Health

Description:

Health services research generally relies on observational data to compare outcomes of patients receiving different therapies. Comparisons of patient groups in observational studies may be biased, in that outcomes differ due to both the effects of treatment and the effects of patient prognosis. In some cases, especially when data are collected on detailed clinical risk factors, these differences can be controlled for using statistical or epidemiological methods. In other cases, when unmeasured characteristics of the patient population affect both the decision to provide therapy and the outcome, these differences cannot be removed using standard techniques. Use of health administrative data requires particular cautions in undertaking observational studies since important clinical information does not exist. We discuss several statistical and epidemiological approaches to remove overt (measurable) and hidden (unmeasurable) bias in observational studies. These include regression model-based case-mix adjustment, propensity-based matching, redefining the exposure variable of interest, and the econometric technique of instrumental variable (IV) analysis. These methods are illustrated using examples from the medical literature including prediction of one-year mortality following heart attack; the return to health care spending in higher spending U.S. regions in terms of clinical and financial benefits; and the long-term survival benefits of invasive cardiac management of heart attack patients. It is possible to use health administrative data for observational studies provided careful attention is paid to addressing issues of reverse causation and unmeasured confounding.

Description:

Most major survey research organizations in the United States and Canada do not include wireless telephone numbers when conducting random-digit-dialed (RDD) household telephone surveys. In this paper, we offer the most up-to-date estimates available from the U.S. National Center for Health Statistics and Statistics Canada concerning the prevalence and demographic characteristics of the wireless-only population. We then present data from the U.S. National Health Interview Survey on the health and health care access of wireless-only adults, and we examine the potential for coverage bias when health research is conducted using RDD surveys that exclude wireless telephone numbers.

Description:

In an effort to increase response rates and decrease costs, many survey operations have begun to use several modes to collect relevant data. While the National Health Interview Survey (NHIS), a multipurpose household health survey conducted annually by the National Center for Health Statistics, Centers for Disease Control and Prevention, is primarily a face-to-face survey, interviewers also rely on the telephone to complete some interviews. This has raised questions about the quality of resulting data. To address these questions, data from the 2005 NHIS are used to analyze the impact of mode on eight key health indicators.

Description:

Many population surveys collecting food consumption data use 24 hour recall methodology to capture detailed one day intakes. In order to estimate longer term intakes of foods and nutrients from these data, methods have been developed that required a repeat recall to be collected from at least a subset of responders in order to estimate day to day variability. During the Canadian Community Health Survey Cycle 2.2 Nutrition Focus Survey, most first interviews were collected in person and most repeat interviews were conducted by telephone. This paper looks at the impact of the mode of interview on the reported foods and nutrients on both the first day and the repeat day and on the estimation of intra individual variability between the first and the second interviews.

Description:

Statistics Canada's Canadian Community Health Survey uses two sample frames and two data collection methods. In cycle 2.1, a change was made in sample allocation between the two frames. A study of the collection method effect by Statistics Canada revealed comparability problems between cycles 1.1 and 2.1. In contrast, the Institut de la statistique du Québec took a comprehensive look at the changes, and classified 178 variables as "comparable" or 'non-comparable". It made recommendations to Quebec users concerning chronological and interregional comparisons.

Description:

This paper describes the sample design used to satisfy the objectives and logistics of the Canadian Health Measures Survey. Among the challenges in developing the design were the need to select respondents close to clinics, the difficulty of achieving the desired sample size for young people, and subsampling for measures associated with exposure to environmental contaminants. The sample design contains solutions to those challenges: the establishment of collection sites, the use of more than one sample frame, and a respondent selection strategy.

Description:

The National Health and Nutrition Examination Surveys (NHANES) is one of a series of health-related programs sponsored by the United States National Center for Health Statistics. A unique feature of NHANES is the administration of a complete medical examination for each respondent in the sample. To standardize administration, these examinations are carried out in mobile examination centers (MECs). The examination includes physical measurements, tests such as eye and dental examinations, and the collection of blood and urine specimens for laboratory testing. NHANES is an ongoing annual health survey of the noninstitutionalized civilian population of the United States. The major analytic goals of NHANES include estimating the number and percentage of persons in the U.S. population and in designated subgroups with selected diseases and risk factors. The sample design for NHANES needs to create a balance between the requirements for efficient annual and multiyear samples and the flexibility that allows changes in key design parameters to make the survey more responsive to the needs of the research and health policy communities. This paper discusses the challenges involved in designing and implementing a sample selection process that satisfies the goals of NHANES.

