Allen Kraut

The relationship between inflammatory bowel disease and socioeconomic variables

Abstract OBJECTIVES: Inflammatory bowel diseases (IBD) are chronic diseases associated with considerable morbidity. This morbidity may have an impact on the ability of patients to remain employed, on their marital status, and on their ability to complete a course of higher education. It has long been held that IBD patients are of a higher socioeconomic status and more educated than the general population. Our aim was to determine the relationship between IBD and employment, income, disability, education, and marital status in two population-based data sets based in the province of Manitoba, Canada. METHODS: Two studies are reported here. In study A, we surveyed persons with IBD, using the population-based University of Manitoba IBD Database, created in 1995–1996. We compared these IBD patients to the general population with respect to employment, education, and marital status using data from the 1996 National Population Health Survey. IBD patients were queried as to their socioeconomic status as of the time of diagnosis and also at the time of the survey (1995–1996). In study B, we used a database that linked health care and census variables to determine differences in employment, income, occupation, and marital status among individuals who met the administrative definition of IBD (created in forming the University of Manitoba IBD Database, based on ICD-9-CM codes 555 for Crohn’s disease and 556 for ulcerative colitis) compared with the rest of working-age population. RESULTS: In study A we found that, compared with the general population, patients with IBD were more likely to be unemployed. Crohn’s disease appeared to affect employment more than ulcerative colitis. IBD patients, however, had a low rate of reporting themselves as disabled (1.3%). Among those married when diagnosed with IBD, approximately 10% of men and up to 20% of women were no longer married 5 yr later. More patients with IBD were married in 1995 compared with the general population; however, more were also divorced. Fewer patients with IBD achieved postsecondary education. In study B, we found that individuals with IBD were twice as likely to be out of the labor force as were controls. Sedentary occupations were twice as likely to be associated with IBD. The income, education level, and marital status of IBD patients were not significantly different from those of controls. CONCLUSIONS: Individuals with IBD at some time in the course of their illness are more likely not to be working than are those in the general population. Based on employment status and job classification, as well as income and education, IBD patients are not of a higher socioeconomic status as previously reported. IBD patients are at least as likely as the general population to be married.

Effect of school age sports on leisure time physical activity in adults: The CORDIS Study.

PURPOSE Data evaluating the impact of various types of childhood physical activity on adult leisure time physical activity (LTPA) are inconsistent. The purpose of this study was to evaluate the influence of organized childhood sporting activities on LTPA as an adult in a cohort of industrial workers. METHODS The frequency of current LTPA, defined as a half hour or more of activity at least once per week, of 3687 industrial workers in the Cardiovascular Occupational Risk Factors in Israel Study (CORDIS) cohort was the outcome variable. We analyzed the association of organized school age sports with adult LTPA, using a multiple logistic regression model, after adjusting for sociodemographic variables including current occupational factors. RESULTS Participating in organized school age sporting activities predicted LTPA as an adult [adjusted odds ratio (OR) 3.55, 95% confidence intervals (95% CI) 2.97-4.23]. This association was consistent in the various subgroups of marital status, age, smoking, shift work, body mass index, and religious observance. CONCLUSIONS Organized school age sporting activities influenced future LTPA in this cohort. Attempts to promote these activities may lead to increased levels of LTPA in adults.

Behavioral change with influenza vaccination: factors influencing increased uptake of the pandemic H1N1 versus seasonal influenza vaccine in health care personnel.

BACKGROUND Many health care personnel (HCP) choose not to get vaccinated against influenza despite recommendations to do so. The pH1N1 epidemic gave a unique opportunity to evaluate the attitudes to influenza vaccination of a group of HCP who routinely choose not to get vaccinated, but accepted the pH1N1 vaccine. METHODS HCP employed at a tertiary care hospital in Winnipeg, Canada who received the pH1N1 vaccine were invited to participate in an online survey asking about attitudes and experiences regarding seasonal and pH1N1 influenza and vaccination. Those eligible included primarily nurses, other clinical staff, and support staff, as few physicians work as employees. RESULTS Of the 684 respondents (29% return rate), 504 reported routinely getting vaccinated (RV) for seasonal influenza and 180 reported routinely not getting vaccinated (NRV). These two groups had different attitude towards the two strains of influenza, with markedly lower level of concern about seasonal influenza than pH1N1 for the NRV group. The contrast was especially notable regarding the NRVs view of the seriousness of the illness, their sense of exposure risk, and their confidence in the vaccine effectiveness (for all, seasonal<pH1N1, p<0.001). The most common motivators for getting vaccinated for both NRV and RV groups related to concerns about personal or family safety, while the choice to decline seasonal vaccination related primarily to lack concern about the illness and concerns about vaccine effectiveness and safety. Coworkers were influential in the decision to get the pH1N1 vaccine for the NRV group. CONCLUSION For HCP who do not routinely get the seasonal vaccination, perception of risk outweighing side effect concerns appeared to be a major influence in going ahead with the pH1N1 vaccine. Educational campaigns that focus on personal benefit, engage peer champions, and address concerns about the vaccine may improve influenza vaccine uptake among health care personnel.

Rates of readmission and death associated with leaving hospital against medical advice: a population-based study

Background: Leaving hospital against medical advice may have adverse consequences. Previous studies have been limited by evaluating specific types of patients, small sample sizes and incomplete determination of outcomes. We hypothesized that leaving hospital against medical advice would be associated with increases in subsequent readmission and death. Methods: In a population-based analysis involving all adults admitted to hospital and discharged alive in Manitoba from Apr. 1, 1990, to Feb. 28, 2009, we evaluated all-cause 90-day mortality and 30-day hospital readmission. We used multivariable regression, adjusted for age, sex, socioeconomic status, year of hospital admission, patient comorbidities, hospital diagnosis, past frequency of admission to hospital, having previously left hospital against medical advice and data clustering (patients with multiple admissions). For readmission, we assessed both between-person and within-person effects of leaving hospital against medical advice. Results: Leaving against medical advice occurred in 21 417 of 1 916 104 index hospital admissions (1.1%), and was associated with higher adjusted rates of 90-day mortality (odds ratio [OR] 2.51, 95% confidence interval [CI] 2.18–2.89), and 30-day hospital readmission (within-person OR 2.10, CI 1.99–2.21; between-person OR 3.04, CI 2.79–3.30). In our additional analyses, elevated rates of readmission and death associated with leaving against medical advice were manifest within 1 week and persisted for at least 180 days after discharge. Interpretation: Adults who left the hospital against medical advice had higher rates of hospital readmission and death. The persistence of these effects suggests that they are not solely a result of incomplete treatment of acute illness. Interventions aimed at reducing these effects may need to include longitudinal interventions extending beyond admission to hospital.

Unemployment and health care utilization

OBJECTIVES This study attempted to determine whether prior use of health services predicts a subsequent risk of unemployment and also to describe the acute effects of exposure to unemployment on the use of health care services. MATERIAL AND METHODS The 1986 census records were linked with comprehensive health care information for the period 1983-1989 for over 44629 randomly selected residents of Manitoba, Canada. All cause and cause-specific rates of hospital admission and ambulatory physician contacts were compared between 1498 unemployed and 18272 employed persons across 4 consecutive time periods related to the onset of unemployment. RESULTS The adjusted rates of hospital admission and physician contacts were higher among the unemployed across all 4 periods. When persons with a history of mental health treatment were excluded, health care use in the period prior to the onset of unemployment was equivalent among the employed and unemployed. When a history of mental health treatment was controlled for, all-cause and cause-specific health care use was elevated among the unemployed during the unemployment spell. CONCLUSIONS Unemployed persons had increased hospitalization rates before their current spell of unemployment. Much of this difference was due to the subgroup with prior mental health treatment. For persons without prior mental health care, hospitalization increased after a period of unemployment.

Prevalence of physician-diagnosed asthma by occupational groupings in Manitoba, Canada.

The objective of this research was to determine whether there are differences in the rate of physician-diagnosed asthma in various occupational groups. A prevalence survey using a population-based administrative database of a sample of the labor force in Manitoba, Canada was used. A sample of 22,561 individuals who were in the labor force at the time of the 1986 census were linked to the provincial administrative health database. The frequency of physician-diagnosed asthma and other obstructive respiratory conditions were measured. A case of asthma was defined as having at least three physician contacts for asthma between April 1, 1986, and March 31, 1990. Data on potential confounding factors such as age, gender, area of residence, income, and education were also available. The results showed that frequency of physician-diagnosed asthma by occupational grouping ranged from a low of 0.1/100 workers to a high of 4.8/100 workers. Three occupational groups, 1) other teaching and related occupations (SOC 279) (OR 2.54, 95% CI 1.18-5.44); 2) fabricating, installing, and repairing occupations of electrical electronic and related equipment (SOC 853) (OR 2.37, 95% CI 1.05-5.33); and 3) other occupations in laboring and other elemental work (SOC 992) (OR 2.51, 95% CI 1.21-5.24) were found to have elevated odds ratios for physician-diagnosed asthma. Datasets linking occupation and health care utilization may be useful tools for surveillance of work-related diseases in general, and for asthma in particular. However, further work should be done utilizing larger databases to determine the overall usefulness of this approach.

A population-based analysis of leaving the hospital against medical advice: incidence and associated variables

BackgroundPrior studies of patients leaving hospital against medical advice (AMA) have been limited by not being population-based or assessing only one type of patient.MethodsWe used administrative data at the Manitoba Centre for Health Policy to evaluate all adult residents of Manitoba, Canada discharged alive from acute care hospitals between April 1, 1990 and February 28, 2009. We identified the rate of leaving AMA, and used multivariable logistic regression to identify socio-demographic and diagnostic variables associated with leaving AMA.ResultsOf 1 916 104 live hospital discharges, 21 417 (1.11%) ended with the patient leaving AMA. The cohort contained 610 187 individuals, of whom 12 588 (2.06%) left AMA once and another 2 986 (0.49%) left AMA more than once. The proportion of AMA discharges did not change over time. Alcohol and drug abuse was the diagnostic group with the highest proportion of AMA discharges, at 11.71%. Having left AMA previously had the strongest association with leaving AMA (odds ratio 170, 95% confidence interval 156–185). Leaving AMA was more common among men, those with lower average household incomes, histories of alcohol or drug abuse or HIV/AIDS. Major surgical procedures were associated with a much lower chance of leaving the hospital AMA.ConclusionsThe rate of leaving hospital AMA did not systematically change over time, but did vary based on patient and illness characteristics. Having left AMA in the past was highly predictive of subsequent AMA events.

Association of self-reported religiosity and mortality in industrial employees: the CORDIS study

This study examined the association between self-reported religiosity and mortality in industrial employees, while controlling for workplace and socioeconomic factors. Subjects were 3638 Jewish Israeli males who participated in a 12-year follow-up study. During this period 253 deaths were recorded. The prevalence of negative workplace and sociodemographic factors: lower education, non-European origin, heavy physical work, blue-collar jobs and adverse job and environmental conditions, was highest among religious employees, and lower in traditional and nonreligious employees in descending order. Using Coxs proportionate hazard model an age by religiosity interaction on mortality was uncovered. In younger employees (age <55 years) religiosity was associated with lower adjusted mortality, after controlling for negative workplace and sociodemographic factors. Compared with nonreligious employees, the hazard ratios for the religious and traditional employees were: 0.64 (p=0.016) and 0.39 (p=0.118), respectively. In older employees (age >/=55 years), religiosity was associated with higher adjusted mortality. The corresponding hazards ratios were 1.69 (p=0.011) and 1.08 (p=0.004), even after controlling for the above possible confounding variables. It was concluded that religiosity had a protective effect on mortality in younger employees, but the reverse was true for older employees. This opposite trend could not be explained by negative sociodemographic and workplace conditions. The possibility of involvement of yet another potent factor of social isolation was discussed.

Occupational allergy after exposure to caddis flies at a hydroelectric power plant.

A cross sectional survey was conducted in a hydroelectric power plant in which the workforce was exposed to large numbers of caddis flies. 28 of 57 employees participated. About 50% of the participants reported work related eye, nose, and sinus symptoms and wheezing. Working in locations with greater exposure to caddis flies was significantly associated with work related symptoms. 17 workers (61%) were skin prick positive to a laboratory prepared caddis fly antigen (LCFA) made from the remains of caddis flies present in the plant and 11 (39%) had positive reactions to a commercial caddis fly antigen (CCFA). Workers stationed in heavily exposed areas were 3.7 times as likely to have a positive response to the LCFA (p = 0.009) and 5.3 times as likely to have a positive response to the CCFA (p = 0.036). 13 (46%) of survey respondents reported three or more work related symptoms. 10 (91%) CCFA positive workers reported three or more work related symptoms. Pulmonary function studies revealed slight, but not significantly decreased forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and FEV1/FVC ratios in workers who were skin test positive to either caddis fly preparation when compared with those who were negative. One worker who was skin test positive to both antigens had a cross shift fall in FEV1 of 20% predicted. Occupational allergy to caddis flies proved to be a significant health problem at this work site.

Proportion of opioid use due to compensated workers' compensation claims in Manitoba, Canada.

Background This study identifies the percentage of opioids prescribed for compensated workplace conditions in Manitoba, Canada and whether Workers Compensation Board (WCB) status is associated with higher prescription opioid doses. Methods Opioid prescriptions for WCB recipients were linked with databases housed at the Manitoba Center for Health Policy. Duration of continuous opioid prescription and morphine equivalents (ME) per day (ME/D) were calculated for individuals age 18–65. Results Over the period from 1998 to 2010, 3.8% of the total opioid dosage of medication prescribed in the study population were prescribed to WCB recipients. WCB recipients accounted for 2.1% of the individuals prescribed opioids. In adjusted analyses WCB recipients were more likely to be prescribed over 120 ME/D (OR 2.06 95% CI, 1.58–2.69). Conclusions WCB recipients account for a small, but significant amount of the total opioid prescribed in Manitoba. Manitobas WCB population is a group at increased risk of being prescribed over 120 ME/day. Am. J. Ind. Med. 58:33–39, 2015.