Publications by authors named "Moira K Kapral"
Turbulence in the system: Higher rates of left-without-being-seen emergency department visits and associations with increased risks of adverse patient outcomes since 2020.
J Am Coll Emerg Physicians Open
December 2024
Objective: To examine risks of severe adverse patient outcomes shortly after a left-without-being-seen emergency department (LWBS ED) visit since 2020.
Methods: In this retrospective study using linked administrative data, we examined temporal trends in monthly rates of ED and LWBS visits for adults in Ontario, Canada, 2014‒2023. In patient-level analyses restricted to the first eligible LWBS ED visit, we used modified Poisson regression to compare the composite outcome of 7-day all-cause mortality or hospitalization following a LWBS ED visit for April 1, 2022‒March 31, 2023 (recent period) to April 1, 2014‒March 31, 2020 (baseline period), adjusted for age, sex, and Charlson comorbidity index.
Article Synopsis
- Stroke survivors have a significantly higher risk of developing dementia compared to matched non-stroke populations, with a 1.76 hazard ratio for dementia risk after stroke.
- In a large-scale study of over 15 million individuals in Ontario, 18.7% of stroke survivors were diagnosed with dementia after a mean follow-up of 5.6 years, compared to 12.5% in the general population.
- The study found that the risk of dementia is particularly high within the first year after a stroke, with a 2.5-fold increase, though this risk decreases over time.
Article Synopsis
- Cerebral amyloid angiopathy (CAA) is a brain disorder caused by the accumulation of beta-amyloid in small blood vessels, leading to increased risk of bleeding in the brain and associated neurocognitive decline.
- It often appears with age, frequently coexists with Alzheimer's Disease, and can result in significant health issues like spontaneous intracerebral hemorrhage and progressive dementia.
- Recent studies suggest a potential link between blood transfusions and the transmission of CAA, raising concerns about public health and the need for further research on whether CAA can be transmitted through blood, alongside its implications for screening practices.
Article Synopsis
- Clinical and health services research often involves clustered data, where individuals (like patients) are grouped within larger entities (like hospitals), creating a multilevel structure.
- This clustering can lead to similar outcomes within the same group, which can skew results if standard statistical methods are applied, leading to misleading conclusions about significance.
- To accurately analyze such data, researchers should use specialized techniques like Generalized Estimating Equations (GEE) or multilevel regression models that properly account for the clustered nature of the data.
Objective: 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.
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- Neighborhood-level income is linked to cardiovascular events, with the relationship differing between immigrants and long-term residents.
- A study of 5.2 million urban-dwelling individuals in Ontario found that the impact of income on cardiovascular events was less pronounced in immigrants than in long-term residents.
- Understanding how immigration status affects health outcomes can inform targeted prevention strategies for those living in low-income neighborhoods.
Background: COVID-19 infection is associated with a pro-coagulable state, thrombosis, and cardiovascular events. However, its impact on population-based rates of vascular events is less well understood. We studied temporal trends in hospitalizations for stroke and myocardial infarction in 3 Canadian provinces (Alberta, Ontario, and Nova Scotia) between 2014 and 2022.
View Article and Find Full Text PDFBackground: People with schizophrenia are less likely than those without to be treated for cardiovascular disease. We aimed to evaluate the association between schizophrenia and secondary preventive care after ischemic stroke.
Methods And Results: In this retrospective cohort study, we used linked population-based administrative data to identify adults who survived 1 year after ischemic stroke hospitalization in Ontario, Canada between 2004 and 2017.
Background: Understanding seasonal variations in stroke can help stakeholders identify underlying causes in seasonal trends, and tailor resources appropriately to times of highest needs. We sought to evaluate the seasonal occurrence of stroke and its subtypes.
Methods: We conducted a retrospective cohort study using administrative data from January 1st, 2003, to December 31st, 2017, in Ontario, Canada's most populous province.
Background And Objectives: Secondary stroke preventive care includes evaluation and control of vascular risk factors to prevent stroke recurrence. Our objective was to evaluate the quality of ambulatory stroke preventive care and its variation by immigration status in adult stroke survivors in Ontario, Canada.
Methods: We conducted a population-based administrative database-derived retrospective cohort study in Ontario, Canada.
Article Synopsis
- The study examines how the timing of endovascular thrombectomy (EVT) treatment impacts the amount of time stroke patients spend at home post-treatment, focusing on a Canadian cohort from 2015 to 2022.
- Faster treatment, specifically when EVT is administered within 4 hours of stroke onset, significantly correlates with increased home-time, with the best outcomes seen when treatment occurs within 2 hours.
- Analysis shows that quicker onset-to-arterial puncture and door-to-puncture times enhance the odds of achieving more home-time, contributing to better recovery and quality of life after a stroke.
Article Synopsis
- Immigrants in high-income countries, like Canada, generally have a lower risk of developing multiple sclerosis (MS), but it's unclear if this risk changes over time as they adapt to their new environment.
- A study in Ontario tracked 1.5 million immigrants from 1985 to 2003 to examine how the length of time spent living in Canada affected their risk of developing MS.
- Results showed that a higher percentage of life spent in Canada increased the hazard of MS, especially for those who spent significantly more time in the country, regardless of sex, immigration class, or age at immigration.
Background: Risk of recurrence after minor ischemic stroke is usually reported with transient ischemic attack. No previous meta-analysis has focused on minor ischemic stroke alone. The objective was to evaluate the pooled proportion of 90-day stroke recurrence for minor ischemic stroke, defined as a National Institutes of Health Stroke Scale severity score of ≤5.
