Community and health system characteristics

Community
Health system
Resources

Community

Population estimates

Definition:
The number of people living in a geographic area by age and sex.

A population’s size and age/sex composition impact the health status of a region and its need for health services. Population data also provide the "denominators" used to calculate rates for most health and social indicators.

Sources:
Statistics Canada, Demography Division. Data are derived from the Census and administrative sources on births, deaths, and migration. Population growth for Alberta and British Columbia were supplied by Alberta Health and Wellness and BC Stats respectively.

Population density

Definition:
Number of people per square kilometre. Calculated by dividing the total population by land area.

Sources:
Statistics Canada, 1996 and 2001 Census, and Geography Division (special tabulations)

Dependency ratio

Definition:
The ratio of the combined child population (aged 0 to 14) and elderly population (aged 65 and over) to the working age population (aged 15 to 64). This ratio is usually presented as the number of dependents for every 100 people in the working age population.

Canadians aged 65 and over and those under age 15 are more likely to be socially and/or economically dependent on working age Canadians, and they may also put certain additional demands on health services.

Sources:
Statistics Canada, Demography Division. Data are derived from the Census and administrative sources on births, deaths, and migration.

Urban and rural population

Definition:
People living in urban areas. An urban area is defined as having a minimum population of 1,000 and a population density of 400 people per square kilometre.

This community characteristic allows users to compare regions with similar proportions of urban/rural population.

Source:
Statistics Canada, 1996 and 2001 Census

Aboriginal population

Definition:
Aboriginal people living in a geographic area. Aboriginal people are those persons who reported identifying with at least one Aboriginal group (e.g. North American Indian, Métis or Inuit) and/or those who reported being a Treaty Indian or a Registered Indian as defined by the Indian Act and/or those who were members of an Indian Band or First Nation.

Health status characteristics and non-medical determinants of Aboriginal people differ from the non-Aboriginal population, for example, infant mortality, unintentional injury deaths, suicides and smoking rates. Knowing the proportion of Aboriginal people in a geographic area provides context to better interpret health indicators.

Sources:
Statistics Canada, 1996 and 2001 Census (20% sample), 1996 and 2001 Census Coverage Studies, and Demography Division (population estimates)

Immigrant population

Definition:
All immigrants living in a geographic area, and those immigrants who came to Canada during the 15 years prior to Census Day.

Canadian, American and Australian studies have shown that immigrants, particularly non-European immigrants, generally have a longer life expectancy and lower risk of certain chronic conditions than the native-born population. However, the Canadian studies have also shown that as the immigrants' period of residence in Canada increases, so does the prevalence of chronic conditions, smoking and disability. Understanding the proportion of immigrants in a geographic area, along with the period of immigration, provides a context for interpreting health indicators.

Source:
Statistics Canada, 1996 and 2001 Census (20% sample)

Internal migrant mobility

Definition:
Percentage of people that lived in a different Canadian municipality at the time of the previous Census (5-year internal migrants) or one year before the current Census (1-year internal migrants). External migrants who were living outside Canada are excluded.

Source:
Statistics Canada, 1996 and 2001 Census (20% sample)

Strong census Metropolitan area and census agglomeration Influenced Zones (MIZ)

Definition:
Strong MIZ (Census Metropolitan Area and Census Agglomeration Influenced Zones) represents the proportion of the population living in Census Metropolitan Areas (CMA), Census Agglomerations (CA) and communities that fall outside CMAs/CAs that have at least 30% of the employed labour force commuting toCMAs/CAs. The larger the proportion, the stronger the relationship between the specific community and a nearby CMA/CA.

The CMAs and CAs are large urban areas with adjacent urban and rural areas that have a high degree of economic and social integration. These CMAs and CAs are defined around urban areas that have attained certain population thresholds: 100,000 for CMAs and 10,000 for CAs.

Sources:
Statistics Canada, 1996 and 2001 Census (20% sample), Geography Division

Lone-parent families

Definition:
Percentage of lone-parent families among all census families living in private households. A census family refers to married or common-law couple or lone parent with at least one never-married son or daughter living in the same household.

Source:
Statistics Canada, 1996 and 2001 Census (20% sample)

Visible minority

Definition:
Population belonging to a visible minority group. As defined by the Employment Equity Act (1986), visible minorities are persons (other than Aboriginal people) who are non-caucasian in race or non-white in colour.

Source:
Statistics Canada, 1996 and 2001 Census (20% sample)

Teen pregnancy

Definition:
Number and rate of pregnancies per 1,000 women aged 15 to 19.

Pregnancies are composed of live births, induced (therapeutic) abortions and fetal loss, including stillbirths (at least 20 weeks gestation or fetal weight of at least 500 grams) and cases of spontaneous abortion, illegally induced abortion, other and unspecified abortion treated in general and allied hospitals in Canada.

