Canadian Journal of Public Health-Revue Canadienne De Sante Publique最新文献

{"title":"Post-arrival HIV acquisition patterns: Insights from African, Caribbean, and Black immigrant communities in Canada.","authors":"Wangari Tharao, Thabani Nyoni, Amrita Daftary, Sandra Bullock, Soraya Blot, Valerie Pierre-Pierre, Mona Loutfy, Rupert Kaul, Darrell Tan, Anita Rachlis, Curtis Cooper, Irving Salit, Henry Luyombya, Shannon Thomas Ryan, Liviana Calzavara","doi":"10.17269/s41997-024-00991-6","DOIUrl":"https://doi.org/10.17269/s41997-024-00991-6","url":null,"abstract":"<p><strong>Objectives: </strong>This mixed methods study examines post-migration HIV acquisition patterns and sexual health behaviours among African, Caribbean, and Black (ACB) immigrant men who have sex with men (MSM), as well as heterosexual men and women in Ontario, Canada.</p><p><strong>Methods: </strong>Data were collected from the MSAFIRI Study, including a cross-sectional quantitative survey (n = 108) and in-depth semi-structured interviews (n = 44). Participants were recruited from the Ontario HIV Treatment Network Cohort Study (OCS) through a purposive sampling of individuals who contracted HIV after migration. Data collection occurred between 2015 and 2017. Quantitative analyses using Fisher's exact tests examined associations between gender and HIV acquisition patterns, while qualitative content analysis identified themes around sexual relationships, HIV disclosure, and health decision-making.</p><p><strong>Results: </strong>Findings highlighted gender and orientation-specific differences in HIV acquisition and associated behaviours. Quantitatively, a higher proportion of men than women could not identify their likely source partner (LSP), frequently describing these relationships as casual. Qualitative insights revealed that LSPs often concealed their HIV status, resulting in unintentional post-diagnosis disclosures. Inconsistent condom use was common, with gendered rationales: heterosexual women often cited partner disapproval or relationship exclusivity, while heterosexual men and MSM cited personal aversion and focus on sexual satisfaction.</p><p><strong>Conclusion: </strong>These findings underscore the distinct post-migration HIV acquisition risks among ACB immigrants in Canada. They suggest the need for culturally responsive public health interventions that consider gender-specific barriers, address stigma, and support health decision-making for ACB migrant communities navigating the complex intersections of migration, health, and relationships.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perinatal mental illness in Ontario (2007-2021): A population-based repeated cross-sectional surveillance study.","authors":"Simone N Vigod, Amreen Babujee, Anjie Huang, Kinwah Fung, Kelsey Vercammen, Jennifer Lye, Susie Dzakpasu, Wei Luo","doi":"10.17269/s41997-024-00987-2","DOIUrl":"10.17269/s41997-024-00987-2","url":null,"abstract":"<p><strong>Objective: </strong>Perinatal mental illness can negatively impact pregnant and postpartum women and gender-diverse birthing persons, their children, and families. This study aimed to describe population-level trends in perinatal mental health service use, including outpatient and acute care contacts, to guide decisions about investments in evidence-based treatment.</p><p><strong>Methods: </strong>In this repeated cross-sectional population-based surveillance study in Ontario, Canada, we measured monthly rates of mental health service use for perinatal people (conception to 1 year postpartum) from January 2007 to December 2021. Event rates were calculated by dividing the number of contacts in a given month by the total eligible perinatal time for that month expressed in per 1000 person-months. Rates by service type (outpatient, acute care), diagnosis, and sociodemographic characteristics, and by history of pre-existing mental illness were also calculated.</p><p><strong>Results: </strong>In total, 22-28% of perinatal people had perinatal mental health service use annually (10-15% in pregnancy, 17-21% in postpartum). Perinatal mental health outpatient care rates decreased initially (2007-2012), stabilized, and then increased after March 2020. Acute care rates were stable from 2007 to 2015, then increased (especially for anxiety and substance/alcohol use disorders). Across all contact types, the highest rates were in postpartum vs. pregnancy, those aged < 25 and > 40 years, non-immigrants, urban-dwellers, and those with pre-existing mental illness.</p><p><strong>Conclusion: </strong>Ensuring rapid access to evidence-based supports and services for perinatal mental illness is essential. Groups with increased need based on sociodemographic and clinical characteristics may benefit from targeted supports and services to ensure optimal treatment and prevent adverse outcomes.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Food insecurity and youth suicidal behaviours: Evidence from the Canadian Health Survey of Children and Youth.","authors":"Lilia Lounis, Lovena Jacqdom, Frank J Elgar","doi":"10.17269/s41997-025-00998-7","DOIUrl":"https://doi.org/10.17269/s41997-025-00998-7","url":null,"abstract":"<p><strong>Objective: </strong>Youth suicide, a major cause of death, is linked to poverty and other adverse experiences. Evidence of its association with food insecurity is unclear due to inadequate controls for household income in previous research. This cross-sectional study used independent reports of household income, food insecurity, and suicidal behaviours to examine these associations in a population-based sample.