17^th Annual EBOSS Research Day | March 12th, 2021

Abstract

Background: Knowledge about COVID-19 in pregnancy is limited, and evidence on the impact of the infection during pregnancy and postpartum is still emerging. The objective was to analyze maternal morbidity and mortality due to severe acute respiratory infections (SARI), including COVID-19, in Brazil.
Methods: This population-based study used surveillance data from the SIVEP-Gripe (Sistema de Informação de Vigilância Epidemiológica da Gripe). Currently and recently pregnant women aged 10-49 years hospitalized for severe acute respiratory infection (SARI) from January through November 2020 were selected. SARI cases were grouped into: COVID-19; influenza or other detected agent SARI; and SARI of unknown etiology. Characteristics, symptoms and outcomes were presented by SARI type and region. We used descriptive statistics to profile the study population. Binomial proportion and 95% confidence intervals (CI) for outcomes were obtained using the Clopper-Pearson method.
Results: Of 945,460 hospitalized SARI cases in the SIVEP-Gripe, we selected 11,074 women aged 10-49 who were pregnant (7,964) or recently pregnant (3,110). COVID-19 was confirmed in 49.4% cases; 1.7% had influenza or another etiological agent; and 48.9% had SARI of unknown etiology. The pardo race/ethnic group accounted for 50% of SARI cases. Hypertension/Other cardiovascular diseases, chronic respiratory diseases, diabetes, and obesity were the most common comorbidities. A total of 362 women with COVID-19 (6.6%; 95% CI 6.0-7.3) died. Mortality was 4.7% (2.2-8.8) among influenza patients, and 3.3% (2.9-3.8) among those with SARI of unknown etiology. The South-East, Northeast and North regions recorded the highest frequencies of mortality among COVID-19 patients.
Conclusion: Mortality among pregnant and recently pregnant women with SARIs was elevated among those with COVID-19, particularly in regions where maternal mortality is already high.

Abstract

Background: Individuals with genetic syndromes can manifest both congenital heart disease (CHD) and cancer due to possible common underlying pathways. However, reliable risk estimates of hematopoietic cancer (HC) among children with CHD based on large population-based data are scant.
Methods: We conducted a population-based analysis to estimate the cumulative incidence of HC in a cohort of children (0-18) born between 1999 and 2017, with at least one hospitalization records of CHD diagnosis. We merged the CIHI-Discharge Abstract Database, which regularly collects hospitalization and day surgery records in all Canadian provinces except Quebec, with Quebec’s CHD database, to develop the Canadian Congenital Heart Disease Database. Hematopoietic cancer and syndromes were both identified by hospitalization diagnoses. We used a modified Kaplan-Meier curve analysis to estimate the cumulative incidences (with 95% confidence intervals) up to 18 years of age, with death as a competing risk and stratified by the genetic syndrome status.
Results: We followed 143,881 CHD children from birth for 1,387,934 person-years. In this study population, 8.7% had genetic syndromes, and 911 HC cases were observed. The cumulative incidence of HC up to age 18 was 2.42% (95% CI: 2.10-2.73%) among children with a genetic syndrome and 0.83% (0.75-0.92%) without the syndrome. The incidence proportion was higher in the first six years of life than the subsequent 6-year intervals up to adulthood. Children with severe CHD lesions and genetic syndrome had a cumulative incidence of 2.95% (95% CI: 2.29-3.61), whereas children with non-severe CHD lesions and genetic syndrome had a cumulative incidence of 2.23% (95% CI: 1.87-2.59).
Conclusion: This is the first population-based analysis documenting that genetic syndromes in CHD children are a powerful predictor of hematopoietic cancers. The finding is essential in informing risk-stratified policy recommendations to protect CHD children from cancer.

Abstract

Background: Researchers often use model-based multiple imputation to handle missing at random data to minimize bias while making the best use of all available data. However, there are sometimes constraints within the data that make model-based imputation difficult and may result in implausible values. In these contexts, we describe how to use random hot deck imputation to allow for plausible multiple imputation in longitudinal studies.
Methods: We illustrate random hot deck multiple imputation using The Childhood Health, Activity, and Motor Performance School Study Denmark (CHAMPS-DK), a prospective cohort study that measured weekly sports participation for 1700 Danish schoolchildren.
Results: Using the random hot deck approach, we were able to match records with missing data to several observed records, generate probabilities for matched records using observed data, and sample from these records based on the probability of each occurring. Because our imputed values were generated randomly, multiple complete datasets can be created and analyzed similarly to model-based multiple imputation.
Conclusion: Multiple imputation using random hot deck imputation is an alternative method when model-based approaches are infeasible, specifically where there are constraints within and between covariates.