Description:

In the last two decades, considerable international effort has been put into the development of summary measures of population health that integrate information of mortality and non-fatal health outcomes and international policy interest in such indicators is increasing. There are two main classes of summary measures of population health: health gaps and health expectancies. The Disability-Adjusted Life Year (DALY) is the best known health gap measure and quantifies the gap between a population's actual health and a normative health goal, defined in terms of a global standard life table specifying the healthy years of life lost due to a death at any given age.

This paper gives an overview of the Global Burden of Disease (GBD) conceptual framework, the relationship of the DALY to other measures of population health, and the GBD analytical approach, with particular attention to issues in (1) dealing with biased and missing data, (2) dealing with uncertainty and (3) specific technical issues in ensuring cross-population comparability. The latter include dealing with variations in quality and completeness of cause of death information, explicit use of a comprehensive framework and internal consistency checks for improving comparability of estimates of incidence, prevalence and mortality for causes, the assessment of disability weights, and techniques for improving the comparability of the assessment of the disease burden attributable to risk factors.

Description:

During the last three decades, there has been general acceptance of an approach to describing health states of individuals in terms of multiple domains of health, and in developing self-report instruments that seek information on each of these domains. A health state is thus a multi-dimensional attribute of an individual that reflects his or her levels on the various components or domains of health. Thus, a health state differs from pathology, risk factors or etiology, and from health service encounters or interventions.

How to describe health states, is a central challenge in undertaking the measurement of health. The relationship of health states to other aspects of health such as future non-fatal health outcomes or risk of mortality need to be examined. The way people report their own health varies consistently with factors such as education, sex, age, or other cultural factors. Various people use different response category cut-points across cultures or population sub-groups, and this 'response shift' implies that self-report categorical data are not comparable across individuals. The responses cannot be directly used to measure health without adjustment.

In recognition of this the WHO World Health Surveys (WHS), used a set of questions across a core set of domains to measure health states and employed vignettes to detect and correct for biases in self-report in order to adjust for response category cut-point shifts. This paper will describe the instrument used in the WHS and the methods used to provide cross population comparable data. It will present results from the WHS demonstrating the existence of systematic reporting biases, the ability of respondents to rate vignettes and their use to adjust for biases in order to make data more comparable. Future strategies to address these problems will be discussed.

Description:

In this presentation, Mr. Murray discusses the notion of functional health status and proposes an agenda for developing comparable methods of measuring this concept.

Description:

Number of fetal deaths (stillbirths - 20 weeks or more of gestation) and late fetal deaths (stillbirths - 28 weeks or more of gestation), 1991 to most recent year.

Description:

Number of live births and fetal deaths (stillbirths), by type of birth (single or multiple), 1991 to most recent year.

Description:

Number and percentage of live births and fetal deaths (stillbirths), by place of birth (hospital or non-hospital), 1991 to most recent year.

Description: Estimated annual number of deaths by 5-year age groups and gender for Canada, provinces and territories.

Description: Estimated annual number of births by gender for Canada, provinces and territories.

Description: Components of natural increase, quarterly: births and deaths.

Description: Number and percentage of children and youth with changes or no change in their functional difficulties between 2019 and 2023 by gender and age group, Canada (excluding territories) and provinces.

Description: Number and percentage of youth who report changes or no change in their health characteristics between 2019 and 2023 by gender and age group, Canada (excluding territories) and provinces.

Description: This dashboard presents provisional monthly estimates of the levels of amphetamine, cannabis, cocaine (benzoylecgonine), codeine, fentanyl (norfentanyl), ecstasy, methadone, methamphetamine, morphine, and oxycodone in the wastewater of Halifax, Montréal, Toronto, Saskatoon, Prince Albert, Edmonton, and Metro Vancouver. The data that are relevant for monitoring the use of these substances in Canadian cities.

