Substance-attributable Morbidity and Mortality Changes to Canada’s Epidemiological Profile: Measurable Differences Over a Ten-year Period

Jayadeep Patra; Benjamin Taylor; Jürgen T Rehm; Dolly Baliunas; Svetlana Popova

doi:10.1007/BF03403718

. 2007 May 1;98(3):228–234. doi: 10.1007/BF03403718

Show available content in

Substance-attributable Morbidity and Mortality Changes to Canada’s Epidemiological Profile

Measurable Differences Over a Ten-year Period

Jayadeep Patra ^114,^214,^314,^✉, Benjamin Taylor ^114,³¹⁴, Jürgen T Rehm ^114,^314,⁴¹⁴, Dolly Baliunas ³¹⁴, Svetlana Popova ^114,^314,⁵¹⁴

PMCID: PMC6975874 PMID: 17626390

Abstract

Background

Substance use is responsible for a large burden of disease in Canada, however updated data are needed for health care planning and policy development. This study replicates and makes improvements on 1992 estimates of substance-attributable morbidity and mortality for the year 2002. There are two objectives, the main one being to compare the substance-attributable morbidity and mortality in 1992 with 2002 using the same methods of calculation, and the second, to compare the two different methods of estimating the substance-attributable mortality and morbidity in 2002.

Method

Estimates of substance-attributable burden were made by combining relative risk data with exposure prevalence data and disease-related mortality and morbidity information from national databases. First, identical relative risk estimates for 1992 were used with the 2002 data in order to draw direct comparisons. In a second analysis, updated relative risk and attributable disease information (post-1992) was used to better estimate the mortality and morbidity for Canada in 2002.

Results

Overall, from 1992 to 2002, there were relative increases in substanceattributable mortality estimates for alcohol and illegal drugs, where the latter relatively increased more; and a relative decrease in tobacco-attributable mortality. In terms of absolute numbers in combined risk factors, deaths and hospital days for those under 70 years of age decreased mainly due to tobacco. Comparisons of the two methods showed that the updated method resulted in more conservative numbers than previous calculations.

Interpretation

There is an unacceptably high burden of substance-attributable disease in Canada in the early 2000s. Exposure changes and epidemiological shifts in population and diseases over the last 10 years have affected where the burden lies, but it is still vital to incorporate policy-based initiatives that have proven to be effective in reducing substanceattributable burden in practice.

MeSH terms: Substance-related disorders, mortality, morbidity, epidemiology, Canada

Résumé

Contexte

La consommation de substances toxiques (alcool, drogue ou tabac) contribue beaucoup au fardeau des maladies au Canada, mais on manque de données à jour pour la planification et l’élaboration des politiques de santé. Cette étude reprend, en les améliorant, des estimations de 1992 portant sur la morbidité et la mortalité attribuables aux substances toxiques pour l’année 2002. Nous avions deux objectifs, le principal étant de comparer la morbidité et la mortalité attribuables à ces substances en 1992 et en 2002 à l’aide des mêmes méthodes de calcul, et le second, de comparer les deux méthodes utilisées pour estimer la mortalité et la morbidité attribuables aux substances en 2002.

Méthode

Nous avons estimé le fardeau des maladies attribuables aux substances toxiques en combinant les données sur le risque relatif, les données sur la prévalence de l’exposition et les données sur la mortalité et la morbidité liées aux maladies, tirées des bases de données nationales. Pour commencer, nous avons utilisé des estimations identiques du risque relatif pour 1992 et pour 2002 afin de pouvoir faire des comparaisons directes. Dans un deuxième temps, nous avons utilisé des données mises à jour sur le risque relatif et les données sur la mortalité et la morbidité liées aux maladies (après 1992) pour mieux estimer la mortalité et la morbidité au Canada en 2002.