Abstract

Background: Excess wintertime cardiovascular mortality is consistently observed in populations globally and is partly attributed to cold-induced elevated blood pressure (BP). An inverse relationship of ambient (outdoor) temperature with BP has been observed, but indoor temperature may be more strongly associated with BP due to the influence of indoor environmental conditions (e.g., heating, insulation) and more time spent indoors, particularly in colder months. We aimed to estimate the relative effects of indoor and outdoor temperature on wintertime blood pressure (BP) and central hemodynamics among adults in peri-urban Beijing, China, assessing whether there was effect measure modification by indoor temperature.
Methods: Participants >40 years from 50 peri-urban Beijing villages were enrolled in a panel study from winter 2018 to 2020. Staff visited participants’ homes to conduct detailed questionnaires and measure environmental exposures and BPs. Indoor temperature was measured within the 5 minutes prior to BP measurements and mean 24-hour outdoor temperature was estimated from government meteorological stations. Multivariable mixed-effects regression models were used to estimate the within- and between-individual effects of indoor and outdoor temperature on BP.
Results: Indoor and outdoor temperatures ranged from 0.0˚C to 28.0˚C and -14.3˚C to 6.4˚C, respectively. Results in 1,262 participants showed an inverse linear relationship between indoor temperature (per 1˚C increase) and BP (mmHg) of −0.4 to −0.5 systolic BP, −0.3 diastolic BP, and −0.2 to −0.3 pulse pressure. We found little evidence of any effect of outdoor temperature with BP, and no evidence that indoor temperature modified the outdoor temperature-BP relationship.
Conclusion: Our results support previous findings of inverse associations between indoor temperature and BP but contrast with prior evidence of an inverse relationship with outdoor temperature. Null findings in outdoor temperature analyses suggest a stronger wintertime relationship of indoor compared to outdoor temperature with BP, highlighting the importance of wintertime home heating to cardiovascular health.

Abstract

Background: The Interim Federal Health Program (IFHP) has provided temporary healthcare coverage to eligible refugees since 1957, but significant amendments reported to be cost-saving were made to the program by the Conservative-led government in 2012. This reform greatly affected refugees’ access to healthcare and quality of life. However, in 2016, a political change resulted in the repeal of this reform. This study, therefore, aimed to understand the agenda-setting factors influencing the 2016 reform.
Methods: Using the Kingdon and 3-I frameworks, “how” and “why” the policy appeared on the government’s agenda was analyzed. Kingdon’s framework exposed the problem, politics and policy proposal streams informing the 2016 reform, while major influencers involved in the reform were identified using the 3-I framework. This analysis involved a comprehensive review of academic articles, grey literature, Bill C-31 readings and the CDRC v Attorney General court case.
Results: Evidence from ad-hoc evaluations showed that contrary to claims made by the Conservatives, the 2012 reform was detrimental to the refugees’ health and the government. The court ruling in 2014, together with the media reporting, made it necessary for the government to take action. Yet, it was the active pushback by human rights activists, healthcare providers and refugee service providers that facilitated the 2016 reform. To add, political climates favoured these reforms. Occupying the majority in government, it was relatively easy for the Liberal government to restore the IFHP to pre-2012 levels. Noteworthily, whilst the 2012 reform received criticisms for evidentiary deficiencies, the government still does not have evaluation plans in place for the IFHP.
Conclusion: The 2016 reform offers a unique opportunity to eliminate structural barriers to accessing healthcare and reduce health disparities experienced by refugees. However, certain service gaps and administrative barriers for healthcare providers exist. These may lead to increased health burdens for some refugees.

Abstract

Background: Poor diets kill 11 million people globally every year. Interventions to promote Fruits and Vegetables (FV) would reduce Non-Communicable Diseases (NCDs) burdens, in particular among individuals with a low socio-economic status (SES) who suffer from a higher occurrence of NCDs and who have limited financial access to fresh FV. Canned and frozen FV consumptions have been encouraged; these ‘non-fresh alternatives’ provide nutrients at a lower or comparable cost to fresh ones. The objective was to identify the presence of substitution between fresh and non-fresh FV and to quantify the differential magnitude of substitution across neighbourhood SES.
Methods: This study was an ecological study using store-level sales and price of fresh and non-fresh FV. We obtained grocery transaction data from one of the leading Canadian grocery retailing chains, and included 155 operating stores in Quebec between Feb 1st 2015 and Sep 30th 2017. The primary outcome was total monthly purchase for each of 6 subgroups (fresh FV, canned FV, frozen FV) in a store. We measured the outcome as a function of an average price per serving of each FV subgroups at a given month and store. We performed 6 separate analyses for each of the subgroups, which were in turn stratified by income and education.
Results: The findings showed the significant substitution between fresh fruits and non-fresh fruits. The magnitude of substitution was greater in low-income areas. When the price of fresh fruits increased by 10%, the monthly purchase of canned and frozen fruits increased by 1.44% [95% CI 0.43% 2.44%] and 2.30% [95% CI 1.34% 3.26%], respectively, with a doubling of the estimates in low-income neighbourhoods compared with high-income neighbourhoods. The magnitude of substitution seemed to be greater in neighbourhoods with higher education level.
Conclusion: Our study provides evidence of price sensitivity for fruits and vegetables. Given the fact that many dietary interventions still target fresh fruits and vegetables, the study findings can lay the groundwork for seeking feasibility of alternative dietary interventions that encourage non-fresh alternatives along with fresh fruits and vegetables.