Canadian Community Health Survey Larry MacNabb CCHS Dissemination Manager Yves Béland CCHS Senior...
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Transcript of Canadian Community Health Survey Larry MacNabb CCHS Dissemination Manager Yves Béland CCHS Senior...
Canadian Community
Health Survey
Larry MacNabbCCHS Dissemination Manager
Yves BélandCCHS Senior Methodologist
Part 1
Health Survey Program Overview
Objectives
• Aid in the development of public policy;
• Understand the determinants of health;
• Collect data on the economic, social, demographic, occupational and environmental correlates of health;
Objectives
• Increase the understanding of the relationship between health status and health care utilization;
• Follow a panel of people to reflect the dynamic processes of health;
• Provide a means to supplement content or sample;
Health Surveys Program
NPHS Household
Longitudinal & X-sectional(Provinces)
NPHS North
Longitudinal & X-sectional(Territories)
NPHS Institutions
Longitudinal & X-sectional (-C3)(Provincial Health Institutions)
HEALTH SURVEYS
1994-1999
Health InformationRoadmap Initiative
• Collaboration between Canadian Institute for Health Information (CIHI), Statistics Canada & Health Canada
• Answer two basic questions:– How healthy is Canada’s health care
system?– How healthy are Canadians?
• Canadian Community Health Survey (CCHS)
CCHS Objectives
• Provide timely, consistent, cross-sectional estimates of health determinants, health status and health system utilization across Canada
• Sub-provincial levels of geography (136 Health Regions)
• Flexible survey instrument– meet specific health region data gaps
– develop focused survey content for key data gaps
– quick response to emerging issues
Health Surveys Program
NPHS Household
Longitudinal & X-sectional(Provinces)
NPHS North
Longitudinal & X-sectional(Territories)
NPHS Institutions
Longitudinal & X-sectional (-C3)(Provincial Health Institutions)
HEALTH SURVEYS
NPHS Household
Longitudinal(Provinces)
NPHS North
Longitudinal(Territories)
NPHS Institutions
Longitudinal(Prov. Hlth Institutions)
CCHS
Cross-sectional(Provinces + Territories)
H E ALTH S U RV E YS
1994-1999
Since 2000
Population Health Surveys
NPHS CCHS Longitudinal Cross sectional
National and National, provincial, territories
provincial levels & health regions levels
One respondent One or two respondents per household per household
Core, focus, buy-in Health region selection of
and supplements optional health modules
Part 2
CCHS Overview
&
Content Summary
CCHS Consultation Partners
• Consultations with stakeholders about the content is another component of the CCHS that makes this health survey so unique and different from the NPHS.
• Stakeholders include:– Regional, Provincial, & Federal health agencies
– CIHI (Canadian Institute for Health Information)
– other Health researchers
– Advisory committee
1999 Consultations
17 workshops, 225+ participants Topic rankings Final Report
common and optional content target youth and seniors smaller health regions in-depth examination of issues
CCHS Survey Design
Year 1• 130,000 respondents
• stratified by health region
• Questionnaire content
– common content
– optional content selected by health regions
• Estimates for health regions, provinces and Canada
Year 2• 30,000 respondents
• stratified by province
• Questionnaire content
– focus content
– additional general content
– 60+ minutes
• Estimates for provinces and Canada
CCHS Content 1.1
Cycle 1.1 Questionnaire (45 min.): Common Content (30 minutes):
Priority topics for all Health Regions
Optional Content (10 minutes): specific modules selected by individual Health
Regions
Standard Socio-demographic content (5 minutes)
Prov. #HRs n Prov. #HRs n_
NF 6 3,870 SK 11 8,009PE 2 3,651 AB 17 14,456NS 6 5,319 BC 20 18,302NB 7 4,996 YT 1 809QC 16 22,667 NT 1 1,001ON 37 39,278 NU1 707MB 11 8,470
sample size (n) = 131,535CANADA 136