Résultats

Globalement, entre 1992 et 2002, il y a eu des augmentations relatives dans les estimations de la mortalité attribuable à l’alcool et à la drogue (ces augmentations étaient relativement plus fortes dans le cas de la drogue), et une diminution relative de la mortalité attribuable au tabac. En chiffres absolus combinant tous les facteurs de risque, les décès et les jours d’hospitalisation chez les personnes de moins de 70 ans ont principalement diminué en raison du tabac. Nos comparaisons des deux méthodes montrent que la nouvelle méthode de calcul donne des estimations plus prudentes que la méthode antérieure.

Interprétation

Le fardeau des maladies attribuables aux substances toxiques était intolérablement élevé au Canada au début des années 2000. Les variations dans les niveaux d’exposition et les changements épidémiologiques dans la population et les maladies au cours des 10 dernières années ont contribué à repositionner ce fardeau, mais il est encore crucial d’adopter des initiatives stratégiques éprouvées pour le réduire dans la pratique.

References

1.World Health Organization. The World Health Report 2002 — Reducing risks, promoting healthy life. Geneva, Switzerland: World Health Organization; 2002. [Google Scholar]
2.Ezzati M, Lopez AD, Rodgers A, Vander Horn S. Murray CJL, and the Comparative Risk Assessment Collaborating Group. Selected major risk factors and global and regional burden of disease. Lancet. 2002;360:1347–60. doi: 10.1016/S0140-6736(02)11403-6. [DOI] [PubMed] [Google Scholar]
3.Single E, Robson L, Xie X, Rehm J. The costs of substance abuse in Canada. Ottawa, ON: Canadian Centre on Substance Abuse; 1996. [Google Scholar]
4.Rehm J, Baliunas D, Brochu S, Fischer B, Gnam W, Patra J, et al. The social costs of substance abuse in Canada 2002. Ottawa: Canadian Centre on Substance Abuse; 2006. [Google Scholar]
5.Hill AB. The environment and disease: Association or causation? Proc Royal Soc Med. 1965;58:295–300. [PMC free article] [PubMed] [Google Scholar]
6.English DR, Holman CDJ, Milne E, Winter MJ, Hulse GK, Codde G, et al. The quantification of drug caused morbidity and mortality in Australia 1995. Canberra, Australia: Commonwealth Department of Human Services and Health; 1995. [Google Scholar]
7.Rothman KJ, Greenland S. Causation and causal inference. In: Rothman KJ, Greenland S, editors. Modern Epidemiology. 2nd, ed. Philadelphia, PA: Lippincott-Raven Publishers; 1998. pp. 7–28. [Google Scholar]
8.Gutjahr E, Gmel G, Rehm J. Relation between average alcohol consumption and disease: An overview. Eur Addict Res. 2001;7(3):117–27. doi: 10.1159/000050729. [DOI] [PubMed] [Google Scholar]
9.Ridolfo B, Stevenson C. The quantification of drug-caused mortality and morbidity in Australia 1998. Canberra: Australian Institute of Health and Welfare; 2001. [Google Scholar]
10.Rehm J, Room R, Monteiro M, Gmel G, Graham K, Rehn N, et al. Alcohol use. In: Ezzati M, Lopez AD, Rodgers A, Murray CJL, et al., editors. Comparative Quantification of Health Risks. Global and Regional Burden of Disease Attributable to Selected Major Risk Factors. Geneva: World Health Organization; 2004. pp. 959–1109. [Google Scholar]
11.Corrao G, Bagnardi V, Zambon A, Arico S. Exploring the dose-response relationship between alcohol consumption and the risk of several alcohol-related conditions: A meta-analysis. Addiction. 1999;94:1551–73. doi: 10.1046/j.1360-0443.1999.9410155111.x. [DOI] [PubMed] [Google Scholar]
12.Corrao G, Rubbiati L, Bagnardi V, Zambon A, Poikolainen K. Alcohol and coronary heart disease: A meta-analysis. Addiction. 2000;95(10):1505–23. doi: 10.1046/j.1360-0443.2000.951015056.x. [DOI] [PubMed] [Google Scholar]
13.Reynolds K, Lewis B, Nolen JD, Kinney GL, Sathya B, He J. Alcohol consumption and risk of stroke: A meta-analysis. JAMA. 2003;289(5):579–88. doi: 10.1001/jama.289.5.579. [DOI] [PubMed] [Google Scholar]
