Thursday, October 1, 1998
9:30 AM - 3:30 PM
North Board Room, North York Civic Centre

Present: Mary-Anne Pietrusiak, Durham Regional Health Unit (Chair)
                Hyewon Lee-Han, Population Health Service, Public Health Branch
                Jo-Anne Peterson, Kingston, Frontenac- Lennox and Addington Health Unit
                Julie Stratton, Perth District Health Unit
                Terry Delmore, Halton Regional Health Department
                Carol Paul, IPE Branch, Ministry of Health
                Jessie Wong, IPE Branch, Ministry of Health
                Doug Manuel, Federal Field Epidemiologist, Ministry of Health

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

Corresponding Member: Dr. Vivek Goel, ICES

Regrets: Patrick Seliske, Waterloo Regional Community Health Department
                Ruth Sanderson, Bruce-Grey-Owen Sound Health Unit
                Nam Bains, Health Information Partnership, Eastern Ontario Region
                Vic Sahai, Northern Health Information Partnership

The indicators for the Environment and Health: Physical Environment Section have been forwarded to David Yap from the Ministry of the Environment for review.

For all indicators, the General Comments section has been changed to Indicator-Specific Comments.

• Air Quality Index

In the Method of Calculation section, the equation should contain a denominator. "The Total # of hours in a year that AQI was greater than 31" should be relative to "total number of hours in the year the air quality was monitored."

In the Usage section, the sentence "High AQI can have adverse effects on the health of large segments of the exposed population, particularly those with respiratory or heart problems" has been moved to Indicator-Specific Comments.

Also under Indicator-Specific Comments, it should be noted that this indicator is site specific based on where the monitor is located in PHU area. It is not a complete picture of the air quality in the community; therefore it cannot be used to assess the air quality of a large area like a health unit.

Other changes to the Indicator-Specific Comments include the sentence, "To compare over time and place." It should read "To compare over time by location." Also, the comments should expand on how the method of calculation has chanced in 1996.

• Ultraviolet Radiation Index

Data Source: Environment Canada

The categories in the Basic Categorization should be added to the definition in the Description section.

Method of Calculation - This section contains no denominator. Maximum readings in a day could be used as a denominator and then converted to % of days.

Other Categorizations - Specific season or month can be included.

Usage section - The sentence needs to be rephrased "To measure the intensity of harmful UV rays that can cause sunburn, which is associated with such long-term harm as skin cancer."

Concern was raised on how the data is collected for this indicator and how it can be obtained for individual health units. This indicator is vague on the geography cut off point between health units. Also, the group discussed how this indicator relates to Sun Safety Objectives from Mandatory Guidelines. This should be documented in the Indicator-Specific Comments section.

• Trihalomethanes (THMs) in Drinking Water

Method of Calculation section: add the denominator, number of days in a year.

Comments Section: rephrase the sentence, "Some sources of drinking water are excluded from the Drinking Water Surveillance Program (DWSP) including households on wells" and expand on DWSP and the difference between IMAC and MAC.

Delete the sentence, "While levels in Metro Toronto rarely exceed the IMAC, other jurisdictions may. Even areas with THMs below the IMAC may be in concern as the Maximum Acceptable Concentrations (MACs) are lowered.

Include a statement on how THMs are formed in the environment. Also, Great Lakes Health Effects (i.e. bladder cancer, etc.) need to be investigated and referenced.

• Posted Beach Closings

Method of Calculation: {Total number of days posted per season per beach/Total number of days monitored}*100

Basic Categorizations section: The sentence should read "Acceptable Benchmark <=100 E.coli/100ml of water" and has been moved to Indicator-Specific Comments section.

Basic Categorizations section has been changed and should read "Geographical area: by public beach.

Usage section- E.coli is an organism that indicates the potential presence of pathogens will be moved to the Indicator-Specific Comments section.

References to be included.

• Perceived Health

Description: "Proportion of people aged 12 and over that perceive themselves to be in 1) Excellent/Very Good Health, 2) Good Health, 3) Fair/Poor Health".

Basic Categorizations: 1) Excellent/Very good; 2) Good; 3) Fair/Poor.

