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Article History

Received: 25 April 2025

Accepted: 4 September 2025

First Online: 8 November 2025

Acknowledgements

: ICES is an independent, non-profit research institute funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). As a prescribed entity under Ontario’s privacy legislation, ICES is authorised to collect and use healthcare data for the purposes of health system analysis, evaluation and decision support. Secure access to these data is governed by policies and procedures that are approved by the Information and Privacy Commissioner of Ontario. This document used data adapted from the Statistics Canada Postal Code OM Conversion File, which is based on data licensed from Canada Post Corporation, and/or data adapted from the Ontario Ministry of Health Postal Code Conversion File, which contains data copied under license from © Canada Post Corporation and Statistics Canada. Parts of this material are based on data and/or information compiled and provided by the Ontario Ministry of Health and Canadian Institute for Health Information (CIHI). The analyses, conclusions, opinions and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred. We thank IQVIA Solutions Canada Inc. for use of their Drug Information File.This Project has been made possible by the Canada Brain Research Fund (CBRF), an innovative arrangement between the Government of Canada (through Health Canada) and Brain Canada Foundation, and Heart and Stroke Foundation of Canada. To date, Health Canada has invested over $130 million through the CBRF which has been matched by Brain Canada Foundation and its donors and partners. The views expressed herein do not necessarily represent the views of the Minister of Health or the Government of Canada.

: The dataset from this study is held securely in coded form at ICES (formerly, Institute for Clinical Evaluative Sciences). While data sharing agreements prohibit ICES from making the dataset publicly available, access may be granted to those who meet pre-specified criteria for confidential access, available at . The full dataset creation plan and underlying analytic code are available from the authors upon request, on the understanding that the computer programs may rely upon coding templates or macros that are unique to ICES and are therefore either inaccessible or may require modification.

: CYW receives financial support from the Canadian Institutes of Health Research (Doctoral Research Award: Canadian Graduate Scholarships; 202111FBD-47623-75801). CYW, WS, AS, JDE and PPL receive financial support from Heart-Brain Connection BHRIITE IMPACT Award from Heart & Stroke Foundation, Brain Canada, and the Brain-Heart Interconnectome CFREF (Canada First Research Excellence Fund) Program. BRS receives support from the University of Toronto as the Novo Nordisk Research Chair in Equitable Care of Diabetes and Related Conditions. WS receives support from the Canada Research Chairs Program (Award Number: CRC-2020-00353), the Ontario Ministry of Colleges and Universities (Award Number: ER21-16-141), the Alzheimer’s Drug Discovery Foundation (Grant Number: GC-202209-2024050), and the Dr. Sandra Black Centre for Brain Resilience and Recovery. AS acknowledges financial support from the FRQS-Junior 1/2 clinician scientist award, the Alberta Innovates Health Solution Clinician Scientist fellowship, the European Society of Cardiology Young Investigator research grant, Janssen, Roche Diagnostics, AstraZeneca, Boehringer Ingelheim, Novartis, Servier, Novo Nordisk, Takeda, and the Canadian Cardiovascular Society Bayer Vascular award. MKK is supported by the Sir John and Lady Eaton Chair from the Department of Medicine, Temerty Faculty of Medicine, University of Toronto. All funders for the present project and other unrelated projects did not influence the conduct, interpretation, and reporting of the present study.

: The authors declare that there are no relationships or activities that might bias, or be perceived to bias, their work.

: CYW, WS and BRS conceptualised the study. CYW, AS, JDE, CFW, BRS and WS made significant contributions to the study design and methodology. CYW, CFW and SP made significant contributions to the data analysis. CYW ran the formal analysis and drafted the manuscript. WS and BRS played a supervisory role for this study. AS, JDE, PPL and WS acquired the funding. All authors had significant input into the interpretation of the results and the review or editing of the manuscript, and had approved the final version for publication. CYW, WS and BRS are the guarantors of this work.