Publications by authors named "Elham Rahme"

172 Publications

Psychiatric disorders in emerging adults with diabetes transitioning to adult care: A retrospective cohort study.

Diabet Med 2021 Feb 12:e14541. Epub 2021 Feb 12.

Division of Endocrinology, Department of Pediatrics, McGill University Health Centre, Montreal, QC, Canada.

Aims: During transition from paediatric to adult diabetes care, adolescents with diabetes are at increased risk of psychiatric disorders compared with those without diabetes. Prolonged gaps between the last paediatric and first adult diabetes care visit are associated with higher perceived stress and lower life satisfaction. We assessed the effect of a gap (>180 days) in establishing adult diabetes care on the risk of psychiatric disorders and determined other risk factors associated with psychiatric disorders during the transfer to adult care.

Methods: Using provincial health administrative databases, we conducted a retrospective cohort study of individuals from Québec, Canada, diagnosed with diabetes between ages 1 and 15 years in 1997-2015. These individuals were followed from 6 months after their last paediatric visit until age 25 years. We used multivariable Cox proportional hazard models to determine the association of gap in care with psychiatric disorders risk.

Results: Among 1772 youth with diabetes, 740 (42%) had a gap in care. There was a non-statistically significant association between gap in care and mood disorders diagnosed in the emergency department or hospital (hazard ratio [HR] 1.38, 95% confidence interval [CI]: [0.92, 2.07]). Older age at transfer, recent birth year and higher number of all-cause emergency department visits in the year before transfer increased the risks of psychiatric disorders.

Conclusions: Prolonged gaps in care during transfer to adult care are common and may be associated with increased psychiatric disorder risk. Developmental factors associated with adolescence and emerging adulthood may further amplify this risk.
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http://dx.doi.org/10.1111/dme.14541DOI Listing
February 2021

Non-Melanoma Skin Cancer Distribution in the Russian Federation.

Dermatology 2020 Dec 23:1-9. Epub 2020 Dec 23.

Division of Dermatology, McGill University, Montreal, Québec, Canada,

Background: Non-melanoma skin cancer (NMSC) incidence has been increasing steadily around the world. The aim of the study is to describe geographic trends in incidence and mortality of NMSC in Russia between 2007 and 2017 and compare findings to other European countries.

Methods: We used geospatial analysis to map the incident cases and descriptive statistical analysis to analyze trends. Additionally, we assessed the relationship between ethnicity, geographic latitude/longitude, and NMSC incidence/mortality rates. We retrospectively analyzed the data from the Moscow Oncology Research Institute, Ministry of Health of the Russian Federation, for 2007-2017. Routine methods of descriptive epidemiology were used to study incidence and mortality rates by age groups, years, and jurisdictions (i.e., Federal Districts and Federal Subjects).

Results: In total, 733,723 patients were diagnosed with NMSC in Russia over the period 2007-2017, of whom 63% were women. The overall age-standardized incidence and mortality rates were 29.64/100,000 and 0.70/100,000, respectively. There was a consistent increase in age-standardized incidence rates over the study period, with a decreasing mortality rate. Geographic mapping revealed north-to-south and east-to-west gradients for NMSC.

Conclusions: This study demonstrated longitudinal trends for NMSC incidence in Russia documenting that skin phototype, latitude/longitude, climate zones, and cultural practices remain dominant risk factors defining the epidemiology of NMSC. Moreover, this work identified several regions in the country (i.e., Republic of Adygea, Samara, Krasnodar Krai, etc.), where patient education/sun awareness campaigns will be useful to help reduce the risk of this malignancy.
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http://dx.doi.org/10.1159/000512454DOI Listing
December 2020

The Challenges of Perceived Self-Management in Lupus.

Arthritis Care Res (Hoboken) 2020 Dec 20. Epub 2020 Dec 20.

Jack Digital Productions, Inc, Montreal, Quebec and Toronto, Ontario, Canada.

Objective: Systemic lupus erythematosus is a chronic autoimmune disease with varied and unpredictable levels of disease activity. The ability to self-manage lupus is important in controlling disease activity. Our objective was to determine levels of patient activation toward self-management in lupus.

Methods: We used baseline results from the MyLupusGuide study that had recruited 541 lupus patients from ten centers. We used the Patient Activation Measure (PAM), a validated self-reported tool designed to measure activation towards self-management ability, as our primary variable and examined its association with demographic, disease-related, patient-provider communication and psychosocial variables captured in our study protocol. Univariable and multivariable linear regressions were performed using linear mixed models, with a random effect for centers.

Results: The average age was 50±14 years, 93% were female, 74% were Caucasian and the average disease duration was 17±12 years. The mean PAM score was 61.2±13.5 with 36% of participants scoring in the two lower levels, indicating low activation. Variables associated with low activation included being single, lower physical health status, lower self-reported disease activity, lower self-efficacy, use of more emotional coping and less distraction and instrumental coping strategies, and perceived lack of clarity in patient-doctor communication.

Conclusion: Low patient activation was observed in more than one third of lupus patients indicating a large proportion of patients perceived that they are lacking in lupus self-management skills. These results highlight a modifiable gap in perceived self-management ability among patients with lupus.
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http://dx.doi.org/10.1002/acr.24542DOI Listing
December 2020

Type 1 Diabetes Mellitus Virtual Patient Network as a Peer Support Community: Protocol for Social Network Analysis and Content Analysis.

JMIR Res Protoc 2020 Aug 31;9(8):e18714. Epub 2020 Aug 31.

Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.

Background: Type 1 Diabetes Mellitus Virtual Patient Network (T1DM-VPN) is a private Facebook group for youths with type 1 diabetes mellitus (T1DM) in Canada intended to facilitate peer-to-peer support. It was built on the finding that stigma is prevalent among youth with T1DM and impedes self-management.

Objective: We aim to determine if T1DM-VPN provides support as intended and to ascertain what type of members provide support. Specifically, we will (1) identify text consistent with any one of 5 social support categories, (2) describe the network by visualizing its structure and reporting basic engagement statistics, and (3) determine whether being a designated peer leader is related to a member's centrality (ie, importance in the network) and how frequently they offer social support.