Method of calculation: (by each category)

{number of people aged 12 and over reporting to be in excellent/very good health/total number of people aged 12 and over }*100

Data Sources: Numerator and denominator: OHS90 and OHS96/97.

Other categorization: add Sex-specific: male, female.

Indicator-Specific Comments: confirm if married persons see themselves as less healthy than the general population. Exclude missing responses (not stated or refusals) (Jessie to check labels).

• Prevalence of Selected Chronic Health Problems

Description: Proportion of people aged 12 and over having selected chronic diseases: 1) COPD or asthma, 2) Diabetes, 3) High blood pressure, relative to the total population aged 12 and over.

Data sources: OHS90 has been included as an additional data source.

Indicator-Specific Comments: "Subjective indicator of the morbidity of the population. COPD and asthma are combined because of the difficulty in clinically differentiating them in adults" (need reference). Add the sentence, Exclude missing responses.

• Breast Cancer Screening

Indicator name may be changed to Mammography or Clinical Breast Exam.

Description: "Proportion of women 50-69 who have had a mammogram in the past two years relative to the total population of women aged 50-69".

Comments section: This indicator is not specific to the OBSP.

• Cervical Cancer Screening

Description: "Proportion of women age 18 and over ever screened for cervical cancer relative to the total population of women aged 18 and over".

Add also in the Description section, "Proportion of women age 18 and over screened for cervical cancer in the last 3 years relative to the total population of women aged 18 and over".

Method of calculation: {number of women aged 18 and over ever having a pap smear/ total number of women aged 18+}*100

Data sources: OHS90 has been included as an additional data source.

Usage section: Sentence "Cervical Cancer is completely treatable if detected early" has been moved to Indicator-Specific Comments section.

Cervical Cancer Screening most recent guidelines and references to be checked.

• Incidence of Leading Cancers

Description: "New cases of cancer by ICD-9 codes during given year represented by: 1) Crude Rate, 2) Age-Specific Rate, 3) Standardized Incidence Ratio".

Method of calculation: {number of new cases of cancer by ICD-9 codes /Total population}* 100,000

Indicator-Specific Comments section: Delete sentence "are at the top of the list for number of new cases and PYLL. Approx. 50% of new cases could be prevented."

Comments on age-standardization and use of adjusted 1991 Canadian population (Doug and Hyewon).

3.0 INJURY PREVENTION (Terry Delmore)

• Death from Selected Causes of Injury

Delete from the Description section, "Injury causes of death are currently defined using external cause or "E" codes from the ninth revision of the WHO International Classification of Disease" Add to the Indicator-Specific Comment section.

Methods of Calculation should include: 1) Crude Rates, 2) Age-Specific Rates, 3) Standardized Mortality Ratio (SMR).

Basic Categorization: E814 will not be used for Pedestrian (traffic-related) injuries. Codes ending in .7 E810-E819 will be used. Boats: codes ending in .0, .1, .4, or .5 for E830-E838 will be used. Suffocation, including choking will be label for that category.

Other Categorizations: Breakdown by sex: males, females.

Usage: Expand on last sentence, Mandatory Health Programs and Service Guidelines. Add in the sentence, To increase the length and quality of life by reducing the mortality and morbidity associated with chronic diseases, injuries and substance abuse (pg.20).

Comments: ICD-9 codes are not specific enough to determine "drowning in waters used for specific recreational purposes.

Reference: The WHO International Classification of Disease, ICD-9.

• Hospital Morbidity from Selected Causes of Injury

Description: Delete the sentence, "Discharge injury diagnoses are defined using external cause or "E" codes from the ninth revision of the WHO International Classification of Disease" and add to Indicator-Specific Comment section.

Data Distributor: Include Data Warehouse in brackets.

Basic Categorization: E814 to be removed from the Pedestrian (traffic-related) section. Codes ending in .7 E810-E819 to be used instead. The Category NearDrowning is to be included.

The Homicide category should be changed to 'Assault'.

• Alcohol-Related Injuries and Deaths from Motor Vehicle Traffic Collisions

Change title to include deaths.