Health Region Sample
CCHS Health Regions - 2001
Health Regions
Cycle 1.1 - Common Content• Alcohol• Alcohol dependence / abuse• Blood pressure check• Breastfeeding• Chronic condition• Contacts with mental health
professionals• Exposure to second hand smoke• Flu shots*• Food insecurity• Fruit & vegetable consumption• General health• Health care utilization• Health Utility Index (HUI)• Height / Weight
• Injuries• Mammography• PAP smear test• Patient Satisfaction**• Physical activities• PSA test• Restriction of activities• Smoking • Tobacco alternatives • Two-week disability• Household composition & housing• Income• Labour force• Socio-demographic characteristics • Administration
Cycle 1.1 Optional Content• Breast examinations
• Breast self examinations
• Changes made to improve health
• Child & adult stressors (traumas)
• Dental visits
• Depression
• Distress
• Driving under influence
• Drug use
• Eye examinations
• Home care
• Mastery
• Mood
• Ongoing problems
• Physical check-up
• Recent life events
• Sedentary activities
• Self-esteem
• Sexual behaviours
• Smoking cessation aids
• Social support
• Spirituality
• Suicidal thoughts and attempts
• Use of protective equipment
• Work stress
Optional Content Selection
TopicHealth
Regions TopicHealth
RegionsDepression 134 Dental visits 56Driving under influence
103 Mastery 55
Changes made to improve health
100 Breast examinations 53
Work stress 97 Self-esteem 45Social support 86 Home care 41Suicidal thoughts and attempts
70 Drug use 29
Breast self-examinations
69 Distress 24
Sedentary activities 68 Mood 14Use of protective equipment
59 Spirituality 8
Sexual behaviours 57 Physical check-up 4Smoking cessation aids
56 Eye exams 2
Cycle 1.1- Optional ContentProportion of Total Sample Asked Optional Module, Canada, Provinces and TerritoriesCanadian Community Health Survey, 2000/01
Module Canada NF PE NS NB PQ ON MB SK AB BC YK NT NUBreast examinations 39% 100% - - 100% - 100% - 32% - - - - -Breast self-examinations 50% - 100% - 100% - 94% - 62% 100% - - 100% -Changes made to improve health 71% 100% 100% - 100% - 100% - 94% 100% 100% 100% - -Dental visits 42% - - - - - 100% - 8% 100% - - - 100%Depression 99% 100% 100% 100% 100% 100% 98% 100% 95% 100% 100% 100% 100% 100%Distress 21% 100% - - - 100% - - 16% - - - - -Driving under influence 82% - 100% 100% - 100% 100% - 54% 100% 100% - - -Drug use 24% - - - - - 79% - - - - - - -Eye exams 1% - - - - - - - 17% - - - - -Flu shots 43% 100% 100% - 100% - 100% - 48% - - - - 100%Home care 35% - 100% 100% 100% 100% 19% - - - - 100% 100% 100%Mastery 36% - - 100% 100% - 19% 100% 18% - 100% 100% 100% -Mood 8% - - - - - - 100% 23% - - - - -Physical check-up 2% - - - - - - - 31% - - - - -Sedentary activities 55% - - - 100% 100% 79% 100% 55% - - 100% - -Self-esteem 27% 100% - - - - - 100% 43% - 100% - 100% 100%Sexual behaviours 44% - 100% - - - 98% - - 100% - 100% - 100%Smoking cessation aids 43% - 100% 100% 100% - 100% - 32% - - - 100% -Social support 63% 100% 100% 100% 100% 100% 2% - 75% 100% 100% 100% 100% 100%Spirituality 5% - - - - - - - 56% - - 100% - 100%Suicidal thoughts and attempts 53% - - 100% 100% 100% 28% 100% - 100% - 100% 100% 100%Use of protective equipment 44% - - - - - 100% - 52% 100% - - - -Work stress 76% - 100% 100% - 100% 100% 100% 79% 100% - - - -
Part 3
Outputs•Microdata•Tabular Statistics•Analytical Products•Client Support
Microdata
• Master File
– Statistics Canada
– Research Data Centers
– Remote Access
• Share File
– Health Canada
– Provincial/Territorial Ministries of health
– Health Regions (3rd Party Sharing)
• Public Use Microdata File– Free 136 Health Regions & sharing partners
Master
Microdata
RecordsVariables
SharePUMF
Share File Production
Master File• Maintained by Statistics
Canada
• Record for every respondent
ID Link Share
A Y Y
B Y N
C N Y
D N N
Share File• Ministries of
Health/Share partners
• Only respondents who agree to share
ID LinkShare
A Y Y
C N Y