Sources:
Statistics Canada, Vital Statistics, Birth and Stillbirth Databases; Canadian Institute for Health Information, Hospital Morbidity Database, and Therapeutic Abortion Survey

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Health system

Inflow/outflow ratio

Definition:
A ratio of the number of separations from acute care hospitals within a given region divided by the number of acute care hospital discharges generated by residents of that region. An overall ratio is calculated for discharges associated with any diagnosis or procedure and separately for coronary artery bypass graft surgery (CABG), hip replacement, knee replacement and hysterectomy procedures.

( CABG: CCP code 48.1, ICD-9- CM procedure code 36.1, CCI code 1.IJ.76; Hip replacement: CCP code of 93.51, 93.52, 93.53, or 93.59, ICD-9-CM procedure code of 81.50, 81.51, or 81.53, CCI code of 1.VA.53.LA-PN, 1.VA.53.PN-PN; Knee replacement: CCP code of 93.40 or 93.41, ICD-9- CM procedure code of 81.54 or 81.55, CCI code of 1.VG.53; Hysterectomy: CCP code of 80.3-80.6, ICD-9- CM procedure code of 68.4-68.7, 68.9, CCI code 1.RM.89, 1.RM.91, 5.CA.89.WJ, 5.CA.89.CK, or 5.CA.89.GB)

This indicator reflects the balance between the quantity of hospital stays provided to both residents and non-residents by all acute care hospitals in a given region and the extent of acute care utilization by residents of that region, whether they receive care within or out of the region. A ratio less than one indicates that hospital stays utilized by residents of a region exceeded hospital care provided within that region, suggesting an outflow effect. A ratio greater than one indicates hospital stays provided by a region exceeded the quantity of stays utilized by its residents, suggesting an inflow effect. A ratio of one indicates that the volume of hospital discharges in the region is equivalent to that generated by its residents, suggesting that inflow and outflow activity, if it exists at all, is balanced.

Source:
Canadian Institute for Health Information, Hospital Morbidity Database, Discharge Abstract Database; Ministère de la Santé et des Services sociaux du Québec

Coronary artery bypass graft (CABG)

Definition:
Age-standardized rate of coronary artery bypass graft (CABG) surgery performed on inpatients in acute care hospitals per 100,000 population age 20 and over.

( CCP code 48.1, ICD-9- CM procedure code 36.1, CCI code 1.IJ.76 ).

As with other types of surgical procedures, variations in CABG surgery rates can be attributed to numerous factors, including differences in population demographics, physician practice patterns, and availability of services. In some cases, percutaneus coronary intervention (an alternative intervention to improve blood flow to the heart muscle) may be used. Variations in the extent of the procedure may result in variations in bypass surgery.

Sources:
Canadian Institute for Health Information, Hospital Morbidity Database, Discharge Abstract Database

Percutaneous coronary intervention (PCI)

Definition:
Age-standardized rate of percutaneous coronary interventions (PCI) performed on patients in acute care hospitals, same day surgery facilities or catheterization laboratories, per 100,000 population age 20 years and over.

(CCP code 48.02, 48.03, ICD-9-CM procedure code 36.01, CCI code 1.IJ.50^^, 1.IJ.57.GQ^^).

In many cases, PCI serves as a non-surgical alternative to coronary artery bypass graft (CABG) surgery and is undertaken for the purpose of opening obstructed coronary arteries. While PCI encompasses several techniques, angioplasty is the procedure most frequently provided. The choice of revascularization mode (i.e. PCI or CABG) depends on numerous factors including physician preferences, availability of services, referral patterns, as well as differences in population health and socio-economic status.

Sources:
Canadian Institute for Health Information, Hospital Morbidity Database, Discharge; Abstract Database, National Ambulatory Care Reporting System; Alberta Health and Wellness, Alberta Ambulatory Care Database

Hip replacement

Definition:
Age-standardized rate of unilateral or bilateral hip replacement surgery performed on inpatients in acute care hospitals per 100,000 population.

(CCP code 93.51, 93.52, 93.53 or 93.59,ICD-9-CM procedure code 81.50, 81.51 or 81.53, CCI code1.VA.53.LA-PN or 1.VA.53.PN-PN).

Hip replacement surgery has the potential to result in considerable improvement in functional status, pain relief, as well as other gains in health-related quality of life. Over the past two decades, rates of surgery have increased substantially. Wide inter-regional variation in the hip replacement rate may be attributable to numerous factors including the availability of services, provider practice patterns, and patient preferences.

Sources:
Canadian Institute for Health Information, Hospital Morbidity Database, Discharge Abstract Database; Ministère de la Santé et des Services sociaux du Québec

Knee replacement

Definition:
Age-standardized rate of total unilateral or bilateral knee replacement surgery performed on inpatients in acute care hospitals per 100,000 population.

( CCP code 93.40 or 93.41, ICD-9- CM procedure code 81.54 or 81.55, CCIcode 1.VG.53).

Knee replacement surgery has the potential to result in considerable improvement in functional status, pain relief, as well as other gains in health-related quality of life. Over the past two decades, rates of surgery have increased substantially. Wide inter-regional variation in the knee replacement rate may be attributable to numerous factors including the availability of services, provider practice patterns, and patient preferences.

