20 (95% CI: 1.02–1.41) per IQR (13.3 ppb)).

Conclusions
In this population-based study in the largest province of Canada, results suggest an association between exposure to ambient air pollution during pregnancy, especially in the first trimester and an increased risk of astrocytoma and ALL. Further studies are required to replicate the findings of this study with adjustment for important individual-level confounders.

Journal - Maternal exposure to ambient air pollution and risk of early childhood cancers: A population-based study in Ontario, Canada (2017)

Participation and retention in the breast cancer screening program in New Brunswick Canada

James Ted McDonald, Yunli Wang, Zikuan Liu

Summary...

New Brunswick (NB) Canada uses its breast cancer screening service program to assess the extent to which eligible NB women are complying with mammography guidelines. While many studies have investigated factors associated with participation in periodic breast cancer screening in Canada and elsewhere, most work has relied on self-reported surveys or smaller scale primary data collection. Using a longitudinal administrative dataset for NB over the period 1996–2011 of 255,789 eligible women aged 45–69, this study examined demographic, socioeconomic and geographic factors associated with initial participation in regular screening at age 50 and ongoing retention in the program. Logistic regression was used to examine correlates of initial screening, while rescreening participation was estimated using survival analysis accounting for rescreening episodes. Initial screening participation was lower for women born outside of NB, many women living farther away from screening centers, women in rural areas, and higher for married women. In contrast, retention was higher for rural women and women recently arrived in NB. For both participation and retention, regional disparities across health zone persisted after controlling for observable personal and locational factors. The analysis highlights important characteristics to be targeted to increase screening but also that how health zones operate their screening programs exerts a very significant effect on the use of screening services by eligible women. This offers lessons for the design and evaluation of any cancer screening program.

Journal - Participation and retention in the breast cancer screening program in New Brunswick Canada (2017)

Comparison of spatiotemporal prediction models of daily exposure of individuals to ambient nitrogen dioxide and ozone in Montreal, Canada

Stephane Buteau, Marianne Hatzopoulou, Dan L. Crouse, Audrey Smargiassi, Richard T. Burnett, Travis Logan, Laure Deville Cavellin, Mark S. Goldberg

Summary...

Background
In previous studies investigating the short-term health effects of ambient air pollution the exposure metric that is often used is the daily average across monitors, thus assuming that all individuals have the same daily exposure. Studies that incorporate space-time exposures of individuals are essential to further our understanding of the short-term health effects of ambient air pollution.

Objectives
As part of a longitudinal cohort study of the acute effects of air pollution that incorporated subject-specific information and medical histories of subjects throughout the follow-up, the purpose of this study was to develop and compare different prediction models using data from fixed-site monitors and other monitoring campaigns to estimate daily, spatially-resolved concentrations of ozone (O3) and nitrogen dioxide (NO2) of participants’ residences in Montreal, 1991–2002.

Results
We found some substantial differences in agreement across pairs of methods in daily mean predicted concentrations of O3 and NO2. On a given day and postal code area the difference in the concentration assigned could be as high as 131 ppb for O3 and 108 ppb for NO2. For both pollutants, better agreement was found between predictions from the nearest monitor and the inverse-distance weighting interpolation methods, with ICCs of 0.89 (95% confidence interval (CI): 0.89, 0.89) for O3 and 0.81 (95%CI: 0.80, 0.81) for NO2, respectively. For this pair of methods the maximum difference on a given day and postal code area was 36 ppb for O3 and 74 ppb for NO2. The back-extrapolation method showed a higher degree of disagreement with the nearest monitor approach, inverse-distance weighting interpolation, and the Bayesian maximum entropy model, which were strongly constrained by the sparse monitoring network. The maps showed that the patterns of agreement differed across the postal code areas and the variability depended on the pair of methods compared and the pollutants. For O3, but not NO2, postal areas showing greater disagreement were mostly located near the city centre and along highways, especially in maps involving the back-extrapolation method.

Conclusions
In view of the substantial differences in daily concentrations of O3 and NO2 predicted by the different methods, we suggest that analyses of the health effects from air pollution should make use of multiple exposure assessment methods. Although we cannot make any recommendations as to which is the most valid method, models that make use of higher spatially resolved data, such as from dense exposure surveys or from high spatial resolution satellite data, likely provide the most valid estimates.

Journal - Comparison of spatiotemporal prediction models of daily exposure of individuals to ambient nitrogen dioxide and ozone in Montreal, Canada (2017)

Re: Does exposure prediction bias health-effect estimation? The relationship between confounding adjustment and exposure prediction

Mark S. Goldberg, Paul Villeneuve, Daniel Crouse

Summary...


Letter to the Editor

Letter to the Editor - Re: Does exposure prediction bias health-effect estimation? The relationship between confounding adjustment and exposure prediction (2017)

Push or pull into self employment? Evidence from Longitudinal Canadian Tax Data

Philip S.J. Leonard, J.C. Herbert Emery, James Ted McDonald

Summary...



Does the choice of self-employment over paid employment reflect that individuals are “pushed” into self-employment by negative economic conditions or “pulled” in by strong economic prospects? Using longitudinal Canadian taxfiler data, we show that the self-employment rate has been very stable over the past decade in spite of the large increase in unemployment rate associated with the 2008 recession. The lack of cyclical association of self-employment rates suggests that self-employment rates are the product of structural and demographic influences in the economy. 


Report - Push or Pull into Self Employment? Evidence from Longitudinal Canadian Tax Data (2017)

Associations between fine particulate matter and mortality in the 2001 Canadian Census Health and Environment Cohort

Lauren L. Pinault, Scott Weichenthal, Daniel L. Crouse, Michael Brauer, Anders Erickson, Aaron van Donkelaar, Randall V. Martin, Perry Hystad, Hong Chen, Philippe Finès, Jeffrey R. Brook, Michael Tjepkema, Richard T. Burnett

Summary...


Background
Large cohort studies have been used to characterise the association between long-term exposure to fine particulate matter (PM2.5) air pollution with non-accidental, and cause-specific mortality. However, there has been no consensus as to the shape of the association between concentration and response.

Results
In models stratified by age, sex, airshed, and population centre size, and adjusted for individual and neighbourhood socioeconomic variables, HR estimates for non-accidental mortality were HR = 1.18 (95% CI: 1.15–1.21) per 10 μg/m3 increase in concentration. We observed higher HRs for cardiovascular disease (HR=1.25; 95% CI: 1.19–1.31), cardio-metabolic disease (HR = 1.27; 95% CI: 1.21–1.33), ischemic heart disease (HR = 1.36; 95% CI: 1.28–1.44) and chronic obstructive pulmonary disease (COPD) mortality (HR = 1.24; 95% CI: 1.11–1.39) compared to HR for all non-accidental causes of death. For non-accidental, cardio-metabolic, ischemic heart disease, respiratory and COPD mortality, the shape of the concentration-response curve was supra-linear, with larger differences in relative risk for lower concentrations. For both pneumonia and lung cancer, there was some suggestion that the curves were sub-linear.

Conclusions
Associations between ambient concentrations of fine particulate matter and several causes of death were non-linear for each cause of death examined.

Journal - Associations between fine particulate matter and mortality in the 2001 Canadian Census Health and Environment Cohort (2017)

Apprenticeship programs in the Atlantic Provinces: Program characteristics, apprentice mobility and earnings

Herb Emery, Ted McDonald, Andrew Balcom

Summary...


This report presents descriptive statistics on various dimensions of apprenticeship training in the Atlantic provinces. The report is based on statistics generated by Statistics Canada from a complex individual-level longitudinal dataset linking data from multiple sources including the Registered Apprenticeship Information System, T1 tax files and T4 statements of earnings over the period 2008-2013 inclusive. The longitudinal nature of the data allow mobility to be evaluated, including comparisons of province of study, province of residence and province of work before, during and after apprenticeship training. 

The report considers three dimensions of apprenticeships: characteristics of participants including demographic characteristics, field of study, and status in the program; mobility of apprentices, comparing province of study with province of employment and province of residence while enrolled and after the program is either completed or discontinued; and earnings of those in the program and those who completed or discontinued the program, with a focus on differences in earnings for movers compared to non-movers. For all three dimensions, results are compared across individuals enrolled in apprenticeship programs in each of the Atlantic provinces.

Report - Apprenticeship programs in the Atlantic provinces: program characteristics, apprentice mobility and earnings (2017)
Summary - Characteristics of apprenticeship programs in the Atlantic provinces (2017)

Comparing the health effects of ambient particulate matter estimated using ground-based versus remote sensing exposure estimates

Michael Jerrett, Michelle C. Turner, Bernardo S. Beckerman, C. Arden Pope III, Aaron van Donkelaar, Randall V. Martin, Marc Serre, Dan Crouse, Susan M. Gapstur, Daniel Krewski, W. Ryan Diver, Patricia F. Coogan, George D. Thurston, Richard T. Burnett

Summary...

Background:
Remote sensing (RS) is increasingly used for exposure assessment in epidemiological and burden of disease studies, including those investigating whether chronic exposure to ambient fine particulate matter (PM2.5) is associated with mortality.

