Association of Neighborhood-Level Material Deprivation With Atrial Fibrillation Care in a Single-Payer Health Care System: A Population-Based Cohort Study.

Aged Anticoagulants / adverse effects Atrial Fibrillation / diagnosis Cohort Studies Delivery of Health Care Female Heart Failure / drug therapy Hemorrhage / chemically induced Humans Male Ontario / epidemiology Risk Factors Stroke / epidemiology
anticoagulants atrial fibrillation cardiologists delivery of health care electric countershock social class

Journal

Circulation
ISSN: 1524-4539
Titre abrégé: Circulation
Pays: United States
ID NLM: 0147763

Informations de publication

Date de publication:
19 07 2022
Historique:
pubmed: 10 6 2022
medline: 26 7 2022
entrez: 9 6 2022
Statut: ppublish

Résumé

There are limited data on the association of material deprivation with clinical care and outcomes after atrial fibrillation (AF) diagnosis in jurisdictions with universal health care. This was a population-based cohort study of individuals ≥66 years of age with first diagnosis of AF between April 1, 2007, and March 31, 2019, in the Canadian province of Ontario, which provides public funding and prohibits private payment for medically necessary physician and hospital services. Prescription medications are subsidized for residents >65 years of age. The primary exposure was neighborhood material deprivation, a metric derived from Canadian census data to estimate inability to attain basic material needs. Neighborhoods were categorized by quintile from Q1 (least deprived) to Q5 (most deprived). Cause-specific hazards regression was used to study the association of material deprivation quintile with time to AF-related adverse events (death or hospitalization for stroke, heart failure, or bleeding), clinical services (physician visits, cardiac diagnostics), and interventions (anticoagulation, cardioversion, ablation) while adjusting for individual characteristics and regional cardiologist supply. Among 347 632 individuals with AF (median age 79 years, 48.9% female), individuals in the most deprived neighborhoods (Q5) had higher prevalence of cardiovascular disease, risk factors, and noncardiovascular comorbidity relative to residents of the least deprived neighborhoods (Q1). After adjustment, Q5 residents had higher hazards of death (hazard ratio [HR], 1.16 [95% CI, 1.13-1.20]) and hospitalization for stroke (HR, 1.16 [95% CI, 1.07-1.27]), heart failure (HR, 1.14 [95% CI, 1.11-1.18]), or bleeding (HR, 1.16 [95% CI, 1.07-1.25]) relative to Q1. There were small differences across quintiles in primary care physician visits (HR, Q5 versus Q1, 0.91 [95% CI, 0.89-0.92]), echocardiography (HR, Q5 versus Q1, 0.97 [95% CI, 0.96-0.99]), and dispensation of anticoagulation (HR, Q5 versus Q1, 0.97 [95% CI, 0.95-0.98]). There were more prominent disparities for Q5 versus Q1 in cardiologist visits (HR, 0.84 [95% CI, 0.82-0.86]), cardioversion (HR, 0.80 [95% CI, 0.76-0.84]), and ablation (HR, 0.45 [95% CI, 0.30-0.67]). Despite universal health care and prescription medication coverage, residents of more deprived neighborhoods were less likely to visit cardiologists or receive rhythm control interventions after AF diagnosis, even though they exhibited higher cardiovascular disease burden and higher risk of adverse outcomes.

