Measuring and Reporting on Health Inequalities at the...
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Measuring and Reporting on Health Inequalities at the Local Health Unit Level Emma Tucker Senior Epidemiologist June 10, 2013
Transcript of Measuring and Reporting on Health Inequalities at the...
Measuring and Reporting
on Health Inequalities at
the Local Health Unit Level
Emma Tucker Senior Epidemiologist
June 10, 2013
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Where do we start?
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1. Income – Household and/or
neighbourhood level
OR
2. Deprivation
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Which Social Determinants of Health?
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How did we measure income?
1. Rapid Risk Factor Surveillance System (RRFSS)
& Canadian Community Health Survey (CCHS)
– Survey questions
– Adjusted for household size
– Categorized into 3 groups: lower, middle, upper
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First Approach:
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How did we measure income?
2. MOHLTC databases: Intellihealth and iPHIS
– Postal code
– PCCF+ mapped to census
dissemination area
– Categorized into 5 groups
based on income quintile
(QAIPPE)
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Second Approach:
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QAIPPE is based
on national level
quintiles.
2.4%
45%
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Which Health Indicators?
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• Mortality
• Hospitalizations
• ED Visits
• Self-Rated
Health
• Self-Rated
Mental Health
• Chronic Disease
Risk Factors
• Overweight &
Obesity
• Physical Activity
• Fruit &
Vegetable Intake
• Smoking
• Alcohol
• Diabetes
• Flu Immunization
• Dental Visits
• Falls
• Activity Limitation
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Based on :
– Database
– Health indicators
– Age groups
We needed to combine 5 years of data
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Ensuring Sufficient Data
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Adults 18+
Based on:
• Needs
• Data Availability
• Which Indicators
– Flu Immunization
– Sexually Transmitted Infections
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Age Groups
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Which Social Determinants
of Health?
Which Health
Indicators?
Where Can I Find the
Data?
Is There Sufficient
Data?
What Age Groups? Where we
started
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Statistical Methods
• Age Standardization
• 95% Confidence Intervals
– Bootstrapping
– Non-overlapping CIs
• STATA
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• Disease Mapping (GIS)
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Smoking
25 22
12
0
10
20
30
40
50
Lower Middle Higher
Perc
en
t
Income
Graph from: Halton Region, Income and Health Inequalities in Halton Region, November 2012
Data Source: Rapid Risk Factor Surveillance System (RRFSS), 2007-2011. Age standardized within each income level to the RRFSS sample.
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Graph from: Halton Region, Income and Health Inequalities in Halton Region, November 2012
Data Source: Rapid Risk Factor Surveillance System (RRFSS), 2007-2011. Age standardized within each income level to the RRFSS sample.
Overweight & Obesity
Income
54 55 53
0
20
40
60
80
100
Lower Middle Higher
Pe
rce
nt
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Graph from: Halton Region, Income and Health Inequalities in Halton Region, November 2012
Data Source: Integrated Public Health Information System (iPHIS), 2007-2011. Extracted July 24, 2012. Age standardized within each income
level to the 1991 Canadian population. Residents of correctional facilities removed from the analysis.
Chlamydia
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All Cause Mortality
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Graph from: Halton Region, Income and Health Inequalities in Halton Region, November 2012
Data Source: Ontario Mortality Database 2003-2007, Intellihealth, MOHLTC.. Extracted July 24, 2012. Age standardized within each income
level to the 1991 Canadian population.
248
deaths
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Relationship with Income No Relationship with Income
Self-Rated Health
Self-Rated Mental Health Overweight & Obesity
Chronic Disease Risk Factors Alcohol Intake (Heavy Drinking)
Smoking Fruit & Vegetable Intake
Physical Activity (Males) Physical Activity (Females)
Diabetes (Age 65+) Diabetes (Age 18-64)
Activity Limitation Influenza Immunization
Dental Visits Falls
Chlamydia Infection (Females) Chlamydia Infection (Males)
Mortality – All-cause, Cancer (Males),
Circulatory
Cancer Mortality (Females)
Premature mortality (Ages 25-74) –
All-Cause, Cancer, Circulatory, Injuries
All-Cause Premature Mortality
(Ages 0-24)
Hospitalizations
Emergency Department Visits
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Relationship with Income No Relationship with Income
Self-Rated Health
Self-Rated Mental Health Overweight & Obesity
Chronic Disease Risk Factors Alcohol Intake (Heavy Drinking)
Smoking Fruit & Vegetable Intake
Physical Activity (Males) Physical Activity (Females)
Diabetes (Age 65+) Diabetes (Age 18-64)
Activity Limitation Influenza Immunization
Dental Visits Falls
Chlamydia Infection (Females) Chlamydia Infection (Males)
Mortality – All-cause, Cancer (Males),
Circulatory
Cancer Mortality (Females)
Premature mortality (Ages 25-74) –
All-Cause, Cancer, Circulatory, Injuries
All-Cause Premature Mortality
(Ages 0-24)
Hospitalizations
Emergency Department Visits
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Limitations
Missing Data
•Refusal for income
question (23%)
•Postal codes (10%)
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Limitations
•Sample size
•2006 census data
• Income levels may not
be homogeneous
within DAs
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Limitations
•RRFSS & CCHS
•self-reported
•under-represents low
income residents
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Next Steps for Halton
1. Support a
communication
strategy
2. Expand the maps
3. Consider children &
youth
4. Measure progress
over time (trend data)
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Measuring and Reporting
on Health Inequalities at
the Local Health Unit Level
Emma Tucker, MSc
June 10, 2013