Objectives:
We compared relative risk estimates of mortality from diseases of the circulatory system for PM2.5 modeled from RS with that for PM2.5 modeled using ground-level information.

Methods:
We geocoded the baseline residence of 668,629 American Cancer Society Cancer Prevention Study II (CPS-II) cohort participants followed from 1982 to 2004 and assigned PM2.5 levels to all participants using seven different exposure models. Most of the exposure models were averaged for the years 2002–2004, and one RS estimate was for a longer, contemporaneous period. We used Cox proportional hazards regression to estimate relative risks (RRs) for the association of PM2.5 with circulatory mortality and ischemic heart disease.

Results:
Estimates of mortality risk differed among exposure models. The smallest relative risk was observed for the RS estimates that excluded ground-based monitors for circulatory deaths [RR = 1.02, 95% confidence interval (CI): 1.00, 1.04 per 10 μg/m3 increment in PM2.5]. The largest relative risk was observed for the land-use regression model that included traffic information (RR = 1.14, 95% CI: 1.11, 1.17 per 10 μg/m3 increment in PM2.5).

Conclusions:
We found significant associations between PM2.5 and mortality in every model; however, relative risks estimated from exposure models using ground-based information were generally larger than those estimated using RS alone.

Journal - Comparing the health effects of ambient particulate matter estimated using ground-based versus remote sensing exposure estimates (2017)

Cancer and the healthy immigrant effect: a statistical analysis of cancer diagnosis using a linked Census-cancer registry administrative database

James Ted McDonald, Michael Farnworth, Zikuan Liu

Summary...

Background
A large volume of research has been published on both the socio economic and demographic determinants of cancer and on the health of immigrants and minority groups. Yet because of data limitations, little research examines differences in the occurrence of cancer incidence between immigrants and non-immigrants and among immigrants defined by region of birth and time in the host country. In particular it is not known whether a healthy immigrant effect is present for cancer and if so, whether this advantage is lost with additional years of residence in the host country.

Methods
This paper uses a large data file from Statistics Canada that links Census information on immigrant status, socioeconomic status including educational attainment, and other person-level information with administrative data on cancer and mortality over a continuous 13 year period of observation. It estimates discrete and continuous time duration models to identify differences in cancer diagnosis by immigrant subgroup after controlling for a variety of potential confounders. Differences in historical smoking behavior are not observable at the individual level in the dataset but are accounted for indirectly using various methods.

Results
Results in general confirm the existence of a healthy immigrant effect for cancer in that, overall, recent immigrants to Canada are significantly less likely than otherwise comparable non-immigrant Canadians to be diagnosed with any cancer and the most common forms of cancer by site. As well, this gap appears to decline with additional years in Canada for immigrant men and women, eventually converging to Canadian-born levels. Differentiating among immigrant subgroups by period of arrival and country of birth reveals significant variation across immigrant subgroups, with immigrant men and women from developing countries typically having a lower likelihood of being diagnosed with cancer than immigrants from the US, UK and continental Europe. As well, controlling for immigrant heterogeneity this way weakens the conclusion that the gap narrows with years in Canada. Immigrant men overall continue to exhibit convergence to Canadian-born levels for diagnosis of any cancer and for prostate cancer, while immigrant women exhibit narrowing over time only for breast cancer. Although smoking behavior is not directly observed, controlling for subgroup-specific lifetime smoking behavior using survey data has only a relatively minor effect on the estimated differences.

Conclusions
The specificity of the results by cancer type, gender, immigrant status and ethnicity provides useful guidance for future research by helping to narrow the possible channels through which social and economic characteristics may be affecting cancer incidence.

Journal - Cancer and the healthy immigrant effect: a statistical analysis of cancer diagnosis using a linked Census-cancer registry administrative database (2017)

Air pollution during pregnancy and cord blood immune system biomarkers

Jillian Ashley-Martin, Eric Lavigne, Tye E. Arbuckle, Markey Johnson, Perry Hystad, Dan L. Crouse, Jean S. Marshall, Linda Dodds

Summary...



Objectives:
We aimed to determine whether average and trimester-specific exposures to ambient measures of nitrogen dioxide (NO2) and particular matter (PM2.5) were associated with elevated cord blood concentrations of immunoglobulin E (IgE) and two epithelial cell produced cytokines: interleukin-33 (IL-33) and thymic stromal lymphopoietin (TSLP).


Methods:
This study utilized data and biospecimens from the Maternal-Infant Research on Environmental Chemicals (MIREC) Study. There were 2001 pregnant women recruited between 2008 and 2011 from 10 Canadian cities. Maternal exposure to NO2 and PM2.5 was estimated using land use regression and satellite-derived models.


Results:
We observed statistically significant associations between maternal NO2 exposure and elevated cord blood concentrations of both IL-33 and TSLP among girls but not boys.


Conclusions:
Maternal NO2 exposure may impact the development of the newborn immune system as measured by cord blood concentrations of two cytokines.


Journal - Air pollution during pregnancy and cord blood immune system biomarkers (2016)

Long-term exposure to fine particulate matter air pollution and the risk of lung cancer among participants of the Canadian National Breast Screening Study

Anna Tomczak, Anthony B. Miller, Scott A. Weichenthal, Teresa To, Claus Wall, Aaron van Donkelaar, Randall V. Martin, Dan Lawson Crouse, Paul J. Villeneuve

Summary...


Recently, air pollution has been classified as a carcinogen largely on the evidence of epidemiological studies of lung cancer. However, there have been few prospective studies that have evaluated associations between fine particulate matter (PM2.5) and cancer at lower concentrations. We conducted a prospective analysis of 89,234 women enrolled in the Canadian National Breast Screening Study between 1980 and 1985, and for whom residential measures of PM2.5 could be assigned. The cohort was linked to the Canadian Cancer Registry to identify incident lung cancers through 2004. Surface PM2.5 concentrations were estimated using satellite data. Cox proportional hazards models were used to characterize associations between PM2.5 and lung cancer. Hazard ratios (HRs) and 95% confidence intervals (CIs) computed from these models were adjusted for several individual‐level characteristics, including smoking. The cohort was composed predominantly of Canadian‐born (82%), married (80%) women with a median PM2.5 exposure of 9.1 µg/m3. In total, 932 participants developed lung cancer. In fully adjusted models, a 10 µg/m3 increase in PM2.5 was associated with an elevated risk of lung cancer (HR: 1.34; 95% CI = 1.10, 1.65). The strongest associations were observed with small cell carcinoma (HR: 1.53; 95% CI = 0.93, 2.53) and adenocarcinoma (HR: 1.44; 95% CI = 1.06, 1.97). Stratified analyses suggested increased PM2.5 risks were limited to those who smoked cigarettes. Our findings are consistent with previous epidemiological investigations of long‐term exposure to PM2.5 and lung cancer. Importantly, they suggest associations persist at lower concentrations such as those currently found in Canadian cities.

Journal - Long-term exposure to fine particulate matter air pollution and the risk of lung cancer among participants of the Canadian National Breast Screening Study (2016)

Application of a global environmental equity index in Montreal: Diagnostic and further implications

Mathieu Carrier, Philippe Apparicio, Yan Kestens, Anne-Marie Séguin, Hien Pham, Dan Crouse, Jack Siemiatycki

Summary...


Urban living environments are known to influence human well-being and health. The literature on environmental equity focuses especially on the distribution of nuisances and resources, which, because of the unequal spatial distribution of different social groups, leads to an increased exposure to risks or to less access to beneficial elements for certain populations. Little work has been done on the multidimensionality of different environmental burdens and the lack of resources in some urban environments. This article has two main objectives. The first objective is to construct an environmental equity index that takes into consideration seven components of the urban environment (traffic-related pollutants, proximity to major roads and highways, vegetation, access to parks, access to supermarkets, and the urban heat island effect). The second objective is to determine whether groups vulnerable to different nuisances—namely, individuals under fifteen years old and the elderly—and those who tend to be located in the most problematic areas according to the environmental justice literature (i.e., visible minorities and low-income populations) are affected by environmental inequities associated with the application of the composite index at the city block level. The results obtained by using four statistical techniques show that, on the Island of Montreal, low-income persons and, to a lesser extent, visible minorities are more frequently located in city blocks close to major roads and with higher concentrations of NO2 and less vegetation. Finally, the environmental equity index is significantly lower in areas with high concentrations of low-income populations in comparison with the wealthiest areas.

Journal - Application of a global environmental equity index in Montreal: Diagnostic and further implications (2016)

Spatial associations between socioeconomic groups and NO2 air pollution exposure within three large Canadian cities

Lauren Pinault, Daniel Crouse, Michael Jerrett, Michael Brauer, Michael Tjepkema

Summary...



