4. Community and health system characteristics

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Community
Health system
Resources

4.1 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.

Source (s):
Statistics Canada, Demography Division. Data are derived from the Census and administrative sources on births, deaths, and migration. The Quebec preliminary estimates are derived from the census division estimates provided by "Institut de la statistique du Québec". Population growth for British Columbia were supplied by BC Stats.

Population distribution by size of population centre

Definition:
The term population centre has replaced the term urban area. Population centres are defined as an area with a population of at least 1,000 and a density of 400 or more people per square kilometre. All areas outside population centres continue to be defined as rural areas.

Population centres are divided into three groups based on the size of their population:

  • small population centres, with a population of between 1,000 and 29,999;
  • medium population centres, with a population of between 30,000 and 99,999
  • large urban population centres, consisting of a population of 100,000 and over.

These counts and rates exclude institutional residents. Rates were calculated on randomly rounded data, and may not necessarily add up to 100%.

Source (s):
2006 Census, Statistics Canada.

Population density

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

Source (s):
Statistics Canada, 2006 Census, and Geography Division (special tabulations).

Dependency ratio

Definition:
The ratio of the combined child population aged 0 to 19 and population aged 65 and over to the population 20 to 64 years old. This ratio is presented as the number of dependents for every 100 people in the working age population.

Canadians aged 65 and over and those under age 20 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.

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

Aboriginal population

Definition:
Aboriginal people living in a geographic area. Aboriginal people are those persons who reported identifying with at least one Aboriginal group (for example, 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.

Source (s):
Statistics Canada, 2006 Census.

Immigrant population

Definition:
Refers to people who are, or have been, landed immigrants in Canada. A landed immigrant is a person who has been granted the right to live in Canada permanently by immigration authorities. Some immigrants have resided in Canada for a number of years, while others have arrived recently. Most immigrants are born outside Canada, but a small number were born in Canada.

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.

Source (s):
Statistics Canada, 2006 Census.

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 (s):
Statistics Canada, 2006 Census.

Metropolitan Influenced Zones (MIZ)

Definition:
Strong Census Metropolitan Area and Census Agglomeration Influenced Zones represent 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 to CMAs/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.

Source (s):
Statistics Canada, 2006 Census, 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 (s):
Statistics Canada, 2006 Census.

Visible minority population

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 (s):
Statistics Canada, 2006 Census.

4.2 Health system

Inflow/outflow ratio

Definition:
A ratio of the number of discharges from relevant facilities (acute care/same day surgery) within a given region divided by the number of discharges generated by residents of that region. An overall ratio is calculated for discharges associated with any diagnosis or procedure for acute care discharges only, and separately for hip replacement, knee replacement, hysterectomy, percutaneous coronary intervention and coronary artery bypass surgery procedures from all relevant facilities.

(Coronary artery bypass graft: CCP code 48.1^ , CCI code 1.IJ.76^^ ;percutaneous coronary intervention: CCP code 48.02^ , 48.03^ , CCI code 1.IJ.50^^ , 1.IJ.57.GQ^^; 1IJ.54.GQ-AZ; Hip replacement: CCP code 93.51, 93.52, 93.53, or 93.59, CCI code 1.VA.53.LA-PN, 1.VA.53.PN–PN; Knee replacement: CCP code 93.40 or 93.41, CCI code 1.VG.53^^; Hysterectomy: CCP code 80.2^ to 80.6^ , CCI code 1.RM.89^^, 1.RM.91^^: or 1.RM.87.BA-GX, 1.RM.87.CA-GX, 1.RM.87.DA-GX, 1.RM.87.LA-GX with extent attribute coded as "SU" ).

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 (s):
Canadian Institute for Health Information (CIHI), Discharge Abstract Database (DAD), National Ambulatory Care Reporting System (NACRS); Alberta Health and Wellness, Alberta Ambulatory Care Database; Fichier des hospitalisations MED-ÉCHO, ministère de la Santé et des Services sociaux du Québec.

Coronary artery bypass graft surgery rate

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^, 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 cases amenable to treatment with less invasive procedures percutaneous coronary intervention (PCI), an alternative intervention to improve blood flow to the heart muscle, may be used. Variations in the extent to which PCI is utilized may result in variations the rate of in bypass surgery.

Source (s):
Canadian Institute for Health Information (CIHI), Discharge Abstract Database (DAD); Fichier des hospitalisations MED-ÉCHO, ministère de la Santé et des Services sociaux du Québec.