Sections du résumé

BACKGROUND
There are limited data on the association of material deprivation with clinical care and outcomes after atrial fibrillation (AF) diagnosis in jurisdictions with universal health care.
METHODS
This was a population-based cohort study of individuals ≥66 years of age with first diagnosis of AF between April 1, 2007, and March 31, 2019, in the Canadian province of Ontario, which provides public funding and prohibits private payment for medically necessary physician and hospital services. Prescription medications are subsidized for residents >65 years of age. The primary exposure was neighborhood material deprivation, a metric derived from Canadian census data to estimate inability to attain basic material needs. Neighborhoods were categorized by quintile from Q1 (least deprived) to Q5 (most deprived). Cause-specific hazards regression was used to study the association of material deprivation quintile with time to AF-related adverse events (death or hospitalization for stroke, heart failure, or bleeding), clinical services (physician visits, cardiac diagnostics), and interventions (anticoagulation, cardioversion, ablation) while adjusting for individual characteristics and regional cardiologist supply.
RESULTS
Among 347 632 individuals with AF (median age 79 years, 48.9% female), individuals in the most deprived neighborhoods (Q5) had higher prevalence of cardiovascular disease, risk factors, and noncardiovascular comorbidity relative to residents of the least deprived neighborhoods (Q1). After adjustment, Q5 residents had higher hazards of death (hazard ratio [HR], 1.16 [95% CI, 1.13-1.20]) and hospitalization for stroke (HR, 1.16 [95% CI, 1.07-1.27]), heart failure (HR, 1.14 [95% CI, 1.11-1.18]), or bleeding (HR, 1.16 [95% CI, 1.07-1.25]) relative to Q1. There were small differences across quintiles in primary care physician visits (HR, Q5 versus Q1, 0.91 [95% CI, 0.89-0.92]), echocardiography (HR, Q5 versus Q1, 0.97 [95% CI, 0.96-0.99]), and dispensation of anticoagulation (HR, Q5 versus Q1, 0.97 [95% CI, 0.95-0.98]). There were more prominent disparities for Q5 versus Q1 in cardiologist visits (HR, 0.84 [95% CI, 0.82-0.86]), cardioversion (HR, 0.80 [95% CI, 0.76-0.84]), and ablation (HR, 0.45 [95% CI, 0.30-0.67]).
CONCLUSIONS
Despite universal health care and prescription medication coverage, residents of more deprived neighborhoods were less likely to visit cardiologists or receive rhythm control interventions after AF diagnosis, even though they exhibited higher cardiovascular disease burden and higher risk of adverse outcomes.

Identifiants

DOI: 10.1161/CIRCULATIONAHA.122.058949 PMID: 35678171 PMC: PMC9287095
pubmed: 35678171
doi: 10.1161/CIRCULATIONAHA.122.058949
pmc: PMC9287095
doi:

Substances chimiques

Anticoagulants 0

Types de publication

Journal Article Research Support, Non-U.S. Gov't Research Support, N.I.H., Extramural

Langues

eng

Sous-ensembles de citation

IM

Pagination

159-171

Subventions

Organisme : NCATS NIH HHS
ID : UL1 TR001863
Pays : United States
Organisme : CIHR
ID : FDN 143313
Pays : Canada

Commentaires et corrections

Type : CommentIn

Références

Can J Cardiol. 2016 Dec;32(12):1561-1565
pubmed: 27742459
N Engl J Med. 2021 Jan 28;384(4):316-324
pubmed: 33197158
Medicine (Baltimore). 2016 Dec;95(49):e5561
pubmed: 27930562
J Health Care Poor Underserved. 2016;27(3):1427-40
pubmed: 27524777
BMC Cardiovasc Disord. 2017 Feb 14;17(1):61
pubmed: 28196528
Circulation. 2003 Jun 17;107(23):2920-5
pubmed: 12771006
Int J Health Geogr. 2021 Mar 1;20(1):11
pubmed: 33648527
Ann Intern Med. 2014 Jul 15;161(2):113-21
pubmed: 25023250
Stroke. 1991 Aug;22(8):983-8
pubmed: 1866765
Europace. 2021 Mar 8;23(3):345-352
pubmed: 32887994
J Health Commun. 2011;16 Suppl 3:177-90
pubmed: 21951251
Int J Popul Data Sci. 2020 Mar 11;4(2):1135
pubmed: 32935037
J Am Heart Assoc. 2020 Oct 20;9(19):e016810
pubmed: 32924719
J Card Fail. 2003 Apr;9(2):80-6
pubmed: 12751127
Europace. 2016 Mar;18(3):463-7
pubmed: 26899998
Am Heart J. 2016 Apr;174:29-36
pubmed: 26995367
J Am Heart Assoc. 2015 Sep 22;4(9):e002097
pubmed: 26396201
Europace. 2021 Feb 5;23(2):313
pubmed: 32526011
Am Heart J. 2017 Jul;189:40-47
pubmed: 28625380
N Engl J Med. 2020 Oct 1;383(14):1305-1316
pubmed: 32865375
JAMA. 2005 Sep 14;294(10):1240-7
pubmed: 16160132
Am Heart J. 2016 Jan;171(1):48-55
pubmed: 26699600
Int J Clin Pract. 2020 Dec;74(12):e13634
pubmed: 32745337
BMC Med Res Methodol. 2017 Aug 14;17(1):122
pubmed: 28806932
Patient Educ Couns. 2021 Apr;104(4):903-910
pubmed: 32843264
JAMA. 2021 Nov 9;326(18):1793-1794
pubmed: 34677579
Can J Public Health. 2012 Apr 30;103(8 Suppl 2):S12-6
pubmed: 23618065
J Am Heart Assoc. 2017 Apr 11;6(4):
pubmed: 28400367
JAMA Oncol. 2020 Aug 1;6(8):1295-1297
pubmed: 32672809
Circulation. 2020 Mar 3;141(9):e139-e596
pubmed: 31992061
Eur Heart J Qual Care Clin Outcomes. 2021 May 3;7(3):295-303
pubmed: 31560375
Am J Cardiol. 2017 May 1;119(9):1378-1381
pubmed: 28400027
Med Care. 2006 Feb;44(2):100-9
pubmed: 16434908
Pacing Clin Electrophysiol. 2012 Sep;35(9):1090-6
pubmed: 22817646
Health Soc Care Community. 2012 Mar;20(2):113-27
pubmed: 21995806
Sci Adv. 2021 Oct;7(40):eabj2099
pubmed: 34586843
JAMA Netw Open. 2020 Dec 1;3(12):e2031640
pubmed: 33372974
JAMA Netw Open. 2021 Feb 1;4(2):e210247
pubmed: 33635328
Circulation. 2019 Jul 9;140(2):e125-e151
pubmed: 30686041
PLoS One. 2016 Feb 25;11(2):e0149142
pubmed: 26914450
Europace. 2013 Aug;15(8):1128-35
pubmed: 23515338
Lancet. 2018 May 5;391(10132):1775-1782
pubmed: 29706364

