Description | Specific Indicators | Ontario Public Health Standards (OPHS) | Corresponding Health Indicator(s) from Statistics Canada and CIHI | Corresponding Indicator(s) from Other Sources | Data Sources | Survey Questions | Alternative Data Sources | Analysis Check List | Method of Calculation | Basic Categories | Indicator Comments | Definitions | Cross-References to Other Indicators | Cited References | Other References | Changes Made | Acknowledgements

• Proportion of the population‡ that reported an injury in the past 12 months.

In the past 12 months:

• Proportion of the population‡ that reported an injury†.
• Proportion of the population‡ that reported an injury† which required attention from a health professional*.
• Proportion of injuries† that resulted in hospitalization.
• Proportion of the population‡ that reported a non-activity limiting injury which required attention from a health professional*.
• Proportion of the population‡ that reported any injury (activity-limiting† or non-activity limiting).
• Proportion of self-reported injuries† that resulted in an emergency department (ED) visit.
• Proportion of self-reported injuries† that resulted in hospitalization.
• Proportion of injury-related† ED visits that were due to fall-related injury†.
• Proportion of fall-related injuries† that resulted in an ED visit.
• Proportion of injury-related† hospitalizations that were due to falls.
• Proportion of fall-related injuries† that resulted in hospitalization.

‡Population: those 12 years of age and older.
†Activity Limiting Injury: an injury serious enough to limit normal activity the day after the injury occurred.
*Health professional: includes physician, nurse, physical therapist, massage therapist, chiropractor, other.

• Board of Health Outcome (Prevention of Injury and Substance Misuse): The board of health is aware of and uses epidemiology to influence the development of healthy public policy and its programs and services for the prevention of injury and substance misuse.
• Board of Health Outcome (Foundational Standard): The public, community partners and health care providers are aware of relevant and current population health information.

http://www.ontario.ca/publichealthstandards 

• Age-Standardized Injury Hospitalization Rate (per 100 000)

http://www.cihi.ca/hirpt

• None

 * module not selected by any Ontario health region or not included in the CCHS survey year or question not included in the module

Note: Please consult data dictionaries for changes to response categories over CCHS cycles.
†Activity-limiting Injury: an injury serious enough to limit normal activity the day after the injury occurred.

* module not selected by any Ontario health region or not included in the CCHS survey year or question not included in the module

Note: Please consult data dictionaries for details of changes to response categories over CCHS cycles. 
† injuries serious enough to limit normal activities
n/a: not asked 

• Discharge Abstract Database (DAD), Canadian Institute for Health Information (CIHI)
• National Ambulatory Care Reporting System Data