</p><p><strong>Methods: </strong>The 2019 Canadian Health Survey on Children and Youth surveyed 6735 youth (15-17 years), gathering data on sadness/hopelessness, suicidal ideation, and suicide attempts. Adults provided information on household food insecurity using a multi-item scale and about diagnosed mood disorders in youth. Household income data were provided by government tax records. We used Poisson regressions to estimate the relative risk (RR) of each suicidal behaviour attributed to household food insecurity, adjusting for household income and other covariates.</p><p><strong>Results: </strong>Approximately one in five (19.8%) youth experienced marginal (5.2%), moderate (7.9%), or severe (3.3%) food insecurity. Moderate or severe food insecurity was associated with increased risks of sadness/hopelessness, mood disorder, suicide ideation, and suicide attempts (RRs 1.30-2.17) after controlling for household income differences and other covariates. Generally, more severe food insecurity was positively associated with suicide behaviours.</p><p><strong>Conclusion: </strong>Household food insecurity is associated with youth suicidal behaviours, independently of household income. Its underlying pathway to youth mental health includes social and psychological factors that require targeted policy intervention.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel adulterants in unregulated opioids and their associations with adverse events.","authors":"Samuel Tobias, Jennifer Angelucci, Evan Wood, Jane A Buxton, Lianping Ti","doi":"10.17269/s41997-024-00990-7","DOIUrl":"https://doi.org/10.17269/s41997-024-00990-7","url":null,"abstract":"<p><strong>Objective: </strong>In recent years, Canada's unregulated drug supply has become permeated by novel adulterants (e.g., fentanyl analogues, benzodiazepines, xylazine). While fentanyl has been shown to be associated with overdose mortality and other non-fatal health outcomes, adverse events (AE) associated with these adulterants remain poorly described. This study seeks to identify whether common adulterants identified through drug checking services are associated with increased prevalence of specific adverse events reportedly experienced by people who use drugs.</p><p><strong>Methods: </strong>Drug checking samples were analyzed using Fourier-transform infrared spectroscopy and immunoassay strips at harm reduction sites in British Columbia. Self-reported AE (e.g., non-fatal overdose, prolonged sedation, seizures) were recorded from individuals who checked opioids post-consumption. Adjusted prevalence ratios (aPR) and 95% confidence intervals (95% CI) of AE among common adulterants were calculated using generalized linear models with a Poisson distribution, controlled for presence of other adulterants, expected drug, geographic location, and month.</p><p><strong>Results: </strong>Between February 2022 and May 2024, 80,415 samples were analyzed at community sites. Among eligible samples, 36.1% were expected opioids, 42.2% of which were checked post-consumption. AE were noted among 10.7% of post-consumption opioid drug checks. After adjustment, the presence of benzodiazepines in opioid samples was associated with increased prevalence of any AE (aPR 1.97; 95% CI 1.70-2.27), as was the presence of xylazine (aPR 1.50; 95% CI 1.09-2.07). Considering specific AE, benzodiazepines were associated with increased prevalence of overdose (aPR 2.05; 95% CI 1.68-2.51) and prolonged sedation (aPR 3.35; 95% CI 2.54-4.43).</p><p><strong>Conclusion: </strong>Non-fatal AE associated with unregulated opioids have been largely undescribed. Our findings report specific AE associated with different adulterants in the unregulated opioid supply. With this information, tailored public health interventions and services focused on these adulterants can be developed.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HIV testing among heterosexual Black men in Toronto: What are the determinants?","authors":"Roger Antabe, Yujiro Sano, Egbe B Etowa, Joseph Bertrand Nguemo Djiometio, Mandana Vahabi, Kenneth Po-Lun Fung, Josephine Pui-Hing Wong, Winston Husbands","doi":"10.17269/s41997-024-00983-6","DOIUrl":"https://doi.org/10.17269/s41997-024-00983-6","url":null,"abstract":"<p><strong>Objectives: </strong>African, Caribbean, and Black (ACB) men in Canada face a higher risk of HIV infection relative to other men. Despite this concern, these are nascent studies focused on the usage of HIV testing services among ACB men. To contribute to health policy in Canada, we seek to understand the prevalence and predictors of HIV testing among heterosexual ACB men living in Toronto.</p><p><strong>Methods: </strong>We used a sample of 325 self-identified heterosexual Black men in Toronto, Ontario, who participated in the weSpeak study, which examined HIV vulnerability among ACB men. Guided by Andersen's framework of health services utilization, we fitted negative log-log regression models to cross-sectional data of ACB men 16 years or older.