Auteurs

Husam Abdel-Qadir (H)

Women's College Hospital, Toronto, Canada (H.A.-Q., J.A.U.).
University Health Network, Toronto, Canada (H.A.-Q., A.C.T.H., C.A.J., D.A.A., R.S.B., M.K.K., K.T., J.A.U., D.S.L.).
ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.).
Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto' Canada.
Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto' Canada.
ORCID: 0000-0002-7105-7931

Leo E Akioyamen (LE)

Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto' Canada.
ORCID: 0000-0002-6959-392X

Jiming Fang (J)

ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.).

Andrea Pang (A)

ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.).

Andrew C T Ha (ACT)

University Health Network, Toronto, Canada (H.A.-Q., A.C.T.H., C.A.J., D.A.A., R.S.B., M.K.K., K.T., J.A.U., D.S.L.).
Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto' Canada.
ORCID: 0000-0002-1275-7313

Cynthia A Jackevicius (CA)

University Health Network, Toronto, Canada (H.A.-Q., A.C.T.H., C.A.J., D.A.A., R.S.B., M.K.K., K.T., J.A.U., D.S.L.).
ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.).
Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto' Canada.
Western University of Health Sciences, Pomona, CA (C.A.J.).
ORCID: 0000-0001-5274-7251

David A Alter (DA)

University Health Network, Toronto, Canada (H.A.-Q., A.C.T.H., C.A.J., D.A.A., R.S.B., M.K.K., K.T., J.A.U., D.S.L.).
ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.).
Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto' Canada.
Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto' Canada.

Peter C Austin (PC)

ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.).
Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto' Canada.
ORCID: 0000-0003-3337-233X

Clare L Atzema (CL)

ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.).
Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto' Canada.
Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto' Canada.
Sunnybrook Health Sciences Centre, Toronto, Canada (C.L.A., C.D.M., I.R., H.C.W., D.T.K., M.J.S.).
ORCID: 000-0002-7236-5522

R Sacha Bhatia (RS)

University Health Network, Toronto, Canada (H.A.-Q., A.C.T.H., C.A.J., D.A.A., R.S.B., M.K.K., K.T., J.A.U., D.S.L.).
Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto' Canada.

Gillian L Booth (GL)

ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.).
Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto' Canada.
Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto' Canada.
Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Canada (G.L.B., I.D.).
ORCID: 0000-0003-2769-6522

Sharon Johnston (S)

Departments of Family Medicine, University of Ottawa, Ottawa, Canada (S.J.).
Institu du Savoir, Hôpital Montfort' Ottawa, Canada (S.J.).

Irfan Dhalla (I)

Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto' Canada.
Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto' Canada.
Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Canada (G.L.B., I.D.).