Previous studies of environmental justice in Canadian cities have linked lower socioeconomic status to greater air pollution exposures at coarse geographic scales, (i.e., Census Tracts). However, studies that examine these associations at finer scales are less common, as are comparisons among cities. To assess differences in exposure to air pollution among socioeconomic groups, we assigned estimates of exposure to ambient nitrogen dioxide (NO2), a marker for traffic-related pollution, from city-wide land use regression models to respondents of the 2006 Canadian census long-form questionnaire in Toronto, Montreal, and Vancouver. Data were aggregated at a finer scale than in most previous studies (i.e., by Dissemination Area (DA), which includes approximately 400–700 persons). We developed simultaneous autoregressive (SAR) models, which account for spatial autocorrelation, to identify associations between NO2 exposure and indicators of social and material deprivation. In Canada’s three largest cities, DAs with greater proportions of tenants and residents who do not speak either English or French were characterised by greater exposures to ambient NO2. We also observed positive associations between NO2 concentrations and indicators of social deprivation, including the proportion of persons living alone (in Toronto), and the proportion of persons who were unmarried/not in a common-law relationship (in Vancouver). Other common measures of deprivation (e.g., lone-parent families, unemployment) were not associated with NO2 exposures. DAs characterised by selected indicators of deprivation were associated with higher concentrations of ambient NO2 air pollution in the three largest cities in Canada.


Journal - Spatial associations between socioeconomic groups and NO2 air pollution exposure within three large Canadian cities (2016)

Long-term ozone exposure and mortality in a large prospective study

Michelle C. Turner, Michael Jerrett, C. Arden Pope III, Daniel Krewski, Susan M. Gapstur, W. Ryan Diver, Bernardo S. Beckerman, Julian D. Marshall, Jason Su, Daniel L. Crouse, Richard T. Burnett

Summary...


Rationale: Tropospheric ozone (O3) is potentially associated with cardiovascular disease risk and premature death. Results from long-term epidemiological studies on O3 are scarce and inconclusive.

Objectives: In this study, we examined associations between chronic ambient O3 exposure and all-cause and cause-specific mortality in a large cohort of U.S. adults.

Methods: Cancer Prevention Study II participants were enrolled in 1982. A total of 669,046 participants were analyzed, among whom 237,201 deaths occurred through 2004. We obtained estimates of O3 concentrations at the participant’s residence from a hierarchical Bayesian space–time model. Estimates of fine particulate matter (particulate matter with an aerodynamic diameter of up to 2.5 μm [PM2.5]) and NO2 concentrations were obtained from land use regression. Cox proportional hazards regression models were used to examine mortality associations adjusted for individual- and ecological-level covariates.

Measurements and Main Results: In single-pollutant models, we observed significant positive associations between O3, PM2.5, and NO2 concentrations and all-cause and cause-specific mortality. In two-pollutant models adjusted for PM2.5, significant positive associations remained between O3 and all-cause (hazard ratio [HR] per 10 ppb, 1.02; 95% confidence interval [CI], 1.01–1.04), circulatory (HR, 1.03; 95% CI, 1.01–1.05), and respiratory mortality (HR, 1.12; 95% CI, 1.08–1.16) that were unchanged with further adjustment for NO2. We also observed positive mortality associations with both PM2.5 (both near source and regional) and NO2 in multipollutant models.

Conclusions: Findings derived from this large-scale prospective study suggest that long-term ambient O3 contributes to risk of respiratory and circulatory mortality. Substantial health and environmental benefits may be achieved by implementing further measures aimed at controlling O3 concentrations.


Journal - Long-term ozone exposure and mortality in a large prospective study (2015)

Ozone exposure and cardiovascular-related mortality in the Canadian Census Health and Environment Cohort (CANCHEC) by spatial synoptic classification zone

Sabit Cakmak, Chris Hebbern, Jennifer Vanos, Dan L. Crouse, Rick Burnett

Summary...



Our objective is to analyse the association between long term ozone exposure and cardiovascular related mortality while accounting for climate, location, and socioeconomic factors. We assigned subjects with 16 years of follow-up in the Canadian Census Health and Environment Cohort (CanCHEC) to one of seven regions based on spatial synoptic classification (SSC) weather types and examined the interaction of exposure to both fine particulate matter (PM2.5) and ground level ozone and cause of death using survival analysis, while adjusting for socioeconomic characteristics and individual confounders. Correlations between ozone and PM2.5 varied across SSC zones from −0.02 to 0.7. Comparing zones using the most populated SSC zone as a reference, a 10 ppb increase in ozone exposure was associated with increases in hazard ratios (HRs) that ranged from 1.007 (95% CI 0.99, 1.015) to 1.03 (95% CI 1.02, 1.041) for cardiovascular disease, 1.013 (95% CI 0.996, 1.03) to 1.058 (95% CI 1.034, 1.082) for cerebrovascular disease, and 1.02 (95% CI 1.006, 1.034) for ischemic heart disease. HRs remained significant after adjustment for PM2.5. Long term exposure to ozone is related to an increased risk of mortality from cardiovascular and cerebrovascular diseases; the risk varies by location across Canada and is not attenuated by adjustment for PM2.5. This research shows that the SSC can be used to define geographic regions and it demonstrates the importance of accounting for that spatial variability when studying the long term health effects of air pollution.


Journal - Ozone exposure and cardiovascular-related mortality in the Canadian Census Health and Environment Cohort (CANCHEC) by spatial synoptic classification zone (2016)

Putting geographic variation in surgical procedures on the map: Geographic variation in coronary artery bypass and hip and knee replacement surgeries in the Maritime provinces

Adrian Levy, James Ted McDonald, Juergen Krause, Philip Leonard, David Stock, Sarah Campbell-McNamara, Mary-Ann MacSwain, Michelle Patterson, Bryn Robinson

Summary...


Research Project P0001 Regionalization of surgical procedures in New Brunswick

MSSU researchers from three Maritime provinces compared the distribution and organization of treatments for total hip and knee arthroplasty and cardiac surgical procedures across different regions of the province;evaluated how patient outcomes vary within and across jurisdictions and as a function of travel times to the hospital; and evaluated how cost and performance measures vary across hospitals offering these services within the province. 



Report - Putting geographic variation in surgical procedures on the map: Geographic variation in coronary artery bypass and hip and knee replacement surgeries in the Maritime provinces (2016)

Risk estimates of mortality attributed to low concentrations of ambient fine particulate matter in the Canadian community health survey cohort

Lauren Pinault, Michael Tjepkema, Daniel L. Crouse, Scott Weichenthal, Aaron van Donkelaar, Randall V. Martin, Michael Brauer, Hong Chen, Richard T. Burnett

Summary...



Background

Understanding the shape of the relationship between long-term exposure to ambient fine particulate matter (PM2.5) concentrations and health risks is critical for health impact and risk assessment. Studies evaluating the health risks of exposure to low concentrations of PM2.5 are limited. Further, many existing studies lack individual-level information on potentially important behavioural confounding factors.

Methods

A prospective cohort study was conducted among a subset of participants in a cohort that linked respondents of the Canadian Community Health Survey to mortality (n = 299,500) with satellite-derived ambient PM2.5 estimates. Participants enrolled between 2000 and 2008 were followed to date of death or December 31, 2011. Cox proportional hazards models were used to estimate hazard ratios (HRs) for mortality attributed to PM2.5 exposure, adjusted for individual-level and contextual covariates, including smoking behaviour and body mass index (BMI).

Results

Approximately 26,300 non-accidental deaths, of which 32.5 % were due to circulatory disease and 9.1 % were due to respiratory disease, occurred during the follow-up period. Ambient PM2.5 exposures were relatively low (mean = 6.3 μg/m3), yet each 10 μg/m3 increase in exposure was associated with increased risks of non-accidental (HR = 1.26; 95 % CI: 1.19-1.34), circulatory disease (HR = 1.19; 95 % CI: 1.07–1.31), and respiratory disease mortality (HR = 1.52; 95 % CI: 1.26–1.84) in fully adjusted models. Higher hazard ratios were observed for respiratory mortality among respondents who never smoked (HR = 1.97; 95 % CI: 1.24–3.13 vs. HR = 1.45; 95 % CI: 1.17–1.79 for ever smokers), and among obese (BMI ≥ 30) respondents (HR = 1.76; 95 % CI: 1.15-2.69 vs. HR = 1.41; 95 % CI: 1.04–1.91 for normal weight respondents), though differences between groups were not statistically significant. A threshold analysis for non-accidental mortality estimated a threshold concentration of 0 μg/m3 (+95 % CI = 4.5 μg/m3).

Conclusions

Increased risks of non-accidental, circulatory, and respiratory mortality were observed even at very low concentrations of ambient PM2.5. HRs were generally greater than most literature values, and adjusting for behavioural covariates served to reduce HR estimates slightly.



Journal - Risk estimates of mortality attributed to low concentrations of ambient fine particulate matter in the Canadian community health survey cohort (2016)

How does skills mismatch affect remittances? A study of Filipino migrant workers

James Ted McDonald, Maria Rebecca Valenzuela

Summary...


In this article, unit record data on Filipino migrants are used to analyze the issue of skills mismatch, its prevalence, and its impact on remittances sent back home. Results obtained using instrumental variable techniques reveal that significant proportions of highly educated Filipino workers are employed in low‐skilled jobs overseas, with systematic variation by gender and by country of work. We find that skills mismatch impacts significantly on the migrant's remittance behavior, with effects that are differentiated between genders. Specifically, where there is mismatch in the migrant's educational attainment and the migrant's job requirement, we find significant reductions in remittances for men but not for women.

