Description | Specific Indicators | Corresponding Mandatory Objectives | Corresponding National Indicators | Data Sources |  Alternative Data Sources | ICD Codes | Analysis Check List | Method of Calculation |  Basic Categories | Indicator Comments | Cross-References to Other Sections | References  
 

Description

• Age-specific hospitalization rates for all causes are the annual number of hospitalizations in a given age group per the population in that age group (usually expressed per 100,000).

• Age-specific hospitalization rates for selected causes are the annual number of hospitalizations in a given age group from selected causes per the population in that age group (usually expressed per 100,000).

Keywords

Hospitalization, morbidity, infant, child, adolescent, asthma, injury, congenital anomalies, respiratory disease, shaken baby syndrome, PHPDB, data warehouse

Specific Indicators

• Child and Adolescent Hospitalization Rate

• Infectious Disease Hospitalization Rate for Children and Adolescents

• Respiratory Disease Hospitalization Rate for Children and Adolescents

• Asthma Hospitalization Rate for Children and Adolescents

• Injury and Poisoning Hospitalization Rate for Children and Adolescents

• Child Abuse Hospitalization Rate

Corresponding Mandatory Objectives

• None

Corresponding National Indicators

• None

Data Sources (see Resources: Data Sources)

Numerator: Hospitalization
Original source: Canadian Institute for Health Information (CIHI)
Distributed by: Provincial Health Planning Database (PHPDB), Health Planning Branch, Ontario MOHLTC
Suggested citation (see Data Citation Notes):
Hospital [In-Patient and/or Day Surgeries] Data [years], Provincial Health Planning Database (PHPDB) Extracted: [date], Health Planning Branch, Ontario MOHLTC
Note: specify in the report whether in-patient discharges or day procedures or both

Denominator: Population Estimates
Original source: Statistics Canada
Distributed by:
1.      Provincial Health Planning Database (PHPDB), Health Planning Branch, Ontario MOHLTC
2.      Health Planning System (HELPS), Public Health Branch, Ontario MOHLTC
Suggested citation (see Data Citation Notes):
1.      Population Estimates [years]*, Provincial Health Planning Database (PHPDB) Extracted: [date], Health Planning Branch, Ontario MOHLTC
2.      Population Estimates [years]*, HELPS (Health Planning System) Release: [date], Public Health Branch, Ontario MOHLTC
* Note: Use the total years of the estimates, including the most recent year, even if not all were used in the analysis. The years used in the analysis should be included in the report itself.

ICD-9 and ICD-10 Codes for Selected Diseases

Survey Questions

• None

Analysis Check List

• Suppress numbers <5 or rates and proportions based on counts less than 5.

• For in-patient separations in PHPDB: use Inpatient Discharges table from Hospital section of model, use Count Distinct function on “CIHI Key” attribute. 

• For day procedures in PHPDB: use Day Procedures table from Hospital section of model, use Count Distinct function on “CIHI Key” attribute.

• Select on geography of patient (geography could be postal code, postal code FSA, province, county-municipality, county, region, district health council or public health unit) using geography code not geography name. If geography code is not known, “Prompts” can be used or codes can be looked up in “Geo Names” Code Table. Institution geography can also be selected by linking to “Institution #” table.

• ICD-10-CA has a greater level of specificity and different code titles than ICD-9. CIHI does not endorse forward conversions because of differences in the classification systems. Refer to Resources: ICD-10-CA for more information.

Method of Calculation 

Child and Adolescent Hospitalization Rate:

 Child and Adolescent Hospitalization Rate for Selected Causes:

Basic Categories

• Age groups for age-specific rates: <1 (infants), 1-9 years (children), 10-19 (adolescents), 0-19 (total children & adolescents).

• Sex: male, female.

• Geographic areas: public health unit, district health council, census division, census sub-division.

Indicator Comments

• Hospitalization reflects the middle to more severe range of the disease severity continuum and shows only the tip of the iceberg of a health problem or disease.