Moira K Kapral (MK)

University Health Network, Toronto, Canada (H.A.-Q., A.C.T.H., C.A.J., D.A.A., R.S.B., M.K.K., K.T., J.A.U., D.S.L.).
ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.).
Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto' Canada.
Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto' Canada.
ORCID: 0000-0002-3444-9928

Harlan M Krumholz (HM)

Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT (H.M.K.).
Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (H.M.K.).
Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.).
ORCID: 0000-0003-2046-127X

Candace D McNaughton (CD)

ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.).
Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto' Canada.
Sunnybrook Health Sciences Centre, Toronto, Canada (C.L.A., C.D.M., I.R., H.C.W., D.T.K., M.J.S.).
ORCID: 0000-0003-0095-9134

Idan Roifman (I)

ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.).
Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto' Canada.
Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto' Canada.
Sunnybrook Health Sciences Centre, Toronto, Canada (C.L.A., C.D.M., I.R., H.C.W., D.T.K., M.J.S.).
ORCID: 0000-0002-4058-4085

Karen Tu (K)

University Health Network, Toronto, Canada (H.A.-Q., A.C.T.H., C.A.J., D.A.A., R.S.B., M.K.K., K.T., J.A.U., D.S.L.).
ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.).
Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto' Canada.
Department of Family and Community Medicine (K.T.), University of Toronto, Toronto' Canada.
North York General Hospital, Toronto, Canada (K.T.).
ORCID: 0000-0003-0883-4934

Jacob A Udell (JA)

Women's College Hospital, Toronto, Canada (H.A.-Q., J.A.U.).
University Health Network, Toronto, Canada (H.A.-Q., A.C.T.H., C.A.J., D.A.A., R.S.B., M.K.K., K.T., J.A.U., D.S.L.).
ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.).
Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto' Canada.
Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto' Canada.
ORCID: 0000-0001-7402-9584

Harindra C Wijeysundera (HC)

ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.).
Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto' Canada.
Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto' Canada.
Sunnybrook Health Sciences Centre, Toronto, Canada (C.L.A., C.D.M., I.R., H.C.W., D.T.K., M.J.S.).
ORCID: 0000-0001-8464-1080

Dennis T Ko (DT)

ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.).
Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto' Canada.
Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto' Canada.
Sunnybrook Health Sciences Centre, Toronto, Canada (C.L.A., C.D.M., I.R., H.C.W., D.T.K., M.J.S.).
ORCID: 0000-0001-6840-8051

Michael J Schull (MJ)

ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.).
Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto' Canada.
Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto' Canada.
Sunnybrook Health Sciences Centre, Toronto, Canada (C.L.A., C.D.M., I.R., H.C.W., D.T.K., M.J.S.).

Douglas S Lee (DS)

University Health Network, Toronto, Canada (H.A.-Q., A.C.T.H., C.A.J., D.A.A., R.S.B., M.K.K., K.T., J.A.U., D.S.L.).
ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Canada (H.A.-Q., J.F., A.P., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.).
Institute of Health Policy, Management, and Evaluation (H.A.-Q., C.A.J., D.A.A., P.C.A., C.L.A., G.L.B., I.D., M.K.K., I.R., K.T., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto' Canada.
Department of Medicine (H.A.-Q., L.E.A., A.C.T.H., D.A.A., C.L.A., R.S.B., G.L.B., I.D., M.K.K., C.D.M., I.R., J.A.U., H.C.W., D.T.K., M.J.S., D.S.L.), University of Toronto, Toronto' Canada.
ORCID: 0000-0001-7078-745X

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female

Evaluation of Low-Value Services Across Major Medicare Advantage Insurers and Traditional Medicare.

Ciara Duggan, Adam L Beckman, Ishani Ganguli et al.
1.00
Humans United States Aged Cross-Sectional Studies Medicare Part C

Effectiveness of Virtual Yoga for Chronic Low Back Pain: A Randomized Clinical Trial.

Hallie Tankha, Devyn Gaskins, Amanda Shallcross et al.
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Association of Neighborhood-Level Material...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Agents hématologiques › Anticoagulants › Association of Neighborhood-Level Material...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Troubles du rythme cardiaque › Fibrillation auriculaire › Association of Neighborhood-Level Material...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Association of Neighborhood-Level Material...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Prestations des soins de santé › Association of Neighborhood-Level Material...
questionsmedicales.fr › Maladies cardiovasculaires › Cardiopathies › Défaillance cardiaque › Association of Neighborhood-Level Material...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Hémorragie › Association of Neighborhood-Level Material...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Association of Neighborhood-Level Material...
questionsmedicales.fr › Régions géographiques › Amériques › Amérique du Nord › Canada › Ontario › Association of Neighborhood-Level Material...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Probabilité › Risque › Facteurs de risque › Association of Neighborhood-Level Material...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Angiopathies intracrâniennes › Accident vasculaire cérébral › Association of Neighborhood-Level Material...