Journal - How does skills mismatch affect remittances? A study of Filipino migrant workers (2016)

Socioeconomic differences in nitrogen dioxide ambient air pollution exposure among children in the three largest Canadian cities

Lauren Pinault, Daniel Crouse, Michael Jerrett, Michael Brauer, Michael Tjepkema

Summary...



 Background: Nitrogen dioxide (NO2 ) is a marker for traffic-related air pollution, which exhibits strong spatial gradients in large cities. Previous studies have shown that in Canadian cities, exposure to ambient NO2 is greater in neighbourhoods of low socioeconomic status (SES). As a result of these differences in exposure, air pollution-related health problems may be more prevalent among children in lower SES urban neighbourhoods. 

Data and methods: Children younger than age 18 enumerated in the 2006 Census who lived in Toronto, Montreal or Vancouver were linked to published air pollution exposure land use regression models to assign exposure at the Dissemination Area (DA) level. Associations between both socioeconomic and visible minority status and exposure to ambient NO2 among children in these three cities were examined in a series of regression models (OLS and simultaneous autoregressive models that account for spatial autocorrelation). 

Results: Children in lower income DAs in all three cities were exposed to higher NO2 concentrations than were children in higher income DAs (mean difference of 2 ppb between lowest and highest income quintiles). In some cities, DAs with larger percentages of children in lone-parent families and visible minority children were characterized by greater NO2 exposure. 

Interpretation: The relatively high incidence of air pollution-related diseases (for example, asthma) among children in lower SES neighbourhoods may be attributable, at least in part, to variations in NO2 air pollution exposure within the same city. 


Report - Socioeconomic differences in nitrogen dioxide ambient air pollution exposure among children in the three largest Canadian cities (2016)

Oxidative burden of fine particulate air pollution and risk of cause-specific mortality in the Canadian Census Health and Environment Cohort (CanCHEC)

Scott Weichenthal, Daniel L. Crouse, Lauren Pinault, Krystal Godri-Pollitt, Eric Lavigne, Greg Evans, Aaron van Donkelaar, Randall V. Martin, Rick T. Burnett

Summary...



Backround

Fine particulate air pollution (PM2.5) is known to contribute to cardiorespiratory mortality but it is not clear how PM2.5 oxidative burden (i.e. the ability of PM2.5 to cause oxidative stress) may influence long-term mortality risk.


Methods

We examined the relationship between PM2.5 oxidative burden and cause-specific mortality in Ontario, Canada. Integrated PM2.5 samples were collected from 30 provincial monitoring sites between 2012 and 2013. The oxidative potential (% depletion/µg) of regional PM2.5 was measured as the ability of filter extracts to deplete antioxidants (glutathione and ascorbate) in a synthetic respiratory tract lining fluid. PM2.5 oxidative burden was calculated as the product of PM2.5 mass concentrations and regional estimates of oxidative potential. In total, this study included 193,300 people who completed the Canadian long-form census in 1991 and who lived within 5 km of a site where oxidative potential was measured. Deaths occurring between 1991 and 2009 were identified through record linkages and Cox proportional hazard models were used to estimate hazard ratios (and 95% confidence intervals) for interquartile changes in exposure adjusting for individual-level covariates and indirect-adjustment for smoking and obesity.


Results

Glutathione-related oxidative burden was associated with cause-specific mortality. For lung cancer specifically, this metric was associated with a 12% (95% CI: 5.0–19) increased risk of mortality whereas a 5.0% (95% CI: 0.1, 10) increase was observed for PM2.5. Indirect adjustment for smoking and obesity decreased the lung cancer hazard ratio for glutathione-related oxidative burden but it remained significantly elevated (HR=1.07, 95% CI: 1.005, 1.146). Ascorbate-related oxidative burden was not associated with mortality.


Conclusions

Our findings suggest that glutathione-related oxidative burden may be more strongly associated with lung cancer mortality than PM2.5 mass concentrations.


Journal - Oxidative burden of fine particulate air pollution and risk of cause-specific mortality in the Canadian Census Health and Environment Cohort (CanCHEC) (2016)

Occupational regulation and foreign qualification recognition: An overview

Arthur Sweetman, James Ted McDonald, Lesleyanne Hawthorne

Summary...

The theory and practice of occupational regulation are outlined together with associated issues regarding foreign qualification recognition. Trade-offs between public safety and the monopoly power inherent in occupational regulation are highlighted, together with a description of the increasing scope of occupational regulation both in terms of the numbers of occupations coming under regulation from government and the share of workers subject to those regulations. The focus is on the implications of occupational regulation for highly skilled immigrants seeking employment in the occupation in which they hold a relevant academic credential. For countries outside of the United States, it is striking how little quantitative research has been conducted in this area. A better understanding is crucial, since policies on and approaches to occupational regulation are evolving rapidly, in part because of the increasing scale of skilled migration.

Journal - Occupational regulation and foreign qualification recognition: An overview (2015)

Incidence of differentiated thyroid cancer in Canada by city of residence

Martin J. Corsten, Matthew Hearn, James Ted McDonald, Stephanie Johnson-Obaseki

Summary...


Background

Thyroid cancer incidence in Canada is increased in high socioeconomic groups, and in urban compared with rural areas. The objective of this study was to analyze patterns in thyroid cancer incidence across Canada, particularly with respect to the major urban areas across the country, to identify whether there are any discrepancies in thyroid cancer incidence between Canadian cities.

Methods

Cases were drawn from the Canadian Cancer Registry. Demographic and socioeconomic information were extracted from the Canadian Census of Population data. We linked cases to income quintiles (InQs) by patients’ postal codes, and categorized residence by census metropolitan area ((CMA), population >100,000). Within the Toronto CMA we further classified by census subdivision (CSD).

Results

There were a total of 33 CMAs across the country. After controlling for demographic and socio-economic factors, we found that the Toronto CMA had an IRR of thyroid cancer that was significantly higher than all other CMAs across the country. For 70 % of CMAs and CAs across Canada, the IRR for thyroid cancer was less than half of the IRR for thyroid cancer in the Toronto CMA.

As Toronto is one of the largest CMAs, we then subdivided the Toronto area into CSDs to examine how incidence of thyroid cancer varies within this large area. The Toronto City core was used as the reference category and all other areas were compared directly to it. In doing so, we found that a contiguous area of three CSDs North of Toronto had higher IRRs compared with the Toronto city core: Markham, Vaughan and Richmond Hill.

Conclusions

After controlling for demographic and socioeconomic factors, we found that the Toronto CMA has the highest incidence of thyroid cancer nationwide. Several explanations could account for this discrepancy including increased detection due to increased access to imaging, differences in ethnicity or environmental exposures.

Journal - Incidence of differentiated thyroid cancer in Canada by city of residence (2015)

Incidence of cutaneous malignant melanoma by socioeconomic status in Canada: 1992–2006

Stephanie E. Johnson-Obaseki, Varant Labajian, Martin J. Corsten, James T. McDonald

Summary...



Background

There are no nationwide studies documenting changes in cutaneous malignant melanoma incidence or association of incidence with socioeconomic status (SES) in Canada. We sought to determine whether melanoma incidence increased from 1992 to 2006 and if there was an association between SES and melanoma incidence. Additionally, we studied whether there was a correlation between province of residence and melanoma incidence.

Methods

Cases from the Canadian Cancer Registry were reviewed. Demographic and socioeconomic information were extracted from the Canadian Census of Population data. Cases were linked to income quintiles by postal code. A negative binomial regression was performed to identify relationships among these variables.

Results

Overall incidence of melanoma in Canada increased by 67 % from 1992 to 2006 (p < 0.0001). The increase in incidence was greater for melanoma in situ compared with invasive melanoma (136 % versus 52 % [p < 0.0001]). Incidence was positively correlated with higher income quintiles; the incidence rates among patients in the lowest income quintiles were 67 % of that for the highest income quintiles (p < 0.0001).

Discussion

A wide variety of explanations have been postulated for an increased incidence in melanoma among persons of higher SES, including access to and awareness of screening, more access to vacations in sunny climates, and increased leisure time. Variations in incidence of melanoma by urban vs. rural location and province may indicate differences in access to dermatologists across Canada.

Conclusions

Melanoma incidence is increasing in Canada and is higher among people in high SES groups. This rise is likely due to a combination of factors including a true rise in incidence due to increases in sun exposure, and also an increased detection rate, particularly in those who are more aware of the disease and have access to resources for detection.



Journal - Incidence of cutaneous malignant melanoma by socioeconomic status in Canada: 1992–2006 (2015)

High-skilled immigration in a globalized labor market

James Ted McDonald, Christopher Worswick

Summary...


The economics literature on the international migration of skilled workers is reviewed and recent policy trends are evaluated. The theoretical implications of skilled migration are discussed within the context of the benefits to the skilled immigrant, the sending country, and the receiving country. The types of immigrant selection mechanisms are also detailed, with emphasis on their advantages and disadvantages. The recent immigration policies of a number of major immigrant-receiving countries such as Canada, the US, and Australia are critically evaluated. The expanded use of skilled temporary foreign workers and international students is discussed, as is and the recent emergence of two-step immigration policies that favor temporary migrants already in the country as sources of permanent immigration. An overview of key results in the literature on the economic performance of skilled immigrants is presented with a particular focus on the wage returns to skill both in terms of regulated and unregulated occupations. The implications of competition among the growing number of countries with skilled immigration policies are considered.

