Opportunities and Challenges From Leading Trends in a Biomonitoring Project: Canadian Health Measures Survey 2007–2017

2022

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BackgroundAn infection with certain HPV genotypes can lead to cancer or genital warts. HPV can be detected with PCR-based tests, and some genotypes can be prevented by vaccines. However, since the infection rates of various HPV genotypes have not been well reported, the present study aims to provide this information.MethodsThe Canadian Health Measures Survey (CHMS) is an ongoing biannual national survey. Between 2009 and 2011, it sampled a nationally representative sample of females aged 14 to 59 years to determine the infection rates of 46 HPV genotypes. Females aged 9 to 29 years and 9 to 59 years were asked whether they received HPV vaccines between 2009 to 2011 (cycle 2) and 2012 to 2013 (cycle 3), respectively. The reported infection rates and vaccination proportions were weighted and adjusted for the survey design.ResultsAmong the estimated 10,592,968 females aged 14 to 59 years at cycle 2, the HPV genotypes with the highest infection rates were 16, 62, 74, and 54, and the rates were 3.42% (95% CI = 1.67% to 5.17%), 2.14% (95% CI = 0.68% to 3.59%), 2.1% (95% CI = 0.51% to 3.69%), and 2.04% (95% CI = 0.38% to 3.7%), respectively. There were an estimated 6,569,100 and 11,603,752 females aged 9 to 29 and 9 to 59 years at cycles 2 and 3, respectively. The proportions receiving a HPV vaccine were 13.55% (11.18% to 15.92%) and 12.3% (9.8% to 14.79%), respectively. The estimated numbers of females that received HPV vaccines were 890,197 and 1,427,000, respectively.ConclusionCanada is one of the few countries that conduct national surveys to determine HPV infection rates by genotype, which are not limited to the surveillance of carcinogenic genotypes. Our study found discrepancies between the HPV genotypes whose infections were the most common, that could be detected by PCR tests, that were carcinogenic, and that could be prevented by vaccines. For example, 5 of the 7 genotypes (42, 54, 62, 66, and 74) with infection rates of more than 1% cannot be detected by PCR tests and are not targeted by vaccines. HPV 51 is carcinogenic, associated with genital warts, and can be detected by PCR tests, but it is not targeted by vaccines. We recommend a better alignment of the genotypes targeted by HPV tests and vaccines with those genotypes with the highest infection rates in Canada.

Section: Discussionmentioning

confidence: 99%

“…In cycle 2, 46 HPV genotypes were tested using urine samples (6,11,13,16,18,26,30,31,32,33,35,39,40,42,43,44,45,51,52,53,54,56,58,59,61,62,66,67,68,69,70,71,72,73,74,81,82,83,84,85,86,87,89,90,91, and 97) (see Figure 1). [22] Samples were obtained from 1,770 female respondents aged 14 to 59 years.…”

Section: Methodsmentioning

confidence: 99%

Human Papillomavirus Infection Rate by Genotype and Vaccination Rates in Canada: Canadian Health Measures Survey 2009 to 2013

2022

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“…[13] Detailed inclusion and exclusion criteria and sampling frames were published elsewhere. [13][14][15][16] Participants in the CHMS were interviewed regarding their health conditions and individual characteristics. [13,17] Mobile units collected blood and urine samples to determine levels of disease biomarkers and environmental chemicals.…”

Section: Methodsmentioning

confidence: 99%

Trends in Diabetes Biomarkers and Treatment Statuses of Non-Institutionalized Canadians: Canadian Health Measures Survey 2007 to 2015

