Julie Bernier

Bio: Julie Bernier is an academic researcher from Statistics Canada. The author has contributed to research in topics: Population & Health Utilities Index. The author has an hindex of 16, co-authored 28 publications receiving 880 citations.

Validation of an index to estimate the prevalence of frailty among community-dwelling seniors

Abstract: Background This study validates cut-points for a frailty index (FI) to identify seniors at risk of a hospital-related event and estimates the number of frail seniors living in the community. The FI developed by Rockwood and Mitnitski defines levels of frailty based on scores of 0 to 1.0. Data and methods The cut-point validation was conducted using Stratum-Specific Likelihood Ratios applied to combined 2003 and 2005 Canadian Community Health Survey (CCHS) data, linked to hospital records from the Discharge Abstract Database (2002 to 2007). Based on the validated cut-points, frailty prevalence was estimated using 2009/2010 CCHS data. Results Seniors scoring more than 0.21 on the FI were considered to be at elevated risk of hospital-related events. Four additional frailty levels were identified: non-frail (0 to ≤0.1), pre-frail (>0.1 to ≤0.21), more frail (>0.30 to ≤0.35) (women only), and most frail (frail-group subset) (0.45 or more). The number of community-dwelling seniors considered to be frail was estimated at about 1 million (24%) in 2009/2010; another 1.4 million (32%) could be considered pre-frail. Frailty prevalence rose with age; was higher among women than among men; and varied by geographic location. Interpretation A cut-point of more than 0.21 can be used to identify frail seniors living in the community.

Health behavior change following chronic illness in middle and later life

Abstract: Objectives Understanding lifestyle improvements among individuals with chronic illness is vital for targeting interventions that can increase longevity and improve quality of life. Methods Data from the U.S. Health and Retirement Study were used to examine changes in smoking, alcohol use, and exercise 2-14 years after a diagnosis of heart disease, diabetes, cancer, stroke, or lung disease. Results Patterns of behavior change following diagnosis indicated that the vast majority of individuals diagnosed with a new chronic condition did not adopt healthier behaviors. Smoking cessation among those with heart disease was the largest observed change, but only 40% of smokers quit. There were no significant increases in exercise for any health condition. Changes in alcohol consumption were small, with significant declines in excessive drinking and increases in abstention for a few health conditions. Over the long term, individuals who made changes appeared to maintain those changes. Latent growth curve analyses up to 14 years after diagnosis showed no average long-term improvement in health behaviors. Discussion Results provide important new information on health behavior changes among those with chronic disease and suggest that intensive efforts are required to help initiate and maintain lifestyle improvements among this population.

Validation of disability categories derived from Health Utilities Index Mark 3 scores.

Abstract: OBJECTIVES: To establish empirical evidence for the validity of the following disability categories derived from Health Utilities Index Mark III (HUI3) global utility scores: none (1.00), mild (0.89 to 0.99), moderate (0.70 to 0.88), and severe (less than 0.70). DATA AND METHODS: Data from the 2005 Canadian Community Health Survey (cycle 3.1) were analyzed. Frequency distributions, stratum-specific likelihood ratios, and multinomial regression were used to examine the relationship between health indicators and the HUI3 disability categories. RESULTS: People reporting chronic conditions, activity restrictions, and fair/poor self-rated health (general and mental) were more likely to be in the moderate and severe disability categories. Those having more positive outcomes on the health indicators tended to fall into the mild and no disability groups. The stratum-specific likelihood ratios increased monotonically with the severity of disability level. Compared to those with positive health status characteristics, those with negative health status characteristics had the highest odds of falling in the severe rather than the non-disabled category. INTERPRETATION: This study makes an initial contribution to the evidence base for the validity of the proposed HUI3 disability categories. The categories were well-supported empirically and are likely to be useful for assessing disability levels. Language: en

Multiple sclerosis in Canada 2011 to 2031: results of a microsimulation modelling study of epidemiological and economic impacts.

Abstract: Introduction The objective of our study was to present model-based estimates and projections on current and future health and economic impacts of multiple sclerosis (MS) in Canada over a 20-year time horizon (2011-2031). Methods Using Statistics Canada's Population Health Microsimulation Model (POHEM) framework, specifically the population-based longitudinal, microsimulation model named POHEM-Neurological, we identified people with MS from health administrative data sources and derived incidence and mortality rate parameters from a British Columbia population-based cohort for future MS incidence and mortality projections. We also included a utility-based measure (Health Utilities Index Mark 3) reflecting states of functional health to allow projections of health-related quality of life. Finally, we estimated caregiving parameters and health care costs from Canadian national surveys and health administrative data and included them as model parameters to assess the health and economic impact of the neurological conditions. Results The number of incident MS cases is expected to rise slightly from 4051 cases in 2011 to 4794 cases per 100 000 population in 2031, and the number of Canadians affected by MS will increase from 98 385 in 2011 to 133 635 in 2031. The total per capita health care cost (excluding out-of-pocket expenses) for adults aged 20 and older in 2011 was about $16 800 for individuals with MS, and approximately $2500 for individuals without a neurological condition. Thus, after accounting for additional expenditures due to MS (excluding out-of-pocket expenses), total annual health sector costs for MS are expected to reach $2.0 billion by 2031. As well, the average out-of-pocket expenditure for people with MS was around $1300 annually throughout the projection period. Conclusion MS is associated with a significant economic burden on society, since it usually affects young adults during prime career- and family-building years. Canada has a particularly high prevalence of MS, so research such as the present study is essential to provide a better understanding of the current and future negative impacts of MS on the Canadian population, so that health care system policymakers can best plan how to meet the needs of patients who are affected by MS. These findings also suggest that identifying strategies to prevent MS and more effectively treat the disease are needed to mitigate these future impacts.

Health behaviour changes after diagnosis of chronic illness among Canadians aged 50 or older.

Abstract: Changes in health behaviours (smoking, physical activity, alcohol consumption, and fruit and vegetable consumption) after diagnosis of chronic health conditions (heart disease, cancer, stroke, respiratory disease, and diabetes) were examined among Canadians aged 50 or older. Results from 12 years of longitudinal data from the Canadian National Population Health Survey indicated relatively modest changes in behaviour. Although significant decreases in smoking were observed among all groups except those with respiratory disease, at least 75% of smokers did not quit. No significant changes emerged in the percentage meeting physical activity recommendations, except those with diabetes, or in excessive alcohol consumption, except those with diabetes and respiratory disease. The percentage reporting the recommended minimum fruit and vegetable intake did not increase significantly among any group.