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The Canadian Jewish population has seen only modest growth in the past 20 years, following a more significant increase between 1981 and 1991. The latter decade coincided with the beginning of significant immigration by Jews from the Former Soviet Union. Jews reside in every region of Canada including the Northern Territories, although they are concentrated heavily in the major urban centers. The metropolitan area of Toronto is home to 188,710 Jews and includes about half (48.2%) of Canada’s Jewish population. The Montreal community numbers 90,780 Jews. The median age of Canadian Jews is slightly older than the national average but much older than ethnic groups with large numbers of more recent immigrants. The Canadian Jewish population has a slightly larger proportion of children (age 0–14) than the total population (18.2% and 17.0% respectively) and a significantly larger proportion of persons over age 65 than the overall Canadian population (16.9% and 13.9% respectively). There are 66,280 elderly Jews 65+ years of age residing in Canada. A total of 10,395 Jewish elderly live below the poverty line. About one in six seniors (15.7%) is poor. Female seniors are almost twice as likely as males to fall below the poverty line (19.3% and 11.6% respectively).

The COVID-19 pandemic is having a profound impact on the health, social and economic well-being of people in Canada and around the world. To address vaccine disparity among vulnerable populations facing social-structural challenges, it is crucial to provide evidence-based information on the importance of completion of the recommended vaccination schedule. In this study, we investigated vaccination rates and variables as facilitators or barriers to COVID-19 vaccination among vulnerable populations living in Vancouver’s inner-city residents. On a weekly basis, a team (including health care providers [HCPs] and support staff) conducts a Community Pop-up Clinic (CPC) event at single room occupancy dwellings in Vancouver’s inner city to provide COVID-19 vaccine and/or related information. Participants also completed a survey about their COVID-19 vaccination status and COVID knowledge, including knowledge about COVID vaccination. We collected data from 892 CPC participants between January 2021–August 2023. The median age at baseline was 45 (IQR 36–55) years, with 317 (35.5 %) female and 285 (31.9 %) self-identified as Indigenous. Within the population, 512 (57.4 %) reported unstable housing and 441 (49.5 %) were active injection drug users. Regarding COVID-19 vaccinations, 235 (26.3 %) were unvaccinated, 119 (13.3 %) had received one dose of the COVID-19 vaccine, 432 (48.4 %) had received 2 doses, and 106 (11.8 %) had received at least 3 doses. Variables such as age (AOR 2.28, 95 % CI 1.37–3.80, p < 0.001) and HCV seropositivity (AOR 1.91, 95 % CI 1.20–3.04, p = 0.005) were significantly associated with higher odds of vaccination uptake. Conversely, unstable housing was significantly associated with a lower odds of vaccination uptake (AOR 0.53, 95 % CI 0.35–0.79, p = 0.002). Results from this study suggest that targeted community focused initiatives are crucial to address vaccine disparity among vulnerable populations living in Vancouver’s inner city facing unstable housing and drug use injection.

Background The health care sector has a significant role to play in fostering equity in the context of widening global social and health inequities. The purpose of this paper is to illustrate the process and impacts of implementing an organizational-level health equity intervention aimed at enhancing capacity to provide equity-oriented health care. Methods The theoretically-informed and evidence-based intervention known as ‘EQUIP’ included educational components for staff, and the integration of three key dimensions of equity-oriented care: cultural safety, trauma- and violence-informed care, and tailoring to context. The intervention was implemented at four Canadian primary health care clinics committed to serving marginalized populations including people living in poverty, those facing homelessness, and people living with high levels of trauma, including Indigenous peoples, recent immigrants and refugees. A mixed methods design was used to examine the impacts of the intervention on the clinics’ organizational processes and priorities, and on staff. Results Engagement with the EQUIP intervention prompted increased awareness and confidence related to equity-oriented health care among staff. Importantly, the EQUIP intervention surfaced tensions that mirrored those in the wider community, including those related to racism, the impacts of violence and trauma, and substance use issues. Surfacing these tensions was disruptive but led to focused organizational strategies, for example: working to address structural and interpersonal racism; improving waiting room environments; and changing organizational policies and practices to support harm reduction. The impact of the intervention was enhanced by involving staff from all job categories, developing narratives about the socio-historical context of the communities and populations served, and feeding data back to the clinics about key health issues in the patient population (e.g., levels of depression, trauma symptoms, and chronic pain). However, in line with critiques of complex interventions, EQUIP may not have been maximally disruptive. Organizational characteristics (e.g., funding and leadership) and characteristics of intervention delivery (e.g., timeframe and who delivered the intervention components) shaped the process and impact. Conclusions This analysis suggests that organizations should anticipate and plan for various types of disruptions, while maximizing opportunities for ownership of the intervention by those within the organization. Our findings further suggest that equity-oriented interventions be paced for intense delivery over a relatively short time frame, be evaluated, particularly with data that can be made available on an ongoing basis, and explicitly include a harm reduction lens.