Chapter - High-skilled immigration in a globalized labor market (2015)

Immigrant selection systems and occupational outcomes of international medical graduates in Canada and the United States

James Ted McDonald, Casey Warman, Christopher Worswick

Summary...



We analyze the process of immigrant selection and occupational outcomes of international medical graduates (IMGs) in the United States and Canada. We find that in Canada, where a point system has been in place, IMGs are less likely to be employed as physicians than are IMGs in the United States, where employer nomination is a more important entry path for IMGs. We also find that when the point system in Canada did not have occupational restrictions, IMGs had a relatively low probability of working as physicians.


Journal - Immigrant selection systems and occupational outcomes of international medical graduates in Canada and the United States (2015)

Is lower socioeconomic status associated with more advanced thyroid cancer stage at presentation? A study in two Canadian centers

Stephanie Siu, James Ted McDonald, Murali Rajaraman, Jason Franklin, Terri Paul, Irina Rachinsky, Deric Morrison, S. Ali Imran, Steven Burrell, Robert Hart, Al Driedger, Mahmoud Badreddine, John Yoo, Martin Corsten, Stan Van Uum

Summary...



Background: Some studies have shown a higher incidence of thyroid cancer in patients with insurance coverage and higher socioeconomic status (SES), and a higher thyroid cancer stage in patients with lower SES, suggesting SES-related health disparity in thyroid cancer. However, it is not known if the same is evident under a universal healthcare system such as that in Canada.

Methods: We used data from the Canadian Thyroid Cancer Consortium, a large thyroid cancer registry that collects data from two major thyroid cancer referral centers (London, Ontario, and Halifax, Nova Scotia). We included patients who presented with thyroid cancer between 1998 and 2011. We determined age at presentation, sex, and thyroid cancer status using the American Joint Committee on Cancer (AJCC) staging criteria. Individuals' postal codes were used to retrieve data from the Canadian census for the years 1996, 2001, and 2006 to approximate household income. Ordered logistic regression was used to determine odds ratios of presenting with more advanced stage thyroid cancer as they relate to income, age, and sex.

Results: We included 1701 patients: 1334 cases from London and 367 from Halifax. Thyroid cancer was diagnosed more frequently in the higher SES groups (p<0.001). Compared to patients in the top income quintile, patients in the lowest and second-lowest income quintiles had significantly higher odds of having more advanced stage thyroid cancer at presentation (OR 1.58, p=0.002; 1.37, p=0.024 respectively).

Conclusions: Our study suggests that, similar to countries that lack a universal healthcare system, health disparity in thyroid cancer also exists in Canada. It appears that while thyroid cancers were diagnosed more frequently in Canadian patients of higher SES, Canadian patients in the lower SES groups had more advanced stage thyroid cancer at presentation.




Journal - Is lower socioeconomic status associated with more advanced thyroid cancer stage at presentation? A study in two Canadian centers (2014)

The relationship between survival and socio-economic status for head and neck cancer in Canada

James Ted McDonald, Stephanie Johnson-Obaseki, Euna Hwang, Chris Connell, Martin Corsten

Summary...




Background

Human papilloma virus (HPV) is emerging as the primary cause for some head and neck cancers. The objective of this study was to investigate the association between head and neck cancer (HNC) survival and socioeconomic status (SES) in Canada, and to investigate changes in the relationship between HNC survival and SES from 1992 to 2005.

Methods

Cases were drawn from the Canadian Cancer Registry (1992–2005), and were categorized into three subsites: oropharynx, oral cavity, and “other” (hypopharynx, larynx, and nasopharynx). Demographic and socioeconomic information were extracted from the Canadian Census of Population data for the study period, which included three census years: 1991, 1996 and 2001. We linked cases to income quintiles (InQs) according to patients’ postal codes.

Results

Overall survival, without controlling for smoking, for oropharyngeal cancer increased dramatically from 1992–2005 in Canada. This increase in survival for oropharynx cancer was eliminated by the introduction of controls for smoking. Survival for all head and neck cancer subsites was strongly correlated with SES, as measured by income quintile, with lower InQ’s having lower survival than higher. Lastly, the magnitude of the difference in survival between the highest and lowest income quintiles increased significantly over the time period studied for oropharynx cancer, but did not statistically significantly change for oral cavity cancer or other head and neck cancers.

Conclusions

These data confirm a significant impact of socioeconomic deprivation on overall survival for head and neck cancers in Canada, and may provide indirect evidence that HPV-positive head and neck cancers are more common in higher socioeconomic groups.




Journal - The relationship between survival and socio-economic status for head and neck cancer in Canada (2014)

The healthy immigrant effect: Patterns and evidence from four countries

Steven Kennedy, Michael P. Kidd, James Ted McDonald, Nicholas Biddle

Summary...



The existence of a healthy immigrant effect—where immigrants are on average healthier than the native born—is a widely cited phenomenon across a multitude of literatures including epidemiology and the social sciences. There are many competing explanations. 

The goals of this paper are twofold: first, to provide further evidence on the presence of the healthy immigrant effect across source and destination country using a set of consistently defined measures of health; and second, to evaluate the role of selectivity as a potential explanation for the existence of the phenomenon. 

Utilizing data from four major immigrant recipient countries, USA, Canada, UK, and Australia allows us to compare the health of migrants from each with the respective native born who choose not to migrate. This represents a much more appropriate counterfactual than the native born of the immigrant recipient country and yields new insights into the importance of observable selection effects. 

The analysis finds strong support for the healthy immigrant effect across all four destination countries and that selectivity plays an important role in the observed better health of migrants vis a vis those who stay behind in their country of origin.


Journal - The healthy immigrant effect: Patterns and evidence from four countries (2014)

Planning for community resiliency in recovery from COVID-19: October 2, 2020

Dr. Sandra Magalhaes, Madeleine Gorman-Asal, Paramdeep Singh, Chandy Somayaji

Summary...


Population-based risk indicators can support decision-making in planning for future waves of, and recovery from, COVID-19. They can inform efforts to limit spread and exacerbation of infection in those most at risk and help identify at-risk groups likely impacted by measures to limit spread. 

As part of our research, we are deriving risk indicators using population-level data that can help identify vulnerable populations who may be at higher risk of consequences related to COVID-19 infection or public health restrictions, including 

  • poor health outcomes associated with infection, 
  • greater risk of infection in collective dwellings, 
  • mental health impacts associated with distancing measures, 
  • poor educational outcomes due to school closures, and 
  • financial vulnerability associated with employment interruptions. 

While stay-at-home measures aim to reduce community spread of infection and protect those vulnerable to poor health outcomes, they increase proximity among those living in collective dwellings. In the absence of complete lockdown, the opportunity for infection to enter the home exists. Those living in residential facilities (e.g. special care homes) and apartments have greater risk of infection. As measures relax, schools re-open, which further increases opportunity for transmission across households. Public health measures to control spread of COVID-19 may also have unintended consequences for individuals residing alone, low-income families, individuals with uncertain employment, children with special needs, individuals susceptible to mental health challenges, and those with chronic conditions unable to manage them effectively. 

The goal of our research is to develop an analytical framework to generate community level indicators that are relevant to COVID-19 pandemic planning and recovery efforts in New Brunswick. 

Report - Planning for community resiliency in recovery from COVID-19: October 2, 2020 (2020)

Self-employment trends in New Brunswick: 1982-2016

Pablo Miah, Philip Leonard, Ted McDonald

Summary...




New research paper - fresh off the press!



Report - Self-employment trends in New Brunswick: 1982-2016 (2020) (Full colour)
Report - Self-employment trends in New Brunswick: 1982-2016 (2020) (Greyscale)

Lifting restrictions for COVID-19

Ted McDonald, Eton Boco, Eva Christensen, Bethany Daigle, Chandy Somayaji, Erfan Bhuiyan, Sarah McRae

Summary...



The purpose of this rapid review (Part 1 in a 2-part series) is to examine the literature on the various steps being taken around the world to lift restrictions implemented to suppress the spread of COVID-19 – including social restrictions, such as those related to physical distancing, and economic restrictions, such as those affecting the closure of non-essential stores and other businesses.

We find that some restrictions, such the closure of schools and non-essential stores and services, are more commonly among the first to be lifted – though this is done so gradually and with accompanying physical distancing and hygiene requirements. Countries around the world have also begun to ease and/or recommend measures impacting travel, recreation, and sectors of the workforce. While it is too soon to observe the outcomes for many of these measures, modelling studies and observations of case trajectories in Asia suggest a COVID-19 resurgence is likely to occur as restrictions are eased – but if appropriate measures are in place to monitor further infection and reinstate intermittent restrictions, future resurgence could be managed.