14.Traffic Injury Research Foundation of Canada. Alcohol-crash problem in Canada: 2002; 2004. [Google Scholar]
15.Transport Canada. Road Safety in Canada — 2001. 2004. [Google Scholar]
16.Council of Canadian Fire MarshalsFire Commissioners. Fire losses in Canada. Annual report 2000. Ottawa: Council of Canadian Fire Marshals and Fire Commissioners; 2003. [Google Scholar]
17.Geduld J, Gatali M, Remis RS, Archibald CP. Estimates of HIV prevalence and incidence in Canada, 2002. Canada Communicable Disease Report. 2003;29:197–208. [PubMed] [Google Scholar]
18.Remis RS. Estimating the Incidence and Prevalence of Hepatitis C Infection in Canada, 2002; 2004. [Google Scholar]
19.MacDonald S, Anglin-Bodrug K, Mann R, Erickson P, Hathaway A, Chipman M, et al. Review: Injury risk associated with cannabis and cocaine use. Drug and Alcohol Dependence. 2003;72:99–115. doi: 10.1016/S0376-8716(03)00202-3. [DOI] [PubMed] [Google Scholar]
20.Popova S, Rehm J, Patra J. Illegal drugattributable mortality and potential years of life lost in Canada 2002: Conclusions for prevention and policy. Cont Drug Problems. 2006;33(3):343–66. doi: 10.1177/009145090603300302. [DOI] [Google Scholar]
21.Tredaniel J, Boffetta P, Buiatti E, Saracci R, Hirsch A. Int J Cancer. 1997. Tobacco smoking and gastric cancer: Review and meta-analysis. [DOI] [PubMed] [Google Scholar]
22.Simonato L, Agudo A, Ahrens W, Benhamou E, Benhamou S, Boffetta P, et al. Lung cancer and cigarette smoking in Europe: An update of risk estimates and an assessment of inter-country heterogeneity. Int J Cancer. 2001;91:876–87. doi: 10.1002/1097-0215(200102)9999:9999<::AID-IJC1139>3.0.CO;2-7. [DOI] [PubMed] [Google Scholar]
23.Plummer M, Herrero R, Franceschi S, Meijer CJ, Snijders P, Bosch FX, et al. Smoking and cervical cancer: Pooled analysis of the IARC multi-centric case-control study. Cancer Causes & Control. 2003;14:805–14. doi: 10.1023/B:CACO.0000003811.98261.3e. [DOI] [PubMed] [Google Scholar]
24.Zeegers MP, Tan FE, Dorant E, van Den Brandt PA. The impact of characteristics of cigarette smoking on urinary tract cancer risk: A metaanalysis of epidemiologic studies. Rev Cancer. 2000;89(3):630–39. doi: 10.1002/1097-0142(20000801)89:3<630::aid-cncr19>3.3.co;2-h. [DOI] [PubMed] [Google Scholar]
25.Hunt JD, van der Hel OL, McMillan GP, Boffetta P, Brennan P. Renal cell carcinoma in relation to cigarette smoking: Meta-analysis of 24 studies. Int J Cancer. 2005;114:101–8. doi: 10.1002/ijc.20618. [DOI] [PubMed] [Google Scholar]
26.Brennan P, Bogillot O, Cordier S, Greiser E, Schill W, Vineis P, et al. Cigarette smoking and bladder cancer in men: A pooled analysis of 11 case-control studies. Int J Cancer. 2000;86:289–94. doi: 10.1002/(SICI)1097-0215(20000415)86:2<289::AID-IJC21>3.0.CO;2-M. [DOI] [PubMed] [Google Scholar]
27.Brennan P, Bogillot O, Greiser E, Chang-Claude J, Wahrendorf J, Cordier S, et al. The contribution of cigarette smoking to bladder cancer in women (pooled European data) Cancer Causes & Control. 2001;12:411–17. doi: 10.1023/A:1011214222810. [DOI] [PubMed] [Google Scholar]
28.Brownson RC, Novotny TE, Perry MC. Cigarette smoking and adult leukemia: A metaanalysis. Arch Intern Med. 1993;153:469–75. doi: 10.1001/archinte.1993.00410040037006. [DOI] [PubMed] [Google Scholar]
29.Law MR, Morris JK, Wald NJ. BMJ. 1997. Environmental tobacco smoke exposure and ischaemic heart disease: An evaluation of the evidence; pp. 973–80. [DOI] [PMC free article] [PubMed] [Google Scholar]
30.Law MR, Wald NJ. Environmental tobacco smoke and ischemic heart disease. Prog Cardiovasc Dis. 2003;46:31–38. doi: 10.1016/S0033-0620(03)00078-1. [DOI] [PubMed] [Google Scholar]
31.U.S. Department of HealthHuman Services. The health consequences of smoking: A report of the Surgeon General. Atlanta, GA: Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office of Smoking and Health; 2004. [Google Scholar]