Background Ontario, the most populous province in Canada, has a universal healthcare system that routinely collects health administrative data on its 13 million legal residents that is used for health research. Record linkage has become a vital tool for this research by enriching this data with the Immigration, Refugees and Citizenship Canada Permanent Resident (IRCC-PR) database and the Office of the Registrar General’s Vital Statistics-Death (ORG-VSD) registry. Our objectives were to estimate linkage rates and compare characteristics of individuals in the linked versus unlinked files. Methods We used both deterministic and probabilistic linkage methods to link the IRCC-PR database (1985–2012) and ORG-VSD registry (1990–2012) to the Ontario’s Registered Persons Database. Linkage rates were estimated and standardized differences were used to assess differences in socio-demographic and other characteristics between the linked and unlinked records. Results The overall linkage rates for the IRCC-PR database and ORG-VSD registry were 86.4 and 96.2 %, respectively. The majority (68.2 %) of the record linkages in IRCC-PR were achieved after three deterministic passes, 18.2 % were linked probabilistically, and 13.6 % were unlinked. Similarly the majority (79.8 %) of the record linkages in the ORG-VSD were linked using deterministic record linkage, 16.3 % were linked after probabilistic and manual review, and 3.9 % were unlinked. Unlinked and linked files were similar for most characteristics, such as age and marital status for IRCC-PR and sex and most causes of death for ORG-VSD. However, lower linkage rates were observed among people born in East Asia (78 %) in the IRCC-PR database and certain causes of death in the ORG-VSD registry, namely perinatal conditions (61.3 %) and congenital anomalies (81.3 %). Conclusions The linkages of immigration and vital statistics data to existing population-based healthcare data in Ontario, Canada will enable many novel cross-sectional and longitudinal studies to be conducted. Analytic techniques to account for sub-optimal linkage rates may be required in studies of certain ethnic groups or certain causes of death among children and infants.

The science of cities seeks to understand and explain regularities observed in the world’s major urban systems. Modelling the population evolution of cities is at the core of this science and of all urban studies. Quantitatively, the most fundamental problem is to understand the hierarchical organization of city population and the statistical occurrence of megacities. This was first thought to be described by a universal principle known as Zipf’s law 1 , 2 ; however, the validity of this model has been challenged by recent empirical studies 3 , 4 . A theoretical model must also be able to explain the relatively frequent rises and falls of cities and civilizations 5 , but despite many attempts 6 – 10 these fundamental questions have not yet been satisfactorily answered. Here we introduce a stochastic equation for modelling population growth in cities, constructed from an empirical analysis of recent datasets (for Canada, France, the UK and the USA). This model reveals how rare, but large, interurban migratory shocks dominate city growth. This equation predicts a complex shape for the distribution of city populations and shows that, owing to finite-time effects, Zipf’s law does not hold in general, implying a more complex organization of cities. It also predicts the existence of multiple temporal variations in the city hierarchy, in agreement with observations 5 . Our result underlines the importance of rare events in the evolution of complex systems 11 and, at a more practical level, in urban planning. A theoretical model in the form of a stochastic differential equation is proposed that describes, more accurately than previous models, the population evolution of cities, revealing that rare but very large interurban migration is a dominant factor.

The aim of our work was to examine differences between trauma patients in rural and urban areas who presented to a tertiary trauma centre in the province of Saskatchewan, Canada. We identified a historical cohort of all level 1 trauma activations presenting to Royal University Hospital (RUH) from April 1, 2020, to March 31, 2022. We divided the cohort into 2 groups (urban and rural), according to the trauma location. The primary outcome of interest was 30-day mortality. Secondary outcomes of interest were hospital length of stay, readmission to hospital within 30 days of discharge, and complication rate. Trauma patients in rural areas were younger (34.1 v. 37 yr; = 0.002) and more likely to be male (80.3% v. 74.4%; = 0.040), with higher Injury Severity Scores (12.3 v. 8.3; < 0.0001). Trauma patients in urban areas were more likely to sustain penetrating trauma (42.5% v. 28.5%; < 0.0001). We saw no differences in morbidity and mortality between the 2 groups, but the rural trauma group had longer median lengths of stay (5 v. 3 d; < 0.0007). Although we identified key differences in patient demographics, injury type, and injury severity, outcomes were largely similar between the urban and rural trauma groups. This finding contradicts comparable studies within Canada and the United States, a difference that may be attributable to the lack of inclusion of prehospital mortality in the rural trauma group. The longer length of stay in trauma patients from rural areas may be attributed to disposition challenges for patients who live remotely.

Estimating the size of key populations is critical for effective research and policy development. We estimated the population size of gay, bisexual, and other men who have sex with men (GBM) based on different definitions and compared the demographic composition of the GBM and non-GBM populations in Canada. This descriptive study used data from the 2015-2016 and 2019-2020 Canadian Community Health Survey (CCHS) cycles. We selected men aged 18-64 years who had valid responses to the sexual identity and sexual behaviour contents. We explored different combinations of the survey questions to estimate the size of the GBM population in Canada and conducted a separate analysis for Canada's four most populous provinces, comparing sociodemographic characteristics. Using a definition of GBM combining sexual identity and behaviour (i.e., men who identify as gay or bisexual or who had sex with men in the last 12 months), the weighted proportion of GBM in the 2015-2016 cycle was 2.7% (95% Confidence Interval (CI) 1.9%-3.4%) in Alberta, 3.5% (95% CI 2.7%-4.4%) in British Columbia, 4.1% (95% CI 3.2%-4.9%) in Ontario, and 4.8% (95% CI 4.0%-5.7%) in Quebec. In the 2019-2020 cycle, the weighted proportion of GBM (i.e., men who identify as gay, bisexual or pansexual, or who had sex with men in the last 12 months) was 4.4% (95% CI 3.3%-5.4%) in British Columbia and 4.7% (95% CI 3.9%-5.4%) in Ontario. Overall, compared to non-GBM, GBM were more likely to be single/never married, have an annual household income of less than $30,000, live in medium and large population centres and have lower mean age. Our estimates showed sexual orientation discordance in Canada. Our findings also suggested that the GBM population might be increasing over time.