</p><p><strong>Results: </strong>The findings indicate that (1) ACB men with secondary or lower levels of educational attainment (OR = 0.57, p < 0.1) were less likely to have ever been tested for HIV compared to their counterparts with a university education or higher, (2) foreign-born men were more likely to have ever been tested for HIV than their Canadian-born counterparts (OR = 3.14, p < 0.01), and (3) ACB men who report multiple sexual partners were more likely to have ever been tested for HIV compared to colleagues with one sexual partner (OR = 2.76, p < 0.01).</p><p><strong>Conclusion: </strong>Based on these findings, we recommend further research to understand the barriers to HIV testing among non-priority risk groups and the design of a more nuanced population-based approach to HIV testing that incorporates case management or various incentives.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of overdose response hotline use for mental health and fatal overdose prevention.","authors":"Will Rioux, Dylan Viste, Taylor Orr, Nathan Rider, S Monty Ghosh","doi":"10.17269/s41997-024-00981-8","DOIUrl":"https://doi.org/10.17269/s41997-024-00981-8","url":null,"abstract":"<p><strong>Objectives: </strong>The overdose crisis remains one of the largest public health issues facing North America to date. Formalized virtual spotting services have gained popularity as a harm reduction intervention, proving early effectiveness in reducing overdose mortality. This study determined the characteristics of individuals who recurrently use one such service, Canada's National Overdose Response Service (NORS).</p><p><strong>Methods: </strong>In this retrospective study, call logs from NORS were analyzed from service inception. Demographics including age, gender, province, community size, substance used, routes of administration, and adverse events were all collected and imputed into a marginal means and rates model to determine the predictors of recurrent service use.</p><p><strong>Results: </strong>A total of 7340 unique calls were included within our analysis. Of those, 1167 (15.8%) reported their gender as male, 3744 (51.0%) as female, and 1329 (18.1%) as gender diverse, and 1100 (14.9%) did not report their gender. In terms of age, 46 (0.6%) were individuals under the age of 18 years, 3561 (48.5%) were between 18 and 30, 557 (7.6%) were between 31 and 40, 2505 (34.1%) were between 41 and 50, 525 (7.1%) were age 51 or over, and 146 (2.0%) did not report their age. Men's rate ratios for recurrent calls were significantly lower than women's (RR = 0.08, 95% CI = 0.07‒0.09), as were those for respondents aged 31‒40 years as compared with those aged 18‒30 (RR = 0.26, 95% CI = 0.15‒0.45). Between regions, rate ratios for callers from British Columbia (RR = 0.28, 95% CI = 0.17‒2.24) and Atlantic provinces (RR = 0.09; 95% CI = 0.07‒0.12) were significantly lower than those for callers from the province of Ontario. Similarly, rural callers demonstrated lower recurrent service use (RR = 0.08; 95% CI = 0.07‒0.11) than their urban counterparts.</p><p><strong>Conclusion: </strong>NORS demonstrates higher usage patterns within certain demographic groups, in particular, urban women. The results can therefore be used to target public health messaging toward those who derive the most benefit from the service and to tailor programming to those who are at highest risk to use alone.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The promises and perils of a free rural inter-city transportation scheme: A mixed-methods study from Northern Saskatchewan.","authors":"Jacob Albin Korem Alhassan, Daniel Fuller, Ron Woytowich","doi":"10.17269/s41997-024-00986-3","DOIUrl":"https://doi.org/10.17269/s41997-024-00986-3","url":null,"abstract":"<p><strong>Objective: </strong>Transportation is a critical health determinant, yet the last decade has witnessed rapid disinvestment across Canada (particularly in rural contexts) with negative health consequences. We sought to explore and describe the benefits and challenges faced in operating the first community-driven free-transportation scheme in Saskatchewan that emerged in response to widespread unavailability of public transportation due to budget cuts (austerity).</p><p><strong>Methods: </strong>We conducted a mixed-methods community-based participatory research study involving 22 interviews with bus riders and service administrators. We also performed descriptive statistics and chi-squared analyses on bus rider data (data on 1185 trips routinely collected between July 2023 and December 2023) to explore sociodemographic characteristics and trip purposes of bus riders.</p><p><strong>Results: </strong>All trips were completed by 616 community members using the free bus service between July 2023 and December 2023. Community members took an average of 5 trips (median = 2.0) with a maximum of 22 trips being taken by one community member (1.9% of all trips). Most trips were by women (53%), and older adults mostly used the free bus for medical purposes (22% of riders were older adults and 34% of these used the bus for medical reasons). Qualitatively, the bus service has increased access to care and promotes social participation and autonomy, especially for older adults. The service however faces some challenges, including funding disruptions and difficulty recruiting and retaining drivers.</p><p><strong>Conclusion: </strong>Free inter-community transportation (i.e. transportation across cities and municipalities) promotes health equity and access. In contexts without access to public transportation, governments could support community-driven initiatives through increased funding.