Epidemiology: Prevalence Studies, Temporal Trends, and Spatial Analysis

Citation:

Pirani, Y., Delgado-Ron, J. A., Marinho, P., Gupta, A, Grey, E., Watt, S., MacKinnon, K., & Salway, T. (2024). Frequency of self-reported persistent post-treatment genital hypesthesia among past antidepressant users: a cross-sectional survey of sexual and gender minority youth in Canada and the US. Social Psychiatry and Psychiatric Epidemiology. [In-press]

Abstract

Persistent post-treatment genital hypoesthesia (PPTGH) is a primary symptom of post-SSRI sexual dysfunction (PSSD), as an iatrogenic syndrome characterized by enduring sexual dysfunction following the discontinuation of some antidepressants. We aimed to estimate the frequency of PPTGH among past users of psychiatric treatments, particularly antidepressants. We used a subsample of UnACoRN, a US/Canada survey of sexual and gender minority youth aged 15 to 29. We included participants with a history of psychiatric drug use. We excluded individuals with genital surgeries or without sexual experience. The analysis involved chi-square tests for initial group comparisons, post hoc tests for multiple comparisons, and logistic regression among those who had stopped taking medication. We exponentiated the regression to estimate the odds of PPTGH by drug type, adjusting for age, sex-assigned-at-birth, hormone treatment, and depression severity in three nested models. 574 of 2179 survey participants reported genital hypoesthesia. They were older and more likely to report male sex assignment at birth, hormonal therapy history, and psychiatric drug history. The frequency of PPTGH among antidepressant users was 13.2% (93/707) compared to 0.9% (1/102) among users of other medications; adjusted odds ratio: 14.2 (95% CI: 2.92 to 257). Antidepressant discontinuation is strongly associated with PPTGH in the US and Canada, where SSRI/SNRI medications account for 80% of antidepressant prescriptions. We call for standardized international warnings and transparent, informed consent. Future research should expand upon our efforts to estimate the risk of PSSD by including all the proposed diagnostic criteria, including documentation of temporal changes in PSSD-related symptoms before and after treatment (³3 months).

In the news

Salway, T., Delgado-Ron J.A., Rich A.J., Dharma, C., Baams L., & Fish, J. (2024). Trends in mental health and smoking disparities between sexual minority and heterosexual adults in Canada, 2003-2020. SSM – Population Health 24, 101697. https://doi.org/10.1016/j.ssmph.2024.101697.

Highlights

  • The study, spanning 18 years, represents one of the longest trend analyses among sexual minority adults, covering four different mental health and substance use outcomes, showing persistent disparities across these areas.
  • Despite improvements in sexual minority-affirming legislation, policy advances, and societal attitudes, relative disparities in mental health and substance use/misuse either remained the same or increased over this 18-year period.

Press release: Sexual minorities still face more mental health, substance use conditions – SFU study

In the news: The Hamilton Spectator

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MacKinnon, K., Jeyabalan, T., Strang, J., Delgado-Ron, J., Lam, J., Gould, W., Cooper, A., & Salway, T., (2024). Discontinuation of gender-affirming medical treatments: Prevalence and associated features in a non-probabilistic sample of transgender and gender-diverse adolescents and young adults in Canada and the United States. Journal of Adolescent Health. https://doi.org/10.1016/j.jadohealth.2024.05.015 [In press].

In the news: New Study Shows Stopping Medical Transition is Not the Same as Detransition

Abstract:

This study investigated the prevalence, correlates, and reasons for discontinuing gender-affirming medical treatment (GAMT) among transgender and gender-diverse adolescents and young adults living in Canada and the United States of America. We used data from an online survey of sexual and gender minority adolescents and young adults aged 15–29 years living in Canada or the United States of America (March–August 2022). The analytic sample was constituted by participants who responded to questions regarding starting and stopping GAMT, as well as reasons for stopping. Correlates of discontinuing GAMT were assessed using univariate logistic regression. The mean age of the analytic sample (N = 3,937) was 21.1 years. Participants were predominantly nonbinary (54.2%) and assigned female at birth (80.8%). 75.5% lived in Canada and 24.5% in the United States of America. Among those who had started GAMT, 121 of 720 (16.8%) reported having ever discontinued treatment. Forty five of 121 (37.2%) who ceased GAMT reported “Yes, but I wish I hadn't.” The most frequently endorsed reasons for discontinuing GAMT were health reasons (37.3%), a change in gender identity (32.0%), and cost (16.0%). Greater age; nonbinary identity, ‘other’ gender identity; diagnosis of or self-identifying as living with schizophrenia; residing in the United States of America (relative to Canada); and endorsing a current Christian identity were associated with discontinuation. Ninety seven of 121 (80.2%) who discontinued GAMT reported a current transgender or gender-diverse identity. Given the dearth of information about the subpopulation who discontinue GAMT, this study advances candidate factors to inform future longitudinal research to better understand the multiple reasons and contexts for stopping GAMT.

