Individuals exposed to higher levels of air pollution had nearly threefold greater odds of developing ACOS. Minimizing exposure to high levels of air pollution may decrease the risk of ACOS.

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All-cause mortality rates have decreased substantially over the past decade. Compared with the general population, the asthma population has higher all-cause mortality and is more likely to die from comorbid conditions. Total asthma mortality was fourfold higher than asthma-specific mortality, highlighting the importance of comprehensive measurement approaches that include asthma-specific and asthma-contributing mortality.

While the magnitude of the September peak has decreased over time, the asthma ED visit rate remains significantly higher in September than in other months. Physician visits are also highest in the fall. These findings stress the importance of empowering children and families to maintain good asthma control throughout the year, including hand washing, to minimize respiratory viral infections in September.

ObjectivesThe objective of this study was to use health administrative and environmental data to quantify the effects of ambient air pollution on health service use among those with chronic diseases. We hypothesised that health service use would be higher among those with more exposure to air pollution as measured by the Air Quality Health Index (AQHI).SettingHealth administrative data was used to quantify health service use at the primary (physician office visits) and secondary (emergency department visits, hospitalisations) level of care in Ontario, Canada.ParticipantsWe included individuals who resided in Ontario, Canada, from 2003 to 2010, who were ever diagnosed with one of 11 major chronic diseases.Outcome measuresRate ratios (RR) from Poisson regression models were used to estimate the short-term impact of incremental unit increases in AQHI, nitrogen dioxide (NO2; 10 ppb), fine particulate matter (PM2.5; 10 µg/m3) and ozone (O3; 10 ppb) on health services use among individuals with each disease. We adjusted for age, sex, day of the week, temperature, season, year, socioeconomic status and region of residence.ResultsIncreases in outpatient visits ranged from 1% to 5% for every unit increase in the 10-point AQHI scale, corresponding to an increase of about 15 000 outpatient visits on a day with poor versus good air quality. The greatest increases in outpatient visits were for individuals with non-lung cancers (AQHI:RR=1.05; NO2:RR=1.14; p<0.0001) and COPD (AQHI:RR=1.05; NO2:RR=1.12; p<0.0001) and in hospitalisations, for individuals with diabetes (AQHI:RR=1.04; NO2:RR=1.07; p<0.0001) and COPD (AQHI:RR=1.03; NO2:RR=1.09; p<1.001). The impact remained 2 days after peak AQHI levels.ConclusionsAmong individuals with chronic diseases, health service use increased with higher levels of exposure to air pollution, as measured by the AQHI. Future research would do well to measure the utility of targeted air quality advisories based on the AQHI to reduce associated health service use.

BackgroundPrevious research has shown variations in quality of care and patient outcomes under different primary care models. The objective of this study was to use previously validated, evidence-based performance indicators to measure quality of asthma care over time and to compare quality of care between different primary care models.MethodsData were obtained for years 2006 to 2010 from the Ontario Asthma Surveillance Information System, which uses health administrative databases to track individuals with asthma living in the province of Ontario, Canada. Individuals with asthma (n=1,813,922) were divided into groups based on the practice model of their primary care provider (i.e., fee-for-service, blended fee-for-service, blended capitation). Quality of asthma care was measured using six validated, evidence-based asthma care performance indicators.ResultsAll of the asthma performance indicators improved over time within each of the primary care models. Compared to the traditional fee-for-service model, the blended fee-for-service and blended capitation models had higher use of spirometry for asthma diagnosis and monitoring, higher rates of inhaled corticosteroid prescription, and lower outpatient claims. Emergency department visits were lowest in the blended fee-for-service group.ConclusionsQuality of asthma care improved over time within each of the primary care models. However, the amount by which they improved differed between the models. The newer primary care models (i.e., blended fee-for-service, blended capitation) appear to provide better quality of asthma care compared to the traditional fee-for-service model.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-015-0232-y) contains supplementary material, which is available to authorized users.

Individuals with asthma and chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) have a more rapid decline in lung function, more frequent exacerbations and worse quality of life than those with asthma or COPD alone [1-3]. Various risk factors may be associated with the development of ACOS, such as smoking history and status, obesity, comorbidity and indoor and outdoor environmental exposures [1, 4-6]. The risk of developing ACOS may vary substantially by region, since demographic and environmental risk factors and community characteristics are not geographically homogeneous. Here, we use population-based data to estimate the incidence of ACOS in the asthma population and to measure the association between demographic factors, community-level characteristics and environmental factors and the risk of incident ACOS and all-cause mortality while accounting for spatial autocorrelation. A cohort approach was used to follow individuals with incident asthma in Ontario, Canada aged ⩾18 years in 1996, to determine the incidence of COPD (i.e. ACOS). While individuals with ACOS may consist of various phenotypes [1, 7, 8], in this paper, our focus is on those with physician-diagnosed asthma who subsequently received a physician diagnosis of COPD. Using validated asthma and COPD health administrative case definitions [9, 10] and linking individual level data across multiple provincial health administrative databases (hospital discharges, emergency department visits, physician claims and death certificates), we identified incident asthma in 1996-2009, incident COPD in 1998-2014 and all-cause mortality in 1996-2014. In order to examine geographical variations in outcomes and risk factors, we applied an ecological design using data at the Census Division (CD) level. In Ontario, there are 49 CDs that vary in size (663-439 000 km 2) and population density (0.1-4150 people per km 2). To distinguish between incident and prevalent cases, a minimum 5-year asthma-or COPD-free observation period prior to the incidence date was applied. Those without a valid health card number for data linkage, missing residence postal code, age at COPD diagnosis <35 years or with COPD diagnosis prior to asthma were excluded. To minimise potential false positives (i.e. an initial asthma diagnosis that was later changed to COPD), those with COPD diagnosed ⩽2 years after asthma incidence were excluded (n=26 591, 6% of asthma population). The following risk factors were calculated at the CD level: 1) the Ontario Marginalization Index (ON-Marg), a proxy measure of socioeconomic status (SES) measured using four dimensions: material deprivation, residential instability, ethnic concentration and dependency [11]; 2) smoking prevalence rates derived from the 2013 Canadian Community Health Survey; 3) the Air Quality Health Index (AQHI), a composite air pollution index based on levels of ozone (O 3), fine particles with a diameter of 2.5 μm or less (PM2.5) and nitrogen dioxide (NO 2) [12], measured from 49 fixed-site monitors around the province; an...