Methods: We will manually extract interaction data from the Facebook group (posts, comments, likes/reactions, seen) generated from June 21, 2017 (addition of first member), to March 1, 2020. Two researchers will independently code posts and comments according to an existing framework of 5 social support categories-informational, emotional, esteem, network, and tangible-with an additional framework for nonsocial support categories. We will calculate how frequently each code is used. We will also report basic engagement statistics (eg, number of posts made per person-month) and generate a visualization of the network. We will identify stable time intervals in the history of T1DM-VPN by modeling monthly membership growth as a Poisson process. Within each interval, each member's centrality will be calculated and standardized to that of the most central member. We will use a centrality formula that considers both breadth and depth of connections (centrality = 0.8 × total No. of connections + 0.2 × total No. of interactions). Finally, we will construct multivariate linear regression models to assess whether peer leader status predicts member centrality and the frequency of offering social support. Other variables considered for inclusion in the models are gender and age at diagnosis.

Results: T1DM-VPN was launched in June 2017. As of March 1, 2020, it has 196 patient-members. This research protocol received ethics approval from the McGill University Health Centre Research Ethics Board on May 20, 2020. Baseline information about each group member was collected upon addition into the group, and collection of interaction data is ongoing as of May 2020.

Conclusions: This content analysis and social network analysis study of a virtual patient network applies epidemiological methods to account for dynamic growth and activity. The results will allow for an understanding of the topics of importance to youth with T1DM and how a virtual patient network evolves over time. This work is intended to serve as a foundation for future action to help youth improve their experience of living with diabetes.

International Registered Report Identifier (irrid): PRR1-10.2196/18714.
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http://dx.doi.org/10.2196/18714DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7490683PMC
August 2020

Type 1 Diabetes Mellitus Virtual Patient Network as a Peer Support Community: Protocol for Social Network Analysis and Content Analysis.

JMIR Res Protoc 2020 Aug 31;9(8):e18714. Epub 2020 Aug 31.

Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.

Background: Type 1 Diabetes Mellitus Virtual Patient Network (T1DM-VPN) is a private Facebook group for youths with type 1 diabetes mellitus (T1DM) in Canada intended to facilitate peer-to-peer support. It was built on the finding that stigma is prevalent among youth with T1DM and impedes self-management.

Objective: We aim to determine if T1DM-VPN provides support as intended and to ascertain what type of members provide support. Specifically, we will (1) identify text consistent with any one of 5 social support categories, (2) describe the network by visualizing its structure and reporting basic engagement statistics, and (3) determine whether being a designated peer leader is related to a member's centrality (ie, importance in the network) and how frequently they offer social support.

Methods: We will manually extract interaction data from the Facebook group (posts, comments, likes/reactions, seen) generated from June 21, 2017 (addition of first member), to March 1, 2020. Two researchers will independently code posts and comments according to an existing framework of 5 social support categories-informational, emotional, esteem, network, and tangible-with an additional framework for nonsocial support categories. We will calculate how frequently each code is used. We will also report basic engagement statistics (eg, number of posts made per person-month) and generate a visualization of the network. We will identify stable time intervals in the history of T1DM-VPN by modeling monthly membership growth as a Poisson process. Within each interval, each member's centrality will be calculated and standardized to that of the most central member. We will use a centrality formula that considers both breadth and depth of connections (centrality = 0.8 × total No. of connections + 0.2 × total No. of interactions). Finally, we will construct multivariate linear regression models to assess whether peer leader status predicts member centrality and the frequency of offering social support. Other variables considered for inclusion in the models are gender and age at diagnosis.

Results: T1DM-VPN was launched in June 2017. As of March 1, 2020, it has 196 patient-members. This research protocol received ethics approval from the McGill University Health Centre Research Ethics Board on May 20, 2020. Baseline information about each group member was collected upon addition into the group, and collection of interaction data is ongoing as of May 2020.

Conclusions: This content analysis and social network analysis study of a virtual patient network applies epidemiological methods to account for dynamic growth and activity. The results will allow for an understanding of the topics of importance to youth with T1DM and how a virtual patient network evolves over time. This work is intended to serve as a foundation for future action to help youth improve their experience of living with diabetes.

International Registered Report Identifier (irrid): PRR1-10.2196/18714.
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http://dx.doi.org/10.2196/18714DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7490683PMC
August 2020

Sex differences in the risk of diabetes mellitus among individuals with psoriasis: A retrospective cohort study in Quebec, Canada.

J Am Acad Dermatol 2020 Jul 23. Epub 2020 Jul 23.

Department of Medicine, Division of Clinical Epidemiology, McGill University, Montreal, Quebec, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2020.07.082DOI Listing
July 2020

A trajectory analysis of daily step counts during a physician-delivered intervention.

J Sci Med Sport 2020 Oct 18;23(10):962-967. Epub 2020 Apr 18.

Division of Clinical Epidemiology, Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Division of Internal Medicine, Department of Medicine, McGill University Health Centre, McGill University, Canada. Electronic address:

Objectives: Higher steps are associated with lower mortality and cardiovascular event rates. We previously demonstrated that tailored physician-delivered step count prescriptions successfully increased steps/day in adults with type 2 diabetes mellitus (T2DM) and/or hypertension. In the present analysis, we examined patterns of step count change and the factors that influence different responses.

Design: Longitudinal observational study METHODS: Active arm participants (n=118) recorded steps/day. They received a step count prescription from their physician every 3-4 months. We computed mean steps/day and changes from baseline for sequential 30-day periods. Group-based trajectory modeling was applied.

Results: Four distinct trajectories of mean steps/day emerged, distinguishable by differences in baseline steps/day: sedentary (19%), low active (40%), somewhat active (30%) and active (11%). All four demonstrated similar upward slopes. Three patterns emerged for the change in steps from baseline: gradual decrease (30%), gradual increase with late decline (56%), and rapid increase with midpoint decline (14%); thus 70% had an increase from baseline. T2DM (odd ratios [OR]: 3.7, 95% CI 1.7, 7.7) and age (OR per 10-year increment: 2, 95% CI 1.3, 2.8) were both associated with starting at a lower baseline but participants from these groups were no less likely than others to increase steps/day.

Conclusions: T2DM and older age were associated with lower baseline values but were not indicators of likelihood of step count increases. A physician-delivered step count prescription and monitoring strategy has strong potential to be effective in increasing steps irrespective of baseline counts and other clinical and demographic characteristics.
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http://dx.doi.org/10.1016/j.jsams.2020.04.010DOI Listing
October 2020

Ruling out early trimester pregnancy when implementing community-based deworming programs.

PLoS Negl Trop Dis 2020 01 30;14(1):e0007901. Epub 2020 Jan 30.

