ObjectivesWe assess how different scenarios of cardiovascular disease (CVD) prevention, aimed at meeting targets set by the World Health Organization (WHO) for 2025), may impact healthcare spending in Quebec, Canada over the 2050 horizon.MethodsWe provide long-term forecasts of healthcare use and costs at the Quebec population level using a novel dynamic microsimulation model. Using both survey and administrative data, we simulate the evolution of the Quebec population’s health status until death, through a series of dynamic transitions that accounts for social and demographic characteristics associated with CVD risk factors.ResultsA 25% reduction in CVD mortality between 2012 and 2025 achieved through decreased incidence could contain the pace of healthcare cost growth towards 2050 by nearly 7 percentage points for consultations with a physician, and by almost 9 percentage points for hospitalizations. Over the 2012–2050 period, the present value of cost savings is projected to amount to C$13.1 billion in 2012 dollars. The years of life saved due to improved life expectancy could be worth another C$38.2 billion. Addressing CVD mortality directly instead would bring about higher healthcare costs, but would generate more value in terms of years of life saved, at C$69.6 billion.ConclusionsPotential savings associated with plausible reductions in CVD, aimed at reaching a World Health Organization target over a 12-year period, are sizeable and may help address challenges associated with an aging population.
Complex population projections usually use microsimulation models; in Canada, Statistics Canada has developed a global dynamic microsimulation model named LifePaths in the Modgen programming language to be used in policy research. LifePaths provides a platform to build on for our research program, conjointly with Dr Janice Keefe from Mount Saint Vincent University, on projections of the Canadian chronic homecare needs for the elderly up to 2031 and of the human resources required. Beside marital status, family networks and living arrangements, future disability status of the elderly is a key variable, but an intricate one. Since disability status transitions were previously conditioned only on age and sex, we will use here the current disability module of LifePaths with longitudinal data from Canada's National Population Health Survey (NPHS). These new disability status transitions are considering other significant explicative variables like marital status, education etc. We will then present projections of future Canadian elderly by disability status and a comparison with nine European countries for the Future Elderly Living Conditions in Europe (FELICIE) Research Program which has used the same approach. Our previous researches have shown the importance of future disability level for the management of an elderly society. The main output of the present paper would first produce, with new health scenarios, new estimates for Canada of elderly in poor health, for those aged 75 and over. Secondly, it would produce an interesting comparative analysis, useful especially for implementing new policies for the well-being of the Canadian elderly.
The first wave of the COVID-19 pandemic has led to excess mortality across the globe, and Canada has been no exception. Nonetheless, the pandemic experience has been very different across provinces, and the objective of this paper is to investigate these differences focusing on two extreme cases. We contrast the mortality experience of British Columbia with that of Québec to understand how large differences in mortality during the first wave of the pandemic emerged across these two provinces. We find that most of the differences can be found in excess mortality in institutions (nursing homes) and that travel restrictions, differences in how deaths are recorded, differences in the seasonality of the flu, or differences in how the pandemic spread across different economic segments of the population are unlikely explain these large differences. We document that the reported death toll from COVID-19 is about 30% larger than excess mortality in Quebec due to lower mortality from other causes of death, in particular malignant tumors, heart disease, and respiratory problems. We do not find evidence of an income gradient (measured by postal code level income) in relative excess death for the first wave. Keywords Excess mortality • COVID-19 • Nursing homes • Cause of death RésuméLa première vague de la pandémie de la COVID-19 a entraîné une surmortalité dans plusieurs pays à travers le monde, incluant le Canada. Par contre, l'ampleur fut bien différente à travers les provinces canadiennes et l'objectif de cette analyse est d'étudier ces différences en se concentrant sur deux provinces spécifiques. Pour ce faire, nous comparons la mortalité de la Colombie-Britannique avec celle du Québec pour tenter de comprendre les grandes différences observées entre ces deux provinces durant la première vague de la pandémie. On constate qu'une grande partie de la sur-
L'ensemble des sociétés occidentales connaissent actuellement une croissance considérable des personnes âgées de 75 ans et plus. De nombreux changements familiaux affectant ces sociétés, il est pertinent de se demander qui prendra en charge les aînés de demain en cas de besoin d'assistance. Cet article compare les projections démographiques du réseau familial des personnes âgées de 75 ans et plus jusqu'en 2030 au Canada et en France. Au cours des 25 années prochaines, le vivier des aidants familiaux potentiels, constitué des conjoint(e)s et des enfants, s'élargira en raison des effets du Baby Boom (dont l'ampleur a été particulièrement forte au Canada) et de la proportion croissante de femmes qui ont un conjoint. Les populations les plus tributaires de l'aide formelle -sans soutien potentiel provenant d'un enfant ou d'un conjoint -augmenteront à un rythme beaucoup plus soutenu au Canada (123 pour cent) qu'en France (34 pour cent), mais moins rapidement toutefois que l'ensemble des personnes âgées. Les politiques publiques de ces deux pays devront être adaptées afi n de soutenir adéquatement des effectifs croissants de personnes âgées confrontés à la dépendance de leurs conjoints. Au Canada, ces politiques devront, de plus, faire face à une hausse, plus forte qu'en France, du nombre d'aînés qui dépendront des services d'aide formelles. ABSTRACTWestern societies are experiencing a dramatic growth in the population aged 75 and older. Changes in family composition raise questions about who will care for those who need assistance. We compared population projections to the year 2030 of those families aged 75 and older in Canada and France. Over the next 25 years, the pool of potential family carers, (i.e., spouses and children), will broaden from the effect of the baby boom and increased proportion of women with spouses. The populations most dependent on formal care, with no potential support from a child or a spouse, will increase more sharply in Canada (123 % ) than in France (34 % ) but at a slower rate than the total population. Policy and programs in both countries will need to prepare for a greater number of elderly spouses providing care and in Canada, at least, a signifi cant increase in the number that will need to rely on formal services.
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