The information presented herein on the experiences of other locations ahead of New Brunswick in their COVID trajectories and in the process of reopening their economies can provide valuable insights into the steps this province could take when lifting its own restrictions in future. For Part 2 of this report, we propose to supplement the current work with a qualitative review of the outcomes of easing restrictions, as well as quantitative metrics on the indicators leading up to lifting restrictions – both of which will be used to guide a discussion of implications for scaling back COVID-19 restrictions in New Brunsw


Report - Part 1 - Rapid response report on lifting restrictions for COVID-19 April 16, 2020 (2020)
Report - Part 2 - Lifting restrictions for COVID-19: Implications for New Brunswick April 26, 2020 (2020)

Rapid response reports on COVID-19 projections in New Brunswick

Erfan Mahmood Bhuiyan, Eva Christensen, Bethany Daigle, Sandra Magalhaes, Ted McDonald, Pablo Miah, Chandy Somayaji

Summary...

This series of reports provides successive updates of projections that the trajectory of COVID-19 cases could follow in New Brunswick based on the experiences of other countries and regions who experienced initial COVID-19 infections earlier than NB. Specifically, these projections estimate what NB’s incident cases, hospitalizations and mortality might be if our province experienced disease trajectories similar to a range of comparison countries and regions, for both 10-day forward and peak infection scenarios. By updating our estimates in subsequent reports as more data become available, we are able to examine how NB is actually doing relative to those scenarios and use the updated data to revise our forecasts accordingly. 

Rapport - Rapport d’intervention rapide concernant la COVID-19 au Nouveau-Brunswick : Le 31 mars 2020 (2020)
Report - Rapid response report on COVID-19 in New Brunswick: March 31, 2020 (2020)
Report - Update: Rapid response report on COVID-19 in New Brunswick: April 14, 2020 (2020)
Report - Update: Rapid response report on COVID-19 in New Brunswick: April 27, 2020 (2020)

Dedicated resources for COVID-19: April 8, 2020

Eva Christensen, Bethany Daigle, Ted McDonald, Chandy Somayaji

Summary...


As the COVID-19 pandemic progresses, policy makers and health care workers are progressively trying to determine best practices for handling the disease – particularly when caring for infected patients. One key question that emerges is whether having dedicated resources (spaces and services) for COVID-19 effectively controls the spread, decreases the severity, and mitigates the cost of the disease – in terms of costs to health care, societal disruption, individual health outcomes (such as scarring of the lungs), and, ultimately, lives lost. This report presents a summary of how health systems in various countries have been separating healthcare resources during pandemic medical management. This includes measures aimed at separation of COVID-19 and non-COVID patient resources, both in terms of separate physical structures for dedicated COVID care and of separation within existing structures, as well as policies aimed at preventing overlap and exposure between point sources of care for medical personnel. 


Report - Rapid response report on dedicated resources for COVID-19: April 8, 2020 (2020)

Key factors in the establishment of an academia-government center of public sector administrative data and policy research

Ted McDonald, James Ayles

Summary...





Summary coming soon...




Journal - Key factors in the establishment of an academia-government center of public sector administrative data and policy research (2018)

The use of public libraries in New Brunswick, 2010-2018

Herb Emery, Bethany Daigle, Ted McDonald

Summary...


Can public libraries remain relevant in an era of lightning-fast Internet access, Kindle e-books, and Amazon Prime’s 2-day book deliveries? Most New Brunswickers admit to loving their public libraries, but how many actually use them? 

Studies show that public libraries provide valuable social capital within their communities. They bring people together, create trust, provide information, and contribute to overall communal well-being. Yet, libraries are increasingly pressured to demonstrate their value and their usefulness to the public. 

In an attempt to demonstrate library value, researchers at the New Brunswick Institute for Research, Data and Training (NB-IRDT) examined the use of public libraries in NB from 2010 to 2018 by looking at how many library cards are being used and how many items are being checked out. 

Results show that active borrowers’ demand for NB public libraries grew by 8% from 2010-2018. Since 2015, the number of active borrowers has been increasing in the South of the province (13%), especially in Moncton, Saint John, and Fredericton (19%). The authors find this positive trend is driven by population growth in the South, and that demand for libraries in the North remains constant, despite slow population growth and a suffering economy. 

Disruptions to library services (i.e., closure, renovations) did not lower demand for library services. Instead, library use increased, especially between 2015 and 2016, likely as a result of policy changes, including (i) more flexible ways of providing library cards, (ii) the elimination of overdue fees for children, and (iii) the opening all public libraries on Saturdays (and some on Sundays).

Overall, the growth and steady demand for Public Library services in NB is remarkable, given the technological and social changes taking place throughout the province.

Rapport - L’utilisation des bibliothèques publiques au Nouveau-Brunswick, de 2010 à 2018 (2019)
Report - The use of public libraries in New Brunswick, 2010-2018 (2019) (Colour)
Report - The use of public libraries in New Brunswick, 2010-2018 (2019) (Greyscale)

Through the legal maze: An Act Respecting Research

Ted McDonald, Patricia MacKenzie, Krista Barry

Summary...


















Conference Presentation - Through the legal maze: An Act Respecting Research (2018)

Sharpening the focus

Nicole Doria, Donna Curtis Maillet

Summary...





Summary coming soon...




Journal - Sharpening the focus: Differentiating between focus groups for patient engagement vs. qualitative research (2018)

Does exposure prediction bias health-effect estimation?

Mark Goldberg, Paul Villeneuve, Dan Crouse

Summary...






Summary coming soon...





Journal - Does exposure prediction bias health-effect estimation? The relationship between confounding adjustment and exposure prediction (2017)

Immigrant retention in New Brunswick results from Biznet and Citizen Database

Philip Leonard, Ted McDonald, Pablo Miah

Summary...



How many immigrants typically land in New Brunswick? And how many stay? 

In an effort to boost the population and economy of New Brunswick, the provincial government has invested many resources in attracting and retaining immigrants. One such initiative is the Provincial Nomination Program (PNP), which accelerates the immigration and Permanent Resident application process for skilled workers and immigrants (and their family members) with experience in business.

In this report. researchers from the New Brunswick Institute for Research, Data and Training (NB-IRDT) use linked data from BizNet and the Citizen Database to investigate the number of landings (2001-2017) and retention rates (2005-2017) of immigrations in New Brunswick, focusing in particular on immigrants who arrived through the PNP. 

Results show that the number of Provincial Nominees has been steadily rising since 2005, reaching over 950 a year in 2017. Meanwhile, of the Nominees in New Brunswick long enough to receive a Medicare number, 75% remain in province one year later; 60% remain 3 years later, and less than 50% remain 5 years later. Report findings indicate that New Brunswick retains approximately 64% of targeted immigrants through the PNP. 

Findings also show that the largest number of Provincial Nominees has consistently come from China, though the number from the Philippines has been increasing rapidly since 2016. Immigrants from the Philippines also have the highest retention rates.

Future updates to the Citizen Database and BizNet datasets will make it possible to analyze retention rates of applicants through the Atlantic Immigration Pilot as well. 


Report - Immigrant retention in New Brunswick: Results from BizNet and Citizen Database (2019) (Colour)
Report - Immigrant retention in New Brunswick: Results from BizNet and Citizen Database (2019) (Greyscale)

The impact of official bilingualism on the geographic mobility of New Brunswickers

J. C. Herbert Emery, PhD Li Wang, MA Bethany Daigle, MA

Summary...


Are bilingual New Brunswickers more or less likely to move? 

New Brunswick is both the only bilingual province in Canada and the province with the highest rates of outmigration and intra-provincial (within the province) migration. Much attention has been paid to the problem of outmigration and movement from rural to urban areas in New Brunswick, as well as to bilingualism within the province – yet, these topics are not typically associated. Is it possible that bilingualism has an impact on the movements of New Brunswickers?

In this report, researchers from the New Brunswick Institute for Research, Data and Training (NB-IRDT) use data from the 2006 and 2016 Census of Population and the 2011 National Household Survey to determine the effect of official bilingualism on the geographic mobility of New Brunswickers – that is, on their movements to relocate. They control for variables known to impact migration decisions, such as age, gender, marital status, and education level; and focus on the origins and destinations of New Brunswickers who move, while also examining the linguistic characteristics of New Brunswickers who remain in place. 

Results show that New Brunswickers with an English mother tongue are the most likely to leave New Brunswick – regardless of whether they are bilingual or unilingual. Meanwhile, acquiring a second official language is most highly associated with intra-provincial migration, suggesting that bilingualism improves labour market efficiency in New Brunswick by increasing the mobility of both Anglophones and Francophones throughout New Brunswick. 

Report - The impact of official bilingualism on the geographic mobility of New Brunswickers: Evidence from 2001 to 2016 (2019) (Greyscale)
Report - The impact of official bilingualism on the geographic mobility of New Brunswickers: Evidence from 2001 to 2016 (2019) (Colour)

Small-Area Population Forecasts for New Brunswick

Paul Peters, Andy Balzer, Bethany Daigle

Summary...

What will the population of New Brunswick look like in the coming years? 