Percutaneous coronary intervention rate

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^, CCI code 1.IJ.50^^, 1.IJ.57.GQ^^,1.IJ.54.GQ-AZ).

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 (that is, PCI or CABG) depends on numerous factors including severity of coronary artery disease, physician preferences, availability of services, referral patterns, as well as differences in population health and socio–economic status.

Rates for Quebec are not available due to differences in data collection.

Source (s):
Canadian Institute for Health Information (CIHI), Discharge Abstract Database (DAD), National Ambulatory Care Reporting System (NACRS); Alberta Health and Wellness, Alberta Ambulatory Care Database.

Cardiac revascularization rate

Definition:
Age-standardized rate of coronary artery bypass graft (CABG) surgery performed on inpatients in acute care hospitals or 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 48.1^ , 48.02^ , 48.03^ and CCI code 1.IJ.76^ ^, 1.IJ.50^ ^, 1.IJ.57.GQ^^ , 1.IJ.54.GQ–AZ)

The choice of revascularization mode (i.e. PCI or CABG) depends on numerous factors including severity of coronary artery disease, physician preferences, availability of services, referral patterns, as well as differences in population health and socio-economic status. The combined cardiac revascularization rate represents total activity of cardiac revascularization in a jurisdiction.

Rates for Quebec are not available due to differences in data collection.

Source(s):
Canadian Institute for Health Information (CIHI), Discharge Abstract Database (DAD), National Ambulatory Care Reporting System (NACRS); Alberta Health and Wellness, Alberta Ambulatory Care Database

Hip replacement rate

Definition:
Age–standardized rate of unilateral or bilateral hip replacement surgery performed on inpatients in acute care hospitals per 100,000 population age 20 years and over.
                           
(CCP code 93.51, 93.52, 93.53 or 93.59, CCI code 1.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.

Beginning with 2005/2006, this indicator is calculated for the population age 20 years and over and therefore is not comparable with rates reported for previous years. Rates for the previous years, calculated using the new definition, are presented to enable comparisons over time.

Source (s):
Canadian Institute for Health Information (CIHI), Discharge Abstract Database (DAD); Fichier des hospitalisations MED-ÉCHO, ministère de la Santé et des Services sociaux du Québec.

Knee replacement rate

Definition:
Age-standardized rate of unilateral or bilateral knee replacement surgery performed on patients in acute care hospitals or same–day surgery facilities, per 100,000 population age 20 years and over.

(CCP code 93.40 or 93.41, CCI code 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.

Beginning with 2005/2006, this indicator is calculated for the population aged 20 years and older and includes same day surgery procedures, and therefore is not comparable with rates reported for previous years. Rates for the previous years, calculated using the new definition, are presented to enable comparisons over time.

Source (s):
Canadian Institute for Health Information (CIHI), Discharge Abstract Database (DAD), National Ambulatory Care Reporting System (NACRS); Alberta Health and Wellness, Alberta Ambulatory Care Database; Fichier des hospitalisations MED-ÉCHO, ministère de la Santé et des Services sociaux du Québec.

Hysterectomy rate

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

CCP code 80.2^ to 80.6^ or CCI code 1.RM.89^^, 1.RM.91^^, 1.RM.87.BA-GX**, 1.RM.87.CA-GX**, 1.RM.87.DA-GX**, 1.RM.87.LA-GX**.

** Procedures with these CCI codes were included only if they were also coded with extent attribute "SU".

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

Beginning with 2006/2007 data, hysterectomy rates include both total and sub-total hysterectomies, similar to the reporting prior to 2001/2002 data.  Sub-total hysterectomy was not uniquely identified in the Canadian Classification of Health Interventions (CCI) versions 2001 and 2003, therefore hysterectomy rates reported for 2001/2002 to 2005/2006 fiscal years included only total hysterectomies. Identification of sub–total hysterectomies became possible again with version 2006 of CCI. For jurisdictions with higher volumes of sub-total hysterectomies comparability with the previous years might be affected.

Beginning with 2005/2006 data, this indicator includes same day surgery procedures. However, due to small counts of same day surgery procedures, comparability with the previous years is not affected.

Source (s):
Canadian Institute for Health Information (CIHI), Discharge Abstract Database (DAD), National Ambulatory Care Reporting System (NACRS); Alberta Health and Wellness, Alberta Ambulatory Care Database; Fichier des hospitalisations MED-ÉCHO, 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.

