In Sickness and In Health: Effects of Cardiovascular Health Shocks on Spouses’ Work and Earnings

Introduction A severe health shock can threaten a patient’s life and alter the lives of their family. Spouses often provide care, and may change their work situation, affecting family income. This could mean less work to allow for more caregiving, or more work to make up for the patient’s lower income. Objectives and Approach We used the Canadian Hospital and Taxation Database to quantify the impact on workforce participation and changes in earnings among spouses of working-age Canadians who survived a heart attack, cardiac arrest, or stroke. All 40-61 year-olds who experienced a health shock between 2005 and 2010, and survived for at least 3 years, were included, along with their spouses. We use 15 variables to match case spouses with up to 5 (weighted) potential control spouses. The main outcome was Total earnings, which included the sum of wages and salaries, net self-employment income and other employment income, normalized to 2012 Cdn dollars. Results Our analysis included 11,208 spouses of heart attack patients, 622 spouses of cardiac arrest patients, and 2,228 spouses of stroke patients, matched with spouses in the control group. For all three health shocks, we found no significant difference in the distribution of changes in earnings between cases and matched controls (p=0.30 for heart attack; p=0.72 for cardiac arrest and p=0.27 for stroke). We also found no difference in levels of working status (ie being employed). We found mixed impacts by spouses’ sex, age, and pre-event earnings for heart attack and stroke patients. These results are consistent with previous findings, but drill deeper by analyzing the distributions of changes in earnings among spouses of patients experiencing health shocks. Conclusion/Implications Despite known decreases in work and earnings among patients experiencing heart attack, cardiac arrest, or stroke, the proportion of spouses whose work and earnings were increased, decreased, or unchanged was the same as for control spouses. This combination implies a significant reduction in family income after serious health events

Academic and Social Outcomes for High‐Risk Youths in Manitoba

This study examined academic and social outcomes for high‐risk youths in Manitoba, using longitudinal, population‐based data. All children born in Manitoba in 1984‐1985 who resided in Winnipeg the year they turned 18 were included in analyses (N = 11,703). High risk youths were defined as those involved with child welfare services, living in poverty, and/or having a mother who was a teen at first childbirth. Of youths with one risk factor, 41 to 57 per cent failed to complete high school, and 84 per cent of those with all three risk factors did not complete high school, compared with only 18 per cent of youths with none of the risk factors. Multiple risk factors put youths at an even greater disadvantage. Similar poor outcomes for high risk youths were observed for performance in grade 9, unemployment in early adulthood, and teen births. The findings suggest an intractable cycle of risk and disadvantage with farreaching social and economic implications

THE COMPLETE STORY: A POPULATION‐ BASED PERSPECTIVE ON SCHOOL PERFORMANCE AND EDUCATIONAL TESTING

All children born in Manitoba in 1984 were tracked for 18 years to assess their grade‐ 12 performance on a provincial examination according to a student’s socio‐economic status. The proportion of youths in families receiving social assistance judged to have passed their language arts exam dropped from 80 per cent to 12 per cent, depending on whether one counts only those in the cohort who took the test on time in 2002 or all youths born in 1984 who should have taken the test in 2002. Getting better data on performance and doing something about the discrepancies should become a Canadian priority. Key words: educational opportunity, exam performance, socio‐economic status, testing, longitudinal studies Tous les enfants nés au Manitoba en 1984 ont été suivis sur une période de 18 ans en vue d’évaluer leur rendement en 12e année lors d’un examen provincial, tenant compte de leur statut socioéconomique. La proportion de jeunes issus des familles recevant de l’aide sociale et considérés comme ayant réussi leur examen au plan des compétences linguistiques passe de 80 % à 12 %, selon que l’on compte seulement ceux qui, dans la cohorte, ont subi l’examen à temps en 2002 ou tous les jeunes nés en 1984 qui auraient dû subir l’examen. En matière d’égalité des chances, la performance du système scolaire actuel au Canada laisse à désirer. Mots clés: possibilités éducatives, résultats d’examen, statut socioéconomique, analyse longitudinale.

