9:30 AM - 3:30 PM
North Board Room, 4^th 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 (recorder)
Ruth Sanderson, Bruce-Grey-Owen Sound Health Unit
Vic Sahai, Northern Health Information Partnership
Hyewon Lee-Han, Population Health Service, Public Health Branch

Others: Enza Gucciardi, U. of T. MHSc. Practicum student

Corresponding Member: Dr. Vivek Goel, ICES

Regrets: Doug Manuel, Federal Field Epidemiologist, Ministry of Health

• most sections are coming along
• have talked to Brian Laundry about putting the indicators on the APHEO website

• ICES puts out atlases looking as different aspect of health status, different health areas. They will be putting out new atlas reports that cover specific health topics. These smaller reports – 15 pages- will start coming out soon. One of the first ones will be using OHS data looking at risk factors, i.e., Cardiovascular risk factors, tobacco use, risk of infectious disease, screening behaviors, injury, etc. ICES wants to age-standardize the rates, and be able to use the bootstrap weights. They are now working on the methods. Once they have figured them out, ICES will disseminate the SAS programs so others can use them. The timeline is to produce a draft for early August. Right now, Health Planning Branch has the bootstrap weights but haven’t distributed them yet.
• ICES will be using the OHS share file and will be doing analysis at level of 23 OHS health areas.

Mary-Anne is going to Winnipeg from June 7-9 to do a poster and 5 minute oral presentation on the indicators.

Mary-Anne has revise and update the article she wrote some time ago. She’ll send out a final draft to everyone if anyone wants to comment.

An abstract very similar to the one submitted for CPHA has been submitted to OPHA for the November, 1999 conference.

3. Issues to Resolve

There is a greater number of respondents in the public use file, but there are a number of key variables that are not in the NPHS that are in the OHS, i.e., disability. Rather than make a specific recommendation as to which file people should use, the emphasis will be to be clear on what you’re using, and why you’re using it. People should use the file that is most appropriate for their need but must be sure to reference what they use. At the local level, most people will probably use the OHS (the sharing file), because they’ll be doing descriptive work. HELPS documentation (2.0) will provide a description of the two files, the differences between them, etc. The Introduction to the indicators will make it clear that where the 1996/97 OHS is mentioned in the document, it is referring to the sharing file.

2. How to handle non-response in the OHS

There will be no specific recommendation except that people should examine the non-response before they decide to exclude them. The decision will depend on the variable, the nature of the question, etc. Users should also be aware of this issue when they go to compare their results with other published data.

3.3 Age groups for age-specific rates

Since 5 year age groups would be difficult to do at the local level, the suggestion is to use the same age groupings that the provincial health status report used: <1, 1-9, 10-19, 20-44, 45-64, 65-74, 75+.

(* for standardizing rates, 5-year age groups will be recommended)

 

3. Standardization Notes

• The notes refer to ‘small numbers’: but how small is small? Since it’s hard to define, it’s better not to give an exact number.
• change the SMR: to read that the standard population should be the Ontario population corresponding to the year of data that you’re looking at (not 1991).
• SRATE using Canadian 1991 population is fine.
• use ‘not-real’ instead of fictitious to talk about standardized rates: it’s the estimate you would have seen if the population had been the same as the standard.

2. Standardization of OHS data

• use the same age groups used by ICES if doing standardization (to be determined – possibly the same age groups which are used to create the weights)
• Sue Bondy will check the ICES reports to see what they did

2. Categorizations

• difference between basic & other (what goes where), is SMR basic or other? Basic: age, sex, ICD-9 codes, geography, Other: standardization (SMRs, SRATEs) etc

3. Next Steps
1. Mechanism for Comment

• will go on the APHEO website by end of June (?)
• send e-mail comments to Mary-Anne by end of summer
• let DHCs, PHUs know that they can see the draft, and comment on it.
• might be more useful to have a ‘comment’ section on the website where people can see what others have said and leave their thoughts, This way there will be less e-mail for Mary-Anne to sort through, and will cut down on many people making the same comment etc. Robert Barnett at NHIP can help Brian Laundry set up a dialog box for such a purpose.