32.Health Promotion Survey. Catalogue 82 M0007GPE. Ottawa: Statistics Canada; 1990. [Google Scholar]
33.AlcoholOther Drugs Survey. Canada’s Alcohol and Other Drugs Survey 1994: A Discussion of the Findings. 1994. [Google Scholar]
34.Canadian Centre on Substance Abuse. Canadian Addiction Survey 2004: Microdata eGuide. Ottawa: Canadian Centre on Substance Abuse; 2004. [Google Scholar]
35.General Social Survey, cycle 6. Statistics Canada. Housing, Family and Social Statistics Division. 1991. [Google Scholar]
36.Canadian Community Health Survey CCHS, cycle 2.1. Catalogue, No. 82M0013XCB. Ottawa: Statistics Canada; 2003. [Google Scholar]
37.Popova S, Rehm J, Fischer B. An overview of illegal opioid use and health services utilization in Canada. Public Health. 2006;120(4):320–28. doi: 10.1016/j.puhe.2005.09.010. [DOI] [PubMed] [Google Scholar]
38.Rehm J, Patra J, Popova S. Alcohol-attributable mortality and potential years of life lost in Canada 2001: Implications for prevention and policy. Addiction. 2006;101:373–84. doi: 10.1111/j.1360-0443.2005.01338.x. [DOI] [PubMed] [Google Scholar]
39.Baliunas D, Patra J, Rehm J, Popova S, Kaiserman M, Taylor B. Smoking-attributable mortality in Canada 2002: Conclusions for prevention and policy. Chron Dis Can (in press). [PubMed]
40.Fischer B, Medved W, Gliksman L, Rehm J. Illicit opiates in Toronto: A profile of current users. Addict Res. 1999;7(5):377–415. doi: 10.3109/16066359909004395. [DOI] [Google Scholar]
41.Moses S, Mestery K, Kaita KD, Minuk GY. Viral hepatitis in a Canadian street-involved population. Can J Public Health. 2002;93(2):123–28. doi: 10.1007/BF03404552. [DOI] [PMC free article] [PubMed] [Google Scholar]
42.Roy E, Haley N, Lemire N, Boivin J, Leclerc P, Vincelette J. Hepatitis B virus infection among street youths in Montreal. CMAJ. 1999;161:689–93. [PMC free article] [PubMed] [Google Scholar]
43.Walter SD. The estimation and interpretation of attributable risk in health research. Biometrics. 1976;32:829–49. doi: 10.2307/2529268. [DOI] [PubMed] [Google Scholar]
44.Walter SD. Prevention of multifactorial disease. Am J Epidemiol. 1980;112:409–16. doi: 10.1093/oxfordjournals.aje.a113007. [DOI] [PubMed] [Google Scholar]
45.Taylor B, Rehm J. When risk factors combine: The interaction between alcohol and smoking for aerodigestive cancer, coronary heart disease, and traffic and fire injury. Addict Behav. 2006;31(9):1522–35. doi: 10.1016/j.addbeh.2005.11.008. [DOI] [PubMed] [Google Scholar]
46.Collins DJ, Lapsley HM. Counting the cost: Estimates of the social costs of drug abuse in Australia 1998–99. National Drug Strategy Monograph Series, no. 49. ISBN 0 642 82181 X. Canberra: Commonwealth Department of Health and Ageing; 2002. [Google Scholar]
47.Statistics Canada, CANSIM, Table 051-0001. Accessed December 16, 2005.
48.Public Health Agency of Canada. Cardiovascular disease surveillance on-line. 2002. Available online at: http://www.dsol-smed.phac-aspc.gc.ca/dsol-smed/cvd/c_time_e.html (Accessed September 16, 2004).
49.Taylor B, Rehm J, Patra J, Popova S, Baliunas D. Alcohol-attributable morbidity and resulting health care costs in Canada in 2002: Recommendations for policy and prevention. J Stud Alcohol Drugs. 2007;68:36–47. doi: 10.15288/jsad.2007.68.36. [DOI] [PubMed] [Google Scholar]
50.Rehm J, Patra J, Popova S. Alcohol-attributable mortality and potential years of life lost in Canada 2001: Implications for prevention and policy. Addiction. 2006;101(3):373–84. doi: 10.1111/j.1360-0443.2005.01338.x. [DOI] [PubMed] [Google Scholar]
51.Rehm J, Monteiro M, Room R, Gmel G, Jernigan D, Frick U, et al. Steps towards constructing a global comparative risk analysis for alcohol consumption: Determining indicators and empirical weights for patterns of drinking, deciding about theoretical minimum, and dealing with different consequences. Eur Addict Res. 2001;7(3):138–47. doi: 10.1159/000050731. [DOI] [PubMed] [Google Scholar]

