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Tuesday, June 15, 2004

Canadian Community Health Survey


More than 1.2 million Canadians were unable to find a regular doctor in 2003, and more than twice as many didn't have one because they hadn't looked for one, according to new results from the Canadian Community Health Survey (CCHS).

The results are part of a comprehensive survey of more than 135,000 Canadians conducted between January and December 2003.

Eighty-six percent of Canadians reported that they had a regular medical doctor in 2003. This proportion was virtually unchanged from 1994, when the National Population Health Survey examined the same issue.

However, for the first time, the CCHS asked those who did not have a regular medical doctor to report why not. About 5% of Canadians, an estimated 1.2 million people, could not find a regular doctor; an additional 9%, or about 2.4 million, had not looked for one.

Note to readers

This release is based on data collected from January to December 2003 from Cycle 2.1 of the Canadian Community Health Survey (CCHS). The survey collected information from about 135,000 individuals, aged 12 and older, in all provinces and territories.

Each two-year collection cycle of the CCHS is composed of two distinct surveys: a sub-provincial health region-level survey in the first year and a provincial-level survey in the second year that is focussed on a special topic. This first survey of the second cycle is designed to provide reliable, comprehensive and comparable data for 126 health regions across Canada.

The target population of Cycle 2.1 of CCHS includes household residents aged 12 and older in all provinces and territories, but excludes Indian reserves, full-time members of the Canadian Armed Forces, health care institutions and some remote areas.

Respondents were asked to report whether they had a regular medical doctor. Those who did not were asked to report why not. Respondents were considered not to have looked for a regular medical doctor if their responses included "have not tried to contact one," or "other reasons."

All other respondents without a regular medical doctor were considered to have been unable to find one. Their responses included various combinations of the following: "no medical doctors available in the area," "medical doctors in the area are not taking new patients," and "had a medical doctor who left or retired."

Several concepts can be used to measure sexual orientation. These include behaviour, that is, whether a person's partner or partners are of the same or the opposite sex, and identity, that is, whether a person considers himself or herself to be heterosexual, homosexual or bisexual.

The CCHS uses the concept of identity. Data from other countries suggest that the number of people who consider themselves to be homosexual is much smaller than the number who report having had sexual relations with someone of the same sex. However, people are more willing to answer questions about identity than about behaviour.

The survey also asked a variety of questions on health issues, ranging from smoking habits to obesity and self-perceived health. For the first time in a Statistics Canada survey, information on sexual orientation was also collected to improve the understanding of health issues specific to the homosexual and bisexual populations. The goal was to provide a statistical snapshot of the health of Canadians at the national, provincial and sub-provincial health-region level.

Data showed, for example, that smoking has decreased substantially during the past 10 years, and that the decline was particularly dramatic among teenagers and young adults. Also, obesity rates were highest among men and those aged 45 to 64. In addition, fewer individuals considered their health to be excellent or very good compared with 10 years ago.

Another goal of the survey was to produce health information for 126 health regions in Canada. These areas are defined by the provinces and generally represent districts of responsibility for regional health boards.

Finding a regular medical doctor not just a rural issue

People living in rural Canada were slightly more likely than those in urban areas to have difficulty finding a regular medical doctor in 2003, according to CCHS data. About 5.5% of individuals in rural areas had difficulty, compared with 4.5% in urban areas. This may reflect differences in the delivery of primary care in rural areas, including, for example, the use of nurse practitioners.

The inability to find a regular doctor is not just a rural issue, however. Of the 1.2 million people who reported that they were unable to find a doctor in 2003, only about 273,000 lived in a rural area. An estimated 965,000 lived in urban Canada.

CCHS data suggest that the inability of certain individuals to find a regular doctor may have implications for the health care system. When these people do succeed in contacting a doctor, the odds that it will be in an emergency room are 3.5 times greater than for those who have a regular doctor.