New Brunswick has one of Canada’s fastest aging populations and lowest levels of in-migration, along with declining fertility rates. A shrinking population presents a challenge to economic growth and has significant implications for other factors, such as the province’s healthcare system, tax base, and social support. Thus, population decline in New Brunswick has been a salient political concern for many years now. 

Researchers at the New Brunswick Institute for Research, Data and Training (NB-IRDT) have been analyzing provincial population trends for a number of years. Earlier reports suggested the province’s population would continue to shift due to inter-provincial outmigration, with growth concentrated in cities through rural to urban migration. 

More recent reports using newly available 2016 Census data update the population statistics,  accounting for the fact that New Brunswick experienced an overall population decline from 2011 to 2016. In these reassessments of population forecasts for small areas in New Brunswick, results are more negative than those of the 2017 reports – possibly due to data reflecting the sluggish provincial economy following the 2008 recession. 

The most current population forecasts suggest net migration is the main driver of population growth; and while the cities of Moncton and Fredericton are predicted to see population increases, the remaining areas in New Brunswick will arguably see either population decline or stagnation. The labour force is likely to follow the same trends as the general population. 

The authors argue that these trends could reflect a cyclical population downturn that will eventually reverse itself with renewed population growth; or they could indicate a future trend of population decline. Ongoing research may be able to tell. 

Report - Small area population forecasts for New Brunswick (2017)
Report - New Brunswick population snapshot (2017)
Report - Small-area population forecasts for New Brunswick with 2016 Census Data: Cohort-component model report (2018)
Report - Small-area population forecasts for New Brunswick with 2016 Census Data: Simplified model report (2018)

Temporary residents in New Brunswick and their transition to permanent residency

Herb Emery, Ted McDonald and Andrew Balcom

Summary...



How well does New Brunswick attract Temporary Residents? And how many become Permanent Residents? 

With a declining population and slow economic growth, New Brunswick is seeking to boost growth in both areas by increasing the number of immigrants settling in the province. Research from Statistics Canada suggests that Temporary Foreign Workers are less likely to settle in the Atlantic provinces than in the rest of Canada. However, this research does not examine provincial variations in the attraction of Temporary Residents and Foreign Workers and transition to Permanent Residency in the Atlantic region. Knowing the characteristics and transition rates of Temporary Residents would allow the New Brunswick government to better identify gaps and opportunities to improve immigration policies.

In this report, researchers from the New Brunswick Institute for Research, Data and Training (NB-IRDT) use data from the Immigration, Refugees and Citizenship Canada (IRCC) database to describe the characteristics of Temporary Residents and Temporary Foreign Workers in New Brunswick as well as retention rates and the rate of transitions to Permanent Resident status.

Results show that from 2000 to 2013, the number of Temporary Residents in New Brunswick has been increasing at the same rate as that of Canada. However, if one considers the the population size of NB alongside the proportion of immigrants in New Brunswick, it becomes apparent that the number of Temporary Residents in New Brunswick is underrepresented, with New Brunswick seemingly holding less attraction for them.

Yet, while New Brunswick appears to be less attractive to Temporary Residents than the other Atlantic provinces it also has a higher rate of transition to Permanent Residency than the Canadian rate. Similarly, Permanent Residents who stay in New Brunswick for one year after transitioning show fairly persistent retention rates. These results suggest that the New Brunswick labour market may have the capacity to absorb more Permanent Residents because it does not receive a proportion of Temporary Residents equal to its proportion of the Atlantic population. 





Report - Temporary residents in New Brunswick and their transition to permanent residency (2017)
Summary - Temporary residents in New Brunswick and their transition to permanent residency (2017)

The economic impacts of migrating from New Brunswick to Alberta/Saskatchewan and return to New Brunswick

Herb Emery, Ted McDonald and René Morissette

Summary...


Are New Brunswickers who leave the province for work any better off if/when they return? 

For many years now, large numbers of young, working-age New Brunswickers have migrated to other provinces for work. While the most popular Canadian destinations for New Brunswickers in the past were Ontario, Nova Scotia, and Quebec, this has changed over the past 20 years, with New Brunswickers migrating more frequently to Alberta and Saskatchewan – likely due to growth and employment opportunities in the oil and gas industry. 

There is a general assumption that New Brunswickers who leave the province to work elsewhere are better off when they return. But does the evidence suggest this is true?  

To answer this question, researchers at the New Brunswick Institute for Research, Data and Training (NB-IRDT) use Statistics Canada tax-filer data to compare the characteristics and earnings of New Brunswickers who migrate Alberta/Saskatchewan and then return (i.e., “Returners”) against those of 

  • NB workers who migrate and remain in AB/SK (“Permanent Migrants”) 
  • NB workers who remained in NB. (“Stayers”)  and
  •  NB workers who migrate to Alberta/Saskatchewan and then return ("returners")

Results show that Returners and Permanent Migrants experienced equally advantageous earnings gains from migrating to AB/SK. There are many possibilities why this is the case. It is possible that Returners are penalized by diminished opportunities. Perhaps they are less motivated to work for lower earnings. Maybe they accumulated enough savings to work fewer hours. 

These findings suggest that policies aiming to boost economic growth through increased GDP, immigration, and return migration in New Brunswick should focus on increasing labour demand, rather than marketable human capital. 



Summary - The economic impacts of return migration (2017)
Report - The economic impacts of migrating from New Brunswick to Alberta/Saskatchewan and return to New Brunswick (2017)

Using administrative and survey data to estimate returns to higher education in Canada

Ted McDonald, Bethany Daigle, Pablo Miah

Summary...



Post-secondary education is valuable – but how should we measure that value?

Education is commonly described as a valuable asset: It benefits the individuals who attain it, and it benefits society at large. Unsurprisingly, research almost exclusively finds that investment in post-secondary education produces positive returns. However, despite widespread agreement on this fact, there is no consensus on the best methods for reliably calculating these returns. 

In this report, researchers at the New Brunswick Institute for Research, Data and Training (NB-IRDT) analyze the existing literature and available datasets to compile a list of recommendations to identify the most accurate and effective methods for calculating the returns to post-secondary education. 

In the short term, the authors recommend measuring the value of post-secondary education by analyzing the datasets linked through Statistics Canada’s Education and Labour Market Longitudinal Platform (ELMLP): The Postsecondary Student Information System (PSIS), the Registered Apprenticeship Information System (RAIS), and T1 Family File tax records. By using these data sets to group earnings cohorts according to observable characteristics and by using tax records to estimate individuals’ participation (or non-participation) in post-secondary education, researchers can create control groups against which to compare the earnings of groups with varying levels of education. 

In the long term, the authors believe the most accurate estimations of the return to post-secondary education in Canada can be obtained by expanding the information available through the ELMLP to include additional data from the Canadian Census, the Longitudinal Administrative Databank (LAD), the Longitudinal and International Study of Adults (LISA), the General Social Survey (GSS), the Programme for the International Assessment of Adult competencies (PIAAC), the Longitudinal Immigration Database (IMDB) and others. 

Report - Using administrative and survey date to estimate returns to higher education in Canada (2019)

Comparisons of high school equivalency and high school diplomas in NB

Philip Leonard, Ted McDonald, Andy Balzer

Summary...



Is getting a GED as “good” as getting a high school diploma? 

New Brunswickers who drop out of high school but later complete their high school education commonly receive a General Equivalency Diploma – otherwise known as a GED. Some may assume that having a GED or other equivalency degree is comparable to having a high school diploma. Meanwhile, others ask if having a GED is better than having no degree at all. To shed light on this issue, researchers at NB-IRDT look at the evidence surrounding labour market outcomes. 

This report uses data from the New Brunswick Institute for Research, Data and Training (NB-IRDT) from the 2016 General Social Survey to examine labour market outcomes – including employment and average income – for New Brunswickers possessing a high school equivalency diploma, a traditional high school diploma, or less than a high school education. New Brunswickers with levels of education beyond high school are not included in this comparison. 

Findings show that while employment rates and average incomes for individuals with an equivalency diploma are not as high as for those with a high school diploma, they are considerably higher than those of individuals who did not complete a high school education. 

At the time of the survey, 51% of individuals with an equivalency diploma were employed, versus 60% with a high school diploma and 31% without a high school education. Individuals with an equivalency diploma were earning approximately $31,742 a year, compared to $32,381 for those with a high school diploma and $19,893 for those without a high school education.

Previous studies have asked whether there is any advantage to getting a GED over not getting one at all. The results suggest the answer is “yes” – in the labour market, at least. 


Report - Comparisons of high school equivalency and high school diplomas in NB (2019)

Characteristics of apprenticeship programs in the Atlantic Provinces

Herb Emery, Ted McDonald, Andrew Balcom

Summary...


What do we know about Atlantic Apprentice Programs?

Over the past 20 years, Canadian apprenticeship programs have seen a 200% increase in registrations – partly due to the need for skilled tradespeople to meet labour shortages as Canada’s aging workforce reaches retirement and partly due to higher wages and more opportunities in the resource sector. 

To better understand the characteristics, mobility and earnings of individuals registered in Atlantic Canadian apprenticeship programs, researchers at the New Brunswick Institute for Research, Data and Training (NB-IRDT) examine linked data from the Registered Apprenticeship Information System, T1 tax files, and T4 statements of earnings and compare results across program registrants in each Atlantic province. 