Andrade-Rivas, F., Naman, P., Spiegel, J., Henderson, S. Parrott, L., Delgado-Ron J., Echeverri, A. & van den Bosch, M. (2023). Mapping potential population-level pesticide exposures using a modular and scalable geospatial strategy. GeoHealth, 7, e2022GH000775. https://doi.org/10.1029/2022GH000775.

Summary:

Pesticide exposures are a concerning issue that threatens ecosystem integrity and human health. However, most countries cannot assess, monitor, and control pesticide contamination. We studied this threat in Ecuador, a country with one of the highest application rates of pesticides worldwide, an export-bound agricultural industry, a large population at risk, remarkable biodiversity, and a limited understanding of the nationwide extent of pesticide contamination. We assessed the geographic distribution of pesticide application rates and identified regions where the potential risk of exposure to human populations and ecosystems requires detailed exposure assessments. Using publicly available global data sets that locate human populations, biodiversity, natural parks, and pesticide use rates, we mapped areas where high levels of pesticide use and high density of human population overlap. We also assessed areas where natural parks and amphibian species may be threatened. Around 28% of Ecuador’s population lived in areas with a high pesticide application rate. We found widespread intensive use of pesticides in Ecuador in regions that overlap with human populations and ecosystems at risk of exposure. The methods developed relied on open-source software and publicly available data. Thus, our approach can be applied to other regions where data on pesticide use are limited.

Editor highlights: English | Spanish

Downloads:

Delgado-Ron, J. A., Jeyabalan, T., Watt, S., Black, S., Gumprich, M., & Salway, T. (2023). Sampling Sexual and Gender Minority Youth With UnACoRN (Understanding Affirming Communities, Relationships, and Networks): Lessons From a Web-Based Survey. Journal of Medical Internet Research, 25:e44175. https://doi.org/10.2196/44175

Highlights:

UnACoRN recruited nearly 10,000 SGM youth in the United States and Canada, and the cost per survey was CAD $1.48. Researchers using online recruitment strategies should be aware of the differences in campaign management each website or social media platform offers and be prepared to engage with their framing (content selection and delivery) to correct any imbalances derived from it. Those who focus on SGM populations should consider how 2S/LGBTQ-oriented campaigns might deter participation from cisgender or heterosexual people or SGM people not identifying as 2S/LGBTQ, if relevant to their research design. Finally, those with limited resources may select fewer venues with lower cost per completed survey or that appeal more to their specific audience, if needed.

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Núñez-González S, Delgado-Ron JA, Simancas-Racines D. Tendencias y análisis espacio-temporal de la mortalidad por diabetes mellitus en Ecuador, 2001-2016 [Trends and space-time analysis of mortality due to diabetes mellitus in Ecuador, 2001-2016]. Revista Cubana de Salud Pública. 2020 Jun 28;46:e1314.

Highlights: Mortality by diabetes mellitus in Ecuador significantly increased in most age groups and provinces during the period 2001-2016. The provinces of Santa Elena, Guayas, Manabí, Los Ríos, and Santo Domingo accumulated the biggest number of deaths due to this cause. This forces decision-makers to address the design and implementation of health policies that allow for improving the registration systems for adequate epidemiological surveillance.

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Núñez-González, S., Lara-Vinueza, A. G., Gault, C., & Delgado-Ron, J. A. (2018). Trends and spatial patterns of suicide among adolescent in Ecuador, 1997-2016. Clinical Practice and Epidemiology in Mental Health: CP & EMH, 14(1), 283-292. doi:10.2174/1745017901814010283

 

Núñez-González S, Delgado-Ron JA, Gault C, Simancas-Racines D. Trends and spatial patterns of oral cancer mortality in Ecuador, 2001–2016. International Journal of Dentistry. 2018 Jul 2;2018.