Furthermore, women who cannot find a regular doctor are less likely to have received basic diagnostic services, such as mammograms and Pap smear tests. In the three provinces (Prince Edward Island, Nova Scotia and Alberta) where questions about blood pressure were asked, those who could not find a doctor were less likely to have had their blood pressure checked.

More than twice as many men as women reported that they had not looked for a regular doctor. This may reflect differences between the sexes in attitudes towards health and illness. Studies have shown that men consider it less important to have their health monitored over time.

Individuals who have not looked for a regular doctor were concentrated in the 20-to-34 age group, whereas the inability to find a doctor was less particular to the young. One possible explanation is that people who have not looked for a doctor include those who have not made it a priority, possibly because they consider themselves to be healthy and are occupied with educational pursuits or work and family responsibilities.

Medical doctors, 2003 
  Has regular medical doctor Has not looked Cannot find
  Number % Number % Number %
Canada  22,810,900   85.8   2,444,000   9.2   1,238,400   4.7 
Newfoundland and Labrador  393,100  85.4  35,400  7.7  28,700  6.2
Prince Edward Island  110,400  92.4  3,100E  2.6E  5,600E  4.7
Nova Scotia  756,700  94.9  23,100  2.9  17,600  2.2
New Brunswick  590,000  92.4  17,500  2.7  30,600  4.8
Quebec  4,711,100  74.0  1,122,100  17.6  490,200  7.7
Ontario  9,433,000  91.8  470,400  4.6  366,000  3.6
Manitoba  765,700  83.7  88,800  9.7  56,600  6.2
Saskatchewan  683,900  85.5  77,300  9.7  36,200  4.5
Alberta  2,181,600  83.8  322,600  12.4  87,600  3.4
British Columbia  3,145,400  89.3  269,800  7.7  101,700  2.9
Yukon  20,300  81.5  2,700  10.8  1,800  7.4
NWT  15,600  47.1  7,500  22.7  9,800  29.6
Nunavut  4,000E  29.2E  3,600E  26.3E F F
Male  10,692,600  81.7  1,678,800  12.8  666,800  5.1
Female  12,118,300  89.8  765,200  5.7  571,600  4.2
12-19  2,822,300  85.1  310,100  9.3  121,700  3.7
20-34  4,805,100  76.1  1,084,900  17.2  415,800  6.6
35-44  4,478,100  84.5  519,100  9.8  294,600  5.6
45-64  7,088,800  90.2  445,000  5.7  324,200  4.1
65 and older  3,616,600  95.5  84,900  2.2  82,100  2.2
Urban  18,471,600  85.6  2,066,800  9.6  965,000 4.5
Rural  4,339,200  86.7  377,100  7.5  273,400 5.5
EUse with caution.
FSuppressed due to high sampling variability.

Smoking: Fewer Canadians puffing

Smoking has declined substantially over the past decade. In 1994, 29.3% of the Canadian population aged 12 and over smoked either daily or occasionally. By 2003, this had declined to 22.9%.

The proportion of the population that smoked daily fell significantly between 1994 and 2003, both in every age group and among both males and females. However, the proportion of the population that smoked occasionally remained unchanged at 5%.

Some of the biggest declines in daily smoking were among teenagers and young adults, the target of numerous federal, provincial and municipal anti-smoking campaigns in recent years. These declines have accelerated in the past two years. For example, 13.6% of teen girls aged 15 to 19 smoked daily in 2003, down from 18.9% in 2000/01, when the CCHS was first conducted, and 20.9% in 1994.

One-third (33.2%) of young adults aged 20 to 24 smoked either daily or occasionally in 2003, the highest rate of any age group. This proportion was slightly lower than the rate of 35.5% for this group 10 years ago, but the decrease is not statistically significant.

Changes in daily smoking, 1994 to 2003 
  1994 2003
  Number of smokers % Number of smokers %
Canada 5,816,900  24.3 4,728,800  17.8 
Newfoundland and Labrador 124,200 25.7 91,600 19.9
Prince Edward Island 29,900 27.2 24,200 20.3
Nova Scotia 208,200 27.3 157,500 19.7
New Brunswick 164,100 26.2 137,700 21.6
Quebec 1,752,000 29.1 1,316,600 20.7
Ontario 2,030,600 22.4 1,716,100 16.7
Manitoba 213,400 24.0 163,900 17.9
Saskatchewan 190,000 24.0 148,700 18.6
Alberta 500,800 23.1 456,300 17.5
British Columbia 603,700 19.9 492,900 14.0
All ages 3,056,300 25.9 2,538,200 19.4
12-14 F F 6,800E 1.0E
15-19 196,400 18.6 144,500 13.9
20-24 222,600 26.6 267,800 24.1
25-34 793,200 33.9 480,700 23.4
35-44 810,500 32.8 672,100 25.2
45-64 814,600 27.4 803,100 20.6
65 and older 200,700 14.3 163,100 9.8
All ages 2,760,600 22.7 2,190,600 16.2
12-14 36,800E 5.9E 13,600E 2.2E
15-19 206,800 20.9 136,100 13.6
20-24 274,600 30.4 227,600 21.6
25-34 723,600 29.9 360,800 17.2
35-44 653,700 27.3 533,500 20.3
45-64 670,900 22.4 733,000 18.5
65 and older 194,300 10.5 185,800 8.7
EUse with caution.
FSuppressed due to high sampling variability.
Note:Totals for 2003 include the Territories.

Obesity rates up slightly

Rates for both obesity and the state of being overweight have increased slightly during the past three years. In 2000/01, 14.1% of the adult population aged 18 and over was considered obese and 32.4% overweight.

By 2003, 14.9% of adult Canadians were considered obese and 33.3% were considered overweight. An estimated 46.7% were in the normal range, and about 2.7% were underweight.

About 15.9% of adult men were considered obese, slightly higher than the rate of 13.9% among adult women. Rates of obesity were highest in the age group 45 to 64.

The rate was below the national average in British Columbia; in Quebec, Ontario and Alberta the difference from the national average was not statistically significant. In all other provinces and territories, the rate of obesity was above the national average.

Among adult women, 4.1% reported being underweight, nearly four times the proportion of adult men (1.2%). Being underweight is considered to harbour the same health risks as being overweight.

As noted in the Joint Canada–US Survey of Health, released June 2, 2004 in The Daily, obesity rates are higher in the United States than in Canada, especially among women.

These data are based on the body mass index (BMI), an internationally accepted standard for assessing the health risks associated with being underweight, overweight and obese. The BMI is calculated by dividing weight in kilograms by height in meters squared. For example, a 37-year-old man who was 1.8 metres tall and who weighed 98 kg would have a BMI of 30.3, and would be considered obese.

The current cycle of CCHS based its findings on height and weight measurements that respondents themselves reported. Studies have shown that both men and women who respond to health surveys tend to underestimate their weight and overestimate their height. This can lead to potentially substantial underestimates of obesity and overweight.

In the autumn of 2005, Statistics Canada will release the results of CCHS Cycle 2.2 on nutrition, which for the first time will include estimates of BMI based on direct measures of height and weight.

Self-perceived health: Fewer consider their health excellent

Fewer Canadians apparently feel that they are in excellent health. In 2003, 58.4% of individuals aged 12 and older reported that they were in excellent or very good health. This was down from 63.1% in 1994.

A further 30.2% reported being in good health in 2003, and 11.3% considered their health to be fair or poor.

Younger people were more likely than the elderly to report being in excellent or very good health. Even among seniors aged 65 and older, however, more considered their health to be excellent or very good (36.6%) than considered it to be fair or poor (26.6%).

In addition, in every age group more men than women considered themselves to be in excellent or very good health.

The odds of reporting excellent or very good health were almost three times as high among people who said they were satisfied in general with their life than among individuals who said they were not. These results were valid even when the influence of other factors such as age, income, smoking and chronic health problems was taken into account.

