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Articles by Joel Ray
Assisted Reproduction and Offspring Neurodevelopment-Untangling Confounding by Indication
No abstract is available for this article. Disclosure M.P.V. has received honoraria from Ferring Pharmaceuticals and EMD Serono outside the submitted work. Conflicts of Interest The authors declare no conflicts of interest. Data Availability Statement Data sharing not applicable to this article as no datasets were generated or analyzed during the current study. References 1, , , et al., “Infertility and Risk of Autism Spectrum Disorder in Children,” JAMA Network Open 6, no. 11 (2023): e2343954.
Infant Emergency Department Use After Midwifery‐ Versus Obstetrician‐Led Perinatal Care: A Population‐Based Cohort Study
Disclosure Statement on use of gender-related language: While we will refer to the childbearing person in this paper as a woman or mother, we acknowledge that not all persons who give birth identify as female, and that there is a broad diversity in gender identity among those giving birth in Ontario. Conflicts of Interest The authors declare no conflicts of interest.
Rhabdomyolysis and Sodium-Glucose-Linked Transport Inhibitors in Patients Taking Statins
Introduction Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are increasingly used to treat diabetes, heart failure, and chronic kidney disease.1 Approximately 80% of individuals taking SGLT2is also receive statins.2 A 2020 case report3 described the onset of rhabdomyolysis after initiation of canagliflozin in a patient taking rosuvastatin.
Maternal-Newborn ABO Blood Groups and Risk of Bacterial Infection in Newborns
Key Points Question If a mother and newborn have incongruent ABO blood groups, is the newborn at a lower risk of bacterial infection than if they had congruent ABO blood group? Findings In this cohort study of 138 207 mother-newborn pairs, ABO blood group incongruence was not associated with a lower risk of bacterial infection within 30 days of birth.
Outlier analysis for accelerating clinical discovery: An augmented intelligence framework and a systematic review
Data labels refer to whether, in a given dataset, we know which observation is an outlier and which is a normal observation before we begin our analysis [40,54,60–62]. Outlier analysis is inherently a classification problem, where observations are classified as either outlier observations or normal observations. There are three scenarios that we can derive from data labels.
Postpartum Emergency Department Use Following Midwifery-Model vs Obstetrics-Model Care
Key Points Question Is care by a midwife compared with an obstetrician associated with different rates of emergency department (ED) use in the postpartum period? Findings In this cohort study of 104 995 patients who were low risk, women receiving innovative midwifery-model care experienced a 22% lower risk of ED use post partum than patients receiving traditional obstetrics-model care.
Teen Pregnancy and Risk of Premature Mortality
Key Points Question What is the risk of premature mortality from 12 years of age onward in association with teen pregnancy? Findings In this population-based cohort study of 2.2 million female teenagers, the risk of premature death was 1.9 per 10 000 person-years among those without a pregnancy, 4.1 per 10 000 person-years among those with 1 pregnancy, and 6.1 per 10 000 person-years among those with 2 or more pregnancies.
Possible Individual-, System-, and Policy-Level Contributors to Teen Pregnancy and Risk of Premature Mortality
Ray and colleagues1 examined how pregnancy history as a teenager is associated with the later risk of premature mortality.
Addressing fragmented early pregnancy care in Canada Original
In this issue of CMAJ, Jain and colleagues argue for multifactorial screening for people at risk of early-onset preeclampsia, and acetylsalicylic acid (ASA) initiation for those who screen positive.1 Multifactorial screening at about 12 weeks’ gestation calculates risk according to clinical risk factors and results of uterine artery ultrasonography and biochemical testing.
Preconception SGLT2 or DPP4 inhibitor use and adverse pregnancy outcomes
To compare preconception use of sodium-glucose cotransporter-2 (SGLT2i) and dipeptidyl peptidase-4 (DPP4i) inhibitors to sulfonylurea agents, and associated peri-conceptional A1c concentration, and risk of pregnancy loss and congenital anomalies. This population-based cohort study used administrative datasets for all of Ontario, Canada, and included women eligible for free medication coverage and who achieved a recognized pregnancy from April 2007-November 2021.
Prenatal opioid exposure and well-child care in the first 2 years of life: population-based cohort study
Discussion In this large, population-based cohort study, we reported lower rates of attendance at the 18-month enhanced well-child visit among children with POE than previously reported for children in Ontario (53% vs 61%).26 Children with prenatal exposure to MOUD and both MOUD and opioid analgesics were least likely to receive recommended well-child care.
