Tuesday, July 7, 1998
10:00 am - 3:00 pm
North York Civic Centre
Committee Room #4

Present:  Mary-Anne Pietrusiak, Durham Regional Health Unit (Chair)
                Patrick Seliske, Waterloo Regional Community Health Department
                Julie Stratton, Perth District Health Unit
                Hyewon Lee-Han, Population Health Service, Public Health Branch
                Ian Johnson, Toronto Public Health, North York Office
                Jessie Wong, IPE Branch, Ministry of Health
                Carol Paul, IPE Branch, Ministry of Health
                Jo-Anne Peterson, Kingston, Frontenac and Lennox and Addington Health Unit
                Nam Bains, Health Information Partnership, Eastern Ontario Region

Others:   Anna Goral, Toronto Public Health, North York Office
                Jill Mallon, Toronto Public Health, North York Office

Corresponding Member: Dr. Vivek Goel, ICES

Regrets: Terry Delmore, Halton Regional Health Department
                Ruth Sanderson, Sudbury and District Health Unit
                Vic Sahai, Northern Health Information Partnership
                Doug Manuel, Federal Field Epidemiologist, Ministry of Health

2.0 Provincial Health Status Update (Ian Johnson)

Currently, the provincial health status report is falling two to four weeks behind schedule because of hold-ups in data availability.

• Abortion data is not available in computerized form, only in hard copies. Ian, Hyewon and Chee to meet next week with contact person to overcome issue of paper copies in early years and to work out electronic access to database.
• Congenital Anomalities - Neural tube defect data is available, but other detailed data within the Congenital Anomalies database is not. Registry data will be used vs. extractions from hospital separation.
• Livebirths - 1995 data is being updated due to geographic coding issues. The data should be available in the next two weeks. Stillbirth data is still being investigated.
• ARF reports have been obtained; investigating whether requests for additional breakdowns are required.
• CHIRPP data - summary data are available; a detailed request including mock tables has to be submitted.
• Cancer Incidence database is available and is being reviewed to get verification on numbers from Cancer Care Ontario as well as a copy of algorithm for calculations to make analysis more consistent.
• Ministry of Transportation data - agreement on access of summary data has been obtained.
• Life Expectancy and PYLL calculations - Ian spoke to Russell Wilkins, of Statistics Canada. He verified that Stats Canada truncates the age variable. He agrees this is an underestimate of age and in doing live expectancies, they add the 0.5 back to each year (assuming equal deaths by months of the year). In terms of PYLL, this addition of 0.5 is not done since it is not a meant as a calculation of risk. Rather, it uses what people commonly report as age. For reasons of comparability, he recommends we use the truncated age variable. In terms of recorded versus calculated age, he agrees that the calculated age is likely more accurate. Therefore, we are following the Stats Canada method.

(Doug Manuel will also be consulted on the Life Expectancy calculation)

• Mental Health - access to data from psychiatric hospitals is being explored.
• OHS96 - Documentation from Statistics Canada is still lacking. Without this documentation it is difficult to know which variable is which. The Information, Planning and Evaluation Branch continues to work on it. Public use file will be available in the fall.
• RDIS - Request to Monika Naus has been submitted. Ian, Hyewon and Anna are meeting Monika on July 9^th to discuss the transfer of databases.
• CIHI data- ICES is prepared to start analysis once the mock tables are in place.
• Census data - arrived and Jill Mallon is now beginning the analysis.

3.0 Behaviour and Health (Jessie Wong)

(See handout distributed by Jessie during the previous meeting)

Related derived variables will be provided next week by Jessie in order to clarify some operational definitions.

• Smoking prevalence by age and sex (distribution). Jessie to check out distribution for next meeting.

Recommendation: by age groups: 12-19, 20-44, 45-64, 65+

• Smoking prevalence among 12-19 years olds
• Age of initiation of smoking indicator was excluded because it is too difficult to interpret at the local level.
• Proportion of tobacco vendors non-compliance with sales to minors - number of tickets and convictions under Ontario Tobacco Control Act is available through CISS. Process indicator to be investigated. Will not be included if already in Ministry's list of compliance indicators.
• Proportion of smoke-free homes

• Proportion consuming 15 or more alcoholic drinks per week
• Prevalence of heavy alcoholic consumption as defined by ARF to be investigated by Ian.
• Population distribution of binge drinking - 5 more drinks in one occasion during the previous 12 months as defined in OHS 96. Note that the OHS 90 defined binge drinking as 10 or more drinks. Jessie will look at distribution to provide recommendation on collapsing categories
• Prevalence of drinking and driving from OHS 96 - In the past 12 months, how many times did you drive when you perhaps had too much to drink? (different from previous question in 1990 OHS which was part of SMAST index)

• Make a note that an indicator showing prevalence of drinking being a problem (such as SMAST from OHS 90) is not in the OHS 96.

• Population distribution of physical activity - Jessie to look at distribution
• Participation of accumulated, moderate physical activity (adults and youth)- Ian to operationalize this indicator
• Proportion of children who are active - include on problem list, Ministry needs to operationalize
• Population distribution of Body Mass Index (OHS90 and OHS96)

(B.M.I as a distribution: less than 20, 20.0-25.0, 25.1-27.0, greater than 27)

Nutrition (OHS 1990 only):

• Average fat intake as percent of calories- ages 18+
• Carbohydrates as percent of energy
• Consumption of vegetables and fruits (five or more servings)
• Consumption of grain products (five or more servings)

*Hyewon will investigate the Family Food Expenditure Survey from Stats Can

4.0 Final Report Format (Mary-Anne Pietrusiak)

It had been suggested that the final report includes:

• Name of indicator
• Definition
• Interpretation
• Data source (numerator and denominator)
• Calculation (includes missing data)
• Limitations
• References

Mary -Anne will prepare the suggested format for a draft indicator and she will e-mail it the members of the PHIWG. Once this format has been agreed upon, each member will prepare their indicators according to the prescribed format and e-mail it, in simple text (no tables) to Mary-Anne. Mary-Anne will put all the indicators together in a draft report that will be reviewed at the September 8^th meeting. The draft will then be sent out to health units, DHCs, Public Health Branch at the Ministry, and Health Intelligence Units for comments.

5.0 Population (Julie Stratton)

(See handout distributed by Julie during the meeting)

• Population by age and sex - include 1991 data onward, 5-year age groups, up to 85+
• Dependency ratio (total, child, aged dependency ratio)
• Male/female sex ratio - to be dropped
• Population growth rate - total population will be used with no age breakdowns (1991 Census and 1996 Census)
• Proportion of immigrants
• Proportion of recent immigrants (last 5 years)
• Ethnicity - under limitation section: refusal rate should be taken into account as this will underestimate the final numbers
• Mother tongue - under limitation section: refusal rate should be taken into account as this will underestimate the final numbers
• Home language
• Proportion of Allophones

5.0 Leading Causes of Mortality and Morbidity (Patrick Seliske)

(See handout distributed during the previous meeting)

Mortality and morbidity data can be handled at the same time as long as it is kept in general format. Leading causes of mortality and morbidity will be done by chapter heading, and only some significant diseases will be separated and put elsewhere in the framework. Suggested specific diseases will include:

Chronic Diseases (mortality and PYLL to be calculated for each item):

• Ischemic heart disease (ICD9: 410-414)
• Stroke (ICD9: 430-438)
• Congenital obstructive lung disease (ICD9: 490-496)
• Female breast cancer (ICD9: 174)(include calculation of incidence as well)
• Cervical cancer (ICD9: 180)
• Prostate cancer (ICD9: 185)
• Colorectal (ICD9: 153, 154)
• Melanoma (ICD9: 174)
• Lung Cancer (ICD9: 162)

Hospital Separation Data

In addition to chronic disease listed above, morbidity data will include diabetes, (ICD9: 250) and pelvic inflammatory disease (ICD9: 614).
*Ian to provide ICD-9/RDIS codes for infectious diseases.

Standardization of Analysis of Mortality and Morbidity Data

The group decided that age and gender specific rates will be recommended. Standard indicator will be SMR for males and females.