2022

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BackgroundDiabetes has been a major source of disease burden in Canada. Moreover, untreated diabetes can lead to complications and severe conditions. A few studies exist on the prevalence of diabetes and the adequacy of diabetes management for the Canadian population, and so this study aims to estimate the diabetes prevalence rates using biomarkers and the treatment statuses of non-institutionalized Canadian patients.MethodsThe Canadian Health Measures Survey (CHMS) cycles 1 to 4 were conducted between 2007 and 2015 as interviews with non-institutionalized Canadians. Four blood diabetic markers were measured: insulin, glycosylated hemoglobin percentages, random-spot glucose, and fasting glucose. Subjects with levels higher than normal ranges were considered to have pre-diabetes or diabetes. Treatment statuses were categorized into treated (using anti-diabetic agents or diagnosed with diabetes), probably treated (taking prescriptions or diagnosed with chronic conditions), potentially treated (taking any medications or diagnosed with chronic conditions), and untreated (not taking any medications and not diagnosed with chronic conditions). Weights were applied to generate nationally representative statistics.ResultsThe blood insulin levels in cycle 4 were significantly higher than those in cycle 1 (ratio = 1.42, 95% CI = 1.04 to 1.79). The proportions of patients with pre-diabetes and diabetes were estimated differently at 0.75% using random-spot glucose and 42.17% using glycosylated hemoglobin percentages, respectively. The proportions of Canadians with uncontrolled pre-diabetes or diabetes varied from 0.59% using random-spot glucose levels to 4.63% using fasting glucose levels, respectively. Through cycles 1 to 4, the proportions of untreated Canadians with pre-diabetes or diabetes ranged from 3.86% to 3.73%. More than 93% of those with high fasting glucose levels were taking prescription medications or had been diagnosed with chronic conditions (probably treated). Less than 33% of those with high fasting glucose levels were diagnosed or actively being treated with anti-diabetic agents (treated).ConclusionDiabetes biomarkers might be useful for screening untreated and undertreated patients with pre-diabetes or diabetes. The treatment categories we used indicated different intensities of intervention that might be useful for determining levels of patient outreach and for planning targeted screening in Canada.

“…We used data from the Canadian Health Measures Survey (CHMS) cycles 3 and 4 implemented in 2012 to 2013 and 2014 to 2015, respectively. [8][9][10] For each of these cycle, more than 5,000 non-institutionalized Canadians, aged 3 to 79 years were sampled (for details about inclusion and exclusion criteria, see previous publications). [11,12] statistical weights were applied to the subjects to estimate the overall distributions and levels of selected measures for more than 30 million non-institutionalized Canadians.…”

Section: Methodsmentioning

confidence: 99%

“…Previous studies have used a trend analysis of blood pressure and environmental chemicals to demonstrate their distributions in the populations and to detect significant changes in the levels of biomarkers over time. [8][9][10] The trends in, and the treatment status of, TSH and thyroid hormones may be useful for understanding how thyroid conditions are clinically managed in Canada. Therefore, this descriptive study conducts a trend analysis of TSH, free T4, and anti-thyroid peroxidase-using the thyroid measures available in a national survey-to detect whether significant changes in their levels are occurring in Canadians, and to estimate the treatment statuses of these thyroid measures.…”

Section: Introductionmentioning

confidence: 99%

Trends in TSH, free T4, and anti-thyroid peroxidase and treatment status: Canadian Health Measures Survey 2012 to 2015

2022

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BackgroundPrevious studies in Canada focused on the prevalence of thyroid conditions have not reported on the levels of the thyroid-stimulating hormone (TSH) and thyroid hormones. To address this issue, the present study describes the trends in TSH, free T4, and anti-thyroid peroxidase and their treatment status for the patients who have clinically high or low levels.MethodsWe used data from the Canadian Health Measures Survey (CHMS) cycles 3 and 4 conducted between 2012 and 2015. The thyroid measures studied were TSH, free T4, and anti-thyroid peroxidase. We used clinical reference ranges to identify abnormality in these measures. We labelled abnormality in these measures as treated if relevant conditions were diagnosed or a disease-specific prescription was reported. Untreated individuals were those with an abnormality in thyroid measures without any medication use or relevant diagnoses. We presented the trends of thyroid measures in mean values and ratios, compared to the values first measured.ResultsThe levels of TSH, free T4, and anti-peroxidase in cycle 4 were not significantly different from those in cycle 3. The proportions of Canadians with clinically high levels of free T4, anti-thyroid peroxidase, and TSH were 0.03 to 0.017, 0.005 to 0.005, and 0.30 to 0.43 for cycles 3 to 4, respectively. The proportions of Canadians with clinically low levels of TSH and free T4 were 0.02 to 0.021 and 0.18 to 0.11 for cycles 3 to 4, respectively. The change in the proportions of treatment statuses varied across the thyroid measures of the Canadians studied.ConclusionThis descriptive study demonstrates the trends in TSH, free T4, and anti-thyroid peroxidase; their distributions in the population; and the proportions of Canadians with clinically high or low levels. We believe the information on the treatment status of those with uncontrolled high levels can be used to design patient screening programs.