• It is recommended that public health units use the Share File provided by the Ministry of Health and Long-Term Care rather than public use file (PUMF) provided by Statistics Canada. The Share File has a slightly smaller sample size because respondents must agree to share their information with the province to be included; however, the share file has more variables and fewer grouped categories within variables. The Share File is a cleaner dataset for Ontario analysis because all variables that were not common content, theme content or optional content for Ontario have been removed.
• Users need to consider whether or not to exclude the ‘Refusal, 'Don't Know' and ‘Not Stated' response categories in the denominator. Rates published in most reports, including Statistics Canada's publication Health Reports generally exclude these response categories.
• In removing not stated responses from the denominator, the assumption is that the missing values are random, and this is not always the case. This is particularly important when the proportion in these response categories is high.
• Estimates must be appropriately weighted (generally the share weight for the CCHS) and rounded.
• Users of the CCHS Ontario Share File must adhere to Statistics Canada's release guidelines for the CCHS data when publishing or releasing data derived from the file in any form. Refer to the appropriate user guide for guidelines for tabulation, analysis and release of data from the CCHS. In general, when calculating the CV from the share file using the bootstrap weights, users should not use or release weighted estimates when the unweighted cell count is below 10. For ratios or proportions, this rule should be applied to the numerator of the ratio. Statistics Canada uses this approach for the tabular data on their website. When using only the Approximate Sampling Variability (CV) lookup tables for the share file, data may not be released when the unweighted cell count is below 30. This rule should be applied to the numerator for ratios or proportions. This provides a margin of safety in terms of data quality, given the CV being utilized is only approximate.
• Before releasing and/or publishing these data, users should first determine the number of sampled respondents who contributed to the calculation of the estimate. If this unweighted number is less than 30, the weighted estimate should not be released regardless of the estimate's coefficient of variation (C.V.). For unweighted estimates of 30 or more, users should determine the C.V. of the rounded weighted estimate and follow the guidelines below:
• Acceptable (C.V. of 0.0 - 16.5) Weighted estimates can be considered for general unrestricted release. Requires no special notation.
• Marginal (C.V. of 16.6 - 33.3) Weighted estimates can be considered for general unrestricted release but should be accompanied by a warning cautioning of high sampling variability.
• Unacceptable (C.V. greater than 33.3) Statistics Canada recommends not releasing estimates of unacceptable quality. However, if the user chooses to do so then estimates should be flagged and the following warning should accompany the estimates: "The user is advised that . . .(specify the data) . . . do not meet Statistics Canada's quality standards for this statistical program. Conclusions based on these data will be unreliable and most likely invalid". These data and any consequent findings should not be published. If the user chooses to publish these data or findings, then this disclaimer must be published with the data.

Note: 2009/2010 variable names are provided in the above equations. Please consult data dictionaries or the Survey Questions section for changes in variable names over CCHS cycles.
‡Population: those 12 years of age and older.
†Activity Limiting Injury: an injury serious enough to limit normal activity the day after the injury occurred.
*Health professional: includes physician, nurse, physical therapist, massage therapist, chiropractor, other.

• Age groups for age-specific rates: 12-19, 20-44, 45-64, 65+
• Sex: male, female and total
• Geographic areas of residence: Ontario, public health unit

• According to the Institute for Clinical Evaluative Sciences (ICES, 2002-2003), someone visits an emergency department approximately every 30 seconds and someone is hospitalized about every 10 minutes in Ontario due to an injury (1).
• In 2009-2010, there were 1,277,121 visits made to EDs for trauma, accounting for almost one-quarter (22.2%) of all visits. Of these, 30.7% were due to unintentional falls (391,839 visits), while 8.8% were due to motor vehicle collisions (111,928 visits). The highest proportion of fall-related ED visits were observed in females age 65 and older (17.3%) and males younger than 20 (18.3%) (2).
• Falls resulting in less serious injuries in older adults may still contribute to a cycle of fear of falling, decreased participation, weakness and deconditioning which increases falls risk (3, 4).
• ED visit and hospitalization data will not capture those who did not seek treatment for an injury in a hospital or those who sought medical attention elsewhere and may therefore underestimate burden of injury.
• Self-reported data from the CCHS will capture individuals who did not seek treatment in hospital but will not include those who died or who were institutionalized as a result of injury (5).
• Prior to 2007, CCHS data collection occurred every two years on an annual period. Data are available for the 2001, 2003 and 2005 periods. In 2007, major changes were made to the survey design with the goal of improving its effectiveness and flexibility through data collection on an ongoing basis. Data collection now occurs every year, from January through December, rather than every two years as was the case prior to 2007 (6).  
• "Injuries" is optional content in the CCHS and was selected as follows:
• 2000/2001 (cycle 1.1): all Ontario health regions
• 2003 (cycle 2.1): all Ontario health regions
• 2005 (cycle 3.1): all Ontario health regions
• 2007/2008: not selected by Ontario
• 2009/2010: Theme Content - all of Canada

• Activity Limiting Injury - an injury serious enough to limit normal activity the day after the injury occurred. 
• Health Professional - includes physician, nurse, physical therapist, massage therapist, chiropractor, other