Source (s):
Statistics Canada, Canadian Community Health Survey.

Contact with a medical doctor

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.

Source (s):
Statistics Canada, Canadian Community Health Survey.

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.

Source (s):
Statistics Canada, Canadian Community Health Survey.

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.

Source (s):
Statistics Canada, Canadian Community Health Survey

Mental illness hospitalization rate

Definition:
Age-standardized rate of separations from general hospitals through discharge or death following a hospitalization for a selected mental illness, per 100,000 population.

Hospitalization rate is a partial measure of general hospital utilization. It does not include inpatients who were using hospital services but had not yet been discharged within the fiscal year of interest. This indicator may reflect differences between jurisdictions, such as the health of the population, differing health service delivery models and variations in the availability and accessibility of specialized, residential and/or ambulatory and community-based services.

Monitoring hospital service use captures only the relatively small proportion of individuals who are acutely ill and require in-hospital treatment, compared to the much larger contingent that receives (or fails to receive) outpatient or community services. For these reasons, this indicator cannot be used to estimate the prevalence of mental disorders in the general population.

While this indicator does not include data from free-standing psychiatric facilities, it is acknowledged that in some jurisdictions (for example, Alberta) direct substitution between general and psychiatric facilities exists; the extent of this practice is unknown. As such, this indicator provides a partial view of hospital utilization for mental health issues in an acute setting.

Note:
The mental illnesses selected for this indicator are substance-related disorders; schizophrenia, delusional and non-organic psychotic disorders; mood/affective disorders; anxiety disorders; and selected disorders of adult personality and behaviour.

Source (s):
Canadian Institute for Health Information (CIHI), Discharge Abstract Database (DAD); Ontario Mental Health Reporting System (OMHRS); Fichier des hospitalisations MED-ÉCHO, ministère de la Santé et des Services sociaux du Québec.

Mental illness patient days rate

Definition:
Age-adjusted rate of total number of days in general hospitals for selected mental illness, per 10,000 population.

The patient days rate is a partial measure of general hospital utilization. It does not include patients who were admitted to hospital but had not yet been discharged within the fiscal year of interest. Patient-days are influenced by the number of hospitalizations and the length of stay. For the same number of hospitalizations, the rate of patient days will increase as length of stay increases. This indicator may reflect differences between jurisdictions, such as the health of the population, differing health service delivery models and variations in the availability of and accessibility to specialized, residential and/or ambulatory and community-based health services.

While this indicator does not include data from free-standing psychiatric facilities, it is acknowledged that in some jurisdictions (for example, Alberta) direct substitution between general and psychiatric facilities exists; the extent of this practice is unknown. As such, this indicator provides a partial view of hospital utilization for mental health issues in an acute setting.

Note:
The mental illnesses selected for this indicator are substance-related disorders; schizophrenia, delusional and non-organic psychotic disorders; mood/affective disorders; anxiety disorders; and selected disorders of adult personality and behaviour.

Source (s):
Canadian Institute for Health Information (CIHI), Discharge Abstract Database (DAD); Ontario Mental Health Reporting System (OMHRS); Fichier des hospitalisations MED-ÉCHO, ministère de la Santé et des Services sociaux du Québec.

4.3 Resources

Doctors

Definition:
Physician counts include all active physicians as of December 31 of the reference year. Physicians in clinical and non-clinical practice are included. Residents and unlicensed physicians who have requested that their information not be published are excluded. Generally, specialist physicians include certificants of the Royal College of Physicians and Surgeons of Canada (RCPSC) and/or the Collège des médecins du Québec (CMQ) with the exception of Saskatchewan, Newfoundland and Labrador, Nova Scotia, New Brunswick and Yukon, where specialists also include physicians who are licensed as specialists but who are not certified by the RCPSC or the CMQ (that is, non-certified specialists). For all other jurisdictions non-certified specialists are counted as general 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. 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).

Physician-to-population rates are useful indicators and are published by a variety of agencies to support health human resource planning. However, due to differences in data collection, processing and reporting methodology, CIHI results may differ from provincial and territorial data. Readers are cautioned to avoid inferences regarding the adequacy of provider resources based on supply ratios alone.

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 (s):
Canadian Institute for Health Information (CIHI), Scott's Medical Database (SMDB).