The authors consider three dimensions of apprenticeship: 

  • characteristics of participants (demographics, etc.)
  • mobility of apprentices (during and after apprenticeship)
  • earnings of participants

Findings show that over 90% of apprentices are male, and electrician is the most common field of study. 
 
About 95% of those studying in the Atlantic provinces are also residents; but after program completion, about 15% of those residents are employed in another province (typically Alberta). 
 
Program completers earn approximately $20,000 more per year than program discontinuers, regardless of where they worked. However, NB completers who work in AB earn significantly more in the first few years than those who work in the Atlantic provinces. 

Summary - Characteristics of apprenticeship programs in the Atlantic Provinces (2017)
Report - Apprenticeship programs in the Atlantic Provinces: Program characteristics, apprentice mobility and earnings (2017)

Will a higher minimum wage decrease poverty in NB

Emily Boyle, Bethany Daigle, Sarah McRae

Summary...



What is the best way to reduce poverty in New Brunswick? 

In recent years, there have been increasing public debates across Canada about the need to implement new policy levers to tackle the problem of poverty. These have largely taken the form of advocacy for accelerated minimum wage increases – specifically to $15 an hour. With the provinces of Alberta, Ontario, and British Columbia raising (or promising to raise) the minimum wage to $15/hour in 2018, 2019, and 2021, respectively, other Canadian provinces have debated whether they should follow suit.

In Fredericton, New Brunswick, a media movement called “Fight for 15 Fredericton” is emulating the original “Fight for 15” initiated by New York City fast-food workers in 2012 – and is hoping to meet with the same success. However, it is important to gather evidence predicting the impact such an increase in minimum wage would have for New Brunswick. Would an increase similar to those in Ontario, Alberta, and British Columbia produce positive or negative results for the region? What outcomes would this kind of increase have on the rate and depth of poverty in New Brunswick? And would a different policy prove more effective?

This report, produced by the New Brunswick Institute for Research, Data and Training, reviews the evidence surrounding minimum wage increases, living wage policies, taxes and transfers, and Universal Guaranteed Basic Income policies to assess how these instruments might impact poverty levels in New Brunswick. The authors find that a higher minimum wage is unlikely to significantly reduce poverty, whereas an income-based prorated Universal Guaranteed Basic Income might be the most far-reaching effective poverty reduction strategy – especially when implemented alongside current tax and transfer policies.


Report - Will a higher minimum wage decrease poverty in New Brunswick? A review of the evidence on minimum wages and other policy alternatives (2019)

Wage Growth in New Brunswick, 1997-2017

Patrick Coe, J.C. Herbert Emery, Derek Mikola

Summary...

Recently, there have been growing concerns over the state of wages in New Brunswick. After all, the province has seen slow overall economic growth, and the labour market has undergone technological changes in production that could potentially impact wages through reduced labour demands. Is it possible these or other factors have slowed down wage growth in the province? 

According to researchers at the New Brunswick Institute for Research, Data and Training (NB-IRDT), wages can serve as an indicator of quality of life, with wage stagnation indicating a stagnant quality of life, as well as a lack of growth in labour productivity.

To ascertain the status of real wages in New Brunswick, this report uses data from the Statistics Canada CANSIM database and focuses on average and median real hourly wages and real weekly earnings, categorized by industry. It compares the evolution of weekly and hourly earnings in the province to estimate the rate of wage growth in New Brunswick, which it also compares to wage growth in Ontario and Canada overall. The results show that wage growth in New Brunswick has followed a trend similar to that of Ontario and Canada; however, there is a relatively constant wage gap between average New Brunswick wages and average Ontario and Canadian wages – of approximately $5 per hour. 

Findings show that long-term wage growth in New Brunswick is associated with national productivity growth, rather than provincial growth. This means that changes to the labour market are more visible in changes in employment, rather than wage rates. A decrease in labour demand will result in fewer employed workers, rather than slower wage growth. This suggests that policies aiming to stimulate the New Brunswick economy should target growing labour demand, rather than pushing for isolated increases in labour supply. 

Report - Wage growth in New Brunswick (2019)

True cost of living measures for 10 provinces

Herb Emery, Xiaolin Guo

Summary...




What is the “True Cost of Living” in Canada?

In Canada, the Consumer Price Index (CPI) is the official measure of the cost of living used by government and other organizations to make policy decisions, such as how to index salaries, public pension payments, and minimum wages. If the CPI does not accurately represent the cost of living, taxpayers could end up paying more than intended, and some households could receive less in the form of transfers and wages. It is therefore important that the “true cost of living” is measured accurately.

Using 1997-2015 data from the Survey of Household Spending, researchers at the New Brunswick Institute for Research, Data and Training (NB-IRDT) construct “true cost of living” measures for subgroups of the Canadian population based on consumers’ behaviour while estimating biases in the official CPI.

Results show that provincial CPI measurements significantly vary from the true cost of living – particularly after the 2008-2009 recession. While the CPI suggests no major shocks to the economy, this report suggests a sharp increase in the cost of living and a decrease in real incomes for all Canadian households – an economic shock that persisted beyond 2012, particularly for females and households with children. For instance, structural changes in the location and slope of Engel Curves after 2009 also appear to coincide with various economic shocks. For instance, gasoline prices increased abruptly in 2010, and energy and food prices have continued to rise. Likewise, after 2009, consumers faced tighter access to consumer credit, which was accompanied by an increase in consumers paying down debt during a time of rapid growth in commodity prices. These findings suggest that households were not buffering against price shocks following the 2008-2009 recession.





Report - True cost of living measures for 10 Provinces: Using an Engel curve approach (2019)

Does the regionalization of health services lead to variations in care?

Adrian Levy, James Ted McDonald, Juergen Krause

Summary...



Regionalizing, or centralizing, health services involves the concentration of health care resources at fewer locations with the aim of reducing wait times, increasing quality of care, and lowering service costs. However, there is the possibility that regionalization can result in geographical barriers to care, as some individuals may need to travel further for services or may need to rely on limited local treatment options.

Even though each Maritime province operates under slightly different health care models, they have some things in common. Each province offers some regionalized services, and each province offers non-regionalized orthopaedic surgeries, which are accessible at many different hospitals. 

In this report, researchers from the Maritime SPOR SUPPORT Unit (MSSU) and the New Brunswick Institute for Research, Data and Training (NB-IRDT) examine variations in surgery rates and surgery types in the Maritime provinces, focusing specifically on three kinds of surgery:

  • coronary artery bypass grafts (CABGs) (regionalized service)
  • hip replacements (not regionalized)
  • knee replacements (not regionalized)

Using data from the Canadian Institute for Health Information Discharge Abstract Database, the authors estimate the types and rates of surgery for adults who had a CABG or a hip or knee replacement surgery between 2001 and 2013, as well as changes in those rates over time.

Study results show that rates of CABGs remained stable over time, while rates of orthopaedic surgery increased. Rates of cardiac surgery were higher for men, whereas rates of orthopaedic surgery were higher for women. 
 
Findings also show regional variations in surgical rates, with CABG showing the least, variation and knee replacements the highest amount of variation. This suggests that some patients may be choosing to undergo orthopaedic surgeries out of province.

Report - Geographic variation in coronary artery bypass surgery and hip and knee replacement surgeries in the Maritime Provinces (2016)

Tobacco use and food insecurity in New Brunswick

Herb Emery, Valerie Tarasuk, Xiaolin Guo, Bethany Daigle, Daniel Dutton, Philip Leonard, Ted McDonald

Summary...


Is smoking tobacco associated with higher rates of food insecurity?

Food insecurity refers to a range of experiences – from concerns about running out of food before having enough money to buy more to not eating for a whole day due to a lack of food and money for food. Food insecurity is most prevalent in households with lower incomes, and food insecure families can find themselves in difficult situations in which they have to decide whether to “heat or eat.” In this report, researchers from the New Brunswick Institute for Research, Data and Training (NB-IRDT), the University of New Brunswick, and the University of Toronto examine the relationship between smoking and food insecurity to see if families are also faced with the decision to either “smoke or eat.”

Using 2007-2017 data from the Canadian Community Health Survey this report asks whether
  • smoking raises the risk of being food insecure, or
  • smoking has no cause effect on food insecurity due to shared characteristics between smokers and food insecure households.

The results show that households with smokers are more likely to be food insecure, though, food insecurity has a stronger relationship  with poor health and well-being than tobacco use.

Apart from the impact of smoking on food insecurity, this report also finds that individuals most likely to be food insecure are families with younger respondents, females, individuals with low levels of education, renters, urban dwellers, Aboriginals, and recent immigrants.

The authors recommend a focus on implementing programs such as counselling, rather than higher taxation on cigarettes, as strategies to decrease tobacco use, as the latter could reduce the purchasing power of families’ incomes, including income available for food.




Report - Tobacco use and food insecurity in New Brunswick (2019) (Greyscale)
Report - Tobacco use and food insecurity in New Brunswick (2019) (Colour)
Rapport - Tabagisme et insécurité alimentaire au Nouveau-Brunswick (2019)