Description: Drug metabolites in wastewater, presented as load per capita, in select Canadian cities, by type of drug. The 95% confidence interval, standard error, and imputation rate of the load per capita of the drug metabolites in wastewater are included.

Description: This article provides insights into the rates of COVID-19 mortality among First Nations peoples and Métis living in private dwellings and the social determinants of COVID-19 mortality among these populations using data from the 2016 Canadian Census Health and Environment Cohorts linked to the Canadian Vital Statistics – Death Database from 2016 to 2021.

Description: Release published in The Daily – Statistics Canada’s official release bulletin

Description: Using data from the 2022 Canadian Survey on Disability (CSD), this factsheet examines the experiences of 2SLGBTQ+ persons with disabilities. It provides information on various sociodemographic and disability characteristics, such as age, disability type, severity of disability, and employment. It also includes comparisons to the non-2SLGBTQ+ persons with disabilities population by age group.

Description: The Canadian Survey on Disability (CSD) is a national survey of Canadians aged 15 and over whose everyday activities are limited because of a long-term condition or health-related problem.

Description: This study presents an updated sociodemographic profile of children aged 0 to 14 years with affirmative responses largely based on parent reports to the questions on the 2021 Census long-form questionnaire about difficulties with activities of daily living.

Description: Extreme heat has significant impacts on mortality. In Canada, past research has analyzed the degree to which non-accidental mortality increases during single extreme heat events; however, few studies have considered multiple causes of death and the impacts of extreme heat events on mortality over longer time periods. This study analyzes the impacts of extreme heat events on nonaccidental, cardiovascular, and respiratory deaths from 2000 to 2020 in 12 of the largest cities in Canada.

Description: Optimal oral health is an essential element of healthy aging. Oral health problems such as tooth loss, periodontal disease, and dry mouth accumulate throughout adult life and worsen with increasing age. Using data from the 2019/2020 Canadian Health Survey on Seniors, this study explores the link between dental insurance, income, and oral health care access among seniors (aged 65 and over) in Canada. It contributes to the understanding of oral health care among seniors before the implementation of the Canadian Dental Care Plan.

Description: This article examines trends in rates of employment and unemployment, as well as hourly wages and work hours, for the year 2023, and explores how disability intersects with age, sex, educational attainment, and racialized groups to influence labour market outcomes.

Description: The purpose of this document is to define the concept of peer groups, to give an overview of how they are created and to demonstrate their usefulness. This paper presents the 2023 classification of the peer groups.

Description: The Health Research Working Paper Series publishes: analytical work-in-progress; background documentation for specific research projects (e.g methodological papers); lengthy reports intended for specific clients, and; compendiums of data tables. Publication in this series does not preclude publication of specific aspects of the work in a peer-reviewed journal.

Description: This survey collects the financial and operating data needed to develop national and regional economic policies and programs.

Description: The main objective of the Survey on Maternal Health is to collect information from biological mothers about their pregnancy and postpartum experiences.

Description: The data contain detailed confirmed cases of coronavirus disease (COVID-19) in Canada, which is compiled by the Public Health Agency of Canada, with the contribution from provincial and territorial Health ministries.

Description: The purpose of this crowdsource questionnaire is to understand the impacts of COVID-19 on Canadian health care workers, with particular focus on access to personal protective equipment (PPE) and infection prevention and control (IPC) measures in the workplace.

Description: The Simcoe Muskoka Opioid Overdose Cohort (SMOOC) is an expansion of a pilot project that had previously been conducted with the province of British Columbia to better understand the characteristics of people who experienced an opioid overdose. The objective of the SMOOC was to create a cohort of individuals who experienced a fatal or non-fatal overdose in the Simcoe Muskoka area between January 2018 and December 2019.

Description: The purpose of this survey is to understand the impact of the COVID-19 pandemic on health care workers in Canada.

Description: This survey covers topics such as the use of and access to primary health care and specialist care, care coordination, barriers to care, prescription medications, and out-of-pocket expenses. The results may be used by Health Canada, the Public Health Agency of Canada, and provincial ministries of health to help inform the delivery of health care services and develop and improve programs and policies to better serve all Canadians.