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolation to stabilization: A Housing First approach to address homelessness in Kingston, Ontario.","authors":"Yvonne Tan, Zack Revell, Victoria Wilson, T Hugh Guan, Julie Lambert, Sahar Saeed","doi":"10.17269/s41997-024-00936-z","DOIUrl":"10.17269/s41997-024-00936-z","url":null,"abstract":"<p><strong>Setting: </strong>Homelessness is a significant and growing public health concern across Canada. In Kingston, Ontario, the number of people experiencing chronic homelessness has more than doubled from 136 people in 2020 to 296 in 2023.</p><p><strong>Intervention: </strong>An emergency shelter-in-place hotel program was established in April 2020 to provide non-congregate shelter to people experiencing homelessness and vulnerable to SARS-CoV-2 infections. Beyond preventing COVID transmission, the unintentional consequence was that a population that experienced chronic homelessness reduced drug consumption and became stable. In 2022, with increased funding from the Ministry of Health and the City of Kingston, a new Housing First program was implemented to transition individuals from homelessness to long-term stable housing.</p><p><strong>Outcomes: </strong>Between November 2022 and June 2023, a total of 34 clients initiated the program. Of these clients, 10 completed the program and were successfully housed, 10 remained active participants, and 14 were discharged before completion. Strengths and challenges were identified. Diverse services provided to meet the population's needs and strong collaborations with various community partners were facilitating factors. Inadequate external resources, a lack of evening and prosocial activities, and outside peers (not part of the program) who influenced recovery plans were identified as challenges.</p><p><strong>Implications: </strong>This program illustrates that simultaneously integrating housing, community building, mental health, and addiction services is possible and provides an innovative way to stabilize this vulnerable population of people experiencing homelessness. Results from this program and the knowledge generated through implementation are being used to further scale up the program.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":" ","pages":"39-46"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11868002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Embracing Housing First as a continuum: A response to \"Safeguarding against the degradation of Housing First\".","authors":"Sahar Saeed, Yvonne Tan, Zack Revell, Victoria Wilson, T Hugh Guan, Julie Lambert","doi":"10.17269/s41997-024-00988-1","DOIUrl":"10.17269/s41997-024-00988-1","url":null,"abstract":"","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":" ","pages":"49"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11870719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142910756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rising out-of-hospital mortality in Canada during 2020‒2022: A striking impact observed among young adults.","authors":"Mukesh Kumar, Jessalyn K Holodinsky, Amy Y X Yu, Candace D McNaughton, Peter C Austin, Anna Chu, Michael D Hill, Colleen Norris, Douglas S Lee, Moira K Kapral, Nadia Khan, Noreen Kamal","doi":"10.17269/s41997-024-00934-1","DOIUrl":"10.17269/s41997-024-00934-1","url":null,"abstract":"<p><strong>Objective: </strong>Out-of-hospital mortality rates surged during the early COVID-19 pandemic. While expecting a return to pre-pandemic levels, the evolving patterns of out-of-hospital mortality in Canada remain uncertain. We investigated whether these rates returned to pre-pandemic levels.</p><p><strong>Methods: </strong>This retrospective study, employing linked administrative data, analyzed out-of-hospital mortality trends among adult residents in Ontario, Alberta, and Nova Scotia. Interrupted time series analysis assessed trends in age- and sex-standardized rates/100,000/quarter during pre-pandemic (April 2014-March 2020) and pandemic periods (April 2020-March 2022), while considering April to June 2020 as the pandemic onset period. Crude mortality rates were also examined, stratified by sex and age groups.</p><p><strong>Results: </strong>Pre-pandemic, Ontario's standardized out-of-hospital mortality rates were rising, while Alberta's and Nova Scotia's remained stable. At the pandemic onset, all provinces experienced significant increases in standardized out-of-hospital mortality rates/100,000 (Ontario: β 14.6, 95% CI [3.97, 25.22]; Alberta: 21.3, 95% CI [9.26, 33.34]; Nova Scotia: 10.5, 95% CI [1.06, 19.88]). During the pandemic, standardized out-of-hospital mortality rates/100,000/quarter remained above pre-pandemic levels, with no significant departure from the increased pandemic onset levels (Ontario: - 1.6, 95% CI [- 3.63, 0.52]; Alberta: 0.45, 95% CI [- 1.47, 2.36]; Nova Scotia: - 0.06, 95% CI [- 2.18, 2.06]). Crude out-of-hospital mortality rates increased most prominently among individuals aged 18 to 45 in Alberta and Ontario, and among males across all provinces.</p><p><strong>Conclusion: </strong>The sustained increase in out-of-hospital mortality, observed from the pandemic's onset, spanning more than 2 years, potentially suggests its persistent direct and indirect effects on population health in Canada.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":" ","pages":"26-38"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11870715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}