Publications by authors named "Amanda Alberga"

9 Publications

  • Page 1 of 1

Deep phenotyping of 34,128 adult patients hospitalised with COVID-19 in an international network study.

Nat Commun 2020 10 6;11(1):5009. Epub 2020 Oct 6.

Clinical Pharmacology Unit, Zealand University Hospital, Køge, Denmark.

Comorbid conditions appear to be common among individuals hospitalised with coronavirus disease 2019 (COVID-19) but estimates of prevalence vary and little is known about the prior medication use of patients. Here, we describe the characteristics of adults hospitalised with COVID-19 and compare them with influenza patients. We include 34,128 (US: 8362, South Korea: 7341, Spain: 18,425) COVID-19 patients, summarising between 4811 and 11,643 unique aggregate characteristics. COVID-19 patients have been majority male in the US and Spain, but predominantly female in South Korea. Age profiles vary across data sources. Compared to 84,585 individuals hospitalised with influenza in 2014-19, COVID-19 patients have more typically been male, younger, and with fewer comorbidities and lower medication use. While protecting groups vulnerable to influenza is likely a useful starting point in the response to COVID-19, strategies will likely need to be broadened to reflect the particular characteristics of individuals being hospitalised with COVID-19.
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October 2020

An international characterisation of patients hospitalised with COVID-19 and a comparison with those previously hospitalised with influenza.

medRxiv 2020 Apr 25. Epub 2020 Apr 25.

Science Policy and Research, National Institute for Health and Care Excellence, UK.

Background: To better understand the profile of individuals with severe coronavirus disease 2019 (COVID-19), we characterised individuals hospitalised with COVID-19 and compared them to individuals previously hospitalised with influenza.

Methods: We report the characteristics (demographics, prior conditions and medication use) of patients hospitalised with COVID-19 between December 2019 and April 2020 in the US (Columbia University Irving Medical Center [CUIMC], STAnford Medicine Research data Repository [STARR-OMOP], and the Department of Veterans Affairs [VA OMOP]) and Health Insurance Review & Assessment [HIRA] of South Korea. Patients hospitalised with COVID-19 were compared with patients previously hospitalised with influenza in 2014-19.

Results: 6,806 (US: 1,634, South Korea: 5,172) individuals hospitalised with COVID-19 were included. Patients in the US were majority male (VA OMOP: 94%, STARR-OMOP: 57%, CUIMC: 52%), but were majority female in HIRA (56%). Age profiles varied across data sources. Prevalence of asthma ranged from 7% to 14%, diabetes from 18% to 43%, and hypertensive disorder from 22% to 70% across data sources, while between 9% and 39% were taking drugs acting on the renin-angiotensin system in the 30 days prior to their hospitalisation. Compared to 52,422 individuals hospitalised with influenza, patients admitted with COVID-19 were more likely male, younger, and, in the US, had fewer comorbidities and lower medication use.

Conclusions: Rates of comorbidities and medication use are high among individuals hospitalised with COVID-19. However, COVID-19 patients are more likely to be male and appear to be younger and, in the US, generally healthier than those typically admitted with influenza.
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April 2020

Size Matters: A Latent Class Analysis of Workplace Health Promotion Knowledge, Attitudes, Practices and Likelihood of Action in Small Workplaces.

Int J Environ Res Public Health 2020 02 15;17(4). Epub 2020 Feb 15.

Alberta Cancer Prevention Legacy Fund; Alberta Health Services, Calgary, AB T2S 3C3, Canada.

Workplace health programs (WHPs) have been shown to improve employee health behaviours and outcomes, increase productivity, and decrease work-related costs over time. Nonetheless, organizational characteristics, including size, prevent certain workplaces from implementing these programs. Past research has examined the differences between small and large organizations. However, these studies have typically used a cut-off better suited to large countries such as the USA. Generalizing such studies to countries that differ based on population size, scale of economies, and health systems is problematic. We investigated differences in WHP knowledge, attitudes, and practices between organizations with under 20 employees, 20-99 employees, and more than 100 employees. In 2017-2018, a random sample of employers from 528 workplaces in Alberta, Canada, were contacted for participation in a cross-sectional survey. Latent Class Analysis (LCA) was used to identify underlying response pattern and to group clusters of similar responses to categorical variables focused on WHP knowledge, attitudes, practices and likelihood of action. Compared to large organizations, organizations with fewer than 20 employees were more likely to be members of the Medium-Low Knowledge of WHP latent class ( = 0.01), the Low Practices for WHP latent class ( < 0.001), and more likely to be members of Low Likelihood of Action in place latent class ( = 0.033). While the majority of workplaces, regardless of size, recognized the importance and benefits of workplace health, capacity challenges limited small employers' ability to plan and implement WHP programs. The differences in capacity to implement WHP in small organizations are masked in the absence of a meaningful cut-off that reflects the legal and demographic reality of the region of study.
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February 2020

Sex Differences in the Prevalent Use of Oral Formulations of Cholinesterase Inhibitors in Older Adults with Dementia.

Drugs Aging 2019 09;36(9):875-884

Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.

Background: Cholinesterase inhibitors (ChEIs) are one of only two drug therapies available to manage cognitive decline in dementia. Given sex-specific differences in medication access and effects, it is important to understand how ChEIs are used by women and men.

Objective: The objective of this study was to provide contemporary sex-stratified evidence on patterns of ChEI use by community-dwelling older adults with dementia to inform opportunities to optimize drug prescribing.

Methods: We conducted a population-based cross-sectional study examining ChEI use in older adults with dementia in Ontario, Canada. We identified all community-dwelling individuals aged 66 years and older with a pre-existing diagnosis of dementia as of 1 April, 2016. We examined the prevalence of ChEI use among women and men separately, and explored the association between ChEI use and age, sex, income status, geographic location of residence, use of palliative care services, comorbidity, and polypharmacy. Concurrent use of drugs known to impair cognition (including antipsychotics, benzodiazepines, and medications with strong anticholinergic properties) was separately assessed among women and men using multivariable analyses and prevalence risk ratios.

Results: Of 74,799 women and 52,231 men living with dementia in the community, nearly 30% currently were using a ChEI (29.3% women, 28.6% men). Close to 70% of users were receiving the target therapeutic dose. Compared to men, women were less often taking the target therapeutic dose (67.8% women vs. 71.6% men, p < 0.001). Over 20% of users also were using drugs known to impair cognition, while being treated for cognitive decline using ChEIs. Compared to men, women were more often concurrently using drugs known to impair cognition (23.9% women vs. 21.8% men, p < 0.001).

Conclusions: This is one of the first studies of ChEI use to account for important sex differences. The results remind clinicians and researchers that patterns of ChEI therapy use differ by sex, as women were less likely to receive target therapeutic doses and more vulnerable to potentially problematic polypharmacy than men.
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September 2019

Reducing repeat imaging in hepato-pancreatico-biliary surgical cancer care through shared diagnostic imaging repositories.

HPB (Oxford) 2019 01 5;21(1):96-106. Epub 2018 Oct 5.

Division of General Surgery, Odette Cancer Centre - Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada.

Background: With regionalization of care, patients often undergo treatment in institutions other than where the initial investigation is conducted. This study assessed the impact of a shared diagnostic imaging repository (SDIR) on processes of care and outcomes in hepato-pancreatico-biliary (HPB) cancer surgery.

Methods: Provincial administrative datasets were linked to study HPB cancer patients operated at a regional cancer centre (2003-2014). SDIR and non-SDIR groups were based on where initial imaging (CT or MRI) was conducted. Outcomes were repeat imaging before surgery and wait times for surgery from initial imaging and surgical consultation.

Results: Of 839 patients, 474 were from SDIR institutions. Fewer SDIR patients underwent any repeat imaging (55.9% vs. 75.3%; p < 0.01) and repeat imaging with same modality and protocol (24.7% vs. 43.0%; p < 0.01). Median wait time to surgery from initial imaging (64 Vs. 79 days; p < 0.01) and surgical consultation (39 Vs. 45 days; p = 0.046) was shorter with SDIR. SDIR patients had lower adjusted odds of any repeat imaging (OR 0.20 [0.14-0.30]), and repeat imaging with same modality and protocol (OR 0.58 [0.41-0.80]).

Conclusion: Radiology sharing with SDIR reduced repeat imaging for HPB cancer surgery, including potentially redundant repeat imaging with same protocol, and shortened wait time to surgical care.
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January 2019

Effects of behavioural risk factors on high-cost users of healthcare: a population-based study.

Can J Public Health 2018 08 19;109(4):441-450. Epub 2018 Sep 19.

Clinical Evaluative Sciences, Toronto, Canada.

Objectives: High-cost users (HCUs) are known to disproportionally incur the majority of healthcare utilization costs relative to their counterparts. A number of studies have highlighted the detrimental effects of risky health behaviours; however, only a few have demonstrated the link to HCUs, a meaningful endpoint for program and policy decision-makers. We investigated the association between health behaviour risks and downstream high-cost healthcare utilization.

Methods: A combined cohort of participants from the Canadian Community Health Survey (CCHS) cycles 2005-2009 was linked to future population-based health administrative data in Ontario. Using person-centered costing methodology, CCHS respondents were ranked according to healthcare utilization costs and categorized as ever having HCU status in the 4 years following interview. Logistic regression models were used to estimate the association between various health behaviours on future HCU status.

Results: Models estimated that smoking and physical inactivity were associated with a significant increase in the odds of becoming an HCU. Compared to individual behaviours, increasing the number of health behaviour risks significantly strengthened the odds of becoming an HCU in subsequent years.

Conclusion: The analyses provide evidence that upstream health behaviours affect high-cost healthcare utilization. Health behaviours are a meaningful target for health promotion programs and policies. These findings can inform decision-makers on appropriate behavioural targets for those on an HCU trajectory and promote public health efforts to support healthcare system sustainability.
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August 2018

Initial Cholinesterase Inhibitor Therapy Dose and Serious Events in Older Women and Men.

J Am Geriatr Soc 2018 09 18;66(9):1692-1699. Epub 2018 Jul 18.

Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.

Objectives: To examine dose-related prescribing and short-term serious events associated with initiation of cholinesterase inhibitor (ChEI) therapy.

Design: Retrospective, population-based cohort study.

Setting: Ontario, Canada.

Participants: Women (n=47,829) and men (n=32,503) aged 66 and older who initiated a ChEI between April 1, 2010, and June 30, 2016.

Measurements: All-cause serious events (emergency department (ED) visits, inpatient hospitalizations, death) within 30 days of ChEI initiation. Multivariable Cox proportional hazards models were used to estimate adjusted rates of serious events.

Results: Overall, 4.8% of older adults were dispensed a lower-than-recommended ChEI starting dose, 87.9% a recommended dose, and 7.3% a higher-than-recommended starting dose. Eight thousand six hundred seventy-one (10.8%) individuals experienced a serious event within 30 days of initiating therapy, primarily ED visits (8,540, 10.6%). Relative to those initiated on a recommended starting dose, those initiated on a higher dose had a significantly increased rate of serious events (women adjusted hazard ratio (aHR) 1.50, 95% confidence interval (CI) =1.38-1.63; men aHR 1.31, 95% CI=1.19-1.45). Similar patterns were found for ED visits and inpatient hospitalizations but not death. The relative effect of higher-than-recommended starting dose dispensed vs. recommended starting dose dispensed was greater in women than it was in men: the number needed to harm was 22 (95% confidence interval (CI)=18-29) for women and 36 (95% CI= 26-61) for men.

Conclusion: Serious events immediately after initiation of ChEIs were associated with starting ChEI dose. This association was stronger in women.
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September 2018

The Relationship Between Life Satisfaction and Healthcare Utilization: A Longitudinal Study.

Am J Prev Med 2018 08 18;55(2):142-150. Epub 2018 May 18.

Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.

Introduction: Studies have highlighted the importance of life satisfaction or, more generally, happiness, on health. However, there are few studies that have prospectively assessed the relationship between life satisfaction and healthcare utilization and costs.

Methods: Participants were from three national survey cycles conducted between 2005 and 2010 to future healthcare utilization up to 2015. Analysis was conducted in 2016-2017. Annual per person costs were calculated and individuals ranked. Adjusted multinomial logistic regression models were used to quantify the association between life satisfaction and being in the top 5% or top 6%-50%, compared to the bottom 50%, during follow-up.

Results: After exclusions, the study population included 85,225 adults. Increasing life dissatisfaction was associated with higher healthcare utilization and costs. In the fully adjusted model, the odds for those with the lowest level of life satisfaction being in the top 5% of healthcare costs relative to the lowest 50% is 3.05 (95% CI=1.61, 5.80). Those with the lowest life satisfaction were also at increased odds of being in the middle utilization category (6%-50%) with a significant OR=2.24 (95% CI=1.60, 3.14). All trends for increasing dissatisfaction were significant (p<0.001).

Conclusions: Life dissatisfaction was significantly associated with being a high-cost user in the future. This relationship persisted after adjustment for demographic factors, comorbidity, socioeconomic factors, and health behaviors. This study points to the importance of considering broader correlates of well-being with respect to future healthcare utilization and costs.
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August 2018

The impact of access to health services on prediabetes awareness: A population-based study.

Prev Med 2016 12 6;93:7-13. Epub 2016 Sep 6.

Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada; Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue G1 06, Toronto, ON, M4N 3M5, Canada; Public Health Ontario, 480 University Ave #300, Toronto, ON, M5G 1V2, Canada. Electronic address:

Research demonstrates that prediabetes awareness has important implications for participation in diabetes risk-reducing behaviors. We examined the impact of levels of access to health services on prediabetes awareness. In 2016, we conducted an analysis among U.S. adults with prediabetes using cross-sectional data from three cycles (2007-2008, 2009-2010, and 2011-2012) of the National Health and Nutrition Examination Survey. Participants aware and unaware of their prediabetes were classified as having full, partial, or no access to health services based on current health insurance coverage and having a routine place to go for health care. Multivariable logistic regression was used to estimate the association between access to health services and prediabetes awareness. Among a total sample of 2999U.S. adults with prediabetes, an estimated 92.0% were unaware of their prediabetes status. Participants that were unaware of their prediabetes tended to be younger, male, and were less likely to be obese or have a family history of diabetes. Having no access to health services significantly increased the odds of being prediabetes unaware (AOR: 2.65; 95% CI: 1.10-6.38). However, participants with insurance but no place of regular care had the greatest odds of being prediabetes unaware (AOR: 3.21; 95% CI: 1.21-8.55). These findings suggest that access to health services is a key factor for prediabetes awareness. Health policies and interventions should strive to ensure equitable access to health services in order to detect prediabetes, and promote awareness and engagement in risk-reducing behaviors to decrease the incidence of diabetes.
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December 2016