Abstract:

The aims of this study were to describe the temporal trend of oral cancer from 2001 to 2016 and to analyze the space and space-time clusters of high mortality due to oral cancer in Ecuador from 2011 to 2016. Methods. The present study is a mixed ecological study; the time trends were obtained using a Joinpoint regression model, space-time scan statistics was used to identify high-risk clusters, and Global Moran I index was calculated. Results. In Ecuador, between 2001 and 2016, OC caused a total of 1,025 deaths. Crude mortality rates significantly increased, with an APC (annual percentage change) of 2.7% (p = 0.009). The age-standardized mortality rate did not significantly increase (APC: 1.73%; p = 0.08). The most likely cluster was detected in 2015, included 20 cantons. The second cluster included 38 cantons, in the years 2014 to 2016. The Global Moran I index for the study period showed a negative spatial autocorrelation (−0.067; p = 0.37). Conclusion. Mortality due to oral cancer in Ecuador significantly increased over the 16-year study period, the young groups being the most affected. Ecuadorian provinces present high variability in types of oral cancer and cancer rates.

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Causal inference

Delgado-Ron, J. A., & Andrade-Rivas, F. (2023). Unwanted or mistimed pregnancy and developmental issues in Ecuadorian children aged 3 to 5: a doubly robust estimate using data from the National Health and Nutrition Survey 2018. Maternal and Child Health Journal 27, 1672–1682. https://doi.org/10.1007/s10995-023-03713-5

Highlights:

What is already known on this subject? Studies from developed countries have shown an association between unintended pregnancy and early child development. Such contexts are not transferable to developing economies and cultures.

What this study adds? Using a doubly robust estimate and avoiding known mediators, we provide the first national-level average population effect estimation of unintended pregnancy on child development from low-and-middle-income countries. Ecuadorian children born from unintended pregnancies had a 42% increased risk of having inadequate development, as measured by the Early Childhood Development Index (ECDI), at ages 3 to 5 compared to wanted children. Inadequate development was found in each of the ECDI domains: numeracy and literacy, social-emotional development, physical development, and approaches to learning.

Delgado-Ron, J. A., Jeyabalan, T., Watt, S., & Salway, T. (2024). Mitigating invalid data bias in the estimation of sexual orientation disparities in a survey of youth in US and Canada. Child Development [In press]. https://doi.org/10.1111/cdev.14111

Abstract:

The current commentary explored the applicability of the methods described in “Mitigating invalid and mischievous survey responses: A registered report examining risk disparities between heterosexual and lesbian, gay, bisexual, or questioning youth” by Dr. Joseph Cimpian and colleagues to explore sexual orientation disparities in preexisting data from a nonprobability sample. Understanding Affirming Communities, Relationships, and Networks was a study of mostly White (77.4%) 9674 sexual and gender-minoritized youth aged 15–29 from the US and Canada. The influence of invalid data on the prevalence ratios of four health outcomes was assessed. The methods yielded similar effects to the original paper. The accuracy varied by outcome prevalence and was robust to misspecification of the model. Therefore, the applicability of this method to preexisting data seems feasible.

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Delgado-Ron, J.A., López-Jaramillo, P. & Karim, M.E. Sodium intake and high blood pressure among adults on caloric deficit: a multi-year cross-sectional analysis of the U.S. population, 2007–2018. J Hum Hypertens (2021). https://doi.org/10.1038/s41371-021-00614-4

Abstract:

Small studies have shown reduced sodium-sensitivity of blood pressure in obese adolescents on a caloric deficit. We aimed to explore the association between mean daily sodium intake and prevalent hypertension among a nationally representative sample of U.S. adults on a calorie deficit. We used a design-based regression model to explore the association between sodium intake and prevalent hypertension. We also conducted sensitivity analyses using multiple imputation chained equations and propensity score matching. We also measured the effect of a binary exposure derived from the widely recommended threshold of 2.3 grams of sodium intake per day. Among 5756 individuals, we did not detect any significant association between increased sodium and the odds of hypertension (OR: 0.97; 95% CI: 0.90; 1.05). All our sensitivity analyses are consistent with our main findings. People on a calorie deficit—a component of healthy weight loss—without malnutrition saw no benefit in reduced sodium intake to lower blood pressure. These results highlight the need to explore new population-specific strategies for sodium intake reduction, including new dietary prescription approaches to improve dietary adherence and reduce the risk associated with sodium-deficient diets.

