These newly developed ICD-10 and ICD-9-CM comorbidity coding algorithms produce similar estimates of comorbidity prevalence in administrative data, and may outperform existing ICD-9-CM coding algorithms.

Liver biopsy rates are increasing likely owing to the changing epidemiology and management of common liver diseases. The similarity of the complication rate in our population-based study with estimates from specialized centres supports the safety of this important procedure.

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The recent epidemiology and outcomes of primary biliary cirrhosis (PBC) in North America are incompletely described, partly due to difficulties in case ascertainment. In light of their availability, broad coverage, and limited expense, administrative databases may facilitate such investigations. We used population-based administrative data (inpatient, ambulatory care, and physician billing databases) and a validated International Classification of Diseases coding algorithm to describe the epidemiology and natural history of PBC in the Calgary Health Region (population Ϸ1.1 million). Between 1996 and 2002, the overall age/sex-adjusted annual incidence of PBC was 30.3 cases per million (48.4 per million in women, 10.4 per million in men). Although the incidence remained stable, the prevalence increased from 100 per million in 1996 to 227 per million in 2002 (P < 0.0005). Among 137 incident cases with a total follow-up of 801 personyears from diagnosis (median 5.8 years), 27 patients (20%) died and six (4.4%) underwent liver transplantation. The estimated 10-year probabilities of survival, liver transplantation, and transplant-free survival were 73% (95% confidence interval [CI] 60%-83%), 6% (95% CI 2.5%-12.6%), and 68% (95% CI 55%-78%), respectively. Survival in PBC patients was significantly lower than that of the age/sex-matched Canadian population (standardized mortality ratio 2.87; 95% CI 1.89-4.17); male sex (hazard ratio [HR] 3.80; 95% CI 1.85-7.82) and an older age at diagnosis (HR per additional year, 1.06; 95% CI 1.03-1.10) were independent predictors of mortality. Conclusion: This population-based study demonstrates that the burden of PBC in Canada is high and growing. Survival of PBC patients is significantly lower than that of the general population, emphasizing the importance of developing new therapies for this condition.

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Research R acial and ethnic disparities in the use of health services and in health outcomes have been extensively studied and well documented in the United States and the United Kingdom. Studies from both countries reveal that black, Hispanic and Asian people are less likely to access health care and experience more barriers than people who are not visibly members of ethnic minorities -that is, white people.1-7 The factors underlying ethnic disparities in health service usage are complex and could include such variables as health insurance coverage, physicians' attitudes toward minority patients, language, poverty, transportation, education, familiarity with the health care delivery system, and the degree and kind of family support. 3,6-17The evidence from the United States and the United Kingdom cannot automatically be generalized to Canada, and there is a need for rigorous study of Canadian ethnic populations and their use of health services. The first reason is that much of the US and UK literature on this topic is broadly categorized into "black" and "Hispanic" populations. The United States, the United Kingdom and Canada have different racial and ethnic population compositions because of historical factors. The legacy of slavery in the United States and of colonization in the United Kingdom have led to a higher proportion of persons identified as black. In contrast, Canada has many Asian people in its ethnic make-up, because in recent years a large proportion of immigrants to Canada have come from Asia (59%), with a small proportion from Central and South America and the Caribbean (11%) and Africa (8%).18 At present, the 3 largest visible minority groups in Canada are Chinese (mainly from Hong Kong, Taiwan and mainland China), South Asian (from Asian India, Pakistan, Bangladesh and Sri Lanka) and black people.The second reason is that culture, health status and sociodemographic characteristics even in the same racial or ethnic population may differ between Canada and the United States or the United Kingdom. In recent years, Canada has selected immigrants with high education, strong technical skills and correspondingly favourable health status, with only a relatively small number of immigrants arriving as refugees; US and UK ethnic minorities may differ in those respects. The third reason is that the Canadian health system differs fundamentally from the US health system, and somewhat from the parallel public and private systems of the United Kingdom. Interpretation: : Use of health services in Canada varies considerably by ethnicity according to type of service. Although there is no evidence that members of visible minorities use general physician and specialist services less often than white people, their utilization of hospital and cancer screening services is significantly less. CMAJ 2006;174(6):787-91 Abstract

Background: Risk adjustment and mortality prediction in studies of critical care are usually performed using acuity of illness scores, such as Acute Physiology and Chronic Health Evaluation II (APACHE II), which emphasize physiological derangement. Common risk adjustment systems used in administrative datasets, like the Charlson index, are entirely based on the presence of comorbid illnesses. The purpose of this study was to compare the discriminative ability of the Charlson index to the APACHE II in predicting hospital mortality in adult multisystem ICU patients.

Background: Computerized tomographic (CT) colonography is a potential alternative to colonoscopy for colorectal cancer screening. Its main advantage, a better safety profile, may be offset by its limitations: lower sensitivity, need for colonoscopy in cases where results are positive, and expense. Methods: We performed an economic evaluation, using decision analysis, to compare CT colonography with colonoscopy for colorectal cancer screening in patients over 50 years of age. Three-year outcomes included number of colonoscopies, perforations and adenomas removed; deaths from perforation and from colorectal cancer from missed adenomas; and direct health care costs. The expected prevalence of adenomas, test performance characteristics of CT colonography and colonoscopy, and probability of colonoscopy complications and cancer from missed adenomas were derived from the literature. Costs were determined in detail locally. Results: Using the base-case assumptions, a strategy of CT colonography for colorectal cancer screening would cost $2.27 million extra per 100 000 patients screened; 3.78 perforation-related deaths would be avoided, but 4.11 extra deaths would occur from missed adenomas. Because screening with CT colonography would cost more and result in more deaths overall compared with colonoscopy, the latter remained the dominant strategy. Our results were sensitive to CT colonography's test performance characteristics, the malignant risk of missed adenomas, the risk of perforation and related death, the procedural costs and differences in screening adherence. Interpretation: At present, CT colonography cannot be recommended as a primary means of population-based colorectal cancer screening in Canada.