WHO Collaborating Centre for Research and Training in Parasite Epidemiology and Control, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.

Background: Large-scale deworming programs have, to date, mostly targeted preschool- and school-age children. As community-based deworming programs become more common, deworming will be offered to women of reproductive age. The World Health Organization recommends preventive chemotherapy be administered to pregnant women only after the first trimester. It is therefore important for deworming programs to be able to identify women in early pregnancy. Our objective was to validate a short questionnaire which could be used by deworming program managers to identify and screen out women in early pregnancy.

Methodology/principal Findings: In May and June 2018, interviewers administered a questionnaire, followed by a pregnancy test, to 1,203 adult women living in the Peruvian Amazon. Regression analyses were performed to identify questions with high predictive properties (using the pregnancy test as the gold standard). Test parameters were computed at different decision tree nodes (where nodes represented questions). With 106 women confirmed to be pregnant, the positive predictive value of asking the single question 'Are you pregnant?' was 100%, at a 'cost' of a false negative rate of 1.9% (i.e. 21 women were incorrectly identified as not pregnant when they were truly pregnant). Additional questions reduced the false negative rate, but increased the false positive rate. Rates were dependent on both the combination and the order of questions.

Conclusions/significance: To identify women in early pregnancy when deworming programs are community-based, both the number and order of questions are important. The local context and cultural acceptability of different questions should inform this decision. When numbers are manageable and resources are available, pregnancy tests can be considered at different decision tree nodes to confirm pregnancy status. Trade-offs in terms of efficiency and misclassification rates will need to be considered to optimize deworming coverage in women of reproductive age.
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http://dx.doi.org/10.1371/journal.pntd.0007901DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6991962PMC
January 2020

Comparative persistence of anti-tumor necrosis factor therapy in ankylosing spondylitis patients: a multicenter international study.

Curr Med Res Opin 2020 04 11;36(4):677-686. Epub 2020 Feb 11.

Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.

To evaluate persistence on conventional DMARDs (cDMARDs) and anti-TNF therapies, and to identify potential determinants of discontinuation among individuals with ankylosing spondylitis (AS) living in Brazil and Quebec, Canada. We conducted a cohort study of AS patients using health administrative data (2010-2015). One-year and 2-year persistence rates were assessed. Cox regression was used to identify potential determinants of therapy discontinuation. One-year persistence was less likely in Brazil for both anti-TNF and cDMARDs (Brazil: 62.1 and 30.7%, Quebec: 66.9 and 67.0%). The 2-year persistence rates were lower for both anti-TNF and cDMARD, but remained higher in Quebec (Brazil: 47.9 and 18.1%, Quebec: 51.5 and 53.5%). In multivariate Cox regression analysis, age, sex and comorbidities were associated with persistence in both countries. In Quebec, persistence did not differ between rural and urban regions or with socioeconomic status. While in Brazil, patients in regions with higher Human Development Index and those in cities with lower Gini index were less likely to discontinue therapy. Canadian AS patients were more likely to persist on therapy compared to Brazilian patients, although rates were lower at 2 years in both countries. Socioeconomic disparity in persistence was found in Brazil, but not in Quebec.
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http://dx.doi.org/10.1080/03007995.2020.1722945DOI Listing
April 2020

Epidemiology of invasive ocular surface squamous neoplasia in Canada during 1992-2010.

Br J Ophthalmol 2020 10 16;104(10):1368-1372. Epub 2020 Jan 16.

Division of Dermatology, McGill University Health Centre, Montreal, Quebec, Canada

Background: Ocular surface squamous neoplasia (OSSN) is the most common non-pigmented ocular surface malignancy. It is classified as invasive OSNN (IOSSN) when the underlying stroma are infiltrated by dysplastic squamous epithelial cells through the basement membrane. Here, we present the descriptive epidemiology and geographical distribution of IOSSN in Canada.

Methods: We determined the incidence and geographical distribution of IOSSN cases diagnosed between 1992 and 2010 using two independent population-based cancer registries: the Canadian Cancer Registry and Le Registre Québécois du Cancer.

Results: The mean annual age-standardised incidence rate (WHO 2000-2025) of IOSSN for 1992-2010 was 0.45 cases per million individuals per year with an average annual percent increase in incidence of 4.5%. IOSSN localisation to the conjunctiva was documented in at least 57% of the reported cases. IOSSN exhibited a male predilection ratio of 3.3:1.0 with a mean age at diagnosis of 69 years. Incidence rates of IOSSN across Canadian provinces and cities showed no significant differences from the crude national average.

Conclusions: Our results, particularly concerning IOSSN patient age and male predilection, corroborate with data reported from the USA. Additional studies are needed to determine whether the observed increase in incidence rate over the study period (1992-2010) is significant.
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http://dx.doi.org/10.1136/bjophthalmol-2019-314650DOI Listing
October 2020

Incidence of acute myeloid leukemia: A regional analysis of Canada.

Cancer 2020 03 24;126(6):1356-1361. Epub 2019 Dec 24.

Research Institute of the McGill University Health Center, McGill University, Montreal, Quebec, Canada.

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http://dx.doi.org/10.1002/cncr.32671DOI Listing
March 2020

Incidence of acute myeloid leukemia: A regional analysis of Canada.

Cancer 2020 03 24;126(6):1356-1361. Epub 2019 Dec 24.

Research Institute of the McGill University Health Center, McGill University, Montreal, Quebec, Canada.

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http://dx.doi.org/10.1002/cncr.32671DOI Listing
March 2020

Epidemiology of ophthalmic lymphoma in Canada during 1992-2010.

Br J Ophthalmol 2020 08 13;104(8):1176-1180. Epub 2019 Nov 13.

Division of Dermatology, McGill University Health Centre, Montreal, Quebec, Canada

Background: Ophthalmic lymphoma (OL) is the most common orbital tumour, particularly in older individuals. Little is known about the epidemiology and geographic distribution of OL in Canada. Descriptive demographic statistics are an important first step in understanding OL burden and are necessary to inform comprehensive national cancer prevention programmes.

Methods: We determined patterns of incidence and geographical distribution of the three major subtypes of OL: extranodal marginal zone B cell lymphoma, follicular lymphoma (FL) and diffuse large B cell lymphoma. Here, we used cases that were diagnosed during 1992-2010 using two independent population-based cancer registries, the Canadian Cancer Registry and Le Registre Québécois du Cancer (LRQC).