Correspondence:

  • Delgado-Ron, J.A., López-Jaramillo, P. & Karim, M.E. (2023). Adding nuance to dietary prescriptions: does sodium reduction benefit people already losing weight? J Hum Hypertension 37, 584–585 (2023). https://doi.org/10.1038/s41371-023-00820-2

Goodyear T, Delgado-Ron, J.A., Ashley F, Knight R, & Salway T. (2023). Sexual orientation and gender identity and expression change efforts and suicidality: Evidence, challenges, and future research directions. LGBT Health 10, 5 (339–343). https://doi.org/10.1089/lgbt.2022.0359

Abstract:

Sexual orientation and gender identity and expression change efforts (SOGIECE) aim to deny or suppress nonheterosexual and transgender identities. SOGIECE, including “conversion practices,” are controversial and remain prevalent despite contemporary legislative bans and denouncement of these harmful practices from numerous health professional organizations. Recent work has questioned the validity of epidemiological studies associating SOGIECE with suicidal thoughts and suicide attempts. This perspective article addresses such critiques, arguing that the balance of available evidence indicates SOGIECE contributes to suicidality while proposing methods to better account for structural context and the multitude of factors that may explain both SOGIECE attendance and suicidality.

Delgado-Ron JA, Adhikari B, Van den Bosch M, Dummer T, Hong A, Sandhu J, Demlow E, Hu Y, Frank LD. Community design and hypertension: Walkability and park access relationships with cardiovascular health. International Journal of Hygiene and Environmental Health. 2021 Aug 1;237:113820.

Summary:

We examined the association between neighbourhood walkability and park availability with hypertension through generalized linear models in two independent population cohorts. One Cohort was 22,418 adults (My Health My Community) and the other cohort was 11,972 adults (BC Generations Project). We employed a path analysis modelling approach to explore the presence and significance of mediating factors contributing to any association between walkability or park availability and hypertension. This study intentionally employed walkability measures enforced through municipal zoning and subdivision regulations legally underpinned by health, safety, and welfare. All models were adjusted for socioeconomic and other characteristics where data were available. We found that higher levels of walkability and park accessibility were both associated with significantly lower odds of self-reported hypertension, especially for lower-income individuals. Mediation analysis showed that obesity accounted for 50% and 52.9% of the total effect of walkability and park accessibility on hypertension, respectively.

Health services

Citation:

Smith, J., Tiwana, M. H., Murage, A., Samji, H., Morgan, R., Delgado-Ron, J.A. (2024). Moral distress related to paid and unpaid care among healthcare workers during the COVID-19 pandemic. PLOS ONE 19(9): e0310132. https://doi.org/10.1371/journal.pone.0310132

Abstract:

While there is growing literature on the experiences of healthcare workers and those providing unpaid care during COVID-19, little research considers the interaction between these two sectors of the care economy. We administered a moral distress survey to healthcare workers in Canada in 2022, collecting data on both paid and unpaid care. There were no significant differences in the proportion of participants providing unpaid care by gender, with both genders equally affected by certain responsibilities such as reduced contact with family/loved ones. However, men were significantly more distressed about specific unpaid care responsibilities. Unpaid care was not significantly associated with differences in intention to leave work. At work, women were significantly more concerned about patients unable to see family, while men were distressed by others mistreating COVID patients. This study enhances understanding of paid and unpaid care relationships, particularly during crises, and proposes an innovative method for assessing unpaid care burdens.
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Citation:

Delgado-Ron, J. A., Tiwana, M., Murage, A., Morgan, R., Purewal, S., & Smith, J. (2024). Moral distress, coping mechanisms, and turnover intent among healthcare providers in British Columbia: a race and gender-based analysis. BMC Health Services Research 24, 925. https://doi.org/10.1186/s12913-024-11377-2

Abstract:

This study explores intersectionality in moral distress and turnover intention among healthcare workers (HCWs) in British Columbia, focusing on race and gender dynamics. It addresses gaps in research on how these factors affect healthcare workforce composition and experiences. Our cross-sectional observational study utilized a structured online survey. Participants included doctors, nurses, and in-home/community care providers. The survey measured moral distress using established scales, assessed coping mechanisms, and evaluated turnover intentions. Statistical analysis examined the relationships between race, gender, moral distress, and turnover intention, identifying disparities across different healthcare roles. Complex interactions were examined through Classification and Regression Trees. Racialized and gender minority groups faced higher levels of moral distress. Profession played a significant role in these experiences. White women reported a higher intention to leave due to moral distress compared to other groups, especially white men. Nurses and care providers experienced higher moral distress and turnover intentions than physicians. Furthermore, coping strategies varied across different racial and gender identities.

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Smith J, Tiwana MH, Samji H, Morgan R, Purewal S, Delgado-Ron JA. An Intersectional Analysis of Moral Distress and Intention to Leave Employment Among Long-Term Care Providers in British Columbia. J Aging Health. 2023 Nov 9:8982643231212981. doi: 10.1177/08982643231212981. Epub ahead of print. PMID: 37943505.

Abstract:

In this study, we aimed to explore the relationship between intersectional inequities and moral distress among those working in Long-Term Care (LTC) in British Columbia, Canada. Methods: This was a cross-sectional and retrospective study. We assessed the moral distress of 1678 respondents using a modified Moral Distress Scale and an equivalent distress mitigation score at the intersections of gender and racial/ethnic identity. Then, we explored which worker attributes were more predictive of intention to leave work. Results: We found notable differences in experiences of moral distress across intersecting identities, including high moral distress scores among Indigenous men and women and white women. Significant differences in mitigation scores were also found by intersectional identities. Discussion: Moral distress was the most important predictor of intention to leave work. The differences across racial and gender identity groups suggest the need for tailored interventions to address moral distress among LTC providers.
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Cevallos JV, Montalvo A, Martínez R, Palma R, Delgado-Ron JA. Resistencia bacteriana en infecciones hospitalarias y adquiridas y su relación con hábitos de prescripción de antibióticos [Bacterial resistance in hospital- and community-acquired infections and its relationship with antibiotic prescription habits]. Tsafiqui-Revista Científica en Ciencias Sociales. 2012 Dec 1(3):7-19.

Summary: We applied a survey to 68% of the medical personnel registered at "Hospital Pablo Arturo Suárez" in Quito-Ecuador, to ask about (a) identify the sources of information and support for antibiotic prescription, (b) understand the habits of empirical antibiotic prescription, (c) investigate the degree of knowledge about bacterial resistance surveillance and studies, and (d) establish whether there is a relationship between the choice of empirical antibiotic prescription and the resistance profiles of 1498 strains isolated in the hospital's laboratory.

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Portada Tsafiqui Nº 3

Okpani AI, Barker S, Lockhart K, Grant J, Delgado-Ron JA, Zungu M, Naicker N, Ehrlich R, Yassi A. A mixed-methods study of risk factors and experiences of healthcare workers tested for the novel coronavirus in Canada. J Occup Environ Med 64(9):p e559-e566. 2022 Sept. doi: 10.1097/JOM.0000000000002614. PMID: 35704778.

The aims of this study were to investigate occupational and non–work-related risk factors of coronavirus disease 2019 among health care workers (HCWs) in Vancouver Coastal Health, British Columbia, Canada, and to examine how HCWs described their experiences. Methods: Matched case-control study using data from online and phone questionnaires with optional open-ended questions completed by HCWs who sought severe acute respiratory syndrome coronavirus 2 testing between March 2020 and March 2021. Conditional logistic regression and thematic analysis were utilized. Results: Providing direct care to coronavirus disease 2019 patients during the intermediate cohort period (aOR: 1.90; 95% confidence interval, 1.04 to 3.46) and community exposure to a known case in the late cohort period (aOR: 3.595%; confidence interval, 1.86 to 6.83) were associated with higher infection odds. Suboptimal communication, mental stress, and situations perceived as unsafe were common sources of dissatisfaction. Conclusions: Varying levels of risk between occupational groups call for wider targeting of infection prevention measures. Strategies for mitigating community exposure and supporting HCW resilience are required.

 

Evidence Appraisal and Synthesis

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