[CR1] 1.World Health Organization. The World Health Report 2002 — Reducing risks, promoting healthy life. Geneva, Switzerland: World Health Organization; 2002. [Google Scholar]

[CR2] 2.Ezzati M, Lopez AD, Rodgers A, Vander Horn S. Murray CJL, and the Comparative Risk Assessment Collaborating Group. Selected major risk factors and global and regional burden of disease. Lancet. 2002;360:1347–60. doi: 10.1016/S0140-6736(02)11403-6. [DOI] [PubMed] [Google Scholar]

[CR3] 3.Single E, Robson L, Xie X, Rehm J. The costs of substance abuse in Canada. Ottawa, ON: Canadian Centre on Substance Abuse; 1996. [Google Scholar]

[CR4] 4.Rehm J, Baliunas D, Brochu S, Fischer B, Gnam W, Patra J, et al. The social costs of substance abuse in Canada 2002. Ottawa: Canadian Centre on Substance Abuse; 2006. [Google Scholar]

[CR5] 5.Hill AB. The environment and disease: Association or causation? Proc Royal Soc Med. 1965;58:295–300. [PMC free article] [PubMed] [Google Scholar]

[CR6] 6.English DR, Holman CDJ, Milne E, Winter MJ, Hulse GK, Codde G, et al. The quantification of drug caused morbidity and mortality in Australia 1995. Canberra, Australia: Commonwealth Department of Human Services and Health; 1995. [Google Scholar]

[CR7] 7.Rothman KJ, Greenland S. Causation and causal inference. In: Rothman KJ, Greenland S, editors. Modern Epidemiology. 2nd, ed. Philadelphia, PA: Lippincott-Raven Publishers; 1998. pp. 7–28. [Google Scholar]

[CR8] 8.Gutjahr E, Gmel G, Rehm J. Relation between average alcohol consumption and disease: An overview. Eur Addict Res. 2001;7(3):117–27. doi: 10.1159/000050729. [DOI] [PubMed] [Google Scholar]

[CR9] 9.Ridolfo B, Stevenson C. The quantification of drug-caused mortality and morbidity in Australia 1998. Canberra: Australian Institute of Health and Welfare; 2001. [Google Scholar]

[CR10] 10.Rehm J, Room R, Monteiro M, Gmel G, Graham K, Rehn N, et al. Alcohol use. In: Ezzati M, Lopez AD, Rodgers A, Murray CJL, et al., editors. Comparative Quantification of Health Risks. Global and Regional Burden of Disease Attributable to Selected Major Risk Factors. Geneva: World Health Organization; 2004. pp. 959–1109. [Google Scholar]

[CR11] 11.Corrao G, Bagnardi V, Zambon A, Arico S. Exploring the dose-response relationship between alcohol consumption and the risk of several alcohol-related conditions: A meta-analysis. Addiction. 1999;94:1551–73. doi: 10.1046/j.1360-0443.1999.9410155111.x. [DOI] [PubMed] [Google Scholar]

[CR12] 12.Corrao G, Rubbiati L, Bagnardi V, Zambon A, Poikolainen K. Alcohol and coronary heart disease: A meta-analysis. Addiction. 2000;95(10):1505–23. doi: 10.1046/j.1360-0443.2000.951015056.x. [DOI] [PubMed] [Google Scholar]

[CR13] 13.Reynolds K, Lewis B, Nolen JD, Kinney GL, Sathya B, He J. Alcohol consumption and risk of stroke: A meta-analysis. JAMA. 2003;289(5):579–88. doi: 10.1001/jama.289.5.579. [DOI] [PubMed] [Google Scholar]

[CR14] 14.Traffic Injury Research Foundation of Canada. Alcohol-crash problem in Canada: 2002; 2004. [Google Scholar]

[CR15] 15.Transport Canada. Road Safety in Canada — 2001. 2004. [Google Scholar]

[CR16] 16.Council of Canadian Fire MarshalsFire Commissioners. Fire losses in Canada. Annual report 2000. Ottawa: Council of Canadian Fire Marshals and Fire Commissioners; 2003. [Google Scholar]

[CR17] 17.Geduld J, Gatali M, Remis RS, Archibald CP. Estimates of HIV prevalence and incidence in Canada, 2002. Canada Communicable Disease Report. 2003;29:197–208. [PubMed] [Google Scholar]

[CR18] 18.Remis RS. Estimating the Incidence and Prevalence of Hepatitis C Infection in Canada, 2002; 2004. [Google Scholar]

[CR19] 19.MacDonald S, Anglin-Bodrug K, Mann R, Erickson P, Hathaway A, Chipman M, et al. Review: Injury risk associated with cannabis and cocaine use. Drug and Alcohol Dependence. 2003;72:99–115. doi: 10.1016/S0376-8716(03)00202-3. [DOI] [PubMed] [Google Scholar]

[CR20] 20.Popova S, Rehm J, Patra J. Illegal drugattributable mortality and potential years of life lost in Canada 2002: Conclusions for prevention and policy. Cont Drug Problems. 2006;33(3):343–66. doi: 10.1177/009145090603300302. [DOI] [Google Scholar]

[CR21] 21.Tredaniel J, Boffetta P, Buiatti E, Saracci R, Hirsch A. Int J Cancer. 1997. Tobacco smoking and gastric cancer: Review and meta-analysis. [DOI] [PubMed] [Google Scholar]

[CR22] 22.Simonato L, Agudo A, Ahrens W, Benhamou E, Benhamou S, Boffetta P, et al. Lung cancer and cigarette smoking in Europe: An update of risk estimates and an assessment of inter-country heterogeneity. Int J Cancer. 2001;91:876–87. doi: 10.1002/1097-0215(200102)9999:9999<::AID-IJC1139>3.0.CO;2-7. [DOI] [PubMed] [Google Scholar]

[CR23] 23.Plummer M, Herrero R, Franceschi S, Meijer CJ, Snijders P, Bosch FX, et al. Smoking and cervical cancer: Pooled analysis of the IARC multi-centric case-control study. Cancer Causes & Control. 2003;14:805–14. doi: 10.1023/B:CACO.0000003811.98261.3e. [DOI] [PubMed] [Google Scholar]

[CR24] 24.Zeegers MP, Tan FE, Dorant E, van Den Brandt PA. The impact of characteristics of cigarette smoking on urinary tract cancer risk: A metaanalysis of epidemiologic studies. Rev Cancer. 2000;89(3):630–39. doi: 10.1002/1097-0142(20000801)89:3<630::aid-cncr19>3.3.co;2-h. [DOI] [PubMed] [Google Scholar]

[CR25] 25.Hunt JD, van der Hel OL, McMillan GP, Boffetta P, Brennan P. Renal cell carcinoma in relation to cigarette smoking: Meta-analysis of 24 studies. Int J Cancer. 2005;114:101–8. doi: 10.1002/ijc.20618. [DOI] [PubMed] [Google Scholar]

[CR26] 26.Brennan P, Bogillot O, Cordier S, Greiser E, Schill W, Vineis P, et al. Cigarette smoking and bladder cancer in men: A pooled analysis of 11 case-control studies. Int J Cancer. 2000;86:289–94. doi: 10.1002/(SICI)1097-0215(20000415)86:2<289::AID-IJC21>3.0.CO;2-M. [DOI] [PubMed] [Google Scholar]

[CR27] 27.Brennan P, Bogillot O, Greiser E, Chang-Claude J, Wahrendorf J, Cordier S, et al. The contribution of cigarette smoking to bladder cancer in women (pooled European data) Cancer Causes & Control. 2001;12:411–17. doi: 10.1023/A:1011214222810. [DOI] [PubMed] [Google Scholar]

[CR28] 28.Brownson RC, Novotny TE, Perry MC. Cigarette smoking and adult leukemia: A metaanalysis. Arch Intern Med. 1993;153:469–75. doi: 10.1001/archinte.1993.00410040037006. [DOI] [PubMed] [Google Scholar]

[CR29] 29.Law MR, Morris JK, Wald NJ. BMJ. 1997. Environmental tobacco smoke exposure and ischaemic heart disease: An evaluation of the evidence; pp. 973–80. [DOI] [PMC free article] [PubMed] [Google Scholar]

[CR30] 30.Law MR, Wald NJ. Environmental tobacco smoke and ischemic heart disease. Prog Cardiovasc Dis. 2003;46:31–38. doi: 10.1016/S0033-0620(03)00078-1. [DOI] [PubMed] [Google Scholar]

[CR31] 31.U.S. Department of HealthHuman Services. The health consequences of smoking: A report of the Surgeon General. Atlanta, GA: Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office of Smoking and Health; 2004. [Google Scholar]

[CR32] 32.Health Promotion Survey. Catalogue 82 M0007GPE. Ottawa: Statistics Canada; 1990. [Google Scholar]

[CR33] 33.AlcoholOther Drugs Survey. Canada’s Alcohol and Other Drugs Survey 1994: A Discussion of the Findings. 1994. [Google Scholar]

[CR34] 34.Canadian Centre on Substance Abuse. Canadian Addiction Survey 2004: Microdata eGuide. Ottawa: Canadian Centre on Substance Abuse; 2004. [Google Scholar]

[CR35] 35.General Social Survey, cycle 6. Statistics Canada. Housing, Family and Social Statistics Division. 1991. [Google Scholar]

[CR36] 36.Canadian Community Health Survey CCHS, cycle 2.1. Catalogue, No. 82M0013XCB. Ottawa: Statistics Canada; 2003. [Google Scholar]

[CR37] 37.Popova S, Rehm J, Fischer B. An overview of illegal opioid use and health services utilization in Canada. Public Health. 2006;120(4):320–28. doi: 10.1016/j.puhe.2005.09.010. [DOI] [PubMed] [Google Scholar]

[CR38] 38.Rehm J, Patra J, Popova S. Alcohol-attributable mortality and potential years of life lost in Canada 2001: Implications for prevention and policy. Addiction. 2006;101:373–84. doi: 10.1111/j.1360-0443.2005.01338.x. [DOI] [PubMed] [Google Scholar]

[CR39] 39.Baliunas D, Patra J, Rehm J, Popova S, Kaiserman M, Taylor B. Smoking-attributable mortality in Canada 2002: Conclusions for prevention and policy. Chron Dis Can (in press). [PubMed]

[CR40] 40.Fischer B, Medved W, Gliksman L, Rehm J. Illicit opiates in Toronto: A profile of current users. Addict Res. 1999;7(5):377–415. doi: 10.3109/16066359909004395. [DOI] [Google Scholar]

[CR41] 41.Moses S, Mestery K, Kaita KD, Minuk GY. Viral hepatitis in a Canadian street-involved population. Can J Public Health. 2002;93(2):123–28. doi: 10.1007/BF03404552. [DOI] [PMC free article] [PubMed] [Google Scholar]

[CR42] 42.Roy E, Haley N, Lemire N, Boivin J, Leclerc P, Vincelette J. Hepatitis B virus infection among street youths in Montreal. CMAJ. 1999;161:689–93. [PMC free article] [PubMed] [Google Scholar]

[CR43] 43.Walter SD. The estimation and interpretation of attributable risk in health research. Biometrics. 1976;32:829–49. doi: 10.2307/2529268. [DOI] [PubMed] [Google Scholar]

[CR44] 44.Walter SD. Prevention of multifactorial disease. Am J Epidemiol. 1980;112:409–16. doi: 10.1093/oxfordjournals.aje.a113007. [DOI] [PubMed] [Google Scholar]

[CR45] 45.Taylor B, Rehm J. When risk factors combine: The interaction between alcohol and smoking for aerodigestive cancer, coronary heart disease, and traffic and fire injury. Addict Behav. 2006;31(9):1522–35. doi: 10.1016/j.addbeh.2005.11.008. [DOI] [PubMed] [Google Scholar]

[CR46] 46.Collins DJ, Lapsley HM. Counting the cost: Estimates of the social costs of drug abuse in Australia 1998–99. National Drug Strategy Monograph Series, no. 49. ISBN 0 642 82181 X. Canberra: Commonwealth Department of Health and Ageing; 2002. [Google Scholar]

[CR47] 47.Statistics Canada, CANSIM, Table 051-0001. Accessed December 16, 2005.

[CR48] 48.Public Health Agency of Canada. Cardiovascular disease surveillance on-line. 2002. Available online at: http://www.dsol-smed.phac-aspc.gc.ca/dsol-smed/cvd/c_time_e.html (Accessed September 16, 2004).

[CR49] 49.Taylor B, Rehm J, Patra J, Popova S, Baliunas D. Alcohol-attributable morbidity and resulting health care costs in Canada in 2002: Recommendations for policy and prevention. J Stud Alcohol Drugs. 2007;68:36–47. doi: 10.15288/jsad.2007.68.36. [DOI] [PubMed] [Google Scholar]

[CR50] 50.Rehm J, Patra J, Popova S. Alcohol-attributable mortality and potential years of life lost in Canada 2001: Implications for prevention and policy. Addiction. 2006;101(3):373–84. doi: 10.1111/j.1360-0443.2005.01338.x. [DOI] [PubMed] [Google Scholar]

[CR51] 51.Rehm J, Monteiro M, Room R, Gmel G, Jernigan D, Frick U, et al. Steps towards constructing a global comparative risk analysis for alcohol consumption: Determining indicators and empirical weights for patterns of drinking, deciding about theoretical minimum, and dealing with different consequences. Eur Addict Res. 2001;7(3):138–47. doi: 10.1159/000050731. [DOI] [PubMed] [Google Scholar]

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Substance-attributable Morbidity and Mortality Changes to Canada’s Epidemiological Profile

Jayadeep Patra, PhD

Benjamin Taylor, MSc

Jürgen T Rehm, PhD

Dolly Baliunas, PhD

Svetlana Popova, PhD

Abstract

Background

Method

Results

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PERMALINK

Substance-attributable Morbidity and Mortality Changes to Canada’s Epidemiological Profile

Jayadeep Patra, PhD

Benjamin Taylor, MSc

Jürgen T Rehm, PhD

Dolly Baliunas, PhD

Svetlana Popova, PhD

Abstract

Background

Method

Results

Interpretation

Résumé

Contexte

Méthode

Résultats

Interprétation

References

ACTIONS

PERMALINK

RESOURCES

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