Results: The OL mean annual age-standardised incidence rate for 1992-2010 was 0.65 cases per million people per year with an average annual increase in the incidence rate of 4.5% per year. The mean age of diagnosis was 65 years. OL incidence rate was the highest in the cities located along the heavily industrialised Strait of Georgia in British Columbia.

Conclusions: Our data on patient age, sex and temporal trends showed similarities with data reported in the USA and Denmark. Additional studies are needed to determine whether the observed increase in OL incidence is genuine or spurious.
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http://dx.doi.org/10.1136/bjophthalmol-2019-314653DOI Listing
August 2020

Group education for adolescents with type 1 diabetes during transition from paediatric to adult care: study protocol for a multisite, randomised controlled, superiority trial (GET-IT-T1D).

BMJ Open 2019 11 11;9(11):e033806. Epub 2019 Nov 11.

Pediatrics, Endocrinology, McGill University Health Centre, Montreal, Québec, Canada

Introduction: Transition from paediatric to adult care is challenging for adolescents and emerging adults (ages 18 to 30 years) with type 1 diabetes (T1D). This transition is characterised by a deterioration in glycaemic control (haemoglobin A1c (HbA1c)), decreased clinical attendance, poor self-management and increased acute T1D-related complications. However, evidence to guide delivery of transition care is lacking. Given the effectiveness of group education in adult diabetes glycaemic control and improvements in qualitative measures in paediatric diabetes, group education is a potentially feasible and cost-effective alternative for the delivery of transition care. In emerging adults with T1D, we aim to assess the effectiveness of group education visits compared with usual care on HbA1c, T1D-related complications, psychosocial measures and cost-effectiveness after the transfer to adult care.

Methods And Analysis: In a multisite, assessor-blinded, randomised, two-arm, parallel-group, superiority trial, 212 adolescents with T1D (ages 17 years) are randomised to 12 months group education versus usual T1D care before transfer to adult care. Visits in the active arm consist of group education sessions followed by usual T1D care visits every 3 months. Primary outcome is change in HbA1c measured at 24 months. Secondary outcomes are delays in establishing adult diabetes care, T1D-related hospitalisations and emergency department visits, severe hypoglycaemia, stigma, self-efficacy, diabetes knowledge, transition readiness, diabetes distress, quality of life and cost-effectiveness at 12 and 24 months follow-up. Analysis will be by intention-to-treat. Change in HbA1c will be calculated and compared between arms using differences (95% CI), along with cost-effectiveness analysis. A similar approach will be conducted to examine between-arm differences in secondary outcomes.

Ethics And Dissemination: The study was approved by McGill University Health Centre Research Ethics Board (GET-IT/MP-37-2019-4434, version 'Final 1.0 from November 2018). Study results will be disseminated through peer-reviewed publications.

Trial Registration Number: NCT03703440.
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http://dx.doi.org/10.1136/bmjopen-2019-033806DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6859409PMC
November 2019

Identifying pediatric diabetes cases from health administrative data: a population-based validation study in Quebec, Canada.

Clin Epidemiol 2019 11;11:833-843. Epub 2019 Sep 11.

Department of Medicine, Division of Clinical Epidemiology, McGill University, Montreal, QC, Canada.

Background: Type 1 diabetes is one of the most common chronic diseases in childhood with a worldwide incidence that is increasing by 3-5% per year. The incidence of type 2 diabetes, traditionally viewed as an adult disease, is increasing at alarming rates in children, paralleling the rise in childhood obesity. As the rates of diabetes increase in children, accurate population-based assessment of disease burden is important for those implementing strategies for health services delivery. Health administrative data are a powerful tool that can be used to track disease burden, health services use, and health outcomes. Case validation is essential in ensuring accurate disease identification using administrative databases.

Aim: The aim of our study was to define and validate a pediatric diabetes case ascertainment algorithm (including any form of childhood-onset diabetes) using health administrative data.

Research Design And Methods: We conducted a two-stage method using linked health administrative data and data extracted from charts. In stage 1, we linked chart data from a large urban region to health administrative data and compared the diagnostic accuracy of various algorithms. We selected those that performed the best to be validated in stage 2. In stage 2, the most accurate algorithms were validated with chart data within two other geographic areas in the province of Quebec.

Results: Accurate identification of diabetes in children (ages ≤15 years) required four physician claims or one hospitalization (with International Classification of Disease codes within 1 year (sensitivity 91.2%, 95% confidence interval [CI] 89.2-92.9]; positive predictive value [PPV] 93.5%, 95% CI 91.7-95.0) or using only four physician claims in 2 years (sensitivity 90.4%, 95% CI 88.3-92.2; PPV 93.2%, 95% CI 91.7-95.0). Separating the physician claims by 30 days increased the PPV of all algorithms tested.

Conclusion: Patients with child-onset diabetes can be accurately identified within health administrative databases providing a valid source of information for health care resource planning and evaluation.
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http://dx.doi.org/10.2147/CLEP.S217969DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6750203PMC
September 2019

Gestational diabetes mellitus and risk of incident primary cancer: A population-based retrospective cohort study.

J Diabetes 2020 Jan 17;12(1):87-90. Epub 2019 Oct 17.

Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada.

Highlights A large retrospective study indicates no association between GDM and most types of cancer; this is in contrast to a few smaller studies that have suggested an association with cancer. An increased risk of thyroid cancer in mothers with GDM was demonstrated. While this risk requires further investigation, it may be advisable for physicians to consider regular thyroid examination for patients with a GDM history.
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http://dx.doi.org/10.1111/1753-0407.12988DOI Listing
January 2020

Analysis of incidence, mortality trends, and geographic distribution of breast cancer patients in Canada.

Breast Cancer Res Treat 2019 Dec 4;178(3):683-691. Epub 2019 Sep 4.

Division of Dermatology, McGill University, Rm. E02.6236, 1001 Decarie Blvd, Montréal, QC, H4A 3J1, Canada.

Background/purpose: Breast cancer is the malignancy with the highest incidence rate excluding non-melanoma skin cancers, and the second leading cause of cancer-related deaths among Canadian women. Many modifiable risk factors have been linked to the pathogenesis of this disease. The purpose of this study is to analyze the epidemiology of breast cancer in Canada and to examine its geographic distribution to help identify new risk factors for this disease.

Methods: Three independent population-based cancer registries were used to retrospectively analyze demographic data from Canadian women diagnosed with invasive breast cancer across all provinces and territories between 1992 and 2010. The incidence and mortality rates were assessed at the provincial, city, and forward sortation area (FSA) postal code levels.

