Provincial Health Indicators Work Group
Friday, May 21, 1999
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 (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
1.0 Status of the report
- most sections are coming along
- have talked to Brian Laundry about putting the indicators on the APHEO website
1.1 ICES Report
- 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 havent distributed them yet.
- ICES will be using the OHS share file and will be doing analysis at level of 23 OHS
2.0 Presentations and Articles
- CPHA presentation
Mary-Anne is going to Winnipeg from June 7-9 to do a poster and 5 minute oral
presentation on the indicators.
2.2 PHERO Article
Mary-Anne has revise and update the article she wrote some time ago. Shell send
out a final draft to everyone if anyone wants to comment.
2.3 OPHA Abstract
An abstract very similar to the one submitted for CPHA has been submitted to OPHA for
the November, 1999 conference.
- Issues to Resolve
3.1 1996/97 OHS sharing file vs. NPHS public use
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 youre using, and why youre 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
theyll 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.
- 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)
- Standardization Notes
- The notes refer to small numbers: but how small is small? Since its
hard to define, its 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 youre looking at (not 1991).
- SRATE using Canadian 1991 population is fine.
- use not-real instead of fictitious to talk about standardized rates:
its the estimate you would have seen if the population had been the same as the
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
- Standardization of OHS data
difference between basic & other (what goes where), is SMR basic or other? Basic:
age, sex, ICD-9 codes, geography, Other: standardization (SMRs, SRATEs) etc
- Next Steps
- 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.
- 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.
- Work through the Sections
Section 2: Population
- 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
- add category of Other (under basic categorization) for Mother Tongue and
- Population growth rate should be changed to population growth.
Section 3a: Social Environment
- 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
Section 3b: Physical Environment
- 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
its collected in.
Section 4: Mortality & Morbidity
- 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)
Section 5: Health-Related Quality of Life
- 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.
Section 6ab: Chronic disease and Cancer Incidence and Early Detection of Cancer
- 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
- Pap smears - Use women aged 18+ who were screened in the past 3 years.
Section 6c: Injury Prevention and Substance Abuse Prevention
- Graham Woodward from CEHIP submitted some comments which Terry and Mary-Anne will look
Section 7: Health Behaviour
- Daily Smoking - keep the indicator specific to daily smoking but change wording to
say when cell size is small, combine daily & occasional, particularly for
- 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., theyre 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,
Section 8a: Sexual Health
- This section had not yet been revised
Section 8b: Child and Adolescent Health
- 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.
Section 9: Mental Health
- Need references from Jessie.
Section 10: Infectious Diseases
- The indicator for flu shot in past year was missing. Mary-Anne will add it in.
Section 11: Use of Health Services and Medication
- 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
The next meeting will not be arranged until comments on the draft have been provided.