This study was exempted from ethics review and informed consent as per Ontario’s Personal Health Information Protection Act. These data sets were linked using unique encoded identifiers and analyzed at ICES. We replicated the analyses in an independent manner for each cohort, so individuals could appear in more than 1 cohort if they fulfilled the inclusion criteria. We adjusted for prespecified covariates (age, sex, socioeconomic status) (eTable in Supplement 1). We used modified Poisson regression to compute adjusted relative risks (RRs) describing the association between each exposure and the outcome, compared with the reference group. The primary outcome was cardiovascular events, defined as a composite of hospitalization for acute myocardial infarction or stroke, or all-cause mortality (eTable in Supplement 1). We characterized exposure status at the index date separately for each cohort. The exposures were diabetes, prior CVD, or both (3 separate categories) people with neither diabetes nor CVD served as the reference group. We identified diabetes using a validated algorithm with 99.1% specificity. Individuals were followed up for up to 5 years (final date of follow-up, March 31, 2019) and censored at departure from Ontario. We excluded those who became eligible for OHIP less than 5 years before the cohort-specific index date to ensure adequate baseline data. Because of computational limitations, we selected a random sample of 25% of each cohort. We created 5 population-based cohorts of adults aged 20 to 84 years who were alive on the index date (April 1) during each of the following years: 1994, 1999, 2004, 2009, and 2014. Physician- and hospital-based services for Ontario residents are publicly funded through the Ontario Health Insurance Plan (OHIP). We conducted a retrospective, population-based study using administrative health care data from Ontario, Canada. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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