Accuracy of aspirin prophylaxis for preeclampsia prevention documentation within a large administrative dataset
Study question How accurately is aspirin prophylaxis for preeclampsia captured within an administrative health database? What's already known Aspirin is recommended for women at higher risk of preeclampsia. Within administrative health databases, capture of aspirin use can be challenging, since it is a medication available over-the-counter. What this study adds Ontario's BORN population-based health database contains a variable describing aspirin prophylaxis in pregnancy.
Accuracy of aspirin prophylaxis for preeclampsia prevention documentation within a large administrative dataset
Study question How accurately is aspirin prophylaxis for preeclampsia captured within an administrative health database? What's already known Aspirin is recommended for women at higher risk of preeclampsia. Within administrative health databases, capture of aspirin use can be challenging, since it is a medication available over-the-counter. What this study adds Ontario's BORN population-based health database contains a variable describing aspirin prophylaxis in pregnancy.
Prenatal opioid exposure and well-child care in the first 2 years of life: population-based cohort study
Statistical analysis We compared characteristics and study outcomes between each type of POE to the 1–29 days of analgesic use group using standardised differences; differences >0.10 were considered meaningful.31 To identify factors associated with each outcome, modified Poisson regression was used to estimate unadjusted and adjusted relative risks (aRRs), with robust variance estimators to account for clustering of multiple births to the same mother.32 Children’s regular primary care...
Receipt of adequate prenatal care for privately sponsored versus government-assisted refugees in Ontario, Canada: a population-based cohort study
Statistical analysis Differences in baseline covariates were assessed using standardized differences (SDs), with a value greater than 0.10 considered potentially important.36 In assessing the study outcomes between the government-assisted and privately sponsored refugee groups, confounding is likely as the distribution of baseline characteristics that affect the outcome differed between the 2 groups of refugees.
Severity of obstructive coronary artery stenosis after pre-eclampsia
Statistical analysis Characteristics of women with pre-eclampsia and their non-pre-eclamptic counterparts were compared using means, proportions and standardised differences of means. Where continuous data were not normally distributed (eg, parity), we reported a median and IQR, without assessing a corresponding standardised difference. Incidence rates for outcomes were calculated as the number of eligible women experiencing the outcome per 10 000 years of follow-up.
Latent class analysis (LCA) offers a powerful analytical approach for categorizing groups (or “classes”) within a heterogenous population. LCA identifies these hidden classes by a set of predefined features, known as “indicators”. Unlike many other grouping analytical approaches, LCA derives classes using a probabilistic approach. In this first paper, we describe the common applications of LCA, and outline its advantages over other analytical subgrouping methods.
Aspirin Use for Preeclampsia Prevention Among Women With Prepregnancy Diabetes, Obesity, and Hypertension
In large cohort studies, preeclampsia has been found to affect 7.3% of pregnant women with and 2.7% of those without clinical risk factors.1 The US Preventive Services Task Force (USPSTF) recommended in 2014 (and reiterated in 2021) that low-dose (81 mg) aspirin be started after 12 weeks’ gestation in all women at high risk for preeclampsia as well as in women with combinations of moderate-level risk factors (B recommendation).2,3 Although there are a number of risk factors for preeclampsia,1...
Comparison of Self-harm or Overdose Among Adolescents and Young Adults Before vs During the COVID-19 Pandemic in Ontario
Key Points Question What was the risk of self-harm or overdose among adolescents and young adults in Ontario, Canada, during the SARS-CoV-2 pandemic compared with the 2 years preceding? Findings In this cohort study of 1 690 733 adolescents and young adults in all of Ontario, the rate of self-harm or overdose was lower during (39.7 per 10 000 person-years) than before (51.0 per 10 000 person-years) the pandemic.
Caesarean birth in women with infertility: population‐based cohort study
RESEARCH ARTICLE Emily Richmond, Department of Obstetrics & Gynecology, Queen’s University, Kingston General Hospital, Kingston, ON, Canada Search for more papers by this author Joel G.
Maternal cardiovascular disease after twin pregnancies complicated by hypertensive disorders of pregnancy: a population-based cohort study
Research Open Access Liran Hiersch, Joel G. Ray, Jon Barrett, Howard Berger, Michael Geary, Sarah D.