View Article and Find Full Text PDFBackground: In the wake of pandemic-related health decline and health care disruptions, there are concerns that previous gains for cardiovascular risk factors may have stalled or reversed. Population-level excess burden of drug-treated diabetes and hypertension during the pandemic compared with baseline is not well characterized. We evaluated the change in incident prescription claims for antihyperglycemics and antihypertensives before versus during the pandemic.
View Article and Find Full Text PDFBackground: Health care teams along the stroke recovery continuum have a responsibility to support care transitions and return to the community. Ideally, individualized care will consider patient and family preferences, best available evidence, and health care professional input. Person-centered care can improve patient-practitioner interactions through shared decision-making in which health professionals and institutions are sensitive to those for whom they provide care.
View Article and Find Full Text PDFObjective: To examine the association of co-morbidity with home-time after acute stroke and whether the association is influenced by age.
Methods: We conducted a province-wide study using linked administrative databases to identify all admissions for first acute ischemic stroke or intracerebral hemorrhage between 2007 and 2018 in Alberta, Canada. We used ischemic stroke-weighted Charlson Co-morbidity Index of 3 or more to identify those with severe co-morbidity.
Article Synopsis
- Stroke outcomes research often lacks a reliable measure for stroke severity, but the Passive Surveillance Stroke SeVerity (PaSSV) score, developed in Ontario, is an administrative tool that can address this gap.* -
- A study involving over 86,000 patients across British Columbia, Nova Scotia, and Ontario found that a higher PaSSV score (indicating less severe strokes) correlated with lower chances of death within 30 days and reduced risk of long-term care admission.* -
- The findings indicate that the PaSSV score is valid across different regions and time frames, making it a valuable tool for researchers to adjust for stroke severity in various studies.*
Background: Canadian data suggest that patients of lower socioeconomic status with acute myocardial infarction receive less beneficial therapy and have worse clinical outcomes, raising questions regarding care disparities even in universal health care systems. We assessed the contemporary association of marginalization with clinical outcomes and health services use.
Methods: Using clinical and administrative databases in Ontario, Canada, we conducted a population-based study of patients aged ≥65 years hospitalized for their first acute myocardial infarction between April 1, 2010 and March 1, 2019.
Background: Adjustment for baseline stroke severity is necessary for accurate assessment of hospital performance. We evaluated whether adjusting for the Passive Surveillance Stroke SeVerity (PaSSV) score, a measure of stroke severity derived using administrative data, changed hospital-specific estimated 30-day risk-standardized mortality rate (RSMR) after stroke.
Methods: We used linked administrative data to identify adults who were hospitalized with ischemic stroke or intracerebral hemorrhage across 157 hospitals in Ontario, Canada between 2014 and 2019.
Aim: We studied the association between neighbourhood material deprivation, a metric estimating inability to attain basic material needs, with outcomes and processes of care among incident heart failure patients in a universal healthcare system.
Methods And Results: In a population-based retrospective study (2007-2019), we examined the association of material deprivation with 1-year all-cause mortality, cause-specific hospitalization, and 90-day processes of care. Using cause-specific hazards regression, we quantified the relative rate of events after multiple covariate adjustment, stratifying by age ≤65 or ≥66 years.
Background And Objectives: The association between socioeconomic status and acute ischemic stroke treatments remain uncertain, particularly in countries with universal health care systems. This study aimed to investigate the association between neighborhood-level material deprivation and the odds of receiving IV thrombolysis or thrombectomy for acute ischemic stroke within a single-payer, government-funded health care system.
Methods: We conducted a population-based cohort study using linked administrative data from Ontario, Canada.
Background: Previous ischemic stroke (IS) is a risk factor for subsequent IS in the general population; it is unclear if this relationship remains true in patients with cancer. Our objective was to examine the association between previous IS and risk for future IS in individuals newly diagnosed with cancer.
Methods: We conducted a retrospective population-based matched cohort study of newly diagnosed adult cancer patients (excluding nonmelanoma skin cancers and primary central nervous system tumors) in Ontario, Canada from 2010 to 2020; those with prior IS were matched (1:4) by age, sex, year of cancer diagnosis, cancer stage, and cancer site to those without a history of stroke.
Background: Estimates of attributable costs of stroke are scarce, as most prior studies do not account for the baseline health care costs in people at risk of stroke. We estimated the attributable costs of stroke in a universal health care setting and their variation across stroke types and several social determinants of health.
Methods: We undertook a population-based administrative database-derived matched retrospective cohort study in Ontario, Canada.
Background: Metformin has been suggested to reduce dementia risk; however, most epidemiologic studies have been limited by immortal time bias or confounding due to disease severity.
Objectives: To investigate the association of metformin initiation with incident dementia using strategies that mitigate these important sources of bias.
Methods: Residents of Ontario, Canada ≥66 years newly diagnosed with diabetes from January 1, 2008 to December 31, 2017 entered this retrospective population-based cohort.
Background And Aims: Female sex is associated with higher rates of stroke in atrial fibrillation (AF) after adjustment for other CHA2DS2-VASc factors. This study aimed to describe sex differences in age and cardiovascular care to examine their relationship with stroke hazard in AF.
Methods: Population-based cohort study using administrative datasets of people aged ≥66 years diagnosed with AF in Ontario between 2007 and 2019.