The global increase in obesity is a major contemporary health problem. The National Health and Nutrition Examination Survey estimated that 69% of US adults were overweight or obese in 2011-2012, whereas 35% met the definition of obesity, an increase in obesity prevalence from 15% in the late 1970s.^1,2 A parallel increase in diabetes prevalence among adults occurred during the latter half of this period, from less than 4% in 1990 to 8.3% in 2012.^3,4 Similar trends have been observed in Canada and other nations worldwide.^5,6

Background: The majority of immigrants to Canada originate from the developing world, where the most rapid increase in prevalence of diabetes mellitus is occurring. We undertook a population-based study involving immigrants to Ontario, Canada, to evaluate the distribution of risk for diabetes in this population. Methods: We used linked administrative health and immigration records to calculate age-specific and age-adjusted prevalence rates among men and women aged 20 years or older in 2005. We compared rates among 1 122 771 immigrants to Ontario by country and region of birth to rates among long-term residents of the province. We used logistic regression to identify and quantify risk factors for diabetes in the immigrant population. Results: After controlling for age, immigration category, level of education, level of income and time since arrival, we found that, as compared with immigrants from western Europe and North America, risk for diabetes was elevated among immigrants from South Asia (odds ratio [OR] for men 4.01, 95% CI 3.82–4.21; OR for women 3.22, 95% CI 3.07–3.37), Latin America and the Caribbean (OR for men 2.18, 95% CI 2.08–2.30; OR for women 2.40, 95% CI: 2.29–2.52), and sub-Saharan Africa (OR for men 2.31, 95% CI 2.17–2.45; OR for women 1.83, 95% CI 1.72–1.95). Increased risk became evident at an early age (35–49 years) and was equally high or higher among women as compared with men. Lower socio-economic status and greater time living in Canada were also associated with increased risk for diabetes. Interpretation: Recent immigrants, particularly women and immigrants of South Asian and African origin, are at high risk for diabetes compared with long-term residents of Ontario. This risk becomes evident at an early age, suggesting that effective programs for prevention of diabetes should be developed and targeted to immigrants in all age groups.

Health administrative data is increasingly being used for chronic disease surveillance. This study explored agreement between administrative and survey data for ascertainment of seven key chronic diseases, using individually linked data from a large population of individuals in Ontario, Canada.

As people diagnosed with HIV and receiving combination antiretroviral therapy are now living longer, they are likely to acquire chronic conditions related to normal ageing and the effects of HIV and its treatment. Comordidities for people with HIV have not previously been described from a representative population perspective.

Ontario, the most populous province in Canada, has a universal healthcare system that routinely collects health administrative data on its 13 million legal residents that is used for health research. Record linkage has become a vital tool for this research by enriching this data with the Immigration, Refugees and Citizenship Canada Permanent Resident (IRCC-PR) database and the Office of the Registrar General’s Vital Statistics-Death (ORG-VSD) registry. Our objectives were to estimate linkage rates and compare characteristics of individuals in the linked versus unlinked files. We used both deterministic and probabilistic linkage methods to link the IRCC-PR database (1985–2012) and ORG-VSD registry (1990–2012) to the Ontario’s Registered Persons Database. Linkage rates were estimated and standardized differences were used to assess differences in socio-demographic and other characteristics between the linked and unlinked records. The overall linkage rates for the IRCC-PR database and ORG-VSD registry were 86.4 and 96.2 %, respectively. The majority (68.2 %) of the record linkages in IRCC-PR were achieved after three deterministic passes, 18.2 % were linked probabilistically, and 13.6 % were unlinked. Similarly the majority (79.8 %) of the record linkages in the ORG-VSD were linked using deterministic record linkage, 16.3 % were linked after probabilistic and manual review, and 3.9 % were unlinked. Unlinked and linked files were similar for most characteristics, such as age and marital status for IRCC-PR and sex and most causes of death for ORG-VSD. However, lower linkage rates were observed among people born in East Asia (78 %) in the IRCC-PR database and certain causes of death in the ORG-VSD registry, namely perinatal conditions (61.3 %) and congenital anomalies (81.3 %). The linkages of immigration and vital statistics data to existing population-based healthcare data in Ontario, Canada will enable many novel cross-sectional and longitudinal studies to be conducted. Analytic techniques to account for sub-optimal linkage rates may be required in studies of certain ethnic groups or certain causes of death among children and infants.

Most Canadians die in hospital, and yet, many express a preference to die at home. Place of death is the result of the interaction among sociodemographic, illness- and healthcare-related factors. Although home death is sometimes considered a potential indicator of end-of-life/palliative care quality, some determinants of place of death are more modifiable than others. The objective of this systematic review was to evaluate the determinants of home and nursing home death in adult patients diagnosed with an advanced, life-limiting illness. A systematic literature search was performed for studies in English published from January 1, 2004 to September 24, 2013 that evaluated the determinants of home or nursing home death compared to hospital death in adult patients with an advanced, life-limiting condition. The adjusted odds ratios, relative risks, and 95 % confidence intervals of each determinant were extracted from the studies. Meta-analyses were performed if appropriate. The quality of individual studies was assessed using the Newcastle-Ottawa scale and the body of evidence was assessed according to the GRADE Working Group criteria. Of the 5,900 citations identified, 26 retrospective cohort studies were eligible. The risk of bias in the studies identified was considered low. Factors associated with an increased likelihood of home versus hospital death included multidisciplinary home palliative care, preference for home death, cancer as opposed to other diagnoses, early referral to palliative care, not living alone, having a caregiver, and the caregiver’s coping skills. Knowledge about the determinants of place of death can be used to inform care planning between healthcare providers, patients and family members regarding the feasibility of dying in the preferred location and may help explain the incongruence between preferred and actual place of death. Modifiable factors such as early referral to palliative care, presence of a multidisciplinary home palliative care team were identified, which may be amenable to interventions that improve the likelihood of a patient dying in the preferred location. Place of death may not be a very good indicator of the quality of end-of-life/palliative care since it is determined by multiple factors and is therefore dependent on individual circumstances.