Add to the Basic Categories section from the Description section: 1) Had been drinking, 2) Ability Impaired, Alcohol (over 0.08), 3) Ability Impaired, Alcohol.

Indicator-Specific Comments: Collisions are categorized geographically by where they occurred, not by the residence of the driver or injured person; however, in 1995, CEHIP arranged for the name of the driver to be linked to the drivers license file in order to obtain information on drivers residence. The linking was done for one arbitrary day of the year. The driver may not have been living at that residence on the day of the collision.

May be underestimated because information about alcohol impairment is not available in hit and run collisions.

Terry to include comments of the Motor Vehicle Traffic Collisions Database.

• Long-term Care Bed Ratio

Move from Description section the sentence, "Currently operating long-term beds are defined as those beds currently licensed, in place and open for (if not filled with) clients" and add to Indicator-Specific Comment section.

Method of Calculation: Delete age categories in the numerator.

{Number of currently operation long-term care beds/Total population aged 65+}*100

{Number of currently operation long-term care beds/Total population aged 75+}*100

Data Sources: Long-Term Care Division, Ontario Ministry of Health.

Other Categorizations: Geographic areas: Census Division.

Comment on population estimates: Add in-"Estimates are continually being revised.", "Population estimates are based on current estimates of patterns of fertility, mortality, immigration refugees, and internal mobility of the population....(Check with Carol Pauls write-up).

Indicator-Specific Comments: Different denominator may be available from the Institutional Branch of the Ontario Ministry of Health.

• Population Projections for Seniors

Description: "Projected proportion of population 65 years and over relative to the total projected population".

Data Source: delete the year 1992 onwards.

Basic Categorization: delete "Single years".

• Living Arrangements for Seniors

Move the definitions of private households in the Description column to Indicator-Specific Comments section.

Method of calculation: Change to {number of people aged 65 years and over by living arrangement/total number of non-institutional persons 65+}*100.

Basic Categorization: Add "Living with relatives, non-relatives, alone

• Selected Causes of Death Among Seniors ; indicator deleted

Change title to from Leading causes to "Selected Causes of Hospitalization Among Seniors.

Data Sources: Delete out the years of data availability.

Basic Categorization: Delete ICD-9 Chapters. This section should read Age-specific (65-74, 75-84, 85+) groups for all cause mortality.

Other Categorizations: Age groups to be added.

Comments on Hospitalization Data: Change sentences to read, The most responsible diagnosis gives the primary reason for the hospital stay. Diagnosis codes after the most responsible diagnosis are not as reliable.

Also change the sentences, Data are based on geographic place of residence and not location of hospital and Data can be analyzed by fiscal or calendar year.

Delete the sentence, Data processing procedures are not always documented or available in a form that is helpful to the research process. And The complexity of disease process and the means by which the associated pathology is investigated affects diagnostic accuracy.

Indicator-Specific Comments should include the sentence, Co-morbidity contributes uncertainty to classifying the underlying cause(s) of death.

• Fall-Related Deaths Among Seniors

Data Sources: Delete out the years of data availability.

Basic Categorizations: Add age categories of 65 to 74 years, 75 to 84 years, 85+ years.

Indicator-Specific Comments: Delete out the sentence, "Reflects the upper limit of the disease severity continuum.

• Hospitalizations From Fall-Related Injuries Among Seniors

Indicator title has been changed from Fall-Related Injuries among Seniors to Hospitalizations from Fall-Related Injuries Among Seniors.

Description: Annual number of fall-related (E880 E888) hospital separations in seniors aged 65 years and older per 100,000 population aged 65 years and older. Delete the sentence, "Falls are based on the most responsible diagnosis..."

Data Sources: Delete the years of data availability.

Comments on Hospital Data: Change 3rd bullet to read, "The most responsible diagnosis gives the primary reason for the hospital stay..."

Indicator-Specific Comments: Add in "E codes are not included in the most responsible diagnosis (excluded from the hospital comments).

• Activity Limitations Among Seniors

Data Sources: Code for Question within OHS will be different from code listed.

Other Possibilities that are similar to this indicator are: