Technical Notes (pdf
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These notes provide general comments to assist with
accurate interpretation of the health indicators. Please see the descriptions
for specific information on indicator definitions, sources, calculation
methods, and other details. Additional information on interpretation,
comparability, relevant standards/benchmarks, and other material is
available upon request.
The methodology used for these indicators was designed
to maximize inter-regional and inter-provincial comparability given
the characteristics of available national datasets. For this reason,
there may be differences between definitions, data sources, and extraction
procedures used in some local, regional, or provincial/territorial reports
when compared to those described here. In addition, discrepancies may
exist due to on-going updates to databases.
Rates are standardized wherever possible to facilitate
comparability across provinces/regions and over time.
Health region level rates and population estimates presented
in this publication are based on the boundaries in effect as of January
Indicators based on hospitalization records are limited
to health regions with population greater than 100,000.
Health region level population estimates:
- Population estimates for health regions were produced
by Statistics Canada (Demography Division) for all provinces, except
Quebec and British Columbia. Quebec health region population estimates
were provided by l'Institut de la statistique du Québec and
British Columbia population estimates were provided by BC Stats.
See Appendix 1
- The population estimates for health regions in Alberta
prepared by Statistics Canada differ from those of Alberta Health
and Wellness, which are based principally on Albertas health
care file. The differences in these estimates are shown in Appendix
2. Work is underway to reconcile these population differences.
Therefore, rates presented in this publication may differ from those
produced by Alberta Health and Wellness.
Health Status indicators based on Vital Statistics (Statistics
Canada - STC)
- Rates are based on place of residence for indicators
derived from birth and death events.
- Vital statistics data in this product are based on
three years of birth and death data (1995-1997) averaged over three
years of births (1995-1997) and the 1996 population estimate, respectively.
Table titles associated with these data reflect the mid-point of the
three-year period being averaged (1996).
- All data presented have an associated
95% confidence interval (CI). The confidence interval illustrates
the degree of variability associated with a rate. Wide confidence
intervals indicate high variability, thus, these rates should be interpreted
and compared with due caution. Some age-standardized rates were suppressed
due to both a very small underlying count plus extremely high variability.
Confidence intervals can also be used to determine whether a rate
in one health region is statistically below, above or no different
than the rate for the same indicator in another health region.
- The confidence intervals for the age-standardized
rates were produced via the Spiegelman method. Reference: Spiegelman
M. Introduction to Demography, Revised Edition. Cambridge MA, Harvard
U Press, 1968. Formula 4.29, p 113.
- The confidence intervals for the birth-related data
were produced via the Fleiss method. Reference: Fleiss JL,
Statistical Methods for Rates and Proportions, 2nd Ed, Wiley and Sons,
- Due to the small population of Churchill health region
(4690), Manitoba (pop. 1,110 in 1996) and the number of deaths, virtually
all vital statistics data for this health region would, in the absence
of any adjustment, need to be suppressed. As such, in this product
all vital statistics data presented for region 4680 (Burntwood) are
an aggregate of Burntwood and Churchill regions. For census-related
data, however Burntwood and Churchill are presented separately.
- Mortality rates, with the exception of infant and
perinatal mortality, are age-standardized using the direct method,
and the 1991 Canadian Census population structure. The use of a standard
population results in more meaningful mortality rate comparisons,
because it adjusts for variations in population age distributions
over time and across different geographic areas.
- Birth and death data for 1996 and 1997 (and 1995
death data from Alberta) have been linked to health regions using
postal codes reported with place of residence and converted
to enumeration area (EA) using the automated geo-coding system developed
in Health Statistics Division. These data were then aggregated to
health region based on the EA level correspondence developed in Health
Statistics Division with the cooperation of provincial Ministries
of Health, Alberta Treasury and BC Stats.
- Birth and death data (except Alberta) from 1995 were
linked to health regions using two methods:
- For most records (where health regions are comprised
of complete census subdivisions) the standard geographical classification
codes recorded on the vital statistics database were used to link
records to health region.