• Causes are based on the most responsible diagnosis (diagnosis associated with the longest duration of treatment) during a given hospital stay. 

• Hospitalizations in psychiatric hospitals are excluded. 

• Hospitalization data from the Provincial Health Planning Database are based on a fiscal year that runs from April 1 to March 31. Since ICD-10-CA was introduced in Ontario in fiscal year 2000/2001, data for 2000 are coded using ICD-9 from January 1 to March 31, and ICD-10-CA from April 1 to December 31. This year may be particularly difficult to analyze. Refer to Resources: ICD-10-CA for more information.

• Changes in hospitalization rates may not reflect changes in the prevalence of a disease or health problem but rather changes in hospital policies, medical procedures and technology. Hospital rates have generally been decreasing as more patients are treated on an outpatient basis or through primary care.

• “Children” and “adolescents” are defined by different age groups, depending upon the data source. For this mortality indicator, infants are defined as age less than one year, children as 1-9 years and adolescents as 10-19 years; these age groupings match population estimates (used for the denominators) which are reported by five-year age groups. Other common definitions include:
  - Infant (< 1 year), preschool children (1-4 years), school-aged children (5-14 years), youth (15-19 years)¹
  - Prenatal and infancy (conception to 18 months), preschoolers (18 months to age 5), school-age children (6-12 years), Adolescence (13-18 years)²
  - Healthy Babies Healthy Children (0-6 years) – Ministry of Health and Long-Term Care.³
  - Early Child Development program (0-6 years) – Ministry of Children and Youth Services.⁴
  - Child (1-9 years)⁵
  - Children and youth (0-19 years)⁶
  - Children (0-19 years) – Canadian Cancer Statistics⁷

• The Health of Canada’s Children report identified that the leading causes of hospitalization among children aged 1-4 years in Canada in 1996-1997 were: 1) respiratory system (41%), 2) digestive system (10%), and 3) injuries . For children aged 5-9 years, the leading causes were: 1) respiratory diseases (29%), 2) injuries (17%), and 3) digestive diseases (11%). For children aged 10-14 years, the leading causes were: 1) injuries (21%), 2) respiratory diseases (17%), and 3) digestive diseases (14%). Among 15-19 year old males, injuries (21%) were the leading cause of hospitalization, but mental disorder (16%) was the leading cause for females, excluding pregnancy-related admissions.¹

• The ICES Practice Atlas, Patterns of Health Care in Ontario, found similar results. Respiratory disease was the most common reason children aged 0-14 years were hospitalized from 1992/93 to 1994/95, with asthma the single most prevalent cause of hospitalization. Among females age 15-19 years, pregnancy and childbirth was the leading cause of hospitalization (40%).⁸ 

• Hospital admissions among children are often recurrent and the result of asthma and neurological conditions, resulting in a relatively small number of children accounting for a large proportion of hospitalizations.¹

• Injury:
  - ICD-9: The ICD-9 uses two sets of codes to classify injury. One set (Chapter XVII-Injury and Poisoning) considers the nature of the injury and corresponds to the underlying cause of death, e.g., fracture of vault of skull. The second set of codes are external cause or “E” codes which classify the environmental events, circumstances and conditions as the cause of the injury, e.g., motor vehicle traffic injury. The E-codes are the principal means for classifying injury deaths. The grouping of unintentional injury deaths excludes e-codes for “misadventures to patients during surgical and medical care”. This coding matches that used for the National Indicators. If appropriate, “E” codes are classified on the death certificate as the underlying cause of death, which is, in turn, selected for tabulation of the official cause of death statistics. 
  I- CD-10-CA: Chapter XX – external causes of morbidity and mortality (V01-Y98) permits the classification of environmental events and circumstances as the cause of injury, poisoning and other adverse effects. Where a code from this section is applicable, it is intended that it shall be used in addition to a code from another chapter of the Classification indicating the nature of the condition. Most often, the condition will be classifiable to Chapter XIX – Injury, poisoning and certain other consequences of external causes (S00-T98).⁹

• Shaken Baby Syndrome (SBS):
  - An objective in the draft Mandatory Health Programs and Services Guidelines (January 2003 version) is that “the morbidity and mortality rates due to Shaken Baby Syndrome will be reduced”.
  - Shaken Baby Syndrome is a condition that occurs when an infant or young child is shaken violently, usually by a parent or a caregiver. It is a collection of findings, all of which may not be present in any individual child with the condition. Injuries that characterize Shaken Baby Syndrome are intracranial haemorrhage (bleeding in and around the brain); retinal haemorrhage (bleeding in the retina of the eye); and fractures of the ribs and at the ends of the long bones. Impact trauma may produce additional injuries such as bruises, lacerations or other fractures.¹⁰
  - Determining the number of hospitalizations from Shaken Baby Syndrome is difficult. The incidence of Shaken Baby Syndrome may be severely underestimated due to missed diagnosis and underreporting.¹⁰
  - Rather than focus solely on Shaken Baby Syndrome, it may more appropriate to report the hospitalization rates for abuse or maltreatment.  Because numbers are small, it is necessary to group many years of data.

Definitions

Infant = age <1 year
Children = 1-9 years
Adolescent = 10-19 years
 

Cross-References to Other Sections

• All-Cause Hospitalization (Section 3: Mortality, Morbidity, Health-Related Quality of Life)
• Chronic Disease Hospitalization (Section 4A: Chronic Diseases)
• Cancer Hospitalization (Section 4B: Cancer Incidence and Early Detection of Cancer)
• Injury Hospitalization (Section 4C: Injury Prevention and Substance Abuse Prevention)
• Attempted Suicide Hospitalization (Section 7: Mental Health)
• Pelvic Inflammatory Disease Hospitalization (Section 8: Infectious Diseases)

References

1. Canadian Institute of Child Health. The Health of Canada’s Children: A CICH Profile, 3^rd edition, 2000

2. Healthy Babies Healthy Children, Ministry of Health and Long-Term Care http://www.health.gov.on.ca/english/providers/pub/child/hbabies/hbabies_update.html 

3. Ontario Early Years Initiatives, Ministry of Children and Youth Services. http://www.children.gov.on.ca/CS/en/programs/EarlyYearsInitiatives/default.htm

4. Public Health Research, Education and Development Program (PHRED). Report on the Health Status of the Residents of Ontario. February 2000.

5. Health Canada. Rusen ID, McCourt C (Eds.) Measuring Up: A Health Surveillance Update on Canadian Children and Youth. Minister of Public Works and Government Services Canada, 1999. Available at: http://www.phac-aspc.gc.ca/publicat/meas-haut/

6. National Cancer Institute of Canada. Canadian Cancer Statistics, 2008. Available at: http://www.cancer.ca/ccs/internet/standard/0,2283,3543_14279__langId-en,00.html

7. Canadian Institute for Health Information. ICD-10-CA/CCI CD, Version 2003. International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Canada (ICD-10-CA), 2003.

8. Health Canada. Sudden Infant Death Syndrome (SIDS): Information. Available at: http://www.phac-aspc.gc.ca/dca-dea/prenatal/sids-js_e.html.

9. Health Canada. Joint Statement on Shaken Baby Syndrome. Available at: http://www.phac-aspc.gc.ca/dca-dea/publications/jointstatement_web_e.html.

10. Chapter 11: Pediatric Health Service Utilization. In: Goel V, Williams JI, Anderson GM, Blackstien-Hirsch P, Fooks C, Naylor CD, editors. Patterns of Health Care in Ontario. The ICES Practice Atlas, 2nd edition. Ottawa: Canadian Medical Association; 1996. p. 287-322.

Date of Last Revision: June 29, 2004