Comparing cancer incidence, stage at diagnosis and outcomes of First Nations and all other Manitobans: a retrospective analysis

Abstract Background Globally, epidemiological evidence suggests cancer incidence and outcomes among Indigenous peoples are a growing concern. Although historically cancer among First Nations (FN) peoples in Canada was relatively unknown, recent epidemiological evidence reveals a widening of cancer related disparities. However evidence at the population level is limited. The aim of this study was to explore cancer incidence, stage at diagnosis, and outcomes among status FN peoples in comparison with all other Manitobans (AOM). Methods All cancers diagnosed between April 1, 2004 and March 31, 2011 were linked with the Indian Registry System and five provincial healthcare databases to compare differences in characteristics, cancer incidence, and stage at diagnosis and mortality of the FN and AOM cohorts. Cox proportional hazard regression models were used to examine mortality. Results The FN cohort was significantly younger, with higher comorbidities than AOM. A higher proportion of FN people were diagnosed with cancer at stages III (18.7% vs. 15.4%) and IV (22.4% vs. 19.9%). Cancer incidence was significantly lower in the FN cohort, however, there were no significant differences between the two cohorts after adjusting for age, sex, income and area of residence. No significant trends in cancer incidence were identified in either cohort over time. Mortality was generally higher in the FN cohort. Conclusions Despite similar cancer incidence, FN peoples in Manitoba experience poorer survival. The underlying causes of these disparities are not yet understood, particularly in relation to the impact of colonization and other determinants of health

Integrated KT 2.0: The next generation of teamwork

ABSTRACT Objective The goal of this study was to engage members of a long-standing Integrated KT collaborative in a process to revitalize team goals and processes. “The Need to Know” Team started in 2001 in Manitoba, to engage knowledge users in the conceptualization, creation, and application of population health research. The team has garnered numerous national awards and citations for its approach. We conducted a survey of team members (N=27), representing all Health Authorities in the province, plus provincial government reps. Questions included frequency of data use and medium (print vs online), how well the team is meeting is goals, open-ended questions about how the team could be more useful to members and their organizations, and their top 3 suggestions to ensure the ongoing success and increase the impact of the team. Method Twenty-two of 27 members responded to the survey (81.5%) within one week. Responses to questions about how well the team is meeting its existing goals revealed high scores – especially among those goals which lay entirely within the scope of the team’s control (91% extremely or moderately well). Objectives relating to larger-scale impacts on the healthcare system had lower ratings (72% extremely or moderately well), as might have been expected. Results Over 75% reported that the team’s work had impacted their organization’s work moderately or a lot. The most commonly cited examples were that the work of the team increased capacity for data analysis/interpretation and research (18%), provided results that were used in staff and/or board meetings (15%), influenced decisions and the discussions leading up to them (15%), influenced the development and use of region-relevant quality indicators (13%), and were used in the ongoing education of health professionals (13%). The open-ended questions regarding optimal next steps solicited a variety of suggestions ranging from developing even richer relationships with existing partners, to including a wider variety of partner organizations (e.g. Indigenous groups); aligning team priorities with those of the provincial government (where feasible); and moving to occasional electronic meetings for appropriate content issues and to increase impact in partner organizations. Conclusion This exercise in reflection and strategic planning has shown that the team has done an exceptional job in achieving its initial goals, most of which remain relevant, but some of which need revision. More importantly, several creative approaches have been suggested which may increase future impact and enhance both the breadth and depth of the team’s reach

Health Service Use in the Winnipeg Regional Health Authority: <i>Variations across Areas in Relation to Health and Socioeconomic Status</i>

The use of healthcare services in Winnipeg is examined to determine whether groups who appear to have a higher need for medical care actually get more care. Despite universal coverage, considerable variation in service use rates exists. Most of the basic healthcare services are provided in accordance with need as measured by premature mortality rates. Nevertheless, visits to specialist physicians, a variety of high profile procedures, and screening and preventative services appear not to be provided in accordance with need. </jats:p