Delay of Pregnancy Among Physicians vs Nonphysicians
Original Investigation Physician Work Environment and Well-Being May 3, 2021 JAMA Intern Med. Published online May 3, 2021. doi:10.1001/jamainternmed.2021.1635 Full Text Key Points Question Are women physicians more likely to delay childbearing or less likely to have children compared with nonphysicians?
Determining intent behind poisoning suicides
Letters Open Access Kayvan Aflaki and Joel Ray CMAJ April 26, 2021 193 (17) E622; DOI: https://doi.org/10.1503/cmaj.78591 We thank Liu and colleagues for their article that described important temporal patterns about suicide in Canada.1 The decline observed in the age-standardized rate of suicide by poisoning leads us to wonder whether this may be because of misclassification of such suicides.
ABO Blood Group, SARS-CoV-2 Infection, and Risk of Venous Thromboembolism: Population-Based Cohort Study
Persons with non-O blood group (i.e., A, AB or B) may be at higher risk of venous thromboembolism (VTE) than those with O blood (odds ratio 1.79, 95% CI 1.56 to 2.05).1 Non-O blood groups may also be predisposed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).2 During the recent SARS-CoV-2 pandemic, a high rate of VTE was observed among infected patients.3 Lung tissue specimens from coronavirus disease 2019 (COVID-19) patients showed a preponderance of alveolar capillary...
Birds Do It Better
In response to: Intrepid Navigators from the February 25, 2021 issue To the Editors: Buried in Robert O. Paxton’s otherwise fascinating article about birds [“Intrepid Navigators,” NYR, February 25] is a seriously misleading statement about humans: “Birds can also detect the earth’s magnetic field, a sense that humans lack entirely.” Humans do sense the earth’s field.
Association Between ABO and Rh Blood Groups and SARS-CoV-2 Infection or Severe COVID-19 Illness
Type O blood may protect against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (). Non–peer-reviewed data from New York City suggest that rhesus-negative (Rh−) status may also be protective (4).
Primary care of mothers and infants by the same or different physicians: a population-based cohort study
Research Natasha R. Saunders, Joel G. Ray, Christina Diong, Jun Guan and Eyal Cohen CMAJ September 08, 2020 192 (36) E1026-E1036; DOI: https://doi.org/10.1503/cmaj.191038 Abstract BACKGROUND: Different primary care delivery models exist for mothers and their infants. We examined whether primary care system performance measures differed when mother–infant dyads received primary care from the same or different providers.
Receipt of routine preventive care among infant daughters and sons of immigrant mothers in Ontario, Canada: a retrospective cohort study
Receipt of routine preventive care among infant daughters and sons of immigrant mothers in Ontario, Canada: a retrospective cohort study http://orcid.org/0000-0001-7010-8496Ariel Pulver1, Astrid Guttmann2,3,4, Joel G Ray2,5,6, Patricia J O'Campo1,7, Marcelo L Urquia1,2,7,8 1Department of Epidemiology, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada 2ICES, Toronto, Ontario, Canada 3Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario,...
Bias in published cost effectiveness studies: systematic review
Chaim M Bell, assistant professor of medicine and health, policy, management, and evaluation,1 David R Urbach, assistant professor of medicine and health, policy, management, and evaluation,2 Joel G Ray, assistant professor of medicine and health, policy, management, and evaluation,1 Ahmed Bayoumi, assistant professor of medicine and health, policy, management, and evaluation,1 Allison B Rosen, assistant professor of medicine,3 Dan Greenberg, senior lecturer,4 and Peter J Neumann, director5...
Mortality in a cohort of 3.1 million children, adolescents and young adults
Mortality in a cohort of 3.1 million children, adolescents and young adults http://orcid.org/0000-0003-1635-4658Joel G Ray1,2,3, Astrid Guttmann3,4, Jose Silveira2, Alison L Park3 1 Medicine, and Obstetrics and Gynecology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada 2 Psychiatry, University of Toronto, Toronto, Ontario, Canada 3 ICES, Toronto, Ontario, Canada 4 Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada Correspondence to Dr Joel G Ray,...
Severe Maternal Morbidity and Mental Health Hospitalizations or Emergency Department Visits
Key Points Question Is severe maternal morbidity (SMM) associated with long-term mental health–related hospitalizations or emergency department (ED) visits after delivery? Findings In this cohort study among 1 579 392 individuals with hospital births in Canada, 35 825 individuals had SMM within pregnancy or up to 42 days post partum, and 1 543 567 individuals did not.
Mortality in a cohort of 3.1 million children, adolescents and young adults
Mortality in a cohort of 3.1 million children, adolescents and young adults Joel G Ray1,2,3, Astrid Guttmann3,4, Jose Silveira2, Alison L Park3 1 Medicine, and Obstetrics and Gynecology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada 2 Psychiatry, University of Toronto, Toronto, Ontario, Canada 3 ICES, Toronto, Ontario, Canada 4 Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada Correspondence to Dr Joel G Ray, Medicine, and Obstetrics and Gynecology,...
Differences in Early Childhood Maltreatment by Maternal Birthplace and Child Sex
To view the full text, please login as a subscribed user or purchase a subscription. Click here to view the full text on ScienceDirect. Figure Flow chart of primary study cohort and sibling subcohorts. Objective To identify patterns of health system-identified early childhood maltreatment by maternal birthplace and child sex, within a multicultural society with universal access to healthcare.
Mortality in a cohort of 3.1 million children, adolescents and young adults
Mortality in a cohort of 3.1 million children, adolescents and young adults Joel G Ray1,2,3, Astrid Guttmann3,4, Jose Silveira2, Alison L Park3 1Medicine, and Obstetrics and Gynecology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada 2Psychiatry, University of Toronto, Toronto, Ontario, Canada 3ICES, Toronto, Ontario, Canada 4Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada Correspondence to Dr Joel G Ray, Medicine, and Obstetrics and Gynecology, St....
A political fable
A customer runs into a coffee shop and tells the waitress, "I think the bank across the road is being robbed." The waitress calls 9-1-1. A few minutes later, as the bank robber prepares to leave the bank with the loot, he sees that the bank is surrounded by police cars. So he puts the money back in the vault. Get our Daily Headlines Sent right to your inbox. Two questions: Has a crime been committed? Do you care who the waitress was?
'Surprise billing' needs independent dispute resolution
As a physician who served a largely rural area, I know recent years have been tough. It is ever harder to build and maintain a successful practice. Providing excellent patient care has become increasingly difficult due to authorization delaying tactics by insurance companies. Further, physician reimbursement has continued to decline, causing physicians to either become employed by a hospital or health care system who end up controlling the health care delivery.
Chronic physical conditions and risk for perinatal mental illness: A population-based retrospective cohort study
Loading metrics Open Access Peer-reviewed Research Article Hilary K. Brown , Andrew S. Wilton, Joel G. Ray, Cindy-Lee Dennis, Astrid Guttmann, Simone N. Vigod Hilary K. Brown, Andrew S. Wilton, Joel G. Ray, Cindy-Lee Dennis, Astrid Guttmann, Simone N. Vigod Published: August 26, 2019 https://doi.org/10.1371/journal.pmed.1002864 Figures Abstract Background One in 5 women experience mental illness in pregnancy or post partum.
Preeclampsia brings the risk of premature cardiovascular disease in women closer to that of men
INTRODUCTION It is generally accepted that women with a history of preeclampsia, especially early-onset preeclampsia necessitating preterm delivery, are at higher risk of premature cardiovascular disease (CVD), compared to non-preeclamptic women1x1McDonald, S.D., Malinowski, A., Zhou, Q. et al. Cardiovascular sequelae of preeclampsia/eclampsia: a systematic review and meta-analyses. Am Heart J.
Effect of postpartum glucose tolerance results on subsequent weight retention in women with recent gestational diabetes: a retrospective cohort study
To view the full text, please login as a subscribed user or purchase a subscription. Click here to view the full text on ScienceDirect. Fig. 1 Consort diagram of cohort selection criteria Abstract Aims Glucose tolerance normalizes postpartum in most women with gestational diabetes (GDM), which may provide false reassurance and decrease weight-reducing behaviours.
Risk prediction models for maternal mortality: A systematic review and meta-analysis
Citation: Aoyama K, D’Souza R, Pinto R, Ray JG, Hill A, Scales DC, et al. (2018) Risk prediction models for maternal mortality: A systematic review and meta-analysis. PLoS ONE 13(12): e0208563. https://doi.org/10.1371/journal.pone.0208563 Editor: Olalekan Uthman, The University of Warwick, UNITED KINGDOM Received: October 13, 2018; Accepted: November 19, 2018; Published: December 4, 2018 Copyright: © 2018 Aoyama et al.
To β or Not to β? Very Likely OK to β
There is little reason to believe that daily use of an oral β-antagonist in the first trimester of pregnancy heightens risk for congenital malformations.
Rapid repeat pregnancy among women with intellectual and developmental disabilities: a population-based cohort study
AbstractBACKGROUND: Rapid repeat pregnancy within 12 months of a live birth is associated with adverse perinatal outcomes. We evaluated the risk for rapid repeat pregnancy among women with intellectual and developmental disabilities, with whom sharing of information about pregnancy planning and contraception may be inadequate.METHODS: We accessed population-based health administrative data for all women with an index live birth in Ontario, Canada, for the period 2002–2013.
Association Between MRI Exposure During Pregnancy and Fetal and Childhood Outcomes
Importance Fetal safety of magnetic resonance imaging (MRI) during the first trimester of pregnancy or with gadolinium enhancement at any time of pregnancy is unknown. Objective To evaluate the long-term safety after exposure to MRI in the first trimester of pregnancy or to gadolinium at any time during pregnancy. Design, Setting, and Participants Universal health care databases in the province of Ontario, Canada, were used to identify all births of more than 20 weeks, from 2003-2015.
Prenatal biochemical screening and long term risk of maternal cardiovascular disease: population based cohort study
This population based cohort study was conducted in Ontario, Canada, where universal healthcare includes prenatal screening and obstetrics care. All prenatal biochemical screening records were eligible and aggregated within the Ontario Maternal Multiple Marker Screening Database for 1993 to 2011.
Dysfunctional Uterine Activity in Labour and Premature Adverse Cardiac Events: population-based cohort study
Among a large cohort of women cared for within a universal health system, no short-term increased risk of heart failure, cardiomyopathy or cardiac dysrhythmia was seen within the first decade after a pregnancy affected by a prolonged first stage of labour.This is the first population-based cohort study to examine the relation between prolonged labour and cardiac outcomes. The study included all livebirths at ?
Magnetic Resonance Imaging Exposure During Pregnancy-Reply
In Reply We agree with Dr Symons and colleagues that the evolution of gadolinium-based contrast agents has likely arrived at a point where currently used agents are largely newer (more stable) macrocyclic chelates. We agree this might mean an even lower risk of adverse outcomes than the already low risks reported in our study, but this would require confirmation. We welcome additional data about these newest forms of gadolinium.
Association Between MRI Exposure During Pregnancy and Fetal and Childhood Outcomes
Importance Fetal safety of magnetic resonance imaging (MRI) during the first trimester of pregnancy or with gadolinium enhancement at any time of pregnancy is unknown. Objective To evaluate the long-term safety after exposure to MRI in the first trimester of pregnancy or to gadolinium at any time during pregnancy. Design, Setting, and Participants Universal health care databases in the province of Ontario, Canada, were used to identify all births of more than 20 weeks, from 2003-2015.
Authors’ reply to Rafi
Joel G Ray, clinician scientist1, Emily Bartsch, medical student21Departments of Medicine, Health Policy Management and Evaluation, and Obstetrics and Gynecology, St Michael’s Hospital, University of Toronto, Toronto, Canada2University of Toronto, Toronto, Canadarayj{at}smh.caWe thank Rafi for his comments on our paper.1 2WHO, NICE, and the US Preventive Services Task Force (USPSTF) conclude, from systematic reviews, that aspirin prophylaxis is appropriate in high risk women.3 4 5These...
Clinical risk factors for pre-eclampsia determined in early pregnancy: systematic review and meta-analysis of large cohort studies
Based on a body of large sample cohort studies, we estimated the contributions of several clinical risk factors to the development of pre-eclampsia, considering the absolute rate and relative risk of pre-eclampsia—metrics understood by clinicians—and also on the population attributable fraction—a metric applicable to public health initiatives at the population level.
Sex ratios at birth after induced abortion
Methods: We examined 1 220 933 births to women with up to 3 consecutive singleton live births between 1993 and 2012 in Ontario. Records of live births, and induced and spontaneous abortions were linked to Canadian immigration records. We determined associations of male:female infant ratios with maternal birthplace, sex of the previous living sibling(s) and prior spontaneous or induced abortions.
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