Source:
Canadian Institute for Health Information, Hospital Morbidity Database, Discharge Abstract Database; Ministère de la Santé et des Services sociaux du Québec

Hysterectomy

Definition:
Age-standardized rate for hysterectomy provided to inpatients in acute care hospitals, per 100,000 women age 20 and over.

(CCP code 80.3-80.6, ICD-9-CM procedure code 68.4-68.7, 68.9 or CCI code 1.RM.89, 1.RM.91).

Utilization rates may reflect the level of uncertainty about the appropriate use of this surgical procedure. The "right" level of utilization is not known.

Sources:
Canadian Institute for Health Information, Hospital Morbidity Database, Discharge Abstract Database; Ministère de la Santé et des Services sociaux du Québec

Contact with alternative health care providers

Definition:
Population aged 12 and over who have consulted with alternative health care providers in the past 12 months.

Alternative health care providers include: massage therapists, acupuncturists, homeopaths or naturopaths, Feldenkrais or Alexander teachers, relaxation therapists, biofeedback teachers, rolfers, herbalists, reflexologists, spiritual healers, religious healers, etc.

Sources:
Statistics Canada, Canadian Community Health Survey 2005, 2003, 2000/01, health file; Statistics Canada, National Population Health Survey, 1994/95, 1996/97 and 1998/99, cross sectional sample, health file and North component

Contact with medical doctors

Definition:
Population aged 12 and over who have consulted with a medical doctor in the past 12 months.

Medical doctor includes family or general practitioners as well as specialists such as surgeons, allergists, orthopaedists, gynaecologists, or psychiatrists. For population aged 12 to 17 includes pediatrician.

Sources:
Statistics Canada, Canadian Community Health Survey 2005, 2003, 2000/01, health file; Statistics Canada, National Population Health Survey, 1994/95, 1996/97 and 1998/99, cross sectional sample, health file and North component

Contact with health professionals about mental health

Definition:
Population aged 12 and over who have consulted with a health professional about their mental health in the past 12 months.

Mental health professionals include: family doctors or general practitioners, psychiatrists, psychologists, nurses, social workers and counsellors.

Sources:
Statistics Canada, Canadian Community Health Survey 2005, 2003, 2000/01, health file; Statistics Canada, National Population Health Survey, 1994/95, 1996/97 and 1998/99, cross sectional sample, health file; Statistics Canada, National Population Health Survey, 1994/95 and 1996/97, cross sectional sample, North component

Contact with dental professionals

Definition:
Population aged 12 and over who have consulted with a dental professional in the past 12 months.

Dental professionals include dentists or orthodontists.

Sources:
Statistics Canada, Canadian Community Health Survey 2005, 2003, 2000/01, health file; Statistics Canada, National Population Health Survey, 1994/95, 1996/97 and 1998/99, cross sectional sample, health file and North component

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Resources

Health expenditures

Definition:
Health expenditures in current dollars; expenditures per capita; percent of Gross Domestic Product; public sector expenditures as a percent of total spending; expenditures by use of funds.

Source:
Canadian Institute for Health Information, National Health Expenditure Database

Doctors

Definition:
Physician counts include all active general practitioners, family practitioners, and specialist physicians as of December 31 of the reference year. The data include physicians in clinical and non-clinical practice and exclude residents and physicians who are not licensed to provide clinical practice and have requested that their information not be published in the Canadian Medical Directory.

For all jurisdictions and data years specialist physicians include certificants of the Royal College of Physicians and Surgeons of Canada (RCPSC) and/or the College des médecins du Québec (CMQ). As of 2004, Saskatchewan and Newfoundland and Labrador specialists also include physicians who are licensed as specialists but who are not certified by the RCPSC or the CMQ (i.e., non-certified specialists). For all other jurisdictions, and for Saskatchewan and Newfoundland and Labrador prior to 2004, non-certified specialists are counted as family practitioners. With the exception of the criteria just noted all other physicians are counted as family practitioners, including certificants of the College of Family Physicians of Canada (CCFP and CCFP-Emergency Medicine). For further information on physician count methodologies please see CIHI’s reports on the “Supply, Distribution and Migration of Canadian Physicians” and “Certified and Non-Certified Specialists: Understanding the Numbers” (www.cihi.ca).

It is recognized that physician specialty classification as noted above does not necessarily reflect the services provided by individual physicians. The range of services provided by a physician is subject to provincial licensure rules, medical service plan payment arrangements, and individual practice choices. Therefore, CIHI physician-to-population rates may differ from those published by other sources.

Physician-to-population ratios are used to support health human resource planning. While physician density ratios are useful indicators of changes in physician numbers relative to the population, inference from total numbers or ratios as to the adequacy of provider resources should not be made.

Note: Scott’s Medical Database (SMDB) information may undercount physicians due to Provincial/Territorial licensing authority data supply interruptions. SMDB data does not reflect licensing authority updates for the following jurisdictions and years: British Columbia 2004; Québec 2003; Ontario 2002; Alberta and the Yukon 2000.

Source:
CIHI, Scott’s Medical Database.