Why Do Past Disabilities Still Haunt the Newly Healthy?

A dynamic labour force participation model is used to estimate the impact of disability shocks on labour force participation using a longitudinal sample drawn from the National Population Health Survey. Findings suggest that state dependence play a crucial role in how temporary disabilities can have long lasting employment effects. A disability shock that last only one period is shown to lower labour force participation up to 3 additional periods. Findings are in support of policies that promote greater labour force attachment for individuals with disabilities.

Patterns of opioid use (codeine, morphine or meperidine) in the Canadian population over time: analysis of the Longitudinal National Population Health Survey 1994–2011

ObjectiveThis study aimed to investigate cohort effects in selected opioids use and determine whether cohort differences were associated with changes in risk factors for use over time.DesignThis study presents secondary analyses of a longitudinal survey panel of the general population that collected data biannually.SettingData from the Canadian Longitudinal National Population Health Survey 1994–2011.PopulationThis study included 12 542 participants from the following birth cohorts: post-World War I (born 1915–1924), pre-World War II (born 1925–1934), World War II (born 1935–1944), Older Baby Boom (born 1945–1954), Younger Baby Boom (born 1955–1964), Older Generation X (born 1965–1974) and Younger Generation X (born 1975–1984).Main outcomeResponses to a single question asking about the use of codeine, morphine or meperidine in the past month (yes/no) were examined.ResultsOver and above age and period effects, there were significant cohort differences in selected opioids use: each succeeding recent cohort had greater use than their predecessors (eg, Gen Xers had greater use than younger baby boomers). Selected opioids use increased significantly from 1994 to 2002, plateauing between 2002 and 2006 and then declining until 2011. After accounting for cohort and period effects, there was a decline in use of these opioids with increasing age. Although pain was significantly associated with greater selected opioids use (OR=3.63, 95% CI 3.39 to 3.94), pain did not explain cohort differences. Cohort and period effects were no longer significant after adjusting for the number of chronic conditions. Cohort differences in selected opioids use mirrored cohort differences in multimorbidity. Use of these opioids was significantly associated with taking antidepressants or tranquillisers (OR=2.52, 95% CI 2.27 to 2.81 and OR=1.60, 95% CI 1.46 to 1.75, respectively).ConclusionsThe findings underscore the need to consider multimorbidity including possible psychological disorders and associated medications when prescribing opioids (codeine, morphine, meperidine), particularly for recent birth cohorts. Continued efforts to monitor prescription patterns and develop specific opioid use guidelines for multimorbidity appear warranted.

Depressive episodes, weight change, and incident diabetes in a Canadian community sample

IntroductionDepression has consistently been associated with an increased risk of diabetes in recent meta-analyses. However, depression is a highly heterogeneous construct and people with specific symptoms of depression, such as weight gain and increased sleep, may be at a higher risk of diabetes. Objectives and ApproachThis work will compare incident diabetes in Ontario adults with recent depressive episodes that included symptoms of weight gain, weight loss, or no weight change and in those with no recent depressive episodes. Participants will be drawn from several waves of the Canadian Community Health Survey and the National Population Health Survey. Past 12-month depressive episodes and weight change during most recent or worst episodes was measured using the CIDI/CIDI short form. Time to incident diabetes will be ascertained through linkage with the Ontario Diabetes Database. Cox proportional hazards regression will assess diabetes incidence by depression and weight change characteristics. ResultsThis study will include 106 084 Ontario adults who participated in the Canadian Community Health Survey (2000/2001, 2002, 2003, 2012) and the National Population Health Survey (1996). Follow-up time will range from 4 to 19 years (until March 2017). Study covariates will include demographic and lifestyle factors, comorbidities, and health care use and will be extracted from the surveys above and from administrative health data. The dataset for this study is currently being prepared by the Institute for Clinical Evaluative Sciences (ICES) and the findings of this analysis will be presented at this conference. Conclusion/ImplicationsThe results of this work will provide insight into who, among those with depression, is at highest risk of new-onset diabetes. These results will be relevant to the development of both personalized and population-level diabetes screening and prevention strategies.