Results: The overall age-adjusted incidence rate was 114.4 cases per 100,000 females per year. Six provinces and several groups of FSAs had significantly higher incidence rates. There was a significant increase in incidence and decrease in mortality rates between 1992 and 2010. The overall mortality rate was 31.5 deaths per 100,000 females per year. However, three provinces had significantly higher mortality rates.

Conclusion: By identifying high-incidence areas for breast cancer, our study will help identify patient populations that are at higher risk for this malignancy. It will also act as a foundation for future studies to establish novel risk factors for this disease.
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http://dx.doi.org/10.1007/s10549-019-05418-2DOI Listing
December 2019

Identification of significant geographic clustering of polycythemia vera cases in Montreal, Canada.

Cancer 2019 11 5;125(22):3953-3959. Epub 2019 Aug 5.

Division of Dermatology, McGill University, Montréal, Québec, Canada.

Background: Polycythemia vera (PV) is a chronic myeloproliferative neoplasm associated at times with debilitating symptoms and a significant mortality rate. Understanding the demographics, epidemiology, and geography of this disease may provide further insight into important risk factors associated with its development. The objective of this study was to analyze patient demographics, incidence, and mortality rates, as well as the geographic distribution of PV patients in Canada between 1992 and 2010.

Methods: This study was achieved by analyzing the Canadian Cancer Registry, Le Registre Québécois du Cancer, and the Canadian Vital Statistics patient databases.

Results: A total of 4645 patients were diagnosed with PV between 1992 and 2010. While the annual incidence rate of this cancer fluctuated in Canada, mortality rate analysis indicated a decreasing trend. Geographically, PV incidence rates were notably elevated in the province of Quebec compared with the Canadian average. Further analysis of high-incidence forward sortation areas indicated a striking clustering of cases in the H4W region encompassing the Côte-Saint-Luc borough of Montreal, with an incidence of 102.97 (95% confidence interval, 75.11-137.79) cases per million per year, which is >13 times the national average.

Conclusion: The residential area of Côte-Saint-Luc is an important PV cluster in Canada, with high concentration of retirement homes and geriatric hospices. Also, Jewish residents comprise >60% of the population in this neighborhood. These findings suggest that an older age and, potentially, an inherent genetic predisposition may be implicated in the pathogenesis of this malignancy. This study provides a comprehensive overview of PV burden/geographic distribution of cases in Canada.
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http://dx.doi.org/10.1002/cncr.32417DOI Listing
November 2019

Cost of Refractory Crohn's Disease Before and After Ustekinumab Utilization.

J Can Assoc Gastroenterol 2020 Dec 1;3(6):257-265. Epub 2019 Aug 1.

Division of Gastroenterology, McGill University Health Center, Montreal, Quebec, Canada.

Background: Crohn's disease (CD) is associated with major health services utilization and costs. Between 2012 and 2015, ustekinumab was used off-label in Quebec, Canada for treatment of refractory CD.

Aims: We assessed the direct medical cost of adult CD patients in the 1-year pre- and 1-year postustekinumab initiation.

Methods: Data were obtained from the provincial administrative databases. CD patients dispensed subcutaneous ustekinumab in 2012 to 2014 were followed for 1 year from the date of initiation (index-date). Kaplan Meier plots were used to display time to ustekinumab discontinuation and factors associated with discontinuation were identified using multivariate Cox regression models. Direct medical costs and 95% confidence interval (CI) of gastrointestinal-related health services were calculated for the 1-year pre- and 1-year post-index-date.

Results: Thirty-four CD patients (mean age ± standard deviation, 44 ± 14 years, 59% women and 41% with low income) were included. Of these, 14 (41%) discontinued ustekinumab during the postperiod. Discontinuation was less likely among older patients: hazard ratio (95% CI) per 5-year age increase, 0.77 (0.61 to 0.96). The total $CAN direct medical cost (mean, 95% CI) was higher in the post- versus preperiod: $1,681,239 ($49,448; $42,265 to $57,160) versus $880,060 ($25,884; $20,391 to 31,596), while the total costs of GI-related health services were similar: $250,206 ($7359, $3536 to $11,674), versus $213,446 ($6278, $3609 to $9423).

Conclusion: In patients with severe refractory CD on off-label ustekinumab, approximately 60% remained on treatment beyond 1 year. The cost of gastrointestinal services did not increase during that year as compared to that of the year preceding ustekinumab use.
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http://dx.doi.org/10.1093/jcag/gwz025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7678737PMC
December 2020

Physical function-derived cut-points for the diagnosis of sarcopenia and dynapenia from the Canadian longitudinal study on aging.

J Cachexia Sarcopenia Muscle 2019 10 15;10(5):985-999. Epub 2019 Jul 15.

School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, Canada.

Background: Aging is associated with sarcopenia (low muscle mass) and dynapenia (low muscle strength) leading to disability and mortality. Widely used previous cut-points for sarcopenia were established from dated, small, or pooled cohorts. We aimed to identify cut-points of low strength as a determinant of impaired physical performance and cut-points of low appendicular lean mass (ALM) as a predictor of low strength in a single, large, and contemporary cohort of community-dwelling older adults and compare these criteria with others.

Methods: Cross-sectional analyses were conducted on baseline data from 4725 and 4363 community-dwelling men and women (65-86 years, 96.8% Caucasian) of the Canadian longitudinal study on aging comprehensive cohort. Physical performance was evaluated from gait speed, timed up-and-go, chair rise, and balance tests; a weighted-sum score was computed using factor analysis. Strength was measured by handgrip dynamometry; ALM, by dual-energy X-ray absorptiometry and ALM index (ALMI; kg/m ), was calculated. Classification and regression tree analyses determined optimal sex-specific cut-points of ALMI predicting low strength and of strength predicting impaired physical performance (score < 1.5 SD below the sex-specific mean).

Results: Modest associations were found between ALMI and strength and between strength and physical performance score in both sexes. ALMI was not an independent predictor of physical performance score. Cut-points of <33.1 and <20.4 kg were found to define dynapenia in men and in women, respectively, corresponding to 21.5% and 24.0% prevalence rates. Sarcopenia cut-points were <7.76 kg/m in men and <5.72 kg/m in women; prevalence rates of 21.7% and 13.7%. Overall, 8.3% of men and 5.5% of women had sarco-dynapenia. Sarcopenic were older and had lower fat mass and body mass index (BMI) than non-sarcopenic participants. While the agreement between current criteria and the updated European Working Group for Sarcopenia in Older Persons recommendations was fair, we found only slight agreement with the Foundation for the National Institute of Health sarcopenia project. Older persons identified with sarcopenia as per the Foundation for the National Institute of Health criteria (using ALM/BMI as the index) have higher BMI and fat mass compared with non-sarcopenic and have normal ALMI as per our criteria.

