Provincial Health Indicators Work Group

Minutes

Thursday October 15, 1998
9:30 AM - 3:30 PM
North Board Room, 4th Floor
North York Civic Centre

Present: Mary-Anne Pietrusiak, Durham Regional Health Unit (Chair)
                Julie Stratton, Perth District Health Unit
                Terry Delmore, Halton Regional Health Department
                Patrick Seliske, Waterloo Regional Community Health Department
                Carol Paul, IPE Branch, Ministry of Health
                Jessie Wong, IPE Branch, Ministry of Health
                Nam Bains, Health Information Partnership, Eastern Ontario Region
                Doug Manuel, Federal Field Epidemiologist, Ministry of Health

Others: Jill Mallon, Toronto Public Health, North York Office
             Tim Leung, Ministry of Health

Corresponding Member: Dr. Vivek Goel, ICES

Regrets: Hyewon Lee-Han, Population Health Service, Public Health Branch
                Jo-Anne Peterson, Kingston, Frontenac- Lennox and Addington Health Unit
                Ruth Sanderson, Bruce-Grey-Owen Sound Health Unit
                Vic Sahai, Northern Health Information Partnership

Introduction

Previous Issues

Moving Through The Framework


A. Behavior and Health (Jessie Wong)

Alcohol Section

Basic Categorizations: Drinking 15+ drinks per week. The draft report will ask people’s opinions of: 1) keeping indicator as 15 or more drinks per week, 2) 0 drinks, 1 –14 drinks, and 15+, 3) 0-14 drinks, 15 drinks or more.

Include in Other Categories section: Standardized ratios and rates: ages 12-19, 20-44, 45-64, 65+. There was considerable discussion about the need to standardize OHS indicators, since standardization is applied to most other indicators. The Group decided that both the proportions and standardized rates would be used.

Change ‘Comments’ section to ‘Indicator-Specific Comments’

‘Comments on the Ontario Health Survey’ section should be changed to ‘Comments on the OHS 90 and OHS 96/97’.

Include the sentence ‘Low-risk drinkers are men drinking 14 or fewer drinks per week, and women drinking 9 or fewer drinks per week, excluding pregnant and breast-feeding women’ in the Indicator-Specific Comment.

Delete the sentence in the ‘Usage’ section referring to the Mandatory Health Programs and services guidelines.

‘Comments on the Ontario Health Survey’ section should be changed to ‘Comments on the OHS 90 and OHS 96/97’.

Basic Categorizations: Categories: 1) Never, 2) Less than once a month, 3) More than once a month (Categories 2 & 3 have been created by splitting the ‘One or more times’ category in two).

The breakdown of these categories in the OHS 96/97 is 45% for people answering ‘never’, 17% for people answering ‘Once a month’.

Exclude the "not applicables", as well as those who are "not stated" and those who refused to answer.

‘Comments on the Ontario Health Survey’ section should be changed to ‘Comments on the OHS 96/97’.

Method of Calculation denominator should read ‘Total population of drivers aged 16+’.

Data Sources: OHS question RSS6_7.

In the Indicator-Specific Comments, include the sentence, ‘Exclude not applicables (those with a valid driver’s license)’.

‘Comments on the Ontario Health Survey’ section should be changed to ‘Comments on the OHS 96/97’.

Physical Activity Section

The description section should read, ‘…physical activities in the previous three months.’

Data Sources: derived variable, include PAC6DEE, and list activities.

Add a sentence in the I-S Comments section stating that the lists of physical activities in the OHS 96/97 are different from those in the OHS 90.

‘Comments on the Ontario Health Survey’ section should be changed to ‘Comments on the OHS 96/97’.

Hyewon will investigate the definitions of accumulated and moderate physical activity since this may be an indicator that could be defined and developed by members from the Provincial Health Status Report group, such as Ken Allison. If defined specifically, Jessie or someone on the PHSR group could derive the variable on the sharing file.

‘Proportion of Youths who had at least 30 minutes of accumulated, moderate physical activity on most if not all days of the week’ indicator could also be defined.

‘Comments on the Ontario Health Survey’ section should be changed to ‘Comments on the OHS 96/97’

Nutrition Section

Method of Calculation – Include ‘Total population aged 20-64 (excluding pregnant women)’ in the denominator.

‘Comments on the Ontario Health Survey’ section should be changed to ‘Comments on the OHS 90 and OHS 96/97’.

Basic Categorizations: Categories: 1)<= 30.0% 2) >30.0 and < 38.0% 3) 38.0+%

‘Comments on the Ontario Health Survey’ section should be changed to ‘Comments on the OHS 90’.

Basic Categorizations – Categories: 1) < 5.0 servings 2) 5.0+ servings

‘Comments on the Ontario Health Survey’ section should be changed to ‘Comments on the OHS 90’.

In ‘Description’ and ‘Method of Calculation’ sections, change the ages to 12 to 17 years old instead of 12 to 16 years old.

Basic Categorizations: Categories: 1) <3.0 servings, 2) 3.0+ servings. Age Categories: ages 12 to 17.

‘Comments on the Ontario Health Survey’ section should be changed to ‘Comments on the OHS 90’.

Include a note in the I-S Comments that the age categories for this indicator are inconsistent with Mandatory Health Programs and Services Guidelines.

Basic Categorizations: Categories: 1) <2.0 servings, 2) 2.0+ servings.

‘Comments on the Ontario Health Survey’ section should be changed to ‘Comments on the OHS 90’.

Basic Categorizations: Categories: 1)<5.0 servings 2) 5.0+ servings

‘Comments on the Ontario Health Survey’ section should be changed to ‘Comments on the OHS 90’


B. Mental Health (Jessie Wong)

Other Categorizations: age groups should include 65+, (Jessie will investigate age categories further).

‘Comments on the Ontario Health Survey’ section should be changed to ‘Comments on the OHS 96/97’.

Change ‘Comments’ section to ‘Indicator-Specific Comments’.

Basic Categorizations: include Crude Rate, Age Specific Rates, SMRs. Age Categories should include: <15, 15-19, 20-24, 25-44, 45-64, 65+. (Nam to investigate the age distribution).

Jessie to include References.

Basic Categorizations: Crude Rate, Age-Specific Rates, SMRs.

Other Categorizations: Age groups: <15, 15-19, 25-44, 45-64, 65+.

C.  Reproductive Health (Mary-Anne Pietrusiak)

Method of Calculation: denominator should read, "Total Population".

Data Sources: Numerator: Ontario Vital Statistics, Office of the Registrar General, Denominator: Statistics Canada, Population Estimates.

‘Comments on Birth Data’ section should be included. Mary-Anne will e-mail a draft once completed.

I-S Comments should include a sentence stating that geographic coding uses the residence of the mother. Out-of-province births are excluded from HELPS since 1993 (the date will be confirmed). Stillbirths are not included in this database but are in a separate database.

Reference needed.

Include under Age Specific Fertility Rate indicator.

Method of Calculation should be identifies as an example.

Delete the year of data availability from the Data Sources section

Change ‘Comments’ section to ‘Indicator-Specific Comments’.

‘Comments on Birth Data’ section should be included.

‘Live births occurring in women under age 15 are excluded; some reports’ should be included in the I-S Comments.

Delete the year of data availability from the Data Sources section.

Basic Categorization: Age Grouping: 10-14, 15-19, 20-24, 25-29, 30-34,35-39, 40-44, 45-49, Aged 15-49 (General Fertility Rate).

‘Comments on Birth Data’ section should be included.

Delete the sentence, ‘Live births occurring in women under age 15 are excluded’.

Description: Number of therapeutic abortions in hospital and in clinic relative to women in a given age group per 1,000 in that age group.

Data Sources: Data is available from 1992 onwards. Basic Categorizations: Age Groupings: 10-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, Total 15-49

Other Categorizations: census sub-divisions are not included.

‘Comments on Abortion Data’ section should be included. Mary-Anne will distribute a draft.

Basic Categorizations: Age Groupings: 10-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, Total 15-49.

‘Comments on Abortion Data’ section should be included

Basic Categorization: Age group 10-14 to be included.

Note: Teen pregnancy rate is defined as ages 15-19.

Comment sections on Hospitalization, Stillbirths, Birth Data and Abortion Data is to be included in this indicator.

Basic Categorizations: Age Groupings: 15-19, 20-29, 30-39, 40+.

‘Comments on Birth Data’ section should be included.

Method of Calculation - should include calculation low birth weight for singletons.

‘Comments on Birth Data’ section should be included.

I-S comments: include a sentence explaining that gestation data are problematic. The rapid increase seen in prematurity has not been seen elsewhere in Canada; may be a data problem. Also comment on association between parity and LBW (lowest risk for second child). Doug to provide a reference.

Indicator has been included under LBW indicator.

Data Sources: delete years of data availability.

Other Categorizations: delete census sub-divisions out.

The denominator will be the number of live births as determined from Vital Statistics, not that used by the CCASS.

‘Comments on Birth Data’ section should be included.

‘Comments on Canadian Congenital Anomalies Surveillance System (CCASS)" section should be included.

Description: the sentence defining ‘stillbirth’ should be added to the Indicator-Specific Comments section.

Comments on Birth Data’ section should be included.

Comments on Stillbirth Data’ section should be included.

Description: the definition of stillbirth should be added to the Indicator-Specific Comments section. The sentence, "An early neonatal death…" should also be added to the I-S Comments section.

Include the sentence, "Babies less than 500g are included but some jurisdictions exclude them’ in the I-S Comments section.

D.  Infectious Disease (Doug Manuel)

Method of Calculation: denominators should read, "Total Population’

Basic Categorizations: ‘Pneumonia and Influenza (480-487)’ should be added; crude rate, age-specific rate, and SMRs should be included.

Usage: The Mandatory Health Programs and Services Guidelines objective should be quoted; Mandatory Programs has 5-year moving average – not used because this was not done with any other indicator and was inconsistent. However, Doug will write up the methodology for doing a 5-year moving average that can be included as an appendix.

Comments on Mortality Data’ section should be included

Combined with ‘Mortality From Infectious Disease’ indicator.

Method of Calculation: denominator should read, ‘Total Population’

Basic Categorization: 1) Diphtheria, tetanus and indigenous polio, 2) pertussis,
3) measles, 4) mumps, 5) congenital rubella, 6) hemophilus influenza type b, 7) acute hepatitis B, 8) rabies.

Basic Categorization should also include a note to use crude rates, age-specific rates and SIRs where applicable.

Usage: delete the sentence, ‘To plan programs for control of sexually transmitted diseases. Include the objectives from Mandatory Programs on vaccine-preventable disease.

Comments on RDIS Data section should be included (have to re-index). Mary-Anne will circulate draft once Doug has written it.

Description: Extract the line "…according to provincial Ministry of Health guidelines against selected diseases".

Data Distributor: Public Health Units.

Basic Categories: 1) Diphtheria, tetanus and polio, pertussis, 2) measles, mumps, rubella, 3) hemophilus influenza type b, 4) acute hepatitis B.

Other Categories: Age.

Usage: delete the sentence ‘To plans program for control of STD’s’; include objective from Mandatory Guidelines.

Comments on IRIS Data section should be included.

Description: Extract the line "…according to provincial Ministry of Health guidelines against selected diseases".

Data Source: Numerator: IRIS; Denominator: Public health unit manual collection.

Data Distributors: Public Health Units.

Basic Categories: 1) Influenza, 2) Pneumococcal disease.

Usage: delete the sentence ‘To plans program for control of STD’s’; include a quote from Mandatory Guidelines.

Comments on IRIS Data section should be included.

Method of Calculation: denominator should read, ‘Total population’.

Data Distributor: Public Health Units.

Basic Categories: Genital Chlamydia (females 15 to 24 years) should be added to section; Crude rate, age-specific rate, SIR, 5-year age groups.

Other Categories: sex-specific categories should be added to section.

Usage: include quote from Mandatory guidelines.

Description: ‘Annual number of hospital separations per 100,000 women’.

Method of Calculation: denominator should read, ‘Total population of women’.

Other Categories: ‘Five year age groups’, delete the reference to trends over time.

I-S Comments should include a sentence stating the Pelvic Inflammatory Disease (PID) is usually underestimated, with reference.

Method of Calculation: two equations, one for total incidence and one for drug-resistant TB.

Data Distributors: Public health units.

Basic Categories: 1) All confirmed cases of Tuberculosis (TB), 2) Confirmed cases of TB that are resistant to any antibiotic, 3) Confirmed cases of Multi-Drug Resistant TB (MDR) that are resistant to both Isoniazid and Rifampin, the two main antibiotics used to treat TB).

Comments on RDIS Data’ section should be included.

Data Distributor: Public health units.

Basic Categories: include bat and cow in list of animals.

Data Distributors: Public health units

Basic Categories: 1) Campylobactor, 2) Salmonella, 3) Verotoxin producing E-coli, 4) Hep A, 5) Shigella.

Include crude rates, age-specific rates, SIRs.

Usage: delete the sentence ‘To plans program for control of STDs’.

Comments on RDIS Data’ section should be included.

Add in a sentence explaining that RDIS is usually an underestimation of rates.

Basic Categorizations: Specify for enteric diseases and HUS

Usage: delete the sentence ‘To plans program for control of STDs’


E.  Consequence of Disease (Nam Bains)

Method of Calculation: denominator should read, ‘Total number aged 12+’.

Data Sources: investigate similar question in OHS 90.

‘Comments on the Ontario Health Survey’ section should be changed to ‘Comments on the OHS 96/97.

Description: ‘General Practitioner’ should have the acronym after it.

Method of Calculation: denominator should read, ‘Total number aged 12+’.

‘Comments on the Ontario Health Survey’ section should be changed to ‘Comments on the OHS 96/97.

Method of Calculation: denominator should read, "Total number aged 12+".

‘Comments on the Ontario Health Survey’ section should be changed to ‘Comments on the OHS 96/97.

Method of Calculation: denominator should read, "Total number aged 12+".

‘Comments on the Ontario Health Survey’ section should be changed to ‘Comments on the OHS 96/97.

Description: ‘Proportion of people aged 12 or older indicating use of one or more drugs on list in the past month’.

Method of Calculation: denominator should read, "total number aged 12+".

Other Categorizations: Type of medication should be included.

‘Comments on the Ontario Health Survey’ section should be changed to ‘Comments on the OHS 96/97’.

In the ‘Indicator-Specific Comments’ section, include the sentence, "Exclude missing responses, those who refused to answer".

Method of Calculation: denominator should read, "Total number aged 12+".

‘Comments on the Ontario Health Survey’ section should be changed to ‘Comments on the OHS 96/97’.

Comment sections on Hospitalization, and Population Estimates should be included in this indicator.


Next Steps:
Communication will occur through e-mail as the draft is prepared.