Context: Obesity rates are rising sharply among all industrialized countries; the situation seems to be worse in English speaking countries. Taking into account genetic predisposition, excess of caloric intake combined with low energy expenditure will usually result in obesity. Objectives: To describe and compare regional obesity rates across Canada and assess the ecological relationship between regional rates of obesity, low level of leisure-time physical activity, and low fruit and vegetable consumption. Design: Cross-sectional population-based analysis from the 2003 Canadian Community Health Survey. Measures and data analyses: Canadian population distributions of body mass index (BMI), leisure-time physical activity and daily fruit and vegetable consumption were obtained from Statistics Canada. All these measures were based on the respondent's selfreported answers to a computer-assisted personal or telephone interview. Obesity rates (BMIX30), rates of low level of leisure-time physical activity (less than 1.5 kcal of energy expenditure per day), and rates of low fruit and vegetable consumption (less than five times a day) for the 106 Canadian Health regions were mapped to illustrate their geographical distribution. Cartograms were used in addition to traditional mapping to take into account the differences in population density between these small areas. Results: In 2003, 15.2% of Canadian individuals aged 20 years and older were considered obese. The rates of obesity varied substantially between the 106 Canadian health regions: from 6.2% in Vancouver to 47.5% in aboriginal population area. At the health region level, low leisure-time physical activity and low fruit and vegetable consumption are both good predictors of obesity (odds ratio of 9.2 and positive predictive value of 93% when considered simultaneously). Conclusion: There is a strong gradient in obesity prevalence between Canadian health regions. At the regional level, high rates of low level of physical activity, and high rates of low fruit and vegetable consumption were both found good predictors of high rates of obesity.

Background: Osteoporosis (OP) is a skeletal disorder characterized by reduced bone strength and predisposition to increased risk of fracture, with consequent increased risk of morbidity and mortality. It is therefore an important public health problem. International and Canadian associations have issued clinical guidelines for the diagnosis and treatment of OP. In this study, we identified potential predictors of bone mineral density (BMD) testing and OP treatment, which include place of residence.

BackgroundRegional disparities in medical care and outcomes with patients suffering from an acute coronary syndrome (ACS) have been reported and raise the need to a better understanding of links between treatment, care and outcomes. Little is known about the relationship and its spatial variability between invasive cardiac procedure (ICP), hospital death (HD), length of stay (LoS) and early hospital readmission (EHR). The objectives were to describe and compare the regional rates of ICP, HD, EHR, and the average LoS after an ACS in 2000 in the province of Quebec. We also assessed whether there was a relationship between ICP and HD, LoS, and EHR, and if the relationships varied spatially.MethodsUsing secondary data from a provincial hospital register, a population-based retrospective cohort of 24,544 patients hospitalized in Quebec (Canada) for an ACS in 2000 was built. ACS was defined as myocardial infarction (ICD-9: 410) or unstable angina (ICD-9: 411). ICP was defined as the presence of angiography, angioplasty or aortocoronary bypass (CCA: 480–483, 489), HD as all death cause at index hospitalization, LoS as the number of days between admission and discharge from the index hospitalization, and EHR as hospital readmission for a coronary heart disease ≤30 days after discharge from hospital. The EHR was evaluated on survivors at discharge.ResultsICP rate was 43.7% varying from 29.4% to 51.6% according to regions. HD rate was 6.9% (range: 3.3–8.2%), average LoS was 11.5 days (range: 7.5–14.4; median LoS: 8 days) and EHR rate was 8.3% (range: 4.7–14.2%). ICP was positively associated with LoS and negatively with HD and EHR; the relationship between ICP and LoS varied spatially. An increased distance to a specialized cardiology center was associated with a decreased likelihood of ICP, a decrease in LoS, but an increased likelihood of EHR.ConclusionThe main results of this study are the regional variability of the outcomes even after accounting for age, gender, ICP and distance to a cardiology center; the significant relationships between ICP and HD, LoS and EHR, and the spatial variability in the relationships between ICP and LoS.

BackgroundEarly access to revascularization procedures is known to be related to a more favorable outcome in myocardial infarction (MI) patients, but access to specialized care varies widely amongst the population. We aim to test if the early gap found in the revascularization rates, according to distance between patients' location and the closest specialized cardiology center (SCC), remains on a long term basis.MethodsWe conducted a population-based cohort study using data from the Quebec's hospital discharge register (MED-ECHO). The study population includes all patients 25 years and older living in the province of Quebec, who were hospitalized for a MI in 1999 with a follow up time of one year after the index hospitalization. The main variable is revascularization (percutaneous transluminal coronary angioplasty or a coronary artery bypass graft). The population is divided in four groups depending how close they are from a SCC (<32 km, 32–64 km, 64–105 km and ≥105 km). Revascularization rates are adjusted for age and sex.ResultsThe study population includes 11,802 individuals, 66% are men. The one-year incidence rate of MI is 244 individuals per 100,000 inhabitants. At index hospitalization, a significant gap is found between patients living close (< 32 km) to a SCC and patients living farther (≥32 km). During the first year, a gap reduction can be observed but only for patients living at an intermediate distance from the specialized center (64–105 km).ConclusionThe gap observed in revascularization rates at the index hospitalization for MI is in favour of patients living closer (< 32 km) to a SCC. This gap remains unchanged over the first year after an MI except for patients living between 64 and 105 km, where a closing of the gap can be noticed.

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