Conclusions: The proposed function-derived cut-points established from this single, large, and contemporary Canadian cohort should be used for the identification of sarcopenia and dynapenia in Caucasian older adults. We advise on using criteria based on ALMI in the diagnosis of sarcopenia. The modest agreement between sarcopenia and dynapenia denotes potential distinct health implications justifying to study both components separately.
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http://dx.doi.org/10.1002/jcsm.12462DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6818452PMC
October 2019

Incidence, Mortality, and Spatiotemporal Distribution of Cutaneous Malignant Melanoma Cases Across Canada.

J Cutan Med Surg 2019 Jul/Aug;23(4):394-412. Epub 2019 May 27.

2 Division of Dermatology, McGill University, Montréal, QC, Canada.

Background: We recently reported a steady increase in the incidence and mortality of cutaneous malignant melanoma (CMM) in Canada during 1992-2010.

Objectives: The objective of this article is to examine the distribution of Canadian CMM patients at the level of provinces, cities, and forward sortation area (FSA) postal codes.

Methods: Using 3 Canadian population-based registries, we conducted an in-depth examination of the incidence and mortality trends for 72 565 Canadian CMM patients over the period 1992-2010.

Results: We found that among 20- to 39-year-olds, the incidence of CMM in women (7.17 per 100 000 individuals) was significantly higher than in men (4.60 per 100 000 individuals per year). Women age 80 years and older had an incidence of CMM (58.46 cases per 100 000 women per year) more than 4 times greater than the national average (12.29 cases per 100 000 population per year) and a corresponding high mortality rate (20.18 deaths per 100 000 women per year), when compared with the Canadian melanoma mortality of 2.4 deaths per 100 000 per year. In other age groups men had higher incidence and corresponding melanoma mortality rates. We also studied CMM incidence by province, city, and FSA postal codes and identified several high-incidence communities that were located near the coast/waterfronts. In addition, plotting latitude measures for cities and FSAs vs CMM incidence rate confirmed the inverse relationship between geographical latitude and incidence of melanoma in Canada (slope = -0.22 ± 0.05).

Conclusions: This research may help develop sex-, age- and geographic region-specific recommendations to decrease the future burden of CMM in Canada.
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http://dx.doi.org/10.1177/1203475419852048DOI Listing
January 2020

Increasing prevalence of diabetic ketoacidosis at diabetes diagnosis among children in Quebec: a population-based retrospective cohort study.

CMAJ Open 2019 Apr-Jun;7(2):E300-E305. Epub 2019 May 14.

Divisions of Endocrinology (Robinson, Nakhla) and General Pediatrics (Li), Department of Pediatrics, McGill University Health Centre; Research Institute of the McGill University Health Centre (Li, Rahme, Nakhla), Montréal, Que.; Institut national de santé publique du Québec (Simard, Larocque), Québec, Que.

Background: Diabetic ketoacidosis at type 1 diabetes diagnosis is a preventable life-threatening complication. Canadian data on the temporal trends of the prevalence of diabetic ketoacidosis at the onset of type 1 diabetes in children are unknown. We aimed to determine the temporal changes in diabetic ketoacidosis prevalence at diabetes diagnosis in Quebec.

Methods: We conducted a population-based cohort study of children (aged 1-17 yr) living in Quebec who were diagnosed with diabetes between 2001 and 2014, using multiple health administrative linked databases available at the Institut national de santé publique du Québec through the Quebec Integrated Chronic Surveillance System. We used multivariate Poisson regression analysis with robust error variance to determine trends in the prevalence of diabetic ketoacidosis.

Results: We found that 25.6% (1471/5741) of children presented with diabetic ketoacidosis at diabetes diagnosis. The incidence of diabetes was stable at 30 cases per 100 000 children per year during the study period. The age- and sex-standardized rates of diabetic ketoacidosis increased from 22% (95% confidence interval [CI] 17%-26%) in 2001 to 30% (95% CI 24%-36%) in 2014. The relative increase of diabetic ketoacidosis prevalence at diabetes diagnosis over the study period was 2.0% per year (rate ratio 1.02; 95% CI 1.01-1.03).

Interpretation: Despite a stable incidence of type 1 diabetes, we found that the prevalence of diabetic ketoacidosis at diabetes onset increased between 2001 and 2014. Our findings are concerning and demonstrate a need to continue to campaign to recognize type 1 diabetes before diabetic ketoacidosis supervenes.
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http://dx.doi.org/10.9778/cmajo.20190047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6517121PMC
May 2019

Incidence trends of conjunctival malignant melanoma in Canada.

Br J Ophthalmol 2020 01 11;104(1):23-25. Epub 2019 May 11.

Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada

Background: Melanoma is the most common primary malignancy of the eye in adults. While the epidemiology of uveal melanoma has recently been described in Canada, little is known about the epidemiology and geographic distribution of patients with conjunctival melanoma (CM) in Canada.

Methods: We conducted a population-based study of CM incidence across all Canadian provinces and territories during 1992-2010 using two independent population-based registries.

Results: 190 patients were diagnosed with CM in Canada from 1992 to 2010. 55.3 % of these patients were men. The mean annual incidence rate of CM in Canada was 0.32 cases per million individuals (0.35 and 0.29 cases per million individuals for men and women, respectively). The incidence rates for Canadian provinces demonstrated that the eastern provinces of Nova Scotia and New Brunswick had higher age-adjusted incidence rates than the national average, with rates of 0.52 and 0.47 cases per million individuals per year, respectively.

Conclusions: This analysis demonstrates novel variations in CM incidence rates between different Canadian provinces. These results taken together with the data reported from the USA confirm the North-to-South geographic gradient of increasing CM incidence. This research highlights that the epidemiology of CM in North America is comparable to that of cutaneous malignant melanoma in contrast to the trends for uveal melanoma distribution.
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http://dx.doi.org/10.1136/bjophthalmol-2019-313977DOI Listing
January 2020

Considering parents as a unit: Associations of gestational diabetes and gestational hypertension with postpartum diabetes and hypertension in couples.