Share File contains no identifiable information
•Name
•Address
•Date of Birth
•Health Care number
Public Use Microdata File
Master File
ID Link Share
A Y Y
B Y N
C N Y
D N N
PUMF• Available to public
• Aggregated data
• Geography (<70 k)
• Age groups vs. single year of age
• Other aggr/suppr
ID Link Share
A Y Y
B Y N
C N Y
D N N
Microdata Release
Committee
•Group of Statistics Canada
experts on maintaining respondent
confidentiality
Data Linkage
Master & Link FileID Link Share
HC#
A Y Y Y1
B Y N Y2
C N Y N
D N N N
Share FileID Link Share
A Y Y
C N Y
Link ID File• By Request Only
• Healthcard# and linkage info
• Random ID links to share
ID Link Share HC#
A Y Y Y1
Administrative Date
HC# Name Add
Y1 Joe123
Sharing Agreement Statistics Canada - Ministry of Health
• Statistics Canada will share individual survey responses collected for the Canadian Community Health Survey with the Ministry of Health– Only responses for individuals agreeing to
share their information will be provided
Usage of Shared Data
• Only statistical aggregates may be published
• Respondent information can not be linked to administrative health records without consent to do so from a survey respondent
Usage Continued
• Information can not be released before the official release by Statistics Canada
• Aggregates released must not identify a person, business or organization directly or indirectly
Confidentiality of Data
• Shared information is to be treated as confidential and must be protected
Third Party Sharing
• Ministry can share with health regions individual survey responses without any names, addresses or identifying numbers if– Written agreement between Ministry of Health and
Health Region
– Health Region can maintain same level of security and protection as required of the Ministry of Health including any Provincial requirements
Microdata Files
• Fixed Record ASCII share file (text)
• File input statement/record layout (SAS, SPSS)
• Variable Format (SAS, SPSS)
• Variable Value Format (SAS, SPSS)
• Bootstrap Weights
• Bootstrap Programs
Microdata Documentation
• Background• Objectives• Content• Sample Design• Data Collection• Processing• Data Quality
• Tabulation Guidelines• Approx. Sampling
Variability Tables• Weighting• File Usage
Microdata Documentation Appendices
• Questionnaire
• Record Layout
• Data Dictionary
• CV Tables
• Derived Variable Specifications
Tabulation Guidelines
Type of estimate CV GuidelinesAcceptable 0.0-16.5 Unrestricted release
Marginal 16.6-33.3 Unrestricted release but with warning cautioning users of the high sampling variability (Identified by E).
Unacceptable > 33.3 No release
(Flagged with F).
Tabulation Guidelines (CV Look-up Estimates)
Must ensure users do not infer greater accuracy than possible with approximate variances:
Estimates in main body of a table rounded to nearest 100;
Subtotals and totals derived from unrounded data and then rounded to nearest 100;
Averages, proportions and rates derived from unrounded and then rounded to 1 decimal place;
Cells based on < 30 respondents should be suppressed Approximate CV reported
Tabulation Guidelines (Bootstrap Variance Estimation)
Exact estimate of variance Unrounded estimates in main body of a table; Unrounded subtotals and totals; Averages, proportions and rates should be derived from
unrounded and then rounded to 1 decimal place; Cells based on <10 respondents should be suppressed CV should be reported
CCHS Variable Naming Convention
Variable names are created from information re: type of data Example: Qu. 8B, Depression Module, cycle 1.1 (DP_Q08B)
8 characters in length Ex.: DPSA_08B 1-3 module/section name DPS (depression) 4 survey cycle A (cycle 1.1) 5 variable type _ (underscore=coll.
data) 6-8 question number 08B
CCHS Variable Naming Convention
Position 1, 2 & 3: Section Name
CCC: Chronic Conditions
INC: Income
LBF: Labour Force
PAC: Physical Activities
SMK: Smoking
SXB: Sexual Behaviour
etc.