- Selected records (those linked to census subdivisions
which are associated with more than one health region) were extracted
from the data base. Using the registration numbers of these events,
birth registration records and death certificates were accessed
and the postal codes for place of residence were captured. These
records were then geo-coded to enumeration areas (same as for data
years 1996 and 1997), linked to health regions using the EA-to-HR
correspondence, then merged with the remaining data for that year
to get the most accurate health region link.
- Life expectancy: This variable was calculated
using the Chiang methodology for abridged life tables. The estimates
are based on three years (1995-1997) of mortality data and 1996 population
estimates, as described above. Abridged life tables use five-year
age groupings of both population and mortality rate inputs (as opposed
to single year age breakdown). Since there is more variability in
the number of events by age in smaller geographic areas, abridged
life tables are more suitable for the adaptation to a sub-provincial
level (health region). Chiangs method in particular was chosen
because it was relatively easy to adapt to the health region level
data and included the calculation of standard error (in this case,
addressing the variability of deaths from one year to the next).
- Birth statistics: Birth data on our Vital
Statistics Database for Ontario are underestimated for data years
1996 and 1997 due to incomplete files. At least 1,500 Ontario births
from 1997 were not available for geocoding. Birth data for those same
years for some other provinces may also be incomplete. Thus, birth-related
data (low birth weight, infant mortality, perinatal mortality), particularly
for Ontario, should be interpreted with caution.
- Low birth weight: Due to a high number of
missing birth weight values from the original 1996 and 1997 birth
files from Quebec, we received supplementary data files that matched
birth records with hospital records. These files allowed us to analyze
a larger group of Quebec births for low birth weight data. Thus, our
present analysis may differ from previous Statistics Canada publications
for low birth weight that present data for those same data years.
Indicators based on 1996 Census Data (STC)
- Regional data on non-medical determinants of health
indicators and certain community characteristics were extracted from
the 1996 Census, based on enumeration areas (EA). A correspondence
file, linking EAs to current health regions has been developed in
the Health Statistics Division of Statistics Canada with the cooperation
of provincial Ministries of Health, Alberta Treasury and BC Stats.
- Income related indicators from 1996 Census are based
on income in 1995.
- Low income rate, children in low income families:
Low income data were not derived for economic families or unattached
individuals in the Territories or on Indian reserves. For health regions
containing Indian reserves, analysis of low income data should only
be done with this caveat explicitly noted.
- Housing affordability: Band housing on Indian
reserves was not included in the calculation of housing affordability.
For health regions containing Indian reserves, analysis of housing
affordability should only be done with this caveat explicitly noted.
- Proportion Aboriginal population: This variable
is derived from three questions asked in the 1996 Census (20% sample).
Aboriginal population refers to those persons who reported identifying
with at least one Aboriginal group, i.e. 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 of Canada and/or who were members
of an Indian Band or First Nation. Census coverage studies were used
to adjust these data with the population estimates for incompletely
enumerated Indian Bands or reserves. The 1996 demographic population
estimates (which adjusts for census undercoverage and refusal reserves)
were used as the denominator for these percentages.
For more information on census concepts, please refer
to the 1996 Census Dictionary, Statistics Canada, Catalogue
Indicators based on 1996 to 1999 Labour Force Data (STC)
- Regional unemployment rates and youth unemployment
rates where calculated as annual averages from the Canadian Labour
Force Survey (LFS). The estimates were derived by linking, at the
enumeration area (EA) level, the LFS geography to the health region
- Some health regions could not be published as the
estimated rate did not meet the minimum requirements for quality and
- The LFS is a monthly sample of approximately 52,000
households. The survey is designed to represent the Canadian population
aged 15 years and older. The survey excludes Indian reserves, full
time members of the Canadian Forces, and persons living in institutions.
The survey also excludes the Territories.
- The unemployment rate is the number of unemployed
persons divided by the labour force population, expressed as a percentage.
An unemployed person is someone who:
- Was without work and had looked for work
- Was on temporary layoff and available for work
- Had a new job to start in the future.
The labour force population consists of the unemployed
people plus the employed persons. To be employed, a person
- Had a job but was not at work during the reference
Health System Indicators (Canadian Institute for Health
Information - CIHI)
CIHIs Privacy and Confidentiality policy does
not permit the publication of data that might reasonably identify an
individual whether a patient or care provider. As a result, data with
small cell sizes have been suppressed. Additional measures have been
taken to protect against residual disclosure from the dissemination
of regional rates.
Hospitalization Data and Rates (CIHI)
- Data are reported based on the region of the patients
residence, not region of hospitalization. For most jurisdictions,
this minimizes opportunities for identifying individual care providers.
As a result of reporting data based on the region of residence, these
figures reflect the hospitalization experience of residents of the
region wherever they are treated, as opposed to the comprehensive
activity of the regions hospitals (who will also treat people
from outside of the region).
- Regional estimates for British Columbia are derived
from reported postal codes using a translation file developed by BC
STATS, BC Ministry of Finance and Corporate Relations. Health region
level data for other provinces were produced through a geo-coding
process using correspondence files developed with input from each
provincial health ministry and Alberta Treasury. The link between
enumeration areas and health regions was first created to provide
the best resolution to census geography, and a census subdivision
link to health regions was derived from this file. The boundaries
are those that were in effect in January 1999. Records with invalid,
missing, or partial postal codes are not included in regional counts.
The absence of complete postal codes from Quebec for some indicators
is likely to particularly affect rates for the Champlain District
Health Council (Ottawa area) and other border regions.
- Where possible, Canadian and provincial indicator
values are provided for comparison purposes. Where data are available,
these totals include all provinces and territories.
- At the national level, rates for health data that
are based on a fiscal year (April to March) use October 1st
population estimates. Unless otherwise specified, Canadian and provincial
hospitalization rates are standardized using the same methodology
as regional rates. Other rates are based on appropriate population
figures. Canadian rates for physicians are based on July 1st
- Standardized rates are adjusted by age (collapsed
to five-year groupings) using a direct method of standardization based
on the July 1st, 1991 Canadian population.
- Unless otherwise specified, hospitalizations include
discharges and deaths for inpatients in acute care hospitals for the
reference period. Same day surgery (outpatient) cases and patients
admitted to non-acute care hospitals (e.g. chronic care, psychiatric
or rehabilitation facilities) are not included in the totals.
- Data from the Discharge Abstract Database include
only jurisdictions that submit comprehensively to the database. Therefore,
data from Quebec regions are not available.
- Where information is available, cancelled and previous
procedures are excluded from the calculations. For Quebec data, cancelled
procedures are not reported and therefore have not been excluded.
- 1997 figures for indicators derived from the Discharge
Abstract Database may vary in some regions from previous figures due
to recent updates to the database for hospitalizations in Saskatchewan,
Alberta, New Brunswick and Ontario.
- Indicator values for Alberta, Newfoundland and Nova
Scotia regions may vary from previously published figures as a result
of revised population estimates, improved techniques to clarify boundaries
or due to actual changes in health region boundaries.
Physician Data (CIHI)
- In some regions, health facilities and personnel
provide services to a larger community than the residents of the immediate
region. In others, residents will frequently seek care from physicians
outside the region where they live. The ratios of physicians to population
reflect the number of doctors in a region and have not been adjusted
to take these movements into account. The extent to which this affects
individual regions is likely to vary.
- Figures include active civilian physicians (including
those that are not providing clinical services, e.g. health research,
administration and teaching) and exclude interns and residents. At
a regional level, records with invalid, missing, or partial postal
codes were excluded from the totals. Reporting is generally based
on the region of the physicians office or hospital address (over
80% of cases), not region of residence. Reporting is based on total
number of physicians on December 31 of the reference year (full or
part time), not full time equivalent figures.
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