1. Ministry of Health and Long-term Care [homepage on the Internet]. Toronto: Queen's Printer for Ontario; 2011 Oct 21 [2012 Jan 27]. Quick Facts: emergency department visits for injury. Available from: http://www.mhp.gov.on.ca/en/prevention/injury-prevention/facts.asp.
2. Canadian Institute for Health Information. Highlights of 2009-2010 inpatient hospitalizations and emergency department visits. Ottawa: Canadian Institute for Health Information; 2011 [cited 2012 Jan 27]. Available from: https://secure.cihi.ca/free_products/quickstats_dad_nacrs_2009_10_highlight_en.pdf.
3. British Columbia Ministry of Health Planning. Prevention of falls and injuries among the elderly. Victoria: British Columbia Ministry of Health Planning, Office of the Provincial Health Officer; 2005 [cited 2012 Jan 26]. Available from: http://www.health.gov.bc.ca/library/publications/year/2004/falls.pdf.
4. Scheffer AC, Schuurmans MJ, Van Dijk N, Van Der Hooft T. Fear of falling: measurement strategy, prevalence, risk factors and consequences. Age and ageing. 2008 [cited 2012 Jan 26];28:19-24. Available from: http://ageing.oxfordjournals.org/content/37/1/19.full.pdf+html.
5. Billette JM, Jans T. Injuries in Canada: insights from the Canadian Community Health Survey. Health at a Glance Statistics Canada Catalogue no. 82-624-X. Ottawa, ON: Her Majesty the Queen in
   Right of Canada; 2011 [cited 2012 Jan 10]. Available from: http://www.statcan.gc.ca/pub/82-624-x/2011001/article/11506-eng.pdf.
6. Statistics Canada [homepage on the Internet]. Ottawa: Statistics Canada;2012 Nov 27 [cited 2012 Dec 14]. Canadian Community Health Survey 2010. Available from: http://www.statcan.gc.ca/cgi-bin/imdb/p2SV.pl?Function=getSurvey&SDDS=3226&lang=en&db=imdb&adm=8&dis=2.

1. Canadian Institute for Health Information [homepage on the Internet]. Ottawa: Canadian Institute for Health Information; 1996-2012 [cited 2012 Jan 27]. Trauma and injuries. Available from: http://www.cihi.ca/CIHI-ext-portal/internet/EN/TabbedContent/types+of+care/specialized+services/trauma+and+injuries/cihi010639.
2. Canadian Institute for Health Information.  Ontario Trauma Registry 2011 Report: major injury in Ontario. Ottawa: Canadian Institute for Health Information; 2011 [cited 2012 Jan 27]. Available from: https://secure.cihi.ca/free_products/OTR_CDS_2009_2010_Annual_Report.pdf.
3. Canadian Institute for Health Information. Analysis in Brief. Emergency departments and children in Ontario. Ottawa: Canadian Institute for Health Information; 2008 [cited 2012 Jan 27]. Available from: http://secure.cihi.ca/cihiweb/products/aib_apr24_08_en.pdf.
4. Macpherson AK, Schull MJ, Manuel D, Cernat C, Redelmeier DA, Laupacis A. Injuries in Ontario: ICES Atlas. Toronto, ON: Institute for Clinical Evaluative Sciences; 2005 [cited 2012 Jan 26]. Chapter 1, General Description of Injuries in Ontario. 2002-2003; p. 1-22. Available from: http://www.ices.on.ca/file/injuries_chp1_final.pdf.
5. SMARTRISK. The economic burden of injury in Canada. Toronto: SMARTRISK; 2009 [cited 2012 Jan 26]. Available from: http://www.smartrisk.ca/downloads/burden/Canada2009/EBI-Eng-Final.pdf.
6. Peden M, Oyegbite K, Ozanne-Smith J, Hyder AA, Branche C, Fazlur Rahman AKM et al, editors. World report on child injury and prevention. Geneva: World Health Organization, 2008 [cited 2012 Jan 26]. Available from: http://whqlibdoc.who.int/publications/2008/9789241563574_eng.pdf.