Pregnancy Hypertens 2019 Apr 18;16:32-37. Epub 2019 Feb 18.

Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, 5252 boul de Maisonneuve, H4A 3S5 Montreal, Quebec, Canada; Department of Medicine, McGill University Health Center, 1001 DecarieBoulevard, H4A 3J1 Montreal, Quebec, Canada. Electronic address:

Objectives: To evaluate the associations of a combined indicator of gestational diabetes mellitus (GDM) and gestational hypertension (GH) with diabetes and with hypertension in parental couples as a 'unit'.

Study Design: Utilizing administrative health data, GH was identified in matched pairs (GDM vs. no GDM) of mothers with singleton live births (Quebec, Canada; cohort inception 1990-2007). Couples were categorized based on GDM/GH status s ('neither'; 'either'; or 'both'). Using validated administrative health database definitions, associations of this indicator with diabetes and with hypertension in both members of the couple (12 weeks postpartum to March 31, 2012) were evaluated through adjusted Cox proportional hazard models.

Results: In 63,438 couples over a mean of 12.8 years (SD 5.4), diabetes risk was 9-fold higher (HR: 8.9; 95% CI 6.4, 12.2) in couples with either GDM/GH and 16-fold higher (HR 16.0; 95% CI 10.9, 23.5) in couples with both conditions compared to those with neither. Hypertension risk was 2-fold higher (HR: 1.8; 95% CI 1.5, 2.0) in couples either GDM/GH and 6-fold higher (HR 5.8; 95% CI 4.9, 7.0) in couples with both conditions compared to those with neither condition.

Conclusions: GDM/GH predict diabetes and hypertension in couples as a unit underscoring the concept of shared couple risk. These findings may help foster couple collaboration for cardiovascular risk reduction in the household.
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http://dx.doi.org/10.1016/j.preghy.2019.02.004DOI Listing
April 2019

Care quality for rheumatoid arthritis patients in Quebec.

Int J Rheum Dis 2019 Jul 16;22(7):1233-1238. Epub 2019 Apr 16.

Division of Clinical Epidemiology, Research Institute of the McGill University Health Center, Montreal, Quebec, Canada.

Aim: The aims of this study were to: (a) measure the proportion of CARTaGENE rheumatoid arthritis (RA) patients fulfilling pre-specified quality indicators (ie disease-modifying antirheumatic drug [DMARD] use, regular follow up, use of folate supplementation, use of vitamin D and calcium, exercise and smoking status); and (b) examine variation in DMARD use with respect to patient age, sex, education and income.

Methods: A cohort of RA patients was constructed based on the CARTaGENE survey and health administrative database. CARTaGENE is a large, established, population-based study which recruited 19 995 participants from four metropolitan regions in Quebec. Six quality indicators (QI) were assessed; four pertained to RA management and treatment received (use of DMARD therapy, annual medical visits, use of folate supplementation with methotrexate therapy, and use of calcium and vitamin D in steroid-exposed patients) and two pertained to lifestyle factors (physical activity and smoking cessation). QI were reported in terms of proportion of patients fulfilling them. Bayesian logistic regression analyses were preformed to investigate potential variation with DMARD use.

Results: Our cohort included 142 RA patients. The QI that pertain to RA pharmacotherapy and medical management ranged 60-80%. Regarding the QI focusing on lifestyle factors, 55% of patients reported performing moderate physical activity and only 16.6% reported current smoking. Results from the Bayesian logistic regression showed no definite associations between DMARD use and patient characteristics (age, education, income and sex).

Conclusion: Our findings suggest a seemingly modest performance of Quebec's health-care system for RA patients, with respect to these QI.
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http://dx.doi.org/10.1111/1756-185X.13580DOI Listing
July 2019

Gestational diabetes associated with incident diabetes in childhood and youth: a retrospective cohort study.

CMAJ 2019 04;191(15):E410-E417

Department of Medicine (Blotsky, Rahme, Dasgupta), McGill University; Centre for Outcomes Research and Evaluation (Blotsky, Rahme, Dahhou, Nakhla, Dasgupta), Research Institute of the McGill University Health Centre; Department of Pediatrics (Nakhla), Division of Endocrinology and Metabolism, McGill University, Montréal, Que.

Background: Indicators of childhood- and youth-onset diabetes may be useful for early detection of diabetes; there is a known association between composite exposure of parental type 2 diabetes and gestational diabetes mellitus with childhood- and youth-onset diabetes. We examined associations between gestational diabetes mellitus and incidence of childhood- and youth-onset diabetes in offspring.

Methods: Using public health insurance administrative databases from Quebec, Canada, we randomly selected singleton live births with maternal gestational diabetes mellitus (1990-2007) and matched them 1:1 with singleton live births without gestational diabetes mellitus. Follow-up was to Mar. 31, 2012. We examined associations of diabetes in offspring with maternal gestational diabetes mellitus through unadjusted and adjusted Cox proportional hazards models. In secondary analyses, we separately considered age groups ranging from birth to age 12 years, and age 12 to 22 years.

Results: Incidence of pediatric diabetes (per 10 000 person-years) was higher in offspring born to mothers with gestational diabetes mellitus (4.52, 95% confidence interval [CI] 4.47-4.57) than in mothers without gestational diabetes mellitus (2.4, 95% CI 2.37-2.46). In an adjusted Cox proportional hazards model, maternal gestational diabetes mellitus was associated with development of pediatric diabetes overall (birth to age 22 yr: hazard ratio [HR] 1.77, 95% CI 1.41-2.22), during childhood (birth to age 12 yr: HR 1.43, 95% CI 1.09-1.89), and in youth (age 12 to 22 yr: HR 2.53, 95% CI 1.67-3.85).

Interpretation: Gestational diabetes mellitus is associated with incident diabetes in offspring during childhood and adolescence. Future studies are needed to examine longer-term outcomes in patients with pediatric diabetes with a maternal history of gestational diabetes mellitus, to ascertain how they compare with other patients with childhood- or youth-onset diabetes, in terms of disease severity and outcomes.
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http://dx.doi.org/10.1503/cmaj.181001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6464886PMC
April 2019

Multiple myeloma epidemiology and patient geographic distribution in Canada: A population study.

Cancer 2019 07 5;125(14):2435-2444. Epub 2019 Apr 5.

Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada.

Background: Multiple myeloma (MM) is a malignancy of mature plasma cells. Environmental risk factors identified for this malignancy, among others, include farming and exposure to pesticides.

Methods: Using 3 independent population-based databases (the Canadian Cancer Registry, le Registre Québécois du Cancer, and Canadian Vital Statistics), this study analyzed patients' clinical characteristics and the incidence, mortality, and geographic distribution of MM cases in Canada during 1992-2015.

Results: In total, ~32,065 patients were identified, and 53.7% were male. The mean age at the time of diagnosis was 70 ± 12.1 years. The average incidence rate in Canada was 54.29 cases per million individuals per year, and linear regression modeling showed a steady rise in the annual rate of 0.96 cases per million individuals per year. At the provincial level, Quebec and Ontario had significantly higher incidence rates than the rest of Canada. An analysis of individual municipalities and postal codes showed lower incidence rates in large metropolitan areas and in high-latitude regions of the country, whereas high incidence rates were observed in smaller municipalities and rural areas. Land use analysis demonstrated increased density of crop farms and agricultural industries in high-incidence areas. A comparison with the available data from 2011-2015 showed several consistent trends at provincial, municipal, and regional levels.

Conclusions: These results provide a comprehensive analysis of the MM burden in Canada. Large metropolitan cities as well as high-latitude regions were associated with lower MM incidence. Higher incidence rates were noted in smaller cities and rural areas and were associated with increased density of agricultural facilities.
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http://dx.doi.org/10.1002/cncr.32128DOI Listing
July 2019

Retinoblastoma Incidence Trends in Canada: A National Comprehensive Population-Based Study.

J Pediatr Ophthalmol Strabismus 2019 Mar;56(2):124-130

Purpose: To determine the incidence rates and geographic distribution of retinoblastoma in Canada to aid cancer control programs.

Methods: Patients with retinoblastoma whose data were available from the Canadian Cancer Registry (CCR) and Le Registre Québécois du Cancer (LRQC) were studied. Using third edition International Classification of Diseases for Oncology (ICD-O) codes, the authors examined the incidence rates and geographic distribution of patients with retinoblastoma between 1992 and 2010. Patient data including sex, age, and laterality of the retinoblastoma were analyzed.

Results: Between 1992 and 2010 in Canada, the average annual incidence rate of retinoblastoma was 11.58 cases per 1 million children younger than 5 years (95% CI [confidence interval]: 10.48 to 12.76). The incidence rate was stable over time, with an average age at diagnosis of 2.30 ± 6.85 years and no gender predilection. The laterality of the reported cases was 81.48% for uni-lateral cases and 18.52% for bilateral cases. Provincially, Nova Scotia had twice the national average and the highest incidence rates of retinoblastoma across the Canadian provinces.

Conclusions: This is the first study to define the disease burden of retinoblastoma and to highlight important longitudinal, geographic, and spatial differences in the distribution of retinoblastoma in Canada between 1992 and 2010. The results of this study indicate continuity of clinical trends between Canada, the United States, and other developed countries. [J Pediatr Ophthalmol Strabismus. 2019;56(2):124-130.].
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http://dx.doi.org/10.3928/01913913-20190128-02DOI Listing
March 2019

Identifying Rheumatoid Arthritis Cases within the Quebec Health Administrative Database.

J Rheumatol 2019 12 15;46(12):1570-1576. Epub 2019 Mar 15.

From the Department of Epidemiology, Biostatistics and Occupational Health, McGill University; Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; Department of Medicine, McGill University, Montreal, Quebec, Canada.

Objective: Our objective was to calculate rheumatoid arthritis (RA) point prevalence estimates in the CARTaGENE cohort, as well as to estimate the sensitivity and specificity of our ascertainment approach, using physician billing data. We investigated the effects of using varying observation windows in the Régie de l'assurance maladie du Québec (RAMQ) health services administrative databases, alone or in combination with self-reported diagnoses and drugs.

Methods: We studied subjects enrolled in the CARTaGENE cohort, which recruited 19,995 participants from 4 metropolitan regions in Québec from August 2009 to October 2010. A series of Bayesian latent class models were developed to assess the effects of 3 factors: the number of years of billing data, the addition of self-reported information on RA diagnoses and drugs, and the adjustment for misclassification error.

Results: The 3-year 2010 point prevalence estimate among cohort members aged 40-69 years, using physician billing plus self-report, adjusting for misclassification error in each source, was 0.9% [95% credible interval (CrI) 0.7-1.2] with RAMQ sensitivity of 84.0% (95% CrI 74.0-93.7) and a specificity of 99.8% (95% CrI 99.6-100.0). Our results show variations in the prevalence point estimates related to all 3 factors investigated.

Conclusion: Our study illustrates that multiple data sources identify more RA cases and thus a higher prevalence estimate. RA point prevalence estimates using billing data are lower if fewer years of data are used.
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http://dx.doi.org/10.3899/jrheum.181121DOI Listing
December 2019

Uveal melanoma incidence trends in Canada: a national comprehensive population-based study.

Br J Ophthalmol 2019 12 28;103(12):1872-1876. Epub 2019 Feb 28.

Division of Dermatology, McGill University Health Centre, Montreal, Québec, Canada

Background: In the developed countries, uveal melanoma is the most common primary intraocular malignancy in adults. Little is known about the epidemiological and geographical distribution of uveal melanoma in Canada.

Methods: To determine the incidence patterns and geographical distribution of uveal melanoma cases in Canada, we conducted the first comprehensive, population-based national study of this malignancy across all Canadian provinces and territories during 1992-2010 years. We examined two independent population-based registries: the Canadian Cancer Registry and Le Registre Québécois du Cancer using corresponding International Classification of Diseases for Oncology-3rd edition codes for all histological subtypes of uveal melanoma.

Results: We report that 2215 patients were diagnosed with uveal melanoma, of which 52.1% were males. The average -annual incidence rate of uveal melanoma in Canada was 3.75 cases per million individuals per year (95% CI 3.60 to 3.91). Overall, we report a steady increase in uveal melanoma incidence with an annual increase of 0.074 cases per million individuals per year. Significant differences in the incidence rates of uveal melanoma between Canadian provinces and territories were noted, where the highest crude incidence was in British Columbia and Saskatchewan with rates of 6.38 and 5.47 cases per million individuals per year, respectively.

Conclusions: This work, for the first time, defines the disease burden of uveal melanoma in Canada and highlights important longitudinal, geographical and spatial differences in the distribution of uveal melanoma in Canada.
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http://dx.doi.org/10.1136/bjophthalmol-2018-312966DOI Listing
December 2019