CCHS Variable Naming Convention
Position 4: Survey Number only one digit use of alphabetical symbols rather than
numbers to limit confusionCycle number Alph.1.1 1 A1.2 2 B2.1 3 C etc.
CCHS Variable Naming Convention
Position 5: Variable Type
_: collected variable
D: derived variable
F: flagged variable
G: grouped variable
CCHS Variable Naming Convention
Position 6-8:
questionnaire number / variable name corresponds to the question number in
questionnaire
ex.: Q03 03; Q02 02 ordered options use a letter to represent the
corresponding options
ex.: Q15, 1st option 15A
Q15, 3rd option 15C
Master File Data Access
Remote Access Submission by email Master dummy files 1000 emails/year with 1.5 program/email
On-site Access (ROs, RDCs) Deemed employee of STC 20 active research teams in Ros; 16 in RDCs
Custom tabulations (cost recovery)
Organization of Electronic Data
Cansim IICansim IIData Warehouse$ for Download
Canadian StatisticsCanadian StatisticsFree
Canada Level Detail
Health IndicatorsHealth IndicatorsFree
Detailed Health Region Information
Health RegionHealth RegionProfilesProfiles
FreeSimple
Tabular Statistics
• CANSIM II main dissemination vehicle– minimum one table for every CCHS questionnaire
module
– Counts and confidence intervals
– Province, Health Region, Age and Sex
• Canadian Statistics
• Corporate Community Profiles
• ePubs such as Health Indicators
Analytical Products
• Health Reports 13.3 - March release• Based on data received during first six
months of collection• National level results focusing on new
CCHS content– Effect of sense of community belonging on self-
perceived health status– Socio-demographic factors affecting winter fruit and
vegetable consumption– Unmet health care needs
Analytical Products
• Daily - May 8, 2002• Data Officially Released• Analysis focusing on
– Obesity– Physical Activity– Unmet health care needs
Other Analytical Products
• Joint Statistics Canada & CIHI Publications– How Healthy are Canadians?– Health Care in Canada
Client Support
• Health Statistics Division & Advisory Services Division client services through head and regional offices
• Regular updates and enhancements to CCHS website
• Customisable workshops covering all aspects of the CCHS– Content, Sample Design, Weighting, Data
Quality, Release Guidelines, Bootstrap Variance Estimation
Future CCHS Cycles
Cycle 1.1 General content 130 000 sample Health region estimates Spring 2002 release
Cycle 2.1 (Final Planning) General content 130 000 sample Health region estimates Summer 2004 release
Cycle 1.2 (In the field) Focus content (mental health) 30 000 sample provincial estimates Fall 2003 release
Cycle 2.2 (Proposed) Focus content (nutrition) 30 000 sample provincial estimates Fall 2005 release
Cycle/Component
Content Sample Collection
1.1 27 Common core + 23 Optional modules 130,000 Sept. 00 - Oct. 01
1.2 Mental disorders, well-being + commoncore repeated
30,000 May – Dec. 2002
2.1 Common core + Optional modulesexpanded
130,000 Jan. – Dec. 2003
2.2 Nutrition, dietary recall, psychosocialdeterminants, fruit and vegetableconsumption, food insecurity + commoncorePotential supplement for physicalmeasures
30,000 Jan –Dec. 2004
3.1 Common core + Optional modulesexpanded
130,000 Jan. – Dec. 2005
3.2 ???? 30,000 Jan. – Dec. 2006
CCHS DescriptionCCHS Description
WEB SITE
NPHS and CCHS Questionnaires and documentation are available on our web site at:
www.statcan.ca/health_surveys