Study design and data sourcesWe constructed a populationbased cohort of deliveries using administrative health data of the singlepayer health care system in Ontario, Canada, held at ICES. We identified parent-infant pair

IMPORTANCE Topical corticosteroids (TCSs) are available in multiple potencies that alter their effectiveness and safety. Pharmacoepidemiologic studies on TCSs are hampered by the absence of a universal potency classification system, limiting comparisons across studies, robust exposure classification, and clinical interpretation.OBJECTIVE To classify TCSs into 3 commonly used potency classification systems and evaluate the agreement and correlation between the 3 systems. DESIGN, SETTING, AND PARTICIPANTSIn this classification study, a comprehensive list of TCS formulations was compiled using sources identified in the literature, the Ontario Drug Benefit Formulary, a recent Cochrane review on the use of TCSs in people with eczema, and the Anatomical Therapeutic Classification (ATC) of the World Health Organization from August 11, 2021, to January 6, 2022. Topical corticosteroid potency classifications were assigned and compared using the 7-category US classification system, a 4-category classification from a recent Cochrane review largely based on the UK formulary, and the 4-category ATC classification. To facilitate comparisons across systems, the 7-category US system was consolidated into 4 categories. MAIN OUTCOMES AND MEASURESCohen weighted κ (κ w ) and Spearman rank correlation coefficients (r) were computed to examine agreement and correlation between the classification systems.RESULTS A total of 232 unique TCS formulations (ATC, n = 231; US classification, n = 232; Cochrane review, n = 89) were included. Overall, there was low-to-moderate agreement but strong correlation between the classification systems. The US classification had weak agreement with the ATC system (κ w , 0.53; 95% CI, 0.45-0.60) and moderate agreement with the Cochrane review classification (κ w , 0.60; 95% CI, 0.48-0.73); there was weak agreement between the ATC and Cochrane review classifications (κ w , 0.58; 95% CI, 0.46-0.71). The US classification strongly correlated with the ATC system (r, 0.77; 95% CI, 0.71-0.82) and Cochrane review classification (r, 0.74; 95% CI, 0.62-0.82). There was also a strong correlation between the Cochrane review and ATC classifications (r, 0.71; 95% CI, 0.58-0.80).CONCLUSIONS AND RELEVANCE This classification study used multiple resources to classify 232 TCS formulations into 3 potency classifications. Because these systems are often incongruent, they may yield different results in pharmacoepidemiologic studies; investigators need to be transparent in their classification approach and consider alternative potency definitions in sensitivity analyses.

The present work examines how culture and age interact to influence self-continuity and life satisfaction. Specifically, we compared Canadian and Chinese young (17–26 years old) and older adults (60–88 years old) in their sense of self-continuity and life satisfaction (N = 424). Consistent with past research, older adults reported greater self-continuity compared to their young counterparts, while cross-cultural comparisons showed that young Chinese reported greater self-continuity than young Canadians. In terms of life satisfaction, older adults again scored higher than younger adults, while cross-cultural comparisons indicated that, this time, young Canadians reported higher life satisfaction than young Chinese. Although the data were cross-sectional, indirect effects analyses showed that self-continuity mediated the effect of age on life satisfaction in both cultural groups, with the indirect effect stronger among Canadians than among Chinese. These findings highlight the importance of considering culture and age when examining psychological outcomes, and the potential of self-continuity as a mechanism to enhance overall life satisfaction.

Background: Pregnant patients with particular types of health insurance may have distinct demographic and medical characteristics that have a biologic effect on associations between opioid analgesics and congenital anomalies (CA). Methods: We followed 199,884 pregnant prescription beneficiaries in Ontario, Canada (1996Canada ( -2018. Opioid analgesics dispensed in the first trimester and CA were identified from universal-access administrative health records. We estimated propensity score adjusted risk ratios (RR) between first trimester exposure and CA (any, major, minor, specific). RRs were compared to those published from an Ontario population-based cohort (N = 599,579, 2013-2018).Results: 15,724 (7.9%) were exposed to first trimester opioid analgesics, mainly codeine (58.1%) or oxycodone (21.3%); CA prevalence in exposed was 3.1%. RRs in the beneficiary cohort appeared higher than the population-based cohort for any CA with hydromorphone (RR = 2.34, 95% CI: 1.65, 3.30) and oxycodone (RR = 1.73, 95% CI: 1.46, 2.05) and major CA with hydromorphone (RR = 2.74, 95% CI: 1.91, 3.94) and oxycodone (RR = 1.72, 95% CI: 1.42, 2.08). Other RRs that appeared higher in the beneficiary cohort included cardiovascular (codeine, oxycodone), gastrointestinal (oxycodone), musculoskeletal (any, hydromorphone, oxycodone), CNS (oxycodone), chromosomal (codeine), and neoplasm and tumor (oxycodone) anomalies. The beneficiary cohort had higher opioid doses, was younger, had lower socioeconomic status, and greater comorbidities. Conclusions: Increased risks of CA after first trimester opioid analgesics were observed in low-income prescription beneficiaries, and some estimates were higher than a population-based cohort from the same setting. Biological differences associated with younger age, lower socioeconomic status and greater comorbidity may affect generalizability of results from pregnant low-income beneficiaries.

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