The decline in the proportion of Canadians describing their health as excellent or very good since 1994 occurred among both men and women and in every age group. This decrease is not entirely attributable to the aging of the population.

Previous attempts to explain patterns of self-rated health have focussed on two sets of explanations: psycho-social factors, which influence how people evaluate their own health; and real changes in health status.

Some factors, such as obesity, which are thought to influence a person's perception of their health, have worsened during the past 10 years. However, other factors, such as smoking and physical activity, have improved.

Similarly, during the past two years the proportion of Canadians reporting that they found life very stressful has declined from 26.1% to 24.4%

However, between 1994 and 2003 the proportion of people who spent at least one day in bed due to an illness or injury rose from 14.3% to 17.0%. This suggests that an actual decrease in health status, rather than a change in how Canadians perceive their health, may be responsible for the decline in self-perceived health.

Health regions

To facilitate comparisons among health regions, the CCHS created nine groups of regions with similar socio-demographic profiles.

For example, in one group of 14 health regions the proportion of the population which could not find a regular medical doctor ranged from a high of 6.5% in Windsor–Essex in Ontario to a low of 2.8% in the Capital Health Region in Edmonton.

The health regions in this group share characteristics such as moderately high population density, low percentage of government transfer income and rapid population growth. This suggests that factors other than these — such as the organization of primary care, the number of doctors available or the rate of retirement of doctors — may explain differences in the ability to find a regular doctor.

Similarly, within the group of "big city" health regions in and around Montréal, Toronto and Vancouver, the proportion of the population that smoked daily ranged from a high of 21.3% in Montréal to a low of 12.4% in Vancouver.

First information on sexual orientation

CCHS Cycle 2.1 is the first Statistics Canada survey to include a question on sexual orientation. This information is needed to understand differences in health-related issues between the homosexual (gay or lesbian), bisexual and heterosexual populations. These issues include determinants of health, such as physical activity, mental health issues, including stress, and problems accessing health care.

Among Canadians aged 18 to 59, 1.0% reported that they consider themselves to be homosexual and 0.7% considered themselves bisexual.

About 1.3% of men considered themselves homosexual, about twice the proportion of 0.7% among women. However, 0.9% of women reported being bisexual, slightly higher than the proportion of 0.6% among men.

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There are no comparable Canadian data on sexual orientation. The results are similar to those obtained in the United States using the concept of identity.

The results indicate that, for some health-related measures, there are important differences between the heterosexual population and the gay, lesbian and bisexual population.

Among individuals aged 18 to 59, for example, 21.8% of homosexuals and bisexuals reported that they had an unmet health care need in 2003, nearly twice the proportion of heterosexuals (12.7%). Homosexuals and bisexuals are more likely than heterosexuals to find life stressful.

In addition, 31.4% of homosexuals and bisexuals reported that they were physically active in 2003, compared with 25.4% of heterosexuals.

Sexual orientation, 2003 
  Homosexual or bisexual
  Number % of total population
Total 316,800 1.7
Newfoundland and Labrador 4,100E 1.3E
Prince Edward Island F F
Nova Scotia 5,900E 1.1E
New Brunswick 7,200E 1.6E
Quebec 103,400 2.3
Ontario 107,200 1.5
Manitoba 9,600E 1.5E
Saskatchewan 6,600E 1.2E
Alberta 23,400E 1.2E
British Columbia 47,700 1.9
Male 172,600 1.8
Female 144,300 1.5
18-34 139,200 2.0
35-44 101,900 1.9
45-59 75,700 1.2
EUse with caution.
FSuppressed due to high sampling variability.

Definitions, data sources and methods: survey number 3226.

The release is co-ordinated with today's release of Health indicators (82-221-XIE, free) a project to produce basic health indicators — such as use of health services, smoking and self-perception of health — for each health region and for peer groups of health regions.

For more information, contact Media Relations (613-951-4636), Communications Division.

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