1. Resources for Electronic Version (Hyewon)

Talked about SRHIPs product: visual basic program that produces chart book pages, which takes the indicators to the next level. It would be nice to automate some of the production of indicators. Hyewon has set up an exploratory meeting with the HIUs to see if there is room to collaborate on such a project.

3.  
4. Work through the Sections

• Clarify the definition of allophone: are we referring to Mother tongue or home language? Leave it the way it is: with home language, but also check the census dictionary & with Statistics Canada releases to see what their definition is.
• Proportion of Allophones should be changed to "Percent who cannot speak English or French".
• add category of ‘Other’ (under basic categorization) for Mother Tongue and Home Language.
• Population growth rate should be changed to population growth.

• Hyewon to get more information on nutritious food basket indicator
• indicator on social assistance to be dropped
• Nam to send MaryAnne the Eastern HIP chartbook page for single parent families

• AQI: need to specify what the denominator is, i.e., unit hours
• UV index: where to get the data? Vic is still trying to find a contact in Environment Canada. Paul Fleiszer may have more information. Also need to know the geographical area it’s collected in.

• The Data Warehouse should be listed as a data distributor.
• For rates, should take out the multipliers (i.e., *10,000 or *100,000) so that people can choose the one that is most appropriate for their data.
• Life expectancy: do we need to put confidence intervals? Check with Doug. Maybe just need comment about the importance of CIs, especially in areas with small numbers.
• Need some more comments on PYLL (Julie)

• The long-term disability indicator should use only the 1996 OHS since the 1990 question is quite different. This variable is only on the sharing file.

• Mammography indicator will have 2 data sources: OHS, and the Ontario Breast Screening Program (will be getting data from OBSP).
• Cervical cancer: do we exclude women who have hysterectomies using hospitalization data? Mary-Anne will check with Philippa Holowaty on methods for doing this and whether it is feasible.
• Pap smears - Use women aged 18+ who were screened in the past 3 years.

• Graham Woodward from CEHIP submitted some comments which Terry and Mary-Anne will look over.

• Daily Smoking - keep the indicator specific to daily smoking but change wording to say ‘when cell size is small, combine daily & occasional, particularly for youth’.
• Former smokers: Have to go back to the stem question if we want to compare the 1990 and 1996. The skip patterns between the two are also different. Stick to ‘Former Daily’ – these estimates will be somewhat reliable. Add it as a category under daily smoking. Probably also best to stick to age 20+.

• Question of whether to include or exclude abstainers – the proportion of current drinkers, and the proportion of low risk drinkers will use the total population as a denominator, whereas the proportion consuming 15 or more drinks per week will use ‘drinkers’ as the denominator with notes under the other categorizations that it can also be expressed per total population.
• will use ages 20+, not 12+
• Low risk: leave in pregnant women (i.e., they’re only low risk if they drink 0)
• Binge drinking now to be called "Frequency of heavy drinking episodes"

• include only the 1996 OHS, not the 1990
• include both weekly activity and energy expenditure

• use the BMI labels suggested by Ruth: Underweight, Acceptable, Possible overweight, Overweight

• This section had not yet been revised

• need more notes about dental data from Ruth
• need notes on IRIS. Hyewon will see if someone from Public Health Branch can do this.

• Directions needed to identify perinatal deaths in HELPS. Hyewon will forward the information to Mary-Anne.

• Need references from Jessie.

• The indicator for flu shot in past year was missing. Mary-Anne will add it in.

• Visited GP or dentist: is it answered by proxy? Yes, because almost half the responses to the general file will be by proxy. A comment will be added to reflect this.
• There are 2 questions which can be used to look at contacts with health professionals. The first one (have you seen your dentist) should be used to measure contact, but the other question (when did you last see your dentist) should be used if trying to get at when the contact was made. Jessie will compare the two questions and get back to Mary-Anne.

The next meeting will not be arranged until comments on the draft have been provided.