Trends in Cardiovascular Risk Factors in Canada: Variation by Migration and Temporal Factors, 2001-2018

Background Cardiovascular disease is a leading cause of death in Canada, but how the major cardiovascular risk factors vary across ethnicity and immigration status has yet to be examined. Methods Using data from the Canadian Community Health Surveys, national trends in health conditions (hypertension, diabetes, high blood cholesterol level, and obesity) and health behaviours (smoking, activity levels, and alcohol consumption) were estimated for the period 2001-2018. In this cross-sectional study, the trends were then compared across sex, age, ethnicity, and immigration status. Results A total of 1,065,391 respondents were examined, for the period 2001-2018. During the study period, the prevalence of the following risk factors increased in Canada over time, as follows: diabetes by 54.5%; hypertension by 23.4%; and obesity by 32.3%. For health behaviours, smoking prevalence decreased overall, especially in racialized populations. Heavy drinking was most prevalent for nonracialized and non-Indigenous Canadian-born populations, and was of lowest prevalence among racialized immigrants. Physical inactivity was most prevalent for racialized immigrant populations. The prevalence of self-reported heart disease decreased by 21.0%, except for racialized established immigrants (≥ 10 years since immigration to Canada), who had a 4.2% increase. Conclusions During this study period, decreases occurred in the prevalences of smoking and physical inactivity, along with increases in obesity, diabetes, and hypertension prevalences. By migration-group status, established immigrants in Canada had a higher prevalence of cardiovascular disease risk factors compared to that among their Canadian-born counterparts. Migration gaps should be considered in future interventions targeted at reducing these cardiovascular risk factors in Canada.

Variable name variations were seen across cycles.
Same measurements for height and weight were used but different variable name.

Physical activity a
PACDEE variable is a derived CCHS variable that calculates the daily energy expenditure in leisure time physical activities for all ages.
In CCHS 2015-2018, ages 12-17 and 18+ years old have separate activity variables, where 12-17 year olds use PAY_XXX and 18+ year olds use PAA_XXX.Leisure activity is not directly measured.We used the CCHS derived variable, PAADVVOL, and removed active transportation using a derived function in cchsflow.
With this function, we combined leisure activity for ages 12+.We calculate the daily energy expenditure which uses the frequency and duration per session of the physical activity as well as the MET value (3 METS for leisure and 6 METS for vigorous activity).

Smoking status
SMKDSTY is a CCHS derived variable that asked "Type of smoker" with the following categories: daily, occasional, always occasional, former daily, former occasional, and never smoked.
SMKDVSTY is a CCHS derived variable that asked "Type of smoker" with the following categories: daily, occasional, experimental, former daily, former occasional, and never smoked.

Alcohol
We derived alcohol status based on the number of alcoholic drinks per day from Monday to Sunday and sex.

Table S3 : Baseline characteristics of unweighted and weighted total CCHS population from 2001 to 2017/2018, stratified by sex.
Source: Canadian Community Health Survey (CCHS) -Public Use Micro Data.Data harmonized using cchsflow.
a Derivation of physical activity post-2015 survey can be found in cchsflow Supplemental

Table S4 : Age-and sex-standardized prevalence of risk factors for survey respondents aged 12 years and older, from 2001 to 2017/2018. Source
: Canadian Community Health Survey (CCHS) -Public Use Micro Data.Data harmonized using cchsflow.The CCHS underwent a major survey redesign starting in 2015.Bootstrap weights were used for 2015 and 2017.Age and sex standardization were done using the 2011 Canadian Census population.

Table S5 : Sex-standardized prevalence of cardiovascular risk factors by age from 2001 to 2017/2018.
Source: Canadian Community Health Survey (CCHS) -Public Use Micro Data.Data harmonized using cchsflow.The CCHS underwent a major survey redesign starting in 2015.Bootstrap weights were used for 2015 and 2017.Sex standardization was done using the 2011 Canadian Census population.

Table S6 : Age-and sex-standardized prevalence of risk factors, by provinces and territories in Canada, from 2001 to 2017/2018.
Source: Canadian Community Health Survey (CCHS) -Public Use Micro Data.Data harmonized using cchsflow.The CCHS underwent a major survey redesign starting in 2015.Bootstrap weights were used for 2015 and 2